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869 book reviews Controlling Health Professionals The future of work and the organization in the NHS by Stephen Harrison and Christopher Pollitