BOOK REVIEWS '\f="7 PHYSICAL REHABILITATION O U T C O M E MEASURES Cole B, Finch E, G ow lan d C, M a yo N (19 94 ), Toronto, Canadian Physiotherapy Association (ISBN 0 -9 6 9 812 2-0 -5) This m anual w as produced b y a w orking group convened by the Canadian P hysiotherapy A ssociation and H ealth Canada. Lack o f suitable, objective outcom e m easures has frequently been cited as a reason for the dearth o f research into the ou tcom e of p hysiotherapy intervention in patients w ith hem iplegia and other central nervous system im pairm ents. In view o f this, the m anual is a valuable contribution to prom oting research into the effects o f physiotherapy in stroke and related conditions. In the survey w hich prom oted the com piling o f the m anual it w as found that current practice involved only limited use of standardised outcom e m easures, one o f the m ajor barriers being lack of know led ge o f the available instrum ents. The survey also show ed that physiotherapists w h o held a degree (as opposed to a diplom a) and w ho w orked in departm ents w ith m ore than 12 therapists w ere m ost likely to use specific outcom e m easures. In order to encourage physiotherapists to m easure outcom e objec­ tively and to select the m ost suitable instrum ents to do so, the m anual investigates 60 outcom e m easures in the field o f adult m otor and functional activity m easures, back a n d /or pain m eas­ ures, cardiopu lm onary m easures and developm ental measures. G eneral standards for the use of m easures are given, and each outcom e m easure is then review ed under the head ings of popu­ lation, time required, cost, training required, clarity of instruc­ tions, scales utilized, reliability and validity. Guidelines are also given for the selection o f system s fo r group or single-case evalu­ ation. Source references are given in full. The m anual w ill prove invaluable fo r physiotherapists w ho are w illing to take on the challenge o f proving that their treatm ent works. It com es in ring-bind er form at and is available from the Canadian P hysiotherapy A ssociation, 890 Y on ge Street, 9 th Floor, Toronto, O ntario M 4W 3P4, Canada, Fax (416) 924-7335. ■ Sheena Irwin-Carruthers [ T ^ 7 STARTING A G A IN - EARLY REHABILITATION AFTER TRAU­ M A T IC BRAIN INJURY OR OTHER SEVERE BRAIN LESION Davies PM (1994), Berlin, S pringer-V erlag. (ISBN 3 -5 40 -5 5 9 3 4 -5 an d ISBN 0-387-55934-51 A lthough this book w as announced previously in the SASP Journal, it w as not review ed. The author is well know n for her previous two b ook s on hem iplegia - "Step s to F o llo w " and "R igh t in the M id d le" - and this third b ook should prove equally popular. Pat Davies takes the very com plex subject o f traum atic brain injury and develops a fram ew ork w hich enables the therapist to understand the m any aspects w h ich contribute to m otor control. In particular she discusses problem s related to disturbed tac- tile/kinaesthetic input - and im portant aspect w hich to date has received very little attention from physiotherapists. The book enables us to understand the confused w orld of the brain-injured patient and to analyse the m any different factors which m ay contribute to functional problem s or inappropriate behaviour. It assists the physiotherapist in predicting and solving problem s and takes us step-by-step through aspects of early positioning, m oving and being m oved in lying and sitting, regain­ ing functional upper extrem ity use, early standing and attaining independent walking. Physiotherapists confronted w ith the short- and long-term com plications o f severe b rain injury w ill find p ractical ad vice on preventing and overcom ing contractu res and d eform ities, avoid­ ing the developm ent o f pressure sores, im proving respiratory function, preventing pain o f cervical origin, avoid ing heterotopic ossification and m aintaining or regaining spinal m obility. The section on the face and m outh, covering facial expression, oral hygiene, feeding and speaking, will encou rage therapists to tackle these all too frequently ignored problem s. The role o f abnorm al neurod ynam ics and the possibilities for m obilising the nervous system are covered in som e d ep th and give a new dim ension w hich therapists can explore and utilise. A s w ith the previous tw o books, am ple p hotograp hs and clinical exam ples not only show the ph y sioth erap ist h ow to do it, b u t also prove that it can b e done. A bove all, the d ignity o f the patient as an individual rem ains a first consid eration. In his forw ard D avid Butler concludes: "T h is elo qu ent b u t sim ple text cuts across m edical boundaries, it enhances team w ork, it dem ys­ tifies the effects o f head injury, and it gives new hope for a ll." The book is an essential resource fo r all therapists w h o encounter brain-injured patients and w ill b e o f value to experienced clini­ cians as w ell as new ly qualifieds. It is h ighly recom m ended. ■ Sheena Irwin-Carruthers '\f="7 PHYSIOTHERAPY IN STROKE M A N A G E M E N T ^ H arrison M A (ED) (1995), Edinburgh, Churchill Livingstone. (ISBN 0-443-05228-X ) This b ook is, in fact, the proceed ings o f the 1st C ongress of W CPT-Europe, held in C openhagen in Ju n e 1994. As such, the quality of the content varies b u t there are a su fficient n u m ber of excellent p resen tations to m ake the p u rch ase o f the volu m e w orthw hile for all those interested in rehabilitation follow ing stroke. The b ook is divided into four sections - the cu rren t state of stroke m anagem ent, aspects o f clinical practice, m easurem ent and research, and psychological aspects and m anagem ent o f change. M ost papers from keynote and plen ary sessions are of excellent quality, including inter alia a review o f cu rren t p h y sioth erap y in stroke m anagem ent b y A nn A shburn, the epid em iolog y o f stroke b y G udrun Boysen, research on stroke rehabilitation b y N adina Lincoln and the role of the physiotherapist in research by Birgitta Bergm ann. A spects o f clinical practice cover m ost o f the current approaches to rehabilitation, including the Bobath concept, m otor retraining, PNF, A ffolter, PN F, orthotics and FES, and m obilisa­ tion o f the nervous system . D isappointingly, the research section only covers studies on m easurem ent and one stud y on outcom e w hich is not related to p hysiotherapy intervention. There is, how ever, an interesting paper b y R avensberg, H alfens and O os- tendorp on a stroke protocol for p hysiotherapy in p rim ary health care. The advantage of appointing an editor to pu blish the proceed ­ ings in book form is seen in the quality o f the w ritten language and the attractive layout o f the book, and M arilyn H arrison is to b e congratulated on her skill in bringing this inform ation together to produce a w orthw hile publication on the cu rrent state o f the art and science o f stroke m anagem ent. ■ Sheena Irwin-Carruthers SA J o u r n a l P h y s io th e r a p y , V o l 5 2 N o 2 M a y 7 9 9 6 P a g e 4 3 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. )