Sensory Re-Education of the Hand After Stroke.

Sensory Re-Education of the Hand After Stroke Yekutiel M. London, England, N1 2UN, Whurr Publishers, 2000, paperback, 146 pp, illus, ISBN: 1-86156-169-5, $34.95.

Because of her concern for the shortcomings of our current approaches to treating patients with stroke, the author presents her method for sensory reeducation (SRE). She feels that physical therapists have ignored the rehabilitation of sensory function and have focused excessively on the return of motor control, to the detriment of our patients. This book contains information that both physical therapists and occupational therapists may find thought provoking and practical.

The first 3 chapters of the book provide an interesting overview of stroke, spontaneous recovery, and the currently popular neurodevelopmental therapy approaches. However, she criticizes these approaches as ineffective and neglectful of the patient's sensory systems. I agree with Yekutiel's argument in that we must challenge our current thinking and find a more complete and effective approach to treating patients with stroke, but some people may find the idea that our current approaches are useless hard to swallow.

In chapter 4, the theoretical basis of SRE is thoroughly described and supported with many recent research studies on neuroplasticity following peripheral or central nervous system damage. Chapter 5 discusses the contributions of psychological research on attention, motivation, and their effects on learning. Although based on sound theoretical principles, this method of SRE is not yet validated in the current literature other than the author's own research, which is detailed later in the book.

In the next few chapters, the author describes SRE, aided by photographs and sketches that illustrate the method well. She makes helpful suggestions on objects to use or easily construct that will provide sensory input. The therapist instructions and possible patient responses that she includes illuminate how a session might truly proceed, but they avoid a cookbook of "how-to" directions.

This book is quite persuasive with its lengthy list of references and description of the first research on the method. It may be the adjunct to therapy that addresses many of our frustrations when we work with patients with stroke who are sensory impaired and who progress slowly and have poorer outcomes than patients with an intact sensory system. The book raises some questions that will hopefully stimulate further research in the area. Some portions may also be of interest to patients and their families who are participating in an SRE program with their therapist.

Janice Bohn, PT, NCS The Rehabilitation Institute of Chicago at Alexian Brothers Medical Center Elk Grove Village, Ill

Ms Bohn is the Neurologic Clinical Facilitator of the rehabilitation program. She specializes in the care of patients with stroke.