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The clinical science of neurologic rehabilitation. 2nd edition
  1. M Barnes

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    By Bruce H Dobkin. Published by Oxford University Press, Oxford, 2003, pp 577. £95.00. ISBN 0-19-515064-3

    This is an excellent book and a major tour de force through the whole field of neurological rehabilitation. The main attraction of this book over an increasing range of textbooks on the same subject is the merging of basic neuroscience and clinical medicine. There are a number of good textbooks on each of these subjects but none that have so successfully bridged the gap between scientific and clinical practice. It is a major achievement for a single author to have successfully spanned this divide. The major advantage of a single author for such a textbook is that the style is uniform and consistent and the background level of knowledge required does not fluctuate from chapter to chapter, as usually happens with multi-author texts. The style is easy and the book is a pleasure to read. Each chapter is very thoroughly referenced for those who wish to go into greater detail.

    The first section covers the neuroscientific foundations for rehabilitation. There are four chapters, which cover neural plasticity, neural repair, functional neuroimaging, and the use of neurostimulators and neuroprostheses. These chapters are particularly interesting for the clinician who has only limited up to date knowledge of the relevant basic neuroscience.

    The second section covers common practices, including chapters on the rehabilitation team, approaches for walking, use of outcome measures, and a chapter on more general acute and chronic medical management including such issues as orthostatic hypotension, the neurogenic bladder, pain management, and nutrition. The chapter on outcome measures is thorough but of necessity does not cover a wide range of outcome measures, but certainly the most common and most helpful measures are discussed. The chapter on medical management is particularly useful and provides a succinct resume of some of the problems that are common to many neurological disorders. Some of the sections are rather short but the excellent referencing system does point to the more detailed literature.

    The third section covers specific neurological disorders, including stroke, traumatic brain injury, and spinal cord injury. There is a relatively short final chapter covering other neurologically disabling disorders, including Parkinson’s disease and multiple sclerosis as well as mentioning cerebral palsy, balance disorders, Alzheimer’s disease, and epilepsy. Some of the latter disorders are covered rather sketchily and it might have been better in retrospect to leave these out altogether. The section on epilepsy, for example, only covers half of one page.

    This is, however, a minor criticism of an excellent book, which is frankly a landmark in the development of neurological rehabilitation. This book clearly illustrates that neurological rehabilitation should now be viewed as an established and vibrant speciality with an exciting future. Bruce Dobkin should be congratulated.

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