28 P H Y S I O T H E R A P Y MARCH ig?8 ABSTRACTS/OPSOMMINGS Geriatrics is the theme o f tw o issues o f Physiotherapy (1976, 62, 146 -1 5 9 ; 1976, 62, 178 -184). A series o f ten articles covering a w ide spectrum of the subject, w ritten from the p o in t o f view o f the p h y sio th erap ist’s involvem ent. T h e subjects covered are: Preven tative Aspects; D ay H ospitals; A Stroke U n it; M ental Illness; In terd iscip lin ary T eam w ork; D iagnosis; N u tritio n ; Incontinence. O f interest is the emergence o f the P sychogeriatric D ay H o sp ital in the U .K ., its uses and functions (T he D ay H ospital, B rocklehurst, J. C., pp. 148- 150). The Place o f a Stroke U nit within Geriatric M edicine (Isaacs, B, 152- 154). T hese units are rapidly increasing in relevance in to-day's society. M ental Illness in the Elderly (R obinson, R. A. 155 - 157) clarifies m any points w hich are encountered both professionally an d socially. E m phasis is placed on the need fo r m ore education in this field. Incontinence (M andelstam , D . A. 182- 184) stresses the role w hich the physiotherapist can play in m anaging this com m on g eriatric sym ptom . O f p a rtic u la r im portance is a statem ent w hich is well w o rth quoting: “G e ria tric w ards a re still peopled by V ictorians, and the attitudes o f th e ir g en eratio n m ust be taken into account. B odily function s fo r m any rem ain unm entionable. Im agine then the anxiety and em barrassm ent caused by asking strangers fo r assis­ tance.” A n o th er p o in t b ro u g h t o u t is bo red o m an d lack o f stim ulus. T his leads one to ask “o f w hat value is the G e ria tric W ard C lass?” A nyone w ho has dealings w ith the elderly, b o th professionally an d socially w ill find som ething o f value in these articles. T hey are well- referenced th ro u g h o u t, and a B ibliography o f 184 item s is given. T his is an aspect o f o u r w ork w hich is becom ing m ore and m ore im p o rtan t as life-expectancy increases. H.C.W . Parker, M . J.: Chronic Obstructive Pulmonary Disease: The R o le o f Physiotherapy. Physiotherapy Canada, October 1977, Vol. 29, N o . 4. T h e article is chiefly concerned w ith the treatm ent and care o f the p atien t w ith cen trilo b u lar em physem a linked w ith chronic b ro n ch itis an d cor pulm onale. Case- finding is discussed and suggestions o n how to get early referrals are made. A com m unity screening program m e is suggested. O ut-patient- and hom e care are em phasised as im portant. T re a tm e n t objectives include increasing alveolar v en tilatio n thro u g h general relax atio n an d careful re­ train in g o f b reathing. Several im p o rtan t p oints are m ade w ith regard to b reath in g exercises: Increasing the tidal volum e decreases the rate o f b reath in g and, since the flow o f a ir is slowed down, results in m o re even ventilation. P ursed lips b reath in g helps the p atien t who suffers from a high closing volum e. D elib erate desensi­ tisatio n to dyspnoea should be o btained. T h e objective of m atching perfu sio n to ven tilatio n is partially realised by postural drainage. T h e reduction o f the energy cost o f b reathing, an o th er aim o f treatm ent, is achieved by helping the p atien t to slow his resp iratio n rate. In s p ira tio n is lengthened slightly and breathing o u t is done in a relaxed way. If exercises alon e cannot im prove the m o b ility o f the chest w all, passive m ove­ m ents o f the rib cage m ay also be necessary. T o o b ta in optim al use o f oxygen by the body m uscu­ lature, relax atio n and correct p osture (which puts the m uscles a t a m echanical advantage) should b e taught. E xercise tolerance should also be im proved. I t is im p o r­ tan t fo r the p h y sio th erap ist to educate th e p a tie n t and help him to take full resp o n sib ility fo r the care o f his chest. She does this b y tra in in g h im to keep his ch clear and to keep fit. est T h e need to study th e effectiveness o f physiothera in C .O .P.D . is stressed; fa r m o re research needs to {? done o n the treatm en t o f early cases. T h e w riter su gests th a t th ere is also a need fo r study o f the physi^ logical basis o f retrain in g o f b reathing, an d of ,i' m ethodology o f increasing exercise tolerance in P)y,e m on ary patients. A com prehensive list o f references given. Is J- M. Hill Journal o f the R hodesian Physiotherapy Association — January 1978. " T his Jo u rn al is to be com m ended to o u r members In this issue a stim ulating e d ito ria l o n “Experience does n o t m ean age” is follow ed by several interesting an d topical articles. J M any R hodesian m edical problem s relating to h variety o f racial groups in the country are sim ilar ft, ours, b u t w ith added problem s arisin g fro m conditions o f the te rro rist w ar, as d em onstrated in an article on ab d o m in al trau m a by M r. G. F . G rave, H ead o f the D ep artm en t o f Surgery, Bulaw ayo U n ited Hospitals. O th er articles