CASH’S TEXTBOOK OF NEUROLOGY FOR PHYSIOTHERAPISTS

Foreword

– by Dame Cicely Saunders DBE, FRCP

The aim of treatment and care for some patients with a neuro- logical disease can be the restoration of full function and health. Here the physiotherapist is a vital member of a team with clear and optimistic goals. But for many who find themselves in the situations discussed in this textbook the aim will rather be to ‘strengthen the things that remain’, and to share with the patient in coming to terms with loss. Hardest of all for the team as well as for the patient will be the progressive deterioration of some diseases, the constant setting of short-term goals and the accept- ance that even they become unrealistic. All have somehow to find the ability to adapt and develop in this situation also .

It is not only the patient who has to come to terms with what is happening but the whole family who have to face a new way of life. The entire therapeutic team may be called on in their differ- ent ways to give them the support they will need, whether it be in hospital, special unit or the patient’s own home.

If physiotherapists are to play their full part in such a team they have to be secure in their own role, with confidence in their particular knowledge and skills. This textbook will be an essential resource for constant referral.

The knowledge available here will be a major help as all try to recognise and encourage both the strengths and the possibilities of the whole family, and the essential independence that can per- sist and grow even in the midst of dependence, whether it be, hopefully, a temporary need, or instead a whole new way of life.

Cicely Saunde

Chairman, St Christopher’s Hospice London SE26 6DZ

Editor’s Preface

Sir Thomas Browne MD, a seventeenth-century writer, offered literary advice in a treatise entitled To a Friend Intending a Dif- ficult Work:

Think and think again on the work you intend; consider how strong your shoulders be; You must be a good swimmer, a Delian even, yet in this stormy sea swim not without a buoy;

Variety of wits, discord of studies, parties, heresies, divide the fates of the noblest productions; and you may fail to please them all, unless you are wise beyond Wisdom….

An editor of a multi-author book is faced with problems not least of which is the control of the authors! In their exuberance to impart knowledge they heed not the guidelines: maximum lengths are exceeded Oh! I didn’t think you meant it (3000 words overlong); deadlines are passed – Oh! No one keeps to a deadline (now you know why books are delayed!). I could go on, but I find comfort in Sir Thomas Browne that even in those distant days the same problems arose. For this new edition I am grateful to all the contributors who co-operated to enable what is a radically revised edition to be assembled.

Disorders of the neurological system provide physiotherapists with a large percentage of their work. Neurophysiological ad- vances have enabled the rationale of many of the techniques used to be better understood, and physiotherapists are now able to select from the different approaches those particular patterns which are most appropriate to the individual patient. This is re- iterated throughout the various treatment chapters.

At the same time therapists are reminded that while ‘cure’ is satisfying, ‘caring always’, even when the patient is visibly deter- iorating as in motor neurone disease, can be even more richly satisfying. Charles and Donna Corr eloquently expand this theme, reminding us that ‘we try to cure them [patients] because we care for them’. Indeed Lois Dyer (1982) has said that ‘the  Care traditional heavy emphasis on cure should change to that of e the book and particularly that support which is needed to be and support’. This notion of support is also reflected throughout given to relatives. On thus bringing new slants on old themes – plus ça change, plus c’est This radical revision has enabled me to invite new contributors la même chose. I have already expressed my grateful thanks to all the contributors, new and old. I am particularly grateful to Pro- fessor Charles Corr and his wife for the opening Chapter Developing a Philosophy of Caring – they have experience in the hospice movement in the USA and are regular visitors to Eng- land, Dr Gillian McCarthy has wide experience of the interdis- ciplinary management of children with neurological disorders, and I thank her not only for her own chapters but also for gen- erous advice. I was asked to include some advanced neuro- physiology, and Dr Geoffrey Kidd accepted my invitation to write a chapter he chose The Myotatic Reflex because he felt it was fundamental to a physiotherapist’s understanding of so much of her work. His reputation as a lecturer at physiotherapy meetings is well-known, and I am sure that all readers will, like me, be appreciative of his willingness to provide a chapter to this book. As always, I say thank you to Mrs Audrey Besterman who has provided yet more illustrations they do so enhance the text allowing the technicalities to be more readily absorbed by the reader. The Chinese were so right when they said ‘One picture is better than a thousand words’. Friends United Press, Rich- mond, Indiana have kindly given permission for the inclusion of the verse on page 31.

Dame Cicely Saunders allowed herself to be persuaded to write a Foreword – she has always been a staunch supporter of physio- therapists and at present is President of the London branch of the Chartered Society of Physiotherapy. I have known her for many years and it gives me much pleasure to have her among the contributors to this book.

I end as I began with Sir Thomas Browne – whether I am ‘wise beyond Wisdom’ only the reader can decide but let me quote further: While you slave at this book, I would not have you think you are boiling asparagus. Rub out, restore, return to the anvil… Pledging your time and labour to pure truth, yet watch that you study not your own small fame, while you claim to serve truth… P.A.D., 1985

REFERENCES

Browne, Sir Thomas. To a Friend Intending a Difficult Work. In Keynes, G. (ed.) (1964). The Works of Sir Thomas Browne, pp. 153-5 vol. 3. Faber and Faber, London.

Dyer, L. (1982). Professional development. Physiotherapy, 68, 390-3.