Long-Term Effects of Stroke.

Bogousslavsky J, ed. New York, NY 10016-0602, Marcel Dekker Inc, 2002, hardcover, 335 pp, illus, ISBN: 0-8247-0624-2, $165.

Although the general population is enjoying a longer life span than decades ago, it is also dealing with health conditions associated with longer life; therefore, the discussion of the sequelae of stroke is a timely one. This book uses 18 contributors from around the world, including Europe, Australia, South America, and the United States, to examine the scientific evidence on the effects of stroke.

The first 3 chapters review definitions and various tests and measures of outcomes and quality of life. Descriptions are provided for 7 measures of global disability, 2 measures of global outcome, and 4 measures of focal disability. For 3 of the tests, the scale is reproduced. The other tests are described in general terms. Some, but not all, of these descriptions discuss the validity and reliability of the measurements and the advantages and disadvantages of the tests. References at the end of the chapters include the original publications of the scales, comparison studies, and reliability and validity studies.

The fourth and fifth chapters examine recurrence of stroke, other outcomes, and mortality by stroke subtype. The chapters review not only predictors of these outcomes, but preventive factors as well. The information is well organized and easy to follow.

Five of the remaining 7 chapters deal with specific conditions associated with stroke, including motor recovery, cognitive and behavioral deficits, sphincter disturbance, mood changes and disorders, and vascular dementia. Most of the focus is on motor and cognitive recovery.

The chapter on motor recovery reviews the clinical predictors of the resolution of hemiparesis after a brain infarct. Although the resulting deficits can also be assessed using measures of functional skills, this chapter focuses on the use of various imaging techniques to assess the viability and perfusion of the lesion and surrounding tissue. By using studies such as perfusion- and diffusion-weighted imaging with magnetic resonance imaging, physicians can improve accuracy of early stroke diagnosis, and researchers can obtain qualitative information regarding the functional state of brain tissue after injury.

The chapter on cognitive and behavioral deficits examines aphasia, neglect, amnesia, apraxia, and other conditions. Although it does not go into great depth on each of these conditions, it does provide easy access to short-term and long-term study results. Both this and the motor recovery chapter provide hundreds of references for the clinician who wishes to obtain more information.

The chapter on drugs and cell-based therapies provides a fascinating look at the enhancement of stroke recovery. It is easy to read and gives descriptions of the mechanisms by which each therapy works.

After reading the rest of the book, the chapter on cost-benefit issues was a disappointment. Nearly half of the chapter was spent defining the various types of costs related to stroke, and the conclusions it rendered were general.

This book was written with physicians as its primary intended audience. Nonetheless, physical therapists, occupational therapists, and other rehabilitation specialists working with patients with neurological conditions will find it a useful reference. Although it will not help the therapist choose any particular intervention, it will help improve overall knowledge of the long-term effects of stroke.

Carolyn Vaillancourt, PT, NCS 

Braintree, Mass

Ms Vaillancourt is a senior therapist in an outpatient facility. She currently serves on the Specialization Academy of Content Experts in Neurology.