B o o k Reviews ...O IF S O F T H E S P IN A L C O R D : T H E M A N A G E - I A c v T O F P A R A P L E G IA A N D T E T R A P L E G IA , G. Sutton, B utterw orth & Co. (S.A.) (Pty) Ltd., p 0 Box 792, D u rb an , RIO,00 plus R0,50 delivery. The a u t h o r o f this boo k is director of th e spinal • es u n it in B risbane, A u stralia, and E m eritus P ro - fnjUor o f Surgery a t th e U niversity o f Q ueensland. In h ? i n t r o d u c t i o n he gives a sh o rt historical review of n' s nroEress m ade in the treatm en t of spinal injuries ̂ m p r e - W o r l d W ar II until the present day, and ounts how spinal injuries units becam e established in fpveral countries, initiated by S ir Ludwig G u ttm an n at stoke Mandeville. N o m ention is m ade o f South A frica, hut the problem s of distance encountered in p arts o f A u stralia are sim ilar to problem s encountered here. In this book of 185 pages, 50 are devoted to an .excellent discussion o f th e anatom y o f the vertebral Ju m n and the anatom y and applied an ato m y of the ( » nai cord. T h ro u g h o u t these sections the a u th o r re­ lates his inform ation to the m ovem ents occurring a t the various levels, as well as to changes encountered during ageing and in traum a. T he section on the blood supply of the spinal cord is particularly valuable, correlating information otherw ise scattered sparsely thro u g h o u t recent literature. Also o f p articu lar interest are the paragraphs on pain, w hich question the traditional co n ­ cept of a well-defined spinothalam ic tract an d which include an unusually clear explanation o f the character­ istics of visceral pain. T h e section on applied anatom y deals with localization o f th e level of in ju ry by applied knowledge of derm atom es, m yotom es an d the lum bar peripheral nerves — including a discussion of degrees of injury to, and possible regeneration of, th e lum bar nerves. Bladder and bowel c o n tro l and the effects of autonomic nervous system dam age are clearly set out. Chapter 6 , the longest single ch ap te r in th e book, covers injury to the vertebral colum n, th e ensuing mechanisms o f cord injury and th e p athology o f the cord lesion. Special atten tio n is given to the m echanism s of extension o f hyperextension injuries, and the vascular elem ent is stressed. T h e m echanism o f cord damage following m in o r trau m a in o lder age groups is explained concisely. A chapter on statistics related to age and causes follows. -The rem ainder o f the boo k (rather m o re than half) ■' w devoted to the treatm en t o f spinal injuries an d is divided into chapters on initial stages in the treatm ent of paraplegia, tetraplegia, later care o f spinal cord in ­ juries, m anagem ent o f autonom ic system dysfunctions, complications, rehabilitation and after discharge from the unit. First aid and tra n sp o rt o f spinal cord injuries are well covered, and m ention th e C ape Tow n unit. T h e author stresses the principle o f conservative treatm ent by means of postural reduction an d recum bency fo r the great m ajority o f spinal injuries, but cites explicitly the few (three) indications fo r operative intervention. In the case of cervical dislocations th e a u th o r advocates skull traction ra th e r than the m ore trau m atic reduction °y manipulation. B lackburn, V inke o r C one calipers are preferred. In the B risbane unit patients are kept recumbent fo r only 6-8 weeks, w hich is ra th e r less than generally practised in South A frica. E arly care o f the p*n, bladder and bowel, resp irato ry com plications and intestinal ileus are covered concisely. Few drugs are advocated. , >s refreshing to read th a t “fro m the first day in ne spinal injuries u n it th e paraplegic p atien t is cared pESEMBER 1973 F I S I O T E R A P I E 1 1 fo r by a physiotherapist . . T h e sections on early stages o f treatm en t conclude w ith an explanation o f spinal shock in term s o f recent research. T h e ch ap te r on the recovery period includes nursing care an d nutrition, m obilization follow ing p o stu ral treatm ent, the selection o f wheel chairs and the control o f neuritic pains, and m uscle spasms. P hysiotherapy, ice-packs and valium are thought preferab le to m ore radical m ethods in th e control o f m uscle spasms. M anagem ent o f autonom ic system dysfunctions covers orthostatic hypotension, paroxysm al hypertension, hyper- hidrosis, im paired bowel function and im paired u rinary function (in detail). T his is follow ed by discussions on the com plications o f respiratory infection, deep vein throm bosis (and p u lm o n ary embolism ), u rin a ry tra c t in ­ fections, pressure sores, heterotopic calcification, hand- deform ities and hydrom yelia. T h e psyiotherapist is con­ sidered im p o rtan t in bofii th e prevention an d detection of deep vein throm bosis. N o blam e is attached to m ovem ent as a causative factor in h eterotopic calcifica­ tion. T h e introduction to th e ch ap te r on reh ab ilitatio n defines n o t only the concept o f re h ab ilitatio n but also, realistically, its lim itations. In a b ook o f this length it was obviously n o t possible to devote m o re th a n five pages o f this chapter to physiotherapy. In this short space, however, th e a u th o r com petently sum m arized the role o f the p hysiotherapist from th e earliest stages of passive m ovem ents an d psychological su p p o rt to m uscle testing, m uscle strengthening, m atw ork, balance, tra n s­ fers, activities o f daily living, standing and w alking, and sports. T h e optim um q u o ta o f patients p e r physio­ th erap ist is considered to be 6-8. Sections follow on occupational therapy and the social w orker, an d th e chapter concludes w ith a discussion on sexual functions and th e possibilities o f procreation. T h e final chapter consists o f brief discussions on hom e care an d hostels, architectural m odifications fo r w heel­ chair patients, vocational training and placem ent, life expectancy, and th e fu tu re outlook w ith respect to p re ­ vention o f spinal injuries and research in to central nervous system regeneration. Illustrations and ch arts throughout are clear and explicit, an d are fu rth er supplem ented b y X -ray p h o to ­ graphs. O ne printing e rro r which rem ains uncorrected m ight possibly be m isleading. T his b ook gives a concise b u t com prehensive review o f the problem s an d m anagem ent o f spinal cord injuries an d is m ost certainly recom m ended to all physiotherapy students as well as qualified therapists intending to w ork in this field. S. Irw in-C arruthers. V E R T E B R A L M A N IP U L A T IO N . T h ird E dition, 1973. G . D . M aitland. B utterw orth & Co. (South A frica) (Pty) L td., P.O . Box 792, D u rb an . Price: Soft cover R7,00, H a rd cover R 11,00, plus R0,50 delivery. T his w ell-known b o o k was w ritten b y an A ustralian physiotherapist w ho has recently been aw arded the F e l­ low ship o f the C hartered Society o f P hysiotherapy fo r his w ork in this field. I t is intended prim arily fo r physiotherapy students and qualified physiotherapists a n d is especially useful to those attending courses in m anipulative therapy. T h e a u th o r describes his approach to the treatm en t o f patients w ith pain an d o ther sym p­ tom s an d signs arising from abnorm alities affecting the m ovem ents o f th e spinal colum n. T h ree techniques are used: gentle m obilizations, localised and general m an ip u ­ lations and traction. T h e book, especially the first and last chapters, also should be helpful to those doctors who wish to refer patients to physiotherapists fo r spinal m anipulation. 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. ) 1 2 P H Y S I O T H E R A P Y DECEMBER, 1973 T he basic structure and chapter headings rem ain the same, except th a t the first chapter, 'by D r. D . A. B rew erton, has been renam ed and rew ritten. T his deals m ainly with the indications fo r m anipulative therapy. T h e headings are clearer and a p a ra g ra p h has been added on “posture an d w ork” . A query arises on page 5 w here ro o t pain is reproduced by . . m aintenance of a spinal posture, such as ro tatio n o f the neck away fr o m the pain . . .” . I t is usual (as described on page 22) to sustain ro ta tio n tow ards the pain fu l side. T he o th er chapters have been expanded by th e a d d i­ tion o f m ore detail an d discussion, an d several illu stra­ tions previously published in articles by th e a u th o r have been added. T h e m o st im proved is C h ap ter 2: “E xam in ation” . I t now includes the derm atone ch art from the b o o k let “T he V ertebral C olum n — exam ination and recording guide” as well as several new test tech­ niques such as the “ q u a d ra n t” tests fo r the cervical and lu m b ar spine. A lso included are tests fo r vertebral artery involvem ent, tension tests a n d th eir m eaning, the sacro-iliac joint, passive intervertebral m ovem ents and the abnorm alities found on passive m ovem ents w ith illustrations o f th u m b pressures on th e vertebrae, m ore techniques o f exam ination o f passive range o f interverte­ b ral m ovem ent by p alpation and quick m ovem ents when pain is n o t provoked a t n o rm al speed. I f one m ay suggest som ething when reviewing a book o f such high standard: it m ight be helpful to u n d e r­ graduates if th e “planning” stage included som e ques­ tions which m ay be asked a t this stage, such as: D o the severity a n d /o r n atu re o f the sym ptom s