Jul 1, 2004
The well-written, comprehensive book Community Rehabilitation in Neurology, written by Barnes, a Professor of Neurorehabilitation, and Radermacher, a research associate, both at the University of Newcastle upon Tyne, UK, provides a focused yet broad description of the concept, practice and desirability of rehabilitation in the community. The rehabilitation of individuals disabled by stroke, traumatic brain injury, spinal cord lesions and other neurological disorders is typically carried out initially in a hospital setting, followed by out-patient care. The disabled person and his care-taking family maintain the ongoing rehabilitation connection within this institutional setting and framework. The perspective of the authors differs from the habitual, traditional model of rehabilitation services and emphasizes the ‘real world’ need for rehabilitation at home and in the community. There should be no disconnect between the initial rehabilitation begun in the hospital or rehabilitation centre and the ongoing need for the disabled individual and his or her family to have community services which promote choice, autonomy and as much independence as possible. Different models of the organization of community-based programmes are offered in the text, carried out by teams comprised of various professionals including the disciplines of physiotherapy, occupational therapy, speech and language therapy, social work, nursing and psychology. Although most of these programme descriptions pertain to the UK, the book is not parochial in nature and the service delivery paradigms are relevant internationally. The authors do not merely resort to fundamental principles of humanism in the holistic care of the disabled person, but cite, where available, evidence-based findings that community rehabilitation may be at least as effective as hospital-based, if not more so, and probably more cost-effective. The essence of community rehabilitation as stated on p. 25 includes ‘approaches that help to alter the environment, both physical and social, so that a given disability carries with it as little as possible associated problem of participation in society as a whole’. The authors avoid the conflictual differentiation between the medical model of disability, which sees the person as ‘sick’, and the social model of disability, which views society as ‘sick’ in its attitudes and practices toward disabled individuals. Both require attention and accommodation, just as the individual being cared for in a community-based programme may at times requite the services of a medical specialist and hospitalization. Throughout the book, the voices of the disabled are heard, beginning with the initial chapter in which four case histories are presented of what went wrong and concluding with the final chapter in which examples are given of how community rehabilitation could have prevented these poor outcomes. Compelling descriptions and statements are made about how the disabled want and need information about services, partnerships with service providers, housing, technical aids, personal assistance, mobility and, hopefully and ideally, a job and independent living. The needs of the person in the family who cares for the disabled individual are given due attention. Barnes focuses on the process of ‘de-medicalization’, a critical moment in the patient’s and family’s lives that can greatly effect the outcome of therapy. The book provides important insights and information that will prove invaluable to many professionals in the field. The authors compare differences in rehabilitation programmes and strategies between those countries whom they refer to as the North (Europe and North America) and those which they call the South, meaning developing countries. While this geographical appellation is confused (with no reference to the origin of the terminology), given that they cite examples in countries such as the Philippines, India, Ukraine, Bosnia-Herzegovina, their point is well taken: developing countries did not have the means to create rehabilitation hospitals and centres, so they, by default, have had to develop community-based approaches. Such programmes rely on family and extended family members as the first resource for the care of the disabled; promote economic self-sufficiency through collectives of disabled persons; use self-help projects run by the disabled, assisted by nonGovernmental organizations; use a WHO training manual for rehabilitation workers recruited directly from the community; use local teachers and provide education about disability to the family and the community—to cite a few examples. The authors, while rightly claiming that there is much to be learned from these strategies, are not naı̈ve and do not see them as substitutes for more comprehensive community-based programmes carried out by trained professionals. One of the book’s strongest qualities is its applicability to the work performed in paediatric rehabilitation the world over, benefiting all professionals engaged in rehabilitation, regardless of where they practice. We highly recommend this book.