A Ashburn

An approach to the management of multiple sclerosis

The role of the physiotherapist working in a multi-disciplinary team helping people suffering from multiple sclerosis is described. The onset and clinical involvement varies considerably, and this process characterises the disease. Consequently, the sensory-motor deficits also vary considerably so that any form of management must be specific to the individual, and be adapted and adjusted as required throughout the course. However, general guidelines to rehabilitation in the different stages are given. The value of accurate assessment and instruction in correct posture, exercises, and general self-care are discussed, along with the importance of support and counselling for the sufferer and family both in the early stages and in long-term management.

Use of myometry in the assessment of neuropathic weakness: testing for reliability in clinical practice

The myometer has been recommended as a quantitative method of measuring muscle strength in clinical practice. The reliability of the myometer was tested in a clinical environment by physiotherapists and a form incorporating the testing positions was designed. An intensive training programme for examiners was instigated and piloted on normal subjects. The study tested the reliability of paired examiners in recording the muscle strength of 20 Guillain-Barre syndrome patients at different stages in their recovery. Ten patients were tested in the first experiment. The error rate between observers was large and unacceptable. Procedures for improving reliability were implemented. Testing was repeated on 10 more patients but no improvement in reliability was observed. The implications for clinical practice are discussed.

Methods of assessing the physical disabilities of stroke patients

A review of the literature describing methods of recording and measuring disabilities following stroke, for activities of daily living (ADL) and neuromuscular function, has highlighted several characteristics that are common components of both types of procedure. The review also identified the requirements for reliable standardised assessments. This paper discusses these factors, using them to indicate the strengths and weaknesses of available assessment procedures.

Immediate effect of tDCS on postural stability and functional mobility in Parkinson's disease

Fregni et al. reported on the application of transcranial direct current stimulation (tDCS) in people with Parkinson’s disease (PwPD), demonstrating a significant improvement after a single active anodal M1 stimulation for the postural stability cluster of the Unified Parkinson’s Disease Rating Scale (UPDRS) motor score. We tested the hypothesis that tDCS would improve more sensitive measures of postural stability and functional mobility in PwPD. We conducted a double-blind, experimental crossover study with participants as their own control and assessed in the on stage. Inclusion criteria were consultant-confirmed diagnosis of idiopathic PD, independently mobile and living in the community. Excluded were those with other neurological conditions, deep brain stimulation, impaired gross cognitive function, metal implants, pacemaker, history of epilepsy, or medication that altered cortical excitability. First, participants performed standardized clinical measures prestimulation: sitto-stand, functional reach, standing-start 180 degrees turning, timed up-and-go, and 10-m walk test. Then, active or sham tDCS was delivered while participants performed the measures during stimulation. Finally, the outcome measures were collected again poststimulation. The anode of the tDCS stimulator (Magstim Eldith, Whitland, Carmarthenshire, UK) was positioned over M1 of the primary motor cortex of the TABLE 1. Case-control association results for the LRRK2 variants that showed evidence for association in at least 1 South African ethnic group

Book reviews : Carr J and Shepherd R 1987: A motor relearning programme for stroke (second edition). London: William Heinemann Medical Books. 208pp. £24.95

on Representative Research and Application and contains notable reviews by O’Connor and Cermak on memory rehabilitation, by Salmon and Butters on the neuropsychology of memory and by Prigatano on personality and psycho-social sequelae of brain damage. Other areas discussed in this section include rehabilitation of attention, of visuoperceptual disorders, of language and of problem-solving ability. In the third part of the book, International Neuropsychological Rehabilitation Programmes in a dozen countries are discussed.

Knowledge of Multiple Sclerosis: Implications for Rehabilitation

People with multiple sclerosis (MS) who attend for physiotherapy but are unaware of their diagnosis are often confused, suspicious and frightened. The mental state of such patients prevents them from gaining the most benefit from physiotherapy as they are unreceptive to treatment due to anxiety about the lack of a concrete diagnosis. The therapist is unable to motivate and treat such patients to the best effect as agreed goals for therapy must be left undefined. Furthermore, the therapist’s position of collusion with secrecy jeopardises any positive patientkherapist relationship for the future. The patienthherapist relationship is very different to the patient/doctor relationship. Physiotherapists have the unique opportunity of spending time with patients, both during individual sessions as well as over extended periods. Physical contact experienced through treatment sessions adds to the feelings of closeness and the