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