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Functional rehabilitation in neurosurgery and neurotraumatology
  1. David Rushton

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    Edited by K R H von Wild (Pp 147, €76). Published by Springer-Verlag Wien, New York, 2002. ISBN 3 211 83739 6

    This volume is Acta Neurochirurgica (Suppl 79), archiving the proceedings of the First International Conference of Neurosurgical Rehabilitation, held in Münster in 2000, together with some abstracts presented at a Conference on Early Rehabilitation held in Maribor in 2001. It is of some interest.

    As is usually the case in collations of this sort, the contributions cover a wide range of aspects of acute and post-acute rehabilitation of neurosurgical and neurotrauma patients. Some broader topics covered include service organisation, outcome predictors, uniform dataset development, long term psychosocial outcomes, and problems in healthcare management. These chapters are necessarily short and sketchy, and largely serve to highlight the gaps in the evidence base, as well as the gaps in the service coverage! Nevertheless, there is an undercurrent theme here, to the effect that brain injury rehabilitation services are a hot potato in many countries. The reason for this is that their cost is potentially vast. Adequate brain injury rehabilitation is a heavy, prolonged consumer of skilled professional time. Patient numbers are much larger than those for spinal injury, which forms the closest analogy in the health service. To set up a comprehensive regional brain injury rehabilitation service, comparable to that for spinal injury, would be an enormous commitment, which public and private health providers the world over have been shamefully unwilling to fulfill.

    Perhaps the more readable contributions, however, are that briefly outline the current status of specific interventions, such as the neurosurgical management of pain, botulinum toxin treatment for upper and lower limb spasticity, or sensory stimulation programmes in PVS.

    There are several chapters on various specialist emergent forms of therapeutic and functional electrical stimulation, such as motor cortex stimulation for pain and movement disorder; deep-brain stimulation for pain; functional implanted stimulators for standing and walking in paraplegia; peroneal nerve stimulator implantation for central drop-foot; vagus nerve stimulation for epilepsy; and cochlear nucleus stimulation for deafness in NF2. Other contributions, such as that on BTXA for tension headache, are rather far removed from what we would recognise as the field of rehabilitation.