Stroke: A Practical Guide to Management (2nd ed.).

C. P. Warlaw M. S. Dennis J. van Gijn G. J. Hankey P. A. G. Sandercock J. M. Bamford J. M. Wardlaw Blackwell Science Limited London, England 2001, 804 pages

The second edition of Stroke: A Practical Guide to Management is a comprehensive medical resource co-authored by British, Dutch, and Australian physicians. Upon reading the text, the reader can infer that these authors are leaders in the European stroke care arena, however an extensive description regarding the backgrounds of these physicians is not presented. The foreword refers to the authors as "pioneers in the emerging practical science."

The authors indicate that this text is not "a stroke encyclopedia," "nor is it meant to be read from cover to cover." The later is important as the imposing length (804 pages) might prevent many interested professionals from availing themselves to the information provided by this resource. The authors describe their writing style as a problem-oriented, evidence based approach. This approach sets the tone for the flow of the chapters, and enables the reader further access to current stroke literature, as a lengthy reference list follows each chapter.

Chapters cover such topics as history of stroke care, medical aspects of various forms of stroke, stroke assessment modalities, causes of stroke, specific medical treatment and management of various forms of stroke, stroke related deficits and interventions, stroke prevention, organization of stroke services, and public health/needs assessments relating to stroke. A multitude of graphs and images detailing the impacts of stroke on brain anatomy, and suggestions for assessment and practice are found throughout. Chapters begin with an open-ended question or a general statement indicating what will be covered throughout the chapter. A brief topical outline of the chapter follows. An additional helpful didactic feature is the provision of multiple web sites to enhance the included information and to provide continually updated information. While stroke related terminology is defined within the chapters, it would have been useful if a glossary were included to provide a centralized location of information.

The authors indicate that the text was written for doctors, nurses, therapists, managers, and anyone who has to deal with stroke in clinical practice. Due to the level of detail relating to medical assessment and treatment of stroke in combination with the limited focus on mental health, employment/productive focus, and family/psychosocial issues, this reference is really more appropriate for physicians and less so for allied health rehabilitation professionals. Several chapters are exceptions to this statement, however, including chapters ten and fifteen. Chapter ten focuses on such issues as developing a rehabilitation plan through goal setting, and utilizing a multidisciplinary team. Chapter fifteen provides an extensive description of assessing stroke associated deficits and suggestions for related interventions that have been found successful. Occupational, physical, and speech therapists, as well as rehabilitation nurses, will find more in these chapters that will help guide their practice when working with individuals who have had strokes. It should be noted that rehabilitation counselors and other mental health professionals will find little other than background medical definitions and descriptions relating to medical assessments that will assist them in their practice. Overall, the interventions and management plans suggested are for medical care. Psychotherapeutic and psychoeducational interventions are mentioned briefly, if at all.

One major consideration limiting the ability to generalize the contents of the text relates to the fact that the book is mainly written from the point of view of the United Kingdom (U.K.) medical system. As there are multiple differences between the U.S. and U.K. medical service delivery paradigms, some suggested interventions and programmatic structures may limit some of the information provided in the text from being utilized by U.S. rehabilitation professionals. One example that highlights this issue is the authors' description of the "core stroke team." U.S. multidisciplinary teams working in stroke or brain injury rehabilitation typically differ from the model described in terms of team leadership, membership, and family/client involvement.

While non-physician professionals will find useful information relating to the causes, symptoms, and diagnosis of stroke, Stroke: A Practical Guide to Management is best viewed as an extensive medical resource relating to medical, hospital-based treatment of stroke written primarily for physicians.

Robert J. Froehlich, Ed.D., LPC, CRC
Assistant Professor
Rehabilitation Counseling Program
University of South Carolina