Meeting the Challenge of Progressive Multiple Sclerosis.

Coyle PK, Halper J. New York, NY 10016, Demos Medical Publishing, 2001, paperback, 143 pp, illus, ISBN: 1-888799-46-3, $19.95.

This book's intended audience is people who have progressive multiple sclerosis (MS). From that perspective, this is a good book to recommend to patients and their families. It is an interesting read, with simply defined medical terms, a discussion of important topics, and a resource guide. However, new graduates in the health care professions and those health care professionals who are reacquainting themselves with the care of people with progressive MS will find that the book covers a wide range of topics in a superficial way.

The book is organized into 9 chapters, with 2 appendixes and an index. The authors' discussion progresses from a medical perspective to the psychosocial and economic issues that people with MS may cope with. Chapters 1-3 deal with the epidemiology, diagnosis, and drugs used to modify the disease pathology. I found the discussion on the 4 types of MS and the drugs used to modify the progressive disease pathology more informative for a layperson than the epidemiology and diagnostic sections were. Most people diagnosed with progressive MS are well acquainted with the medical system and have already gone through the diagnostic workup several times.

Impairments such as fatigue, increased reflex activity, tremor, pain, trigeminal neuralgia, bowel and bladder dysfunction, sexual problems, skin care, depression, and cognitive problems are discussed in chapter 4. The interventions identified for most of these impairments are pharmacologic agents or surgical procedures. Some emphasis is placed on behavioral modification for fatigue management or psychological support for depression; however, physical therapy is not mentioned in this chapter. Chapter 5 is devoted to the rehabilitation process. The team members are defined, and assistive devices for mobility and activities of daily living are identified.

The remaining chapters of the book deal with the psychosocial and economic issues that are faced by this patient population. Topics such as filing for disability, income taxes, legal rights, and job modifications are discussed briefly in chapter 6. Chapter 7 discusses coping with the disease's progression. The authors acknowledge that the disease can infiltrate all aspects of a person's life and suggest that he or she find an "MS free zone" in his or her life, a place where the disease does not touch. Chapter 8 deals with specific women's health issues, and the last chapter is a health care screening tool. The appendixes contain additional readings and listing of Web sites and organizations that can provide valuable information for the person with MS.

In conclusion, this book makes a significant contribution to its intended audience. It provides a framework for further investigation and discussion; one in which a family member, health care professional, or a person with MS can use as a starting point.

Clare C Bassile, PT, EdD
Columbia University
New York, NY

Dr Bassile is Assistant Professor of Clinical Physical Therapy in the Program in Physical Therapy.