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Exercises for Lymphoedema of the Arm A handbook for patients by Michael Mason MCSP MAPA FASMF. Published by Adelaide Lymphoedema Clinic, 90 Fullarton Road, Norwood, South Australia 5067, 1996 (ISBN 0 646 29403 2)- Illus. 107 pages. Aus $31 air mail including postage. Bulk discounts on appli- cation.

This soft-back book is designed to provide patients with lymphoedema of the arm(s) with a number of grad- uated exercise programmes for use during phases 1 (the initial inten- sive period of treatment) and 2 (the ongoing maintenance over ensuing years) of. the ‘complex physical therapy’ (CPT) as described by Professor Foldi (Germany), and developed by Michael Mason and Judith Casley-Smith a t the Adel- aide Lymphoedema Clinic which opened in 1987.

Exercise is one of the four corner- stones of lymphoedema mana- gement advocated by the British Lymphology Interest Group.

A very readable volume, weighing 250 grams, it is produced on good quality A5 size paper; a spiral binding enables the book to be held open at any page for easy reference. Logically organised, the first 21 pages contain a simple description of the lymphatic system, a definition of lymphoedema, and helpful advice to prevent overload of the lymphatic system. The inclusion of information on weight control is a helpful addi- tion to the catalogue of advice, most of which can be found in other patient handbooks currently on the market.

A ten-page section, devoted to enabling patients t o understand why active exercise plays a such an important role in management, precedes the 65-page section detailing the four groups of ten exercises and clearly illustrated by simple diagrams.

Much of the material is repeated, as each of the four sections starts with the same basic exercise (four pages) and ends with the identical description of self-massage (four pages). While appreciating that the author wished to make the hand- book ‘user friendly’, this point was drawn to my attention by a patient, who felt that the book would have seemed less daunting and lighter to carry around with fewer pages!

I would have felt happier if the

instruction ‘These movements.. . should always be performed slowly, never quickly’ had appeared at the beginning of exercise 1 rather than at the end. However, all instructions given are clear and easy t o follow. The specific aim of each exercise is also given, an important factor in encouraging patient compliance.

The advocated exercise pro- grammes, designed to cater for all ages and all levels of physical fitness, are certainly more extensive than those recommended in other patient handbooks. The suggested daily allocation of time for exer- cising is 15-25 minutes plus 15-20 minutes for self-massage.

The handbook would be a helpful guide for patients who wish to be well informed and active in the management of their condition, but it should be used only under the guidance of a physiotherapist profi- cient in lymphoedema management, This is not clearly expressed in the booklet, which simply assumes that

Self-massage directions for one and two- arm lymphoedema

the exercise programme will be therapist-led.

If importing costs do not prove to be too prohibitive, this handbook could be of assistance to UK thera- pists organising exercise pro- grammes for their patients.

Diane Robinson MCSP

Rehabilitation Studies Handbook edited by Barbara A Wilson and D L McLellan. Cambridge University Press, 1997 (ISBN 0 521 43713 X). 415 pages. f29.95.

The aim of this book is to ‘provide a valuable resource for all those involved in the care and rehabilita- tion of people with disability’. It sets out to deal with concepts and prin- ciples of rehabilitation, and good clinical practice with all age groups, and describes itself as an ‘essential text for MSc students of rehabilita- tion studies and other health care professionals wishing to enlarge and deepen their understanding of the process of rehabilitation’.

Many of the contributors to the book appear to be from centres of higher education with medical and psychology backgrounds. None of the chapters have input from any of the professions allied to medicine. Physiotherapy is mentioned in chapter 15 ‘The multiply handi- capped child’ which provides the statement: ‘The role of the physio- therapist in the care of children with multiple handicap remains unevaluated in the long term.’

The opening chapter is a good introduction to the concept of reha-

bilitation, discussing the many ways of considering ‘What is rehab- ilitation?’ ‘Who does it?’ and ‘How is it measured?’ Chapter 2 goes on t o consider ‘Disabled people in society’ - who are they and how many? The question of who consider themselves disabled is raised and the concept that it is a label that some people do not want.

Other chapters deal with rehab- ilitation education, management in rehabilitation, research and eval- uation and statistics.

Two chapters deal with ‘clinical’ issues. Chapter 13 uses a case study to illustrate how to help people with challenging behaviour, and chapter 15 deals with multiply handicapped children - this is the chapter that has all the references t o physio- therapy bar one!

I agree that this could be a useful text for MSc students of rehabilita- tion - i t provides many points for discussion and broadens the concept of rehabilitation, also making prac- tical suggestions about research and evaluation and statistics. I wonder if more could have been made of the rehabilitation team, but with such a large subject not everything can be covered.

Jane Stephenson BA MCSP

Physiotherapy, August 1997, vol 83, no 8