getting the best from your wheelchair
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respond well t o external visual or verbal cues. The role of the proprio- ceptive, vestibular and visual systems is explained in depth, ending with some relevant com- ments on the contribution of the musculoskeletal system t o energy conservation.
The third chapter by Woollacott and colleagues reviews nornlal and abnormal development of balance and gait control, ending with an interesting perspective on how the systems model of motor control can be used for assessment.
The second section on the assess- ment of balance and gait disorders contains four chapters by very well- known researchers. It is full of very practical information, Patrick, an orthopaedic surgeon, addresses the interface between neurology and orthopaedics. His starting point for assessment asks the question 'Why is the patient disabled?' The remaining chapters look at neuro- logical and neuro-otological ass- essment. The last chapter in this section looks a t the interaction between the vestibulospinal and proprioceptive reflexes in the ass- essment of balance control.
The section on clinical disorders contains seven chapters, on vest- ibular, cerebellar, basal ganglia, spastic and frontal disorders. Drop attacks and psychogenic disorders each also merit a chapter. Each chapter presents an excellent overview of each disorder with reference to recent comprehensive reviews and good tables on the functional organisation o f brain structures such as the cerebellum.
The fourth section on rehabilita- tion contains three chapters, on balance, gait and psychosocial aspects. Chapter 15 by Shumway- Cook and colleagues is one of the most useful for physiotherapists, with many thought-provoking ideas on treatment.
The same cannot be said for the following chapter on gait by Mauritz and Hesse, which needs t o be re- focused with more emphasis on a comprehensive review of the litera- ture. The authors cite old references with regard to the Bobath concept (Bobath, 1978) and favour the use of treadmill training, botulinum toxin and functional electrical stimulation when more conventional thera- peutic approaches have yet to be properly evaluated. The authors are
perfectly justified in stating that physiotherapists need to develop rational guidelines for manage- ment. In future editions this chapter would benefit from the collabora- tion of an experienced neurological physiotherapist.
Chapter 17 in this section offers excellent suggestions of how the psychosocial aspects of vestibular rehabilitation can be addressed.
The final section addresses prob- lems specific to older people, looking a t balance control, gait disorders, medication and falls.
This is an outstanding textbook that achieves the difficult task of providing relevant in-depth in- formation to a multi-disciplinary
audience. The contributors are all acknowledged experts in their field, who have successfully combined clinical practice and research. This is an invaluable textbook for experi- enced physiotherapists specialis- ing in neurological rehabilitation; however it is expensive and for that reason is destined to remain a useful addition to any library book- shelf.
The editors have successfully demonstrated how all professionals involved in neurological rehabilita- tion can benefit from broadening the horizon of their specialty as stated in this book's preface.
Sheila Lennon MSc MCSP
Getting The Best From Your Wheelchair A guide to using a basic wheelchair published by The Royal Association for Disability and Rehabilitation (RADAR), 12 City Forum, 250 City Road, London EC1 V 8AF, 1995, revised edn (ISBN 0 900270 69 I). Illus. 62 pages. €1.
This A5 size booklet is intended for first-time wheelchair users and their carers. I t was first published in 1992. The main text of this revised edition is virtually unal- tered but the section on sources of further information has been updated.
Basic transit (pushed) and manual (self-propelled) wheelchairs are described and instructions are given on handling of the chair by a user or carer. Several methods of removing and replacing different types of armrests and footrests are described and this could be a little confusing for some readers.
In a booklet of this size it is not possible to give detailed information on topics such as transfers, loading wheelchairs into cars or more advanced manoeuvres such as self-propelling up kerbs. These techniques need t o be taught by an experienced therapist.
The simple text and clear draw- ings should be easily understood by most readers and throughout the booklet there are warnings in bold type of potential dangers.
This booklet would be helpful for first-time wheelchair users and their carers, and it would also give useful basic advice to therapists with no previous knowledge in this field. Jo Kavanagh MCSP
Going down steps with experienced helpers, loading a chair into a car, and going up a kerb backwards - from many illustrations in 'Getting the Best from your Wheelchair'
Physiotherapy, November 1997, vol83, no 11