in this issue discuss paraplegia, the use o f in term itten t positive v e n tilatio n in th e treat­ m ent o f resp irato ry disorders, som e aspects o f pathology lab o rato ry results, as well as the im age o f physiotherapy, physiology o f handicap, and in te rn a tio n a l co-operation am ong physiotherapists. T h e ed ito rs have indicated th a t they are prepared to advertise any courses held in the R ep u b lic free, provided it is n o t a display advertisem ent. Single copies of this Jo u rn al are $1 (R hodesian) post-free. Inquiries regarding subscriptions should be m ade to th e Editor. P. Chatterton MacMaster, W. C. (1977). A literary review on ice therapy in injuries. Amer. J. Sports Med., 5, 3. H eat and cold have dissim ilar an d in a large part reciprocal physiological effects. C ollagen u n d er non- physiological conditions exhibits viscous properties or plastic d efo rm atio n as w ell as the visco-elastic proper­ ties o f creep and stress relaxation. H e a t decreases the resistance to plastic deform ation, w hilst cold enhanof th e elastic p roperties o f collagen. C old affects m u s l activity in v arious ways and depresses the excitability o f free nerve endings an d p e rip h e ra l nerve fibres, in­ creasing th e ir threshold to pain. C old also produces a reduction in blood flow, inflam m atory response, local oedem a and haem orrhage. T h e contra-indications, in­ dications and applications o f ice th erap y fo r various types o f lesion are discussed; prolonged application of cold fo r treating the acute in ju ry is advocated. M. J. Runnalls Paraplegia 1976, 13, 223 - 226. Cervical Cord Injury follow ing Chiropractic M anipulation — Ringay Reynolds, Jameson and Hamilton. T h e case histo ry is given o f a p atien t w ho, following a fall, w as treated fo r “ pain in th e n eck ” by m anipula­ tion, an d his subsequent tetraplegia. A discussion follow s o f com plications arisin g fro m ill-advised m a n ip u la tio n o f undiagnosed pre-existing spinal disease. It is a clear w arning o f the need fo r care and an accurate diagnosis being fu rn ish ed before treatm ent is given. H.C.W. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) |V|AARt 1978 F I S I O T E R A P I E 29 BOOK REVIEW •hthTEB R A L M A N IP U L A T IO N . G . D . M aitland. ^ e d i t i o n . B utterw orths, L ondon, 1977. A vailable f B utterw orth & Co. (S.A.) (Pty.) Ltd., P.O. f ro vm 79 2 , D u rb a n 4000. ,/lrtebral m anipulation has becom e a stan d ard text- v \n m any teaching in stitu tio n s in this country. T his ̂ edition is indicative o f the dynam ic ap p ro ach of ne'v vjaitland, and is enhanced by b etter captions. Mr- are several im provem ents to the chapter on T .nation T h e testing o f m uscle strength o f muscles ?XTrvated by the C l, C2 and C3 nerve roots is m- if,n'r j A m ore detailed in itial exam ination procedure ( cervical, th o racic and lu m b ar problem s inclusive o f [jjg planning o f th e objective exam ination is docu- ^Treatm ent techniques continue to be m ost adequately ■ bribed an d illustrated. T h e a d d itio n al section on nhilisation o f th e rib s is welcome. H ow ever, I jo in \ se ntim ents o f the review er of this b o o k fo r the I rtered Society o f P h y sio th erap y in requesting th a t the fifth ed itio n include th e ex am in atio n and treatm ent nf sacro-iliac jo in t problem s. The greatest inn o v atio n is the inclusion o f a chapter nil assessment. M r. M aitlan d says “W ith o u t assess­ ment treatm ent is m erely an ap p licatio n o f techniques lacking guidelines.” F u rth e rm o re he says “I t is u n i­ versally accepted th a t m edical diagnosis o f spinal con­ ditions is extrem ely difficult. H ow ever, a diagnosis indicating th a t no disease process is involved is usually possible. F ro m th e m an ip u lativ e th e ra p ist’s p o in t of view the m ain concern, once the p atien t has been referred, lies in ap p reciatin g th e m echanical factors related to each p a tie n t’s sym ptom s.” Mr. M aitland pursues his line o f action by virtue o f a “left and right compartment.” F a c to rs such as th e history, signs _and symptoms an d w hich are indisputable fall into th e “left compartment” w hereas disputable facts such as th e b io ­ mechanics, pathology and diagnosis fall into th e f r i g h t compartment.” A p p licatio n o f treatm en t is based on the factors in the “ left co m p artm en t” b u t never losing sight of the factors in th e “rig h t co m p artm en t.” A ssessment of the “left co m p artm en t” facto rs a t the in itial exam ina­ tion, at the beginning, th e end an d during each tre a t­ ment session as well as a t th e end of a treatm en t series is essential “to th e w hole p u rp o se o f assessm ent; "ROVING T H E V A L U E O F E A C H T R E A T M E N T i'C H N IQ U E ”. T h e tw o appendices a t the end o f the - J )k elucidate som e o f th e specific factors w hich need to be assessed Mr. M aitland discusses fo r th e first tim e m an ip u latio n under anaesthesia (M .U.A .). T h e re a re definite in d ica­ tions fo r m a n ip u la tio n o f a conscious p a tie n t and fo r manipulation u n d er anaesthetic. Som etim es, patients may require a balance o f both. The Journal o f B one and Joint Surgery’s reviewer of the third edition o f this boo k said “I w ould respect­ fully suggest th a t this b o o k is a M U ST fo r Physical Medicine D ep artm en ts an d a S H O U L D fo r m ost o rth o ­ paedic surgeons.” I w ould suggest th a t this b o o k is also a MUST fo r all physiotherapists w orking in this field and all p h y siotherapy students especially as m ovem ent diagrams now fo rm p a rt o f th e syllabus. M. J. R unnalls M aitland, G . D . — P e rip h e ra l M an ip u latio n . 