Relating to the Relatives Breaking bad news, communication and support

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    book reviews Advances in Motor Learning and Control edited by Howard N Zelaznik. Human Kinetics, Leeds, 1996 (ISBN 0 87322 947 9). Illus. 309 pages. f34.

    The aim of this book is t o provide graduate students with an up-to- date reference manual of key issues in motor behaviour and motor control. There are 20 contributors mainly from the fields of psychology and kinesiology representing many different approaches. Chapters 1 to 5 present reviews of the speedaccu- racy trade-off paradigm, reaction times as a technique for investi- gating motor programmes, inform- ation feedback, central nervous system (CNS) control and motor skills learning, ending with a chapter on visual motor control. Chapters 6 to 10 present informa- tion about different theoretical approaches to motor control.

    This whole book is very theoret- ical and research-based and is truly aimed, as stated, a t academics and researchers on a postgraduate level; however from the contents page, chapters 3, 4, 5, and 6 appear to offer some clinically relevant infor- mation to experienced physiother- apists. These chapters form the main basis of this review.

    Chapter 3 discusses the role of extrinsic feedback in motor skills learning emphasising that the role of knowledge of results (m) is still not well understood. The author of this chapter makes the point that performance on motor tasks can change without extrinsic feedback; in fact this type of feedback could actually be detrimental to perfor- mance as its use would greatly depend on the characteristics of the task at hand. This fits well with some clinical approaches to neuro- logical rehabilitation where the emphasis is on the learner acquiring skills through essentially visual and proprioceptive information. This chapter contains a comprehensive review of experimental evidence on KR.

    Chapter 4 focuses on the neural basis of human motor learning, looking in particular a t the cerebral cortex, the basal ganglia and the cerebellum. Once again there is an

    excellent overview of current liter- ature concluding that centres for motor control are distributed within the CNS; a t present there is little evidence to suggest that the cere- bellum is critically involved in human skills acquisition. The style of this chapter is interesting with a series of questions being posed and answered; there is reference to patients with neurological impair- ments.

    Chapter 5 discusses how visual information affects the character- istics of all three components of prehension: transport, grasp and object manipulation. Physiother- apists specialising in neurological rehabilitation will find that this chapter really stimulates their thinking about the rationale behind many treatment techniques in the recovery of upper limb function.

    Chapter 6 on the electromyo- graphic (EMG) analysis of perform- ance enhancement is disappointing;

    it really does no more than state that there are specific EMG and kinematic changes as a result of practice in different tasks.

    Chapters 7 through to 10 are rather dry essays on the value of different theories of movement co-ordination, motor learning and neural networks; clinicians would probably find the terminology used difficult to cope with.

    Overall this textbook achieves its aim. There is not much information of direct clinical relevance for experienced physiotherapists. It is expensive. It would be more useful for academics and researchers whose main interests are in build- ing a scientific knowledge base for motor learning and control. There are some excellent chapters. The contributors are obviously expert in their fields. This book in my opinion is more suited for university library purchase.

    Sheila Lennon MSc MCSP

    Relating to the Relatives Breaking bad news, communication and support by Thurstan Brewin with Margaret Sparshott. Radcliffe Medical Press, Abingdon, Oxon, 1996 (ISBN 1 85775 081 0). 177pages. f 13.50.

    The author of this book is a retired consultant in clinical oncology, and has subsequently worked with three medical charities: Marie Curie Cancer Care, the Sue Ryder Foun- dation and Health Watch.

    Although he begins by saying that the book is for all those working in the hospital environment and primary care teams, most of the text specifically relates to doctors. Phys- iotherapists are not mentioned. Many of the concepts and ideas can be applied to others working with patients and their families and carers. It is intended for those who have to give bad news, and who offer support afterwards, a t all stages of a patients illness from initial diagnosis through t o death, and grieving.

    It is written in an anecdotal style, referring continually to specific events during the authors career to illustrate the underlying message

    he is giving. At times this can make the text difficult to follow, and a little confusing. It must be stressed that often a whole chapter needs to be read and reflected on to grasp the concepts within it. On initial glance, statements can appear ambiguous and questions seem to be left unan- swered. However, by persevering, ideas often follow to the queries originally raised.

    The chapter on The angry rela- tive, written with Margaret Spar- shott, is particularly interesting, giving guidelines and suggestions on coping with and handling angry people in difficult situations.

    I did find the style of this book difficult to follow a t times. The structure of each chapter and the use of anecdotal evidence often makes it a little hard t o find the message contained within. The book would be useful to those starting out in posts where they will have a lot of contact with patients, and their relatives and carers, particularly where the emotional demands on themselves will be high. There is a very good reference list at the end of the book for further reading.

    Michelle Earle MCSP

    Physiotherapy, August 1997, vol83, no 8


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