245 ~~

Stroke Rehabilltation Structure and Strategy by Polly Laidler. Chapman and Hall. London, 1994 (ISBN 0 412 46950 2). Illus. 296 pages. f 14.99.

In the words of the author, ‘the purpose of this book is not to prescribe but to describe, to update on the neurological factors underlying the complexity of stroke . . . to enable both professionals and non-professionals to evolve and progress their own special skills in aswssment and problem-solving to ensure ongoing recovery! The book is organised into four parta - ‘What’, ‘Why’, ‘How’ and ‘Need to know’ - and is aimed at all health care professionals (and interested others) involved in stroke rehabilitation.

The book is generally well written and the liberal use of humour, anecdotes and quotations from sources ranging from The Bible to John Hegley help to make it interesting, enjoyable and thought- provoking to read. The strength of this text lies in the p a t emphasis placed upon the need for a multi- disciplinary approach to rehab- ilitation. The holistic care model is explored in depth, with useful sections on cognition, perception and depression, and valuable information on continence, speech, chewing and swallowing.

Each chapter ends with a list of references and other source material and the text is supported by clear photographs and drawings. This is not a book for those seeking

specific physiotherapy tachniquerr Chapter 10 ’Rehabilitative strateg-

ies’ is deliberately generalised, with topica including positioning, t d e r s and facilitating movement. Some suggestions are made for tackling problems such as ataxia and ‘pushers’ but the author does not address these in sufficient depth to be particularly helpful and some points might be considered confusing.

Hmver, the book includes some excellent general advice. Chapter 13 ‘Essential skills’ covers aseieted washing, dressing and toileting, and

Quality and Excellence in Human Sewlces by Paul Dlckens. w//6y Publishers.

1W (ISBU 0 4zI WE4 a. I& Pagea fl4=

‘Not another quality book!’ was my first reaction to this new publication. It does howaver tackle the area from a different point of view, maybe because the author is a clinical psychologist. Following the obligatory comparisons with in- dustry, chapter 2 provide8 a useful exploration of the problems in defining health services and models of health care, suggesting that the resulting difficulties with quality assessment are not surprising

The main features of quality assurance in industry are then addressed with an appraisal of the value of the varioue methods in- cluding total quality management and BS6750. When discussing the tools and techniques for human service quality, the author begins with statistical approachea Monitor- ingand audit are dealt with from the perspective of being only a part of the whole quality picture. ’hole of inspection, accreditation and service evaluation are disseminated and reviewed with the advantages and

in chapter 14 the positioning charts and drawings of the Amer-Ind communication gestures are very clear.

A number of pointa are made rather dogmatically and not supported by references to appropriate evidenca For example, on page 11 it is asserted that ‘most of the chronic disabilitiee aasociatad with stroke are acquired ae a d t of traditional management and doctrinaire techniguee! The author appears to be heavily influenced by the Bobath approach to stroke rehabilitation although she doee suggest that those wiehing to familiarise themselves with specialimd techniques shauld attad relevant courses This stimulating book ie likely to

be particularly valuable to physie therapy students, provided some of the more categorical statements are questioned, and also to therapiete returning to neurology who wieh to update themselves on current approaches to rehabilitation and some areaa of neurological research.

Dianne Rees MCSP

disadvantages clearly given. When exploring the problem OT

seeking the vim of consumers and imlving them in the quality process the author highlighta the difticultiea ofuntrainedpdeseional d b e i n g involved in unstructllred gmupe and quality circlee. He pragreeeee the diecueeion into the arena of con- sumer satisfaction mrveys, which warta and all are still an important part of the quality programma

The bendits and disadvantages of quality ayetern in mental health and learning disabilities are tackled in the penultimate chapter which ale0 highlighta the fiict that although there are many descriptions of %tal Quality Management pmgramma none evaluatee ita dectivenese. The book concludes on an encouraging note that while it is accepted that consumers have to be involved in aaseming the quality of health care, more WOrL ie needed on how they are involved.

“hie book is a welcome addition to the literature on quality and will be ueetul to thoae involved in setting

in mental health and learning disabilities eervicea

Ann Hunter MA K;sp

UP d i t y Programmee, especially