2nd Edition. B utterw orths, L ondon, 1977. A vailable from B utterworth & Co (S.A.) (Pty) Ltd., P.O. Box 792, D urban 4000 at R26,95 (plus 40c fo r delivery). The opening ch ap te r o f this b o o k defines an d states •he role o f m o b ilizatio n an d m an ip u latio n , p o in tin g o u t especially the relief o f p ain o b tain ed by using special passive m ovem ent techniques. T h e subjective and o b jec­ tive ex am in atio n o f p eripheral jo in ts is detailed and the m ost salient p oints stand o u t clearly in the text eg. T h e aim o f exam ining m ovem ents is to find one o r m ore com parable “signs” in an a p p ro p ria te jo in t o r joints. “M any anom alies occur in the clinical situ atio n w hich do n o t entirely agree w ith w hat is know n anatom ically and p hysiologically”. T h e text dem onstrates this ad ­ m irab ly by referrin g to the m ovem ent betw een the cap itate an d th e ham ate. In the chapter on principles o f technique, a useful ad d itio n is th e grading o f m ovem ent in the hyper- m obile joint. F u rth e r excellent a d d itio n s in this edition are: (1) A ch ap te r on assessm ent, the crux o f success­ ful treatm ent, w here the role of assessm ent a t the in itial e x am in atio n and treatm en t session, during a treatm ent session an d also over a period o f treatm ent, a t the end o f treatm ent, an d to assist in differential diagnosis is discussed, and: (2) A chapter on treatm ent, w here the use o f treatm en t m ovem ents to relieve the p ain , im prove the painless stiff jo in t w hich does n o t have a functional range, tre a t resistance in a jo in t disorder w hilst not exacerbating p ain , and replace to rn structures o r loose bodies w ith in a joint, a re described in detail. T h ere is also a section o n treatm en t related to pathology. T he lack o f reference to pathology w as perhaps the greatest draw back in the first edition o f this book, and its inclusion in this edition is tru ly welcome. Still m ore allusions to pathology are m ade in P a rt II o f this book. H ere th e specific objective exam ination including special an d q u ick tests used to determ ine jo in t problem s, and the techniques fo r treatm en t and m anage­ m ent o f each p erip h eral jo in t are clearly described a n d / o r illustrated. T h e b ook concludes w ith a ch ap te r on recording treatm en t and two appendices w hich describe the m echanics o f m ovem ent diagram s. T h is b o o k is a tru e gem fo r th e m anipulative th e ra ­ pist. M r. M aitlan d m ust again n o t only be congratu­ lated on his p resen tatio n o f a subject to w hich he is obviously clearly dedicated, b u t also be com m ended because o u r patients will surely benefit if physio­ th erap ists use th e know ledge gained from this im proved and m ost excellent edition o f P eripheral M anipulation. M. J. R unnalls Cash, J. E. (1976). A T ex tb o o k o f M edical C onditions fo r P hysiotherapists. 5th E d itio n . M acm illan, London. T h is b o o k is divided into fo u r sections, w ith the b ib lio g rap h y listed a t the end o f each section — a m ore p ractical arran g em en t than previously. A p a rt fro m th e sections o n general pathology and paediatrics, the au th o rs o f the sections differ fro m those in previous editions. T h e general in tro d u ctio n to each section arouses m ore interest th an the usual standardized dry and factu al textbook. F re e use is m ade of illustrations, m ore especially in the section o n rheum atology, b u t they are lacking in the section o n skin diseases w here they could be valuable in illu stratin g the ap p licatio n of u ltra v io le t light. P athology and treatm en t have been b ro u g h t u p to date an d the p o in t-b y -p o in t layout w ith clear headings and subdivisions m akes fo r easy reference; grouping is also m ore logical. A p a rt fro m the first section on general pathology and treatm ent, pathology has been very con­ densed an d is som etim es insufficient. T h e second section, rh eu m atic disorders, has been considerably enlarged and re-organized. T h e inclusion o f m o re detailed drug th erap y an d indications fo r its use in th e treatm en t of jo in t disease, as well as the R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )