Functional Recovery After Stroke.

Functional Recovery After Stroke

Wagenaar RC. Amsterdam, The Netherlands 1081 HV, VU University Press, 1990, paperback, 230 pp, illus, $33.50.

The purpose of this book is to analyze the functional recovery of the patient who has had a stroke and the effects of different physical therapy techniques on that recovery. There are eight chapters. each begins with a summary of the chapter's subject matter and concludes with a discussion of the material covered and an extensive reference list. Graphs and tables help to illustrate some of the studies.

The author states that there is a large gap between theory and practice" in physical therapy for the patient who has had a stroke and that much is based on tradition rather than on modern motor control developments. He then proceeds to review and critically evaluate 165 studies on the efficacy of present methods of stroke rehabilitation. Brushing, icing, vibration, reflex-inhibiting patterns, splinting, and biofeedback all produce positive effects, but the transfer to activities of daily living appears minimal. Only functional electrical stimulation, combined with electromyographic feedback and visual scanning training during wheelchair navigation showed clinical relevance. This confirms the belief that treatment should consist of task-specific activities.

Chapters 4 and 5 relay studies comparing neurodevelopmental treatment and Brunnstrom techniques on the functional outcome of the patient who has had a stroke. The conclusion is that there are no relevant differential effects. one study provided evidence that the later post-stroke recovers, starts, the less functional recovery, will occur.

Hemiplegic gait is the topic of another chapter in which variables including speed and trunk rotation of nondisabled patients and patients who have had a stroke are studied. In general, patients who have experienced a stroke showed excessive pelvic rotation and a lack of timing in thoracic-lumbar rotation. Future studies in these areas are suggested, such as hoop rolling or ball bouncing with the unaffected hand. The importance of speed as part of gait analysis in hemiplegic gait is also emphasized.

Overall, I cannot recomend this book for most physical therapy practitioners. The summaries provide useful information, but the in-depth statistical equations research background. A lengthy chapter on the advantages and disadvantages of controlled single-case experimental design is of only limited interest to those in pure clinical practice. This book would, however, be an appropriate addition to a physical therapy education library, as a source of information to aid in future studies relating to stroke recovery, Bonnie Bauer Swafford, PT Kansas University Medical Center Kansas City, Kan