indicate caution? Is this an irritable condition? Is it likely that a com parable sign will be found easily or not? W hat is the pathology an d a t w h at stage is it? W hat is the pro b ab le prognosis? A re th ere any dangers to m an ip u ­ lation? Is a neurological exam ination necessary? This w ould clarify th e aim s of the subjective exam ination. One feels that, as this boo k is used by those w ho have n o t alw ays h a d ap p ro p riate practical and clinical in ­ struction, the chapters or “E xam ination” and “ A pplica­ tio n ” could be tied up m ore definitely. R eference could be m ade a t the end o f “ E xam ination” to the need fo r careful selection o f technique, the level to b e treated and th e grade o f application (as explained in C h ap ter 4). T eaching experience has show n th a t “techniques” are too often divorced from “ application” when learning to m anipulate. In addition to the techniques described in the second edition, fifteen m ore techniques have b een included and some illustrated. T he sym bols used fo r recording tre a t­ m ent have now been included here. A m ong th e ad d i­ tional techniques are A P unilateral v erteb ral pressure, cervical and lum bar flexion, lum bar ro tatio n w ith straight leg raising, an d tractio n in hospital. T he adjustable cervical h a lte r is also described and illustrated. M ore u p p er cervical localised m anipulations are added and the P A th ru st described and illustrated. T h e nam es and illustrations of th e cervical m anip ulations-are clearer, and m ore thoracic m anipulations are included. In “A pplication o f M obilization” m o re reference is m ade to know n pathological conditions an d techniques are correlated w ith these. T h ere are tw o page-reference errors on page 161; supine neck flexion is described on page 26 (n o t page 9) and the straight leg raising test on page 25 (n o t page 137, w here th e treatm en t techniques is described). In “A pplication o f M an ip u latio n ” the a u th o r clearly explains his use o f m anipulation, an aspect o f his w ork w hich is often overlooked by the uninform ed. In “Principles A pplied” the a u th o r clarifies his ap p ro ach , an d w hy he uses signs an d sym ptom s to guide his assessm ent. H e describes th e recording of exam ination an d treatm ent. T he case-histories are in- tended fo r reference. T hey clarify the total approach, guiding factors, progression an d interchange of tech­ niques. T h e possible prognosis using these techniques is illustrated, including the n u m b er of treatm ents required, when to stop or discontinue treatm en t fo r a while, when collars a re used, or when and how the p atien t is advised to rest. O ther form s of physiotherapy are mentioned briefly in the a p p ro p riate cases. T h e cases hav e been grouped in to fo u r m ain categories, eight new case-his­ tories have been added an d one om itted. A m ong the new case-histories a re severe lum bar ro o t pain and cervical jo in t locking. Physiotherapists interested in m anipulation, orthopaedics an d treatm en t o f th e spinal joints are advised to buy this book even if they already possess the second edition (although, lik e m ost other things, the price has been increased). B.W. M echanics for Movement N o tes fo r P hysiotherapy students by F rancoise A . M cD onald P ublished by G . Bell & Sons L td., Y o rk H ouse, Portu­ gal Street, L ondon. Price £1,25 net. Francoise A . M cD onald, M .C.S.P. D ip. T .P., who teaches in the A berdeen H ospitals School o f Physio­ therapy, has produced a very useful little paperback b ook in w hich the m echanics required b y physiotherapy students is gathered into one convenient volum e. The book is w ritten in a simple concise form an d is copiously illustrated w ith clear line drawings. The Physics is n o t dealt w ith in depth but each aspect o f the physics is referred to the b ody o r the physio­ th erap y ap p aratu s to w hich it applies and herein lies its value fo r the physiotherapist. T h ere are four sec­ tions — Introduction to M echanics, Equilibrium, M achines, and Liquids, covering such things as Centr'’ of G ravity, Stability, A ngle o f Pull, Inclined Planl, Springs, B uoyancy D iffusion and Osmosis, as well as the usual Forces Levers and Pulleys and, I feel, w ould be a useful addition to any physiotherapy student’s book­ shelf. A . McF. F O R SA LE V aritherm W ax B ath and W ax, R80. — J. M. Grace, 44 G lenw ood C entre, M oore R oad, D urban. Tel: 345315. . F O R SA LE O ld established Practice fo r sale.— F u rth e r informa­ tion please phone: C ape Tow n 493558 office hours; 448795 evenings; M rs. G . B otha, 301 U nited Buildings. R egent R oad, Sea P oint, C ape Town. 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. )