Australian Journal of Physiotherapy 2003 Vol. 49 279

Book Review

Carr JH and Shepherd RB (2002): StrokeRehabilitation: Guidelines for Exerciseand Training to Optimise Motor Skill.Edinburgh: Butterworth-Heinemann,301 pp. ISBN 075 064 7124

Considering that knowledge in the fields of basic motorcontrol, brain reorganisation following injury, and clinicaltrials to improve functional performance following strokeis rapidly increasing, this text provides a timely andreadable synopsis. The text provides clear andcomprehensive information to answer the questions of“why” as well as “how” in the area of stroke rehabilitation.It provides not only an excellent literature review ofspecific areas for the budding researcher or experiencedclinician, but also a clear and logical approach for thephysiotherapy student or even stroke survivors and theirfamilies.

The book is presented in three sections. The first providesan overview of brain reorganisation following stroke, howthe environment can influence this, and the importance ofmeasurement. The section on mechanisms of functionalrecovery following stroke provides both classic and morerecent studies as evidence for the importance of usingintensive training of relevant tasks in an optimallystimulating environment. The rehabilitation environment isan important element that often gets overlooked in othersimilar texts. Here, predominantly recent evidence is usedto support clinically relevant issues such as circuit trainingfor stroke patients, the importance of focussing attention,the role of feedback, and task practice. These sectionsprovide an overall background from which the morespecific task-related sections build.

The second section comprises the bulk of the text andprovides the scientific evidence behind the resultantclinical guidelines to train the motor skills of balance,walking, standing up and sitting down, and reaching andmanipulation. All sections include a biomechanicaldescription of the primary task, age-related changes,analysis of motor performance, guidelines for training andmeasurement, as well as notes on specific methods used intraining such as treadmill training, forced use and the useof functional electrical stimulation. The structure of thismaterial offers the reader a sound rationale for the trainingapproach and selection of specific training strategies. Thepractical step-by-step approach to training and examplesthroughout help the reader consolidate the information andgather a pool of ideas to be used to train motorperformance. Examples of different ways physiotherapistscan deliver services are presented, including group work,work in pairs and a workstation approach.

A thorough discussion of potential limitations to motorperformance following stroke is presented in section three.The primary impairments such as motor, sensory, visual,perceptual and motor planning are discussed, with

suggestions based on scientific evidence, if available, as tohow best to minimise their negative effects on function.Specific attention is then given to the major impairmentsof muscle weakness or paralysis, soft tissue contractureand a lack of endurance and physical fitness. Strength andphysical conditioning training of the stroke patient havebeen controversial issues in the past. It is thus pleasing tosee a discussion of more recent evidence advocating theimportance of these areas and guidelines for cliniciansbased on research outcomes.

A final overview returns the focus of the text to the strokesurvivor and the issues with which they present. From thisperspective, guidelines for the provision of physiotherapyservice within the acute stage of rehabilitation are outlined.Difficulties associated with maintaining and progressingfunctional abilities are identified including lack of follow-up services, poor access to services and a lack of follow-upservices, and a lack of community exercise facilities. Howthese may be overcome is not addressed, but is beyond thescope of this book.

Illustrations are plentiful, clear and give detailedinformation. It is pleasing to see that the clinical hot topicssuch as treadmill, strength and conditioning training andcircuit training are discussed. There is limited informationin the text regarding the use of computerised balancesystems for training. This would be a useful addition in alater edition as these systems have been the intervention ofchoice for many outcome studies and are becoming morecommon in Australia. Overall, however, this is acomprehensive, easy to read text highly recommended toclinicians and students involved in rehabilitation of thestroke survivor.

Sandra Brauer and Ruth BarkerThe University of Queensland

Book Review