Multiple Sclerosis: A Rehabilitation Approach to Management.

This book is intended to serve as a basic introduction to the management of multiple sclerosis. The emphasis is placed on nonpharmacological approaches, although basic drug interventions are described where appropriate. Five multiauthored chapters address not only the basic neurological problems of multiple sclerosis, but also the management of these problems with physical therapy, occupational therapy, speech therapy, and swallowing therapy. Contributors to the various chapters include physical therapists, occupational therapists, and speech therapists, as well as die author. Unfortunately, the book fails to include a specific section on management of the various psychological and social problems that frequently affect people with multiple sclerosis. The various contributors do, however, describe the impact of such problems on physical management from their professional perspectives.

Each chapter on therapy covers some of the most commonly seen problems in that particular area. Some of the major problems addressed m this book include weakness, fatigue, decreased range of motion, poor balance, sensory deficits, limited ability to manage activities of daily living, cognition deficits, communication disabilities, and swallowing problems. A basic analysis of each problem and direct suggestions for managing that problem are provided. The classical division of upper- and lower-extremity problem management between occupational therapy and physical therapy is perpetuated. Perhaps for this reason, management of neuromuscular dysfunction (eg, spasticity, tremor, fatigue) is dealt with in greater detail for the lower extremities than for the upper extremities.

Both self-directed and assisted management approaches are addressed. This is not meant to be a "do-it-yourself" text for the patient, however. in all cases, only sufficient information that makes the relevant exercises or other management techniques understandable is provided. The person with multiple sclerosis would have to work with a therapist to develop appropriate individual management exercises.

The information provided is necessary when dealing with a disease with varied and complex symptoms, both general and introductory. For the newcomer, this material will provide a valuable orientation to the problem of multiple sclerosis. The list of suggested readings at the end of the book provides avenues for further, basic exploration for expanded information.

This book is clearly written and were organized and should be accessible to most laypeople. The line drawings included are clear, though one might wish that a few more had been used in some sections, particularly those dealing with oral problems such as speech and swallowing. The quality of the photographs could have been improved.

The anticipated audience for this book appears to be laypeople who are dealing with multiple sclerosis either as it affects them directly or as it may affect a friend or relation. As such, the book offers minimal or no theoretical background for the treatment approaches addressed. Others who might benefit from this book include health care workers who have limited theoretical preparation arid who are not routinely involved with the care of those with multiple sclerosis. Therapists and physicians would find this book a valuable tool in providing initial patient education both for people with multiple sclerosis and for their families.