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Doody's Review ServiceReviewer: Laurie Lundy-Ekman, PhD, PT (Pacific University)
Description: This is an impressive guide to the contemporary understanding of upper motoneuron syndromes and spasticity. Among the book's many strengths are the clarity and organization of the material, the scientific basis of the presentation, and the thorough coverage of management of the impairments and functional limitations associated with upper motoneuron syndromes.
Purpose: The authors' purpose is to provide a practical guide and reference to improve the management of spasticity and other effects of upper motoneuron syndrome. This book is an exceptionally important contribution to the field, because the authors have primarily used an evidence-based approach, covering all aspects of the clinical management of people with upper motoneuron syndrome. The readability and applicability of the information ensure its usefulness to clinicians and researchers.
Audience: The book is written for physicians, surgeons, therapists, orthotists, and engineers. I believe that students, residents, and practitioners in these fields also would benefit from this book. The authors are established experts in their fields.
Features: The complete neurophysiology and management of upper motoneuron syndrome is thoroughly discussed. An algorithm for clinical decision making is presented in the first chapter, and the subsequent chapters provide essential information for making the decisions. The chapter on physiotherapy management is especially strong, providing up-to-date evidence on management techniques. Unfortunately, some chapters perpetuate the myth that significant muscular exertion increases spasticity. Although this outdated concept is debunked in other chapters, this inconsistency may lead to confusion and to harmful interventions. Specifically, prohibiting significant muscular exertion produces increasing paresis, loss of function, and deconditioning. Similarly, the concept of antagonist restraint post-stroke is not placed in context as a relatively rare phenomenon, but is misrepresented as a common impairment limiting function.
Assessment: This book is a major improvement over other books in the field, which tend to persist in advocating disproven rationales and interventions for the management of upper motoneuron syndrome. A consistent evidence-based approach would further strengthen the usefulness of this book.