The Invaluable Guide to Life After Stroke: An Owner's Manual.

At last a book has been written with some very practical information for the stroke survivor and family! The Invaluable Guide to Life After Stroke: An Owner's Manual is a "user friendly," easy-to-read handbook which addresses numerous concerns and questions about stroke and its aftermath. A consumer-oriented book, it is written in language that the lay-person can understand, not medical or technical jargon. The author, an attorney whose own life changed course ten years ago as a result of a stroke, writes with compassion and humor.

The Foreword, written by Dr. Stumt H. Mann of the American Heart Association, discusses the common failure among physicians and other members of the rehabilitation team to acknowledge the psychosocial aspects of stroke and the resulting lifestyle and personality changes. Mann talks about empowerment, and stresses the importance of taking responsibility for one's own healing and learning to cope with the newly acquired disability.

In the Introduction, Josephs tells how life "turned around" the day he had his stroke. For his wife, that meant economic worries and the feeling of "living with a stranger. "For Josephs, it meant dealing with aphasia. He claims that lack of knowledge was a large part of many of the problems. Consequently, he was inspired to write this manual about his own experiences with aphasia and impaired movement following a stroke.

In Chapter One, "What Happened to Me," he describes stroke as a heart attack of the brain. He goes on to describe what it feels like to survive a stroke. Though each person's stroke is different, Josephs identifies two commonalities of all strokes. The first is that, as a result of stroke, each person has lost a part of himself forever. The second is that each person will improve, in some degree, for the rest of his life. This poignant message recurs throughout the book.

"What Was it the Doctor Said" is the focus of Chapter Two. Sadly, many doctors no longer take the time to provide the patient with information. "They save your life and then move along," states Josephs. Patients want more than just medical information about their condition. Josephs succeeds in taking a step to fill that gap for other survivors of stroke and for their families.

Chapters Three and Four discuss some of the emotional problems that often follow stroke. It is not uncommon to experience depression or even uncontrolled crying and lability. Anger and selfishness sometimes accompany stroke. Frustration is understandably a repercussion of stroke. After all, the body no longer operates on "automatic pilot," as Josephs calls it. He empathetically encourages the person who has survived a stroke to be kind to himself and accept the limitations that follow stroke. Guilt is detrimental in the rehabilitation process. The chapter would not have been complete without the practical discussion of sex after stroke.

Chapters Five and Six provide some quick tips to gain confidence upon returning home from the hospital. Josephs encourages stroke survivors to find out the location and cause of their stroke, as this may be a factor in preventing subsequent strokes. He also gives some comforting information on the relative harmlessness of seizures for stroke survivors.

The next chapters discuss lifestyle. Positive social contacts are an important part of mental health following stroke. Friends who avoid visiting may, themselves, be uncomfortable dealing with illness. Persons who have experienced stroke need to be as independent as possible but also need to take extra care and slow down, be patient, and take responsibility for their own health and well-being.

Chapters Nine, Ten and Fourteen talk about some "tricks of the trade" for the stroke survivor. For example, learning the correct way to fall is important, "should the occasion arise. "Re-learning to drive is especially important. Driving is more than just getting from place to place. It is symbolic of the freedom that all of us require. Also included are some helpful hints of the use of buses, and outings to supermarkets and restaurants.

Chapter Twelve is one of the longer chapters in this manual and is about the importance of support groups. Josephs offers some guidelines for the logistics of setting up and operating these groups but implies flexibility to these rules. He suggests that they be conducted by a trained facilitator who possesses the sensitivity to lead a group which will have any number of non-verbal participants and also a good intuitive sense of which of its members need the most support and help. Support groups can be helpful to both stroke survivors and their families in discarding self-consciousness. Marriage and relationships are discussed. The chapter concludes with some phone numbers to locate local support groups.

Chapter Sixteen provides some communication tips for families where aphasia has resulted from a stroke. Good listening is crucial. One sound at a time makes it easier for the person with aphasia to make sense of the conversation. Josephs makes his point clear when he compares aphasia to talking on the phone to someone with an accent when there is static! The family needs to find that delicate balance between being sensitive and telling a person when their speech is unclear.

The last chapter defines the need for the person who survives a stroke to learn to measure success in new ways and to pay attention to the small milestones, not just the larger ones. It is an upbeat, optimistic and encouraging way to conclude the book.

Finally, there is a list of national and regional resources where help and information can be found for the stroke survivor and his family.

The Invaluable Guide to Life After Stroke: An Owner's Manual is an intelligent and compassionately written resource that should accompany every stroke survivor home from the hospital. Even health care providers, who so often get caught up in the psychological and medical aspects of stroke, might find their bed-side manner improved from some of the pointers in this book. Kudos to Mr. Josephs for his very candid contribution on a subject of which seemingly little has been written for the lay-person.

Debra L. Karplus Champaign, Illinois