Anda di halaman 1dari 1

101

J ournal of N eurological P hysical T herapy

be achieved to receive continuing education units. Exam


questions are objective, clear and are appropriate considering the depth and breadth of the course content. This
reviewer received his course materials 8 days after ordering
them on the APTA web site and received notification of his
exam grade 11 days after submitting his exam by fax.
Gerard G Fluet, MS, PT
JFK-Johnson Rehabilitation Institute
Center for Head Injuries
Edison, NJ
Mr. Fluet is a Senior Physical Therapist at Johnson
Rehabilitation Institute and an Adjunct Instructor, lecturing on Neurologic Physical Therapy, at the University of
Medicine and Dentistry of New Jersey.

BOOK REVIEW
Stroke Rehabilitation: Guidelines for Exercise and
Training to Optimize Motor Skill. Carr J, Shepherd R.
Edinburgh: Butterworth-Heinemann; 2003, softcover, 301
pp. illus, ISBN: 0-7506-4712-4, $54.95.
The aim of this book, as stated by the authors, is to present a text which will translate science into clinical care for
patients with stroke. It provides an updated approach to
stroke rehabilitation based on motor learning, task-oriented
training, biomechanical analysis of function, and exercise
principles. In Chapter 1 an overall rationale for task-oriented training in a contemporary environment is presented.
Neural adaptability is discussed in the context of use-dependent reorganization. The authors recommend a rehabilitation environment that provides opportunities for intensive
and frequent practice of motor skills; a model for group/circuit training and methods for implementation are
described. Supportive evidence for skill-optimizing training
features, including feedback, practice, transfer of learning,
and task-specific/goal directed training principles is
reviewed.
In the next 4 chapters, background and training suggestions for specific functional activities (Balance, Walking,
Standing Up and Sitting Down, and Reaching and
Manipulation) are presented. Each of these chapters follows
a similar format. First, a biomechanical description of the
function in able-bodied subjects is presented. Less commonly analyzed tasks are included, such as sitting balance,
stand to sit, and the negotiation of stairs, ramps, curbs, and
obstacles. Next, the authors identify age-related changes
which may influence performance of the tasks, and analyze
typical performance by individuals post-stroke. This analysis
is both quantitative and qualitative, and includes common
deviations and adaptations. Useful illustrations complement
the descriptions of normal and faulty performance.
Within Chapters 2 through 5, the Guidelines for
Training sections provide a framework of tasks that can be

Vol. 28 No. 2 2004

used to develop training protocols. Details about treatment


activities are accompanied by common movement errors or
compensations. Suggestions are made regarding how to
alter task difficulty and vary practice conditions with attention to safety concerns. The authors also address impairments that may interfere with task performance and suggest
related treatments. The organization of these Guidelines,
mostly via bulleted topics, can be difficult to follow. The
illustrations that accompany the treatment ideas depict
high-functioning patients more frequently than persons
with a range of abilities.
Additional topics included in Chapters 2 through 5 are
outcome measures for each functional task; a brief table
summarizing clinical outcome studies; a protocol for treadmill walking with and without partial body weight support
and a harness; a literature review on upper extremity recovery, including predictive factors and treatment effectiveness; and sections on constraint-induced therapy, computerized training, and electrical stimulation for the
hemiparetic arm.
Chapters 6 through 8 are labeled as Appendices, and
are very valuable components of the text. Chapter 6,
Impairments and Adaptations, provides a comprehensive
discussion about muscle weakness, loss of dexterity, spasticity, muscle stiffness, abnormal motor patterns, and sensory impairments. The discussion about spasticity differentiates reflex hypersensitivity and resistance to passive
stretch as separate phenomena. Implications for function
and treatment are included.
In Chapter 7 the physiological rationale, benefits, and
evidence-based efficacy for strength training and physical
conditioning for clients with stroke are explored. The
authors address specificity of exercise and the transfer of
strength training into function, and provide exercise prescription guidelines for strength, flexibility, and physical
conditioning.
The book concludes with Chapter 8, in which multisystem complications of acute stroke are presented along with
methods for managing these complications. Overall, this
book is a comprehensive composite of evidence-based practice ideas, motor learning and control principles, and concrete, detailed rehabilitation strategies for patients with
stroke. It has the potential to be helpful for clinicians who
desire to better understand scientific principles underlying
important functional tasks, re-evaluate the rationale for current modes of practice, and update clinical practice to incorporate contemporary models of stroke rehabilitation.
Educators and students will benefit from the comprehensive
presentation of these principles, in addition to a sciencebased discussion of sensorimotor impairments post-stroke.
Susan B. Perry, MS, PT, NCS
Chatham College
Pittsburgh, PA

Anda mungkin juga menyukai