Recovery after Stroke is an edited book (656 pages), and its contributors hale mostly from the United Kingdom and Western Europe. The title might suggest a focus on rehabilitation and treatment, but the contents extend well beyond, and include the neuroanatomic foundations of stroke syndromes as well as their “natural” course of recovery. The book is quite clearly intended for a general, multidisciplinary audience. As such, it covers a wide variety of topics such as spasticity/pain, imbalance and gait disorders, sleep disorders, incontinence, dysphagia, and the theory and practice of physical rehabilitation. More systemically, there are chapters addressing the principals of vocational rehabilitation, community rehabilitation, and sexual relationships after stroke.
An excellent introductory chapter by G.R. de Freitas and colleagues provides a brief overview of stroke's epidemiology, etiology, and risk factors, although some areas are not covered in any significant detail (for example, antiphospholipid antibodies and the quickly progressing field of genetic susceptibilities such as Factor V Leiden and angiotensin-converting enzyme polymorphisms).
In keeping with the intended multidisciplinary audience of the volume, many chapters devote the bulk of their discussion to the nature and localization of stroke-related syndromes and are without intensive detail on treatment or management. Several chapters do, of course, review their respective field's literature on treatment efficacy. However, a few do so in somewhat cursory ways, and without more in-depth discussions about the strengths and weaknesses of the data in question. Readers interested in detailed, empirical discussions on treatment and management would therefore best view this as a good introduction and survey of existing work.
Having said that, one of the more fascinating chapters is authored by Hogan et al. who review their own data on robotic therapy. In brief, this is a system that presents visual prompts that cue patients to move a robotic arm, which then provides graded assistance in the absence of the patient's own movement. The data provide compelling evidence of the technique's efficacy and point to the notion of “activity-dependent” neuronal plasticity during recovery.
A highly interesting series of chapters reviews data on functional recovery, neuronal regeneration, and cerebral reorganization after stroke in both animals and humans. These works are most focused on focal sensory and motor ability, which are clearly easier starting points than the more complex and variable systems that preoccupy readers of this journal. Included here are good discussions and reviews of recent compelling data that were impossible to collect not that many years ago, before the advent of functional magnetic resonance imaging.
Cognitive topics are specifically addressed in only approximately 20% of the book's chapters. Although some review of cognitive rehabilitation techniques is certainly present, this is a minor part of the volume. Marjorie Nicholas' chapter is a particularly good, concise, and easily understood review of the aphasic syndromes and approaches to their treatment. As with most of the book's chapters, it is written to be accessible to a larger audience that may not specialize in cognitive problems.
A rather clever and unique cap to the work is the perspective of a young North London attorney who suffered a stroke at age 43. This is a particularly articulate account delivered with insight and reflection, as well as good English wit and irony (one imagines that the English High Court does not often have to usher away wigged barristers gripped by fits of pathological laughter). Those interested in the politics of healthcare will also be interested in reading this patient's reflections on Britain's healthcare system.
Overall, the key benefit of the volume is its coalescence of thought and data spanning the disciplines involved in stroke rehabilitation. While this inevitably limits the detail and depth in any one area, it does provide a comprehensive reference from which to branch off in more specific directions. It also provides a more detailed glimpse at the other parts of the stroke rehabilitation apparatus that we might not otherwise take the time to investigate. As such, those of us mired in the detail of our own fields and subspecialties derive from Recovery after Stroke the ability to poke our heads above ground, and see what new ideas and collaborations can be had down the hallway.
