Multiple Sclerosis: a Guide for Rehabilitation and Health Care Professionals.

Rumrill, P. D., Jr., & Hennessey, M. L., Editors Charles C. Thomas Publishing Springfield, IL 2001, 215 pages, $47.95 for hard cover and $31.95 for paper cover

Multiple sclerosis (MS) is an illness that effects approximately 2.5 individuals worldwide and is the most common neurological illness in North America and Europe. Characteristics of MS include the unpredictable nature of the illness, the delayed period of time between the onset of symptoms and confirmed diagnosis of the illness, and the range of physiological and psychological symptomatology that may be present in an individual. In addition to these issues, the intersection among the personal, social, physical, mental, and vocational aspects may at times be both complex and daunting for persons with MS and people who work with this population to understand. In this vein, a comprehensive book such as Multiple Sclerosis: A Guide for Rehabilitation and Health Care Professionals is a valuable addition to the existing literature on this topic.

The first editor, Philip D. Rumrill, Jr., is an Associate Professor and Director of the Center for Disability Studies at Kent State University. His scholarly research in the field of multiple sclerosis is extensive with one of his foci being in the area of employment issues for persons with MS. The second editor, Mary L. Hennessey, is a vocational specialist at VocWorks, Inc. of Dublin, Ohio. Her scholarly research has focused on the areas of research design and measurement and chronic illness. Mary McNary of the National Multiple Sclerosis Society's National Capital Chapter served as the consulting editor for the book.

The overall intent of the book is to provide the reader with an interdisciplinary and comprehensive view of MS. In this effort, the book consists of topic areas that are germane to the lives of persons with MS. In accordance with the interdisciplinary orientation of the book, the contributing authors, who range from nurses to people with MS, have diverse training and theoretical approaches to the content areas presented. The persons with MS who served as contributing authors wrote essays at the end of each chapter to provide a personal perspective on the issue presented in that chapter.

In Chapter 1, Hennessey and Rumrill provide context to the book by providing the reader with an orientation to MS. This information serves as the foundation for information that is presented in subsequent chapters as the information then progresses into how these physiological and psychological effects have an effect on issues such as community living, employment and career development, and family issues.

In Chapter 2, Randall T. Schapiro builds upon the information presented in Chapter 1 by providing the reader with information on how to effectively manage the illness. The main benefit of this chapter is that it invites the reader to infuse the perspectives of both theory (in this case, information about the illness that was presented in the previous chapter) and practice (applying the information to daily life issues and challenges). To demonstrate this, Schapiro structured the chapter so that first, information on the most prevalent physiological symptomatology found in MS was presented. He then broadened his discussion of each symptom topic by providing the reader with applied strategies for how to manage these symptoms. In Chapter 3, Connie J. McReynolds and Lynn C. Koch address the psychological factors and symptom management issues for persons with MS. Family issues are presented in a comprehensive manner in Chapter 4, where Peggy A, Crawford discusses how MS may have an effect on the individual's marital relationship, children, other family members, and parenting issues.

The next three chapters in the book (Chapters 5-7) focus on issues that are geared toward fostering and/or increasing independence among persons with MS. In Chapter 5, Nancy Cooper, Wendy Sullivan, and Rosemary Zuck focus on community living issues for persons with MS, providing information on community-based care programs such as respite care, adult day programs, and assisted living facilities. The authors also take the opportunity to provide the reader with information regarding the range of services that an individual may receive from the National MS Society in their local area and how they may be supportive to the community living goals of a person with MS.

In keeping with the focus on progression towards independence issues, Chapters 6 and 7 are the most noteworthy in the book. In Chapter 6, Rumrill provides very detailed information regarding career development and employment issues for persons with MS. In this effort, Rumrill provides the reader with information regarding some of the physiological and psychological factors that affect the significant rate of unemployment among persons with MS. He then progresses into how this information and other factors, such as the environment of the workplace, may have a role in how a person with MS is able to perform at his/her job. Rumrill also takes the opportunity to be critical of the Social Security Program and the work disincentive that is in place in its guidelines for persons with disabilities. For example, Rumrill discusses that it is challenging for persons with MS to seek employment because Social Security Disability Income (SSDI) and Social Security Insurance (SSI) benefits are likely to be terminated once the individual obtains employment. Rumrill provides information later in the chapter that may address some of these employment challenges.

Assistive technology is the focus of the final chapter of the book. Since it was the last chapter and had the advantage of the information presented in the previous chapters, the author, Wendy Strobel, was able to share more with the reader on how to effectively use assistive technology instead of focusing more on the illness-related issues that would warrant or benefit from such devices (this was adequately covered in Chapters 2 and 3). In addition, to help provide context to the discussion, Strobel included a case study in the chapter to illustrate how assistive technology may be helpful in improving the quality of life for a person with MS.

With the overall framework of the book in mind, it is important to note that there are several advantages to the book. As previously stated, providing the reader with comprehensive information on MS ranging from general information on the illness to a discussion on how assistive technology may be helpful for persons with MS was noteworthy. The second advantage of the book is the personal perspective essays at the end of each chapter. In addition to the aforementioned advantages, there are some areas where the book was limited. Although professionals in the area of MS wrote the chapters in the book, the disadvantage was that at times the material seemed to be repetitive. Overall, the book is recommended to rehabilitation professionals who work in the areas of supported employment, Social Security, assistive living, and vocational rehabilitation. It is also suggested for graduate students in rehabilitation counseling who are interested in learning more about persons with MS or as a supplemental textbook for graduate courses and seminars on medical issues in rehabilitation counseling and job placement. In closing, the book is a thoughtful and welcomed contribution to the rehabilitation field on the topic of MS.

Jhan D. Doughty, D.Ed., CRC 

NIMH Post-doctoral Fellow, Department of Epidemiology and Public Health

Yale University School of Medicine