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Upper motor neurone syndrome and spasticity. Clinical management and neurophysiology
  1. DERICK WADE

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    Upper motor neurone syndrome and spasticity. Clinical management and neurophysiology. Edited by michael p barnes andgarth r johnson (Pp 317, £34.95). Published by Cambridge University Press, Cambridge, 2001. ISBN 0 521 79427 7.

    This multiauthor book aims to improve the management of patients with spasticity in two ways. It provides a clear and clinically relevant account of the underlying neurophysiology that will help clinicians understand the nature and genesis of the problem. And it provides a critical and up to date review of much of the relevant clinical evidence. Some parts of the book are weak, but this book will not mislead and is good value for money.

    One weak area in the book is the coverage of the measurement of spasticity. There is one chapter devoted to the topic, by one of the editors, yet this chapter does not make any reference to the Tardieu scale, which forms an important part of the next chapter on physiotherapy management. The next edition should ensure at least adequate cross reference. There is little discussion of the indirect measurement of spasticity, measuring the consequences of spasticity such as reduced range of movement, pain, frequency of spasms, or the difficulty experienced by carers in activities. It is these measurements which are being used in modern trials. It would be helpful to include a review of measures used in studies of the management of spasticity, especially because this will be the main clinical interest in measurement.

    Two excellent chapters cover the explanation of the neurophysiology and the pharmacological management of spasticity. Both draw heavily on evidence which is heartening.

    High quality evidence is lacking in many other areas, but the discussion of matters such as seating and the use of intrathecal baclofen does draw on experience, and is clearly written. In practice most clinicians will need to learn from direct experience, but if good teachers are not easily available then this text will give a good start to the learning curve.

    Some chapters do not use all the evidence that is available. The chapter on orthoses focuses too much on being a catalogue of available orthoses, with any critical evaluation of their utility. The chapter on chemical neurolysis similarly lists and describes the various anatomical options. There are certainly studies, including a large randomised controlled trial from The Netherlands that investigate the use both of orthoses and neurolysis and this study is not referenced. There are several studies investigating the use of ankle-foot orthoses.

    Finally there is a good chapter on the use of botulinum toxin, its only and inevitable weakness being that some studies are omitted because more evidence is being published regularly. However, it is sensible and accurate and will be a sound basis for action in most cases.

    In summary this book covers almost all aspects of spasticity that doctors, therapists, nurses and other clinicians may be interested in. Its use of evidence is good, although it could be improved. It cannot substitute for being taught by someone who has experience, nor can it substitute for keeping up to date through continuing professional development but if spasticity management is only a part of your workload (rather than being your specialty) then this book will give a good foundation for clinical practice for the next few years.

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