Aging with Spinal Cord Injury.

The goal of this text is to provide a better understanding of the real and potential problems people with spinal cord injury (SCI) may encounter as they age. The authors approach this challenge from seven perspectives. These perspective correspond to the sections of the text - research, physiologic, psychosocial, SCI survivor's, societal, provider's, and future. Input was provided by 38 contributors, most with medical backgrounds. Although no specific audience is cited, the text is appropriate for physical therapists and other health professionals working with persons with SCI.

In the initial overview, the authors provide demographic data suggesting that increasing survival rates of persons with SCI have led to an increased aging of the SCI population. A model of aging with SCI is presented and described separately for each of three phases following injury: acute, maintenance, and declination. This overview provides the basis for the text's importance. The research section describes the normal aging process and includes a critical review of literature on past studies of SCI and aging.

The section on the physiologic perspective is the largest and makes up approximately 40% of the volume. This section uses a systems approach, with each chapter addressing a different body system such as musculoskeletal, respiratory, and nervous. The general format for this section is to include a review of relevant information about the effect of SCI on the system being addressed and to then integrate the literature currently available from SCI and aging studies. The final chapter in this section includes coverage of multiple-organ/system involvement with SCI and aging, addressing symptom patterns across systems, infection, nutrition, and pharmacology.

The other sections in the text include 3 chapters on the psychosocial perspective, 3 chapters addressing the survivor's perspective, and 5 chapters depicting a societal perspective, The societal perspective section includes such diverse topics. as financing health and personal care, ethical issues, and spiritual components of aging with disability.

An additional five chapters document a perspective often missed in texts on rehabilitation of patients with SCI, that of the provider. This section details changes in health care, rehabilitation philosophy, educational philosophy, adaptive equipment, and the impact of these changes on aging and SCI. The last chapter in this section offers a model of lifetime services.

The final section, which is a single chapter, is a perspective on the future, and advocates several steps toward identifying common or critical problems facing the "complex phenomenon" of aging with SCI. In this chapter, the authors suggest the need for a better conceptual framework from which to work. They support identifying appropriate interventions with consideration that some treatments may need to include lifetime care. They also support research strategies to build upon these goals.

Overall, the editors have attempted to provide a comprehensive and holistic approach to a row of topics rarely presented in other volumes. For example, the chapter on die immune system includes coverage of the in influence of stress on the immune system of the caregiver. The effect of stress on the caregiver is also considered in the psychosocial section.

The text provides a current and thoughtful presentation of the materials in a very readable format. The level of scientific and technical material presented varies from chapter to chapter, but the level is consistently appropriate for the content of the chapter. The text includes an assortment of tables and charts, with few illustrations. Brief case studies provide concrete examples for the topics in many chapters.

I strongly recommend this text for physical therapists and other rehabilitation professionals working with persons with SCI. It has an obvious place in the hands and on the shelves of the rehabilitation professionals who are treating older patients with SCI, but it would be unfortunate if this were the only audience. The text is equally useful for those rehabilitation professionals who are treating younger patients with SCI, because the population has a clearly increasing life expectancy, which is the very basis of the text. This unique volume offers rehabilitation professionals information about the prognosis of SCI with consideration of individuals with SCI, their family, their caregivers, and medical providers. Because rehabilitation professionals are often in long-term relationships with persons with SCI, this knowledge has the potential to enhance these therapeutic relationships.