Life on Wheels: For the Active Wheelchair User.

Karp G. Sebastopol, CA 95472, O'Reilly & Associates Inc, 1999, paperback, 573 pp, ISBN: 1-56592-253-0, $24.95.

This book describes what daily life is like for people with permanent disabilities, and it is written for people with permanent disabilities and those who interact with them. It also shows them how individuals with disabilities have the potential for greater participation in personal and societal relationships. As such, this book is not written with health care professionals as the primary audience. The book has 11 chapters, a list of resources, chapter notes, a bibliography, and an index. The author himself has a spinal cord injury, and, as a result, the book focuses on the experiences of people with that injury more than any other pathology. The book is one of a series of "Patient-Centered Guides" available from the publisher.

Chapter 1, "The Disabilities," describes a variety of pathologies and impairments, such as amputation, amyotrophic lateral sclerosis, cerebral palsy, multiple sclerosis, muscular dystrophy, myasthenia gravis, rheumatoid arthritis, spina bifida, spinal cord injury, stroke, and "temporary and age-related disabilities." These descriptions are intended to help people with disabilities and their caregivers understand the various ways in which people may become disabled. Once again, these descriptions are not aimed at the health care professional.

The chapter entitled "Rehabilitation" contains information about the availability and types of services, how they are reimbursed, how to choose a rehabilitation center, and the roles of the different professions on the rehabilitation team. The chapter entitled "Medical Concerns" describes some of the more common medical complications of permanent disability. These descriptions are oriented primarily toward people with spinal cord injury. The next chapter, "Staying Healthy," complements this chapter and has valuable information on ways to prevent complications (eg, exercise programs, nutrition, skin care, bowel and bladder management), disability-related expenses that will be incurred over a lifetime, and finding and choosing a personal care assistant.

"The Experience of Disability" (chapter 5) examines the psychological and emotional consequences of disability and the adjustments that must be made to have a meaningful life. The next 3 chapters are concerned with pragmatic issues and cover wheelchair selection, home access, and sexual function. The book ends with chapters on current and future spinal cord research, how to understand the political process when advocating for people with disabilities, and advice on traveling, employment, and recreation.

The early chapters are probably the least valuable for the experienced physical therapist. For the therapist who is just beginning to work with patients with permanent disabilities, the chapters entitled "Medical Concerns," "Staying Healthy," The Experience of Disability," and "Intimacy, Sex and Babies" provide good reviews. The chapters on wheelchairs and home access give good practical advice to the consumer, but they are not detailed enough to serve as a reference for a health care professional. The chapter "Getting Out There" has many details and considerations regarding travel that many health care providers probably do not think much about, but should.

The list of organizational and adaptive equipment resources is fairly extensive and includes e-mail and World Wide Web addresses where available. The "Notes" section lists sources of selected facts and quotations by chapter.

Life on Wheels: For the Active Wheelchair User is a valuable book, but the reader should not expect as much emphasis on wheeled mobility as the title suggests. A separate title by the same author, Choosing a Wheelchair: A Guide for Optimal Independence is also available from the publisher and may be more appropriate for that topic. Life On Wheels is valuable because of its application to a variety of permanent disabilities and the abundant practical information available. Therapists should be aware of it, if for no other reason than to recommend it to clients who are newly disabled, their families, and caregivers. Its tone is always optimistic and inspirational. The book could also serve as a text for physical therapist education courses dealing with the concept of disability.

Robert Fuchs, PT University of Nebraska Medical Center Omaha, Neb

Mr Fuchs is Assistant Professor in the Division of Physical Therapy Education in the School of Allied Health Professions.