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Neurological rehabilitation of stroke
  1. R Botell

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    Edited by Nick Losseff. Published by Taylor & Francis Books Ltd, 2004, £29.95 (hardcover), pp 100. ISBN 1841843229

    This is the second book in the Queen Square Neurological Rehabilitation Series and follows the same formula as the first, with chapters on the molecular basis of neural repair and recovery following stroke, the interdisciplinary team, the impact of stroke from both medical and patient viewpoints, outcome assessments, and models of service delivery. Successful neurological rehabilitation after stroke is achieved by working as an interdisciplinary team, and the book follows this principle with each chapter written by different members of the team, including the patient.

    The first chapter is a summary of recovery after stroke from the basic science level and how this applies to current stroke management. It describes animal and human models of brain plasticity, the potential for functional recovery, the biochemical changes around the time of a stroke, and studies of pharmacological management in stroke recovery. It is fairly detailed and includes a comprehensive reference section.

    The theme of the second chapter is the interdisciplinary team. It explains the roles of team members in the acute rehabilitation of stroke, identified as the first 6 weeks after the event. Emphasis is made on the change from the multidisciplinary team, where individuals work alongside each other on discipline-specific goals; to an interdisciplinary team approach with team members working together on mutually set goals with high levels of communication. The principle of using the World Health Organization (WHO) International Classification of Function (ICF) system rather than the International Classification of Impairment, Disability, and Handicap to plan goal-orientated rehabilitation is explained. This chapter gives quite a general overview of the interdisciplinary team, but specific points are illustrated in a case summary at the end.

    The medical view of stroke is the subject of the third chapter. It is both concise and comprehensive in the description of the pathogenesis, mortality, incidence, and prevalence of stroke. It discusses outcome in terms of impact at the patient and population level using the ICF system and considers the implications on resources of the National Sentinel Stroke Audit 2001/2 and the Royal College of Physicians Stroke Guidelines.

    The next chapter describes the impact of stroke from a personal view and despite it being the shortest chapter it is perhaps the most essential for those involved in stroke management. It is written by Robert McCrum, author of “My Year Off”, and gives a brief summary of his own experience of a stroke. He includes a particularly constructive Do’s and Don’ts list.

    The fifth chapter looks at evaluating rehabilitation as an intervention following stroke, using outcomes at the patient level and more broadly at the provider and population level. It includes the use of the ICF system of impairment, activity and participation, health related quality of life from the patient perspective, and also the evidence for stroke rehabilitation and cost-effectiveness of stroke care.

    The topic for the final chapter is service delivery and it details the evidence for the need for specialist stroke management and describes the models of care currently used to achieve this.

    The writers emphasize that this book only covers the first 6 weeks of rehabilitation after a stroke and it would be a mistake to come away from reading it with the impression that the rehabilitation process ends there. Further rehabilitation usually continues in an inpatient neurological rehabilitation unit or in the community. A patient’s functional level may continue to improve over many months, and in some cases years after the acute event. In summary this handy textbook provides a concise and accessible overview of the acute rehabilitation of stroke. It follows an evidence-based approach and includes a comprehensive reference list. I would recommend it to anyone involved in stroke rehabilitation and those new to neurological rehabilitation would find it particularly useful.

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