Tetraplegia and Paraplegia: A Guide for Physiotherapists, 4th ed.

Tetraplegia and Paraplegia: A Guide for Physiotherapists, ed 4

Bromley I. New York, NY 10011, Churchill Livingstone Inc, 1991, paperback, 219 pp, illus, $39.95.

Tetraplegia and Paraplegia is the fourth edition of this book, with the stated purpose of providing information on spinal cord injury treatment to those practitioners with little experience in this area. There are 17 chapters in a logically outlined format, with numerous tables, line drawings, and photographs. Appendixes, references, further readings, and an index conclude the book.

This book was written in Great Britain; therefore, a few differences are notable. "Tetraplegia," defined here as "partial or complete paralysis of all four limbs and the trunk," is usually referred to as "quadriplegia in the United States." Other words can be figured out in context; for example, a "frame" is a walker, and a "boot" refers to the trunk of a car. Common equipment not mentioned (perhaps because they are not widely used in that country) include transfer boards, bath benches, shower chairs, and transfer belts.

This edition differs from the 1985 edition in that the information here is better organized. Respiratory care is covered in a separate chapter that includes helpful illustrations for assisted coughing in supine and sitting positions. The incomplete lesion is more thoroughly addressed, with analysis of normal movement and techniques for patients with low or high tone detailed. A table, reprinted from another source on muscle activity during normal gait, is marred by the mislabeling of swing phase as stance phase.

The chapter addressing transfers has excellent step-by-step drawings for a variety of situations. One technique for assisted transfers is unrealistic, however, showing a therapist doing a total lift, going from the chair to a plinth by turning a patient around 180 degrees. Other shortcomings are the omissions of a forward floor-to-chair transfer and only showing a car transfer by putting the legs into the car first.

This book covers a wide variety of topics relating to spinal cord injury. Basic information explaining spastic and flaccid paralysis, stages of pressure sores, postural considerations, and psychological factors are very useful for the clinician. More in-depth coverage would have been helpful, such as different types of braces for ambulation, The chapter on sports covers archery and swimming thoroughly, but does not mention tennis or road racing.

Tetraplegia and Paraplegia does succeed in its objective of providing guidelines for the inexperienced physical therapy practitioner. The pictures are very clear, and the format is easy to follow. For a comprehensive source of information in this area, however, I suggest supplementing this manual with at least one other source to provide additional strategies of treatment for the patient with spinal cord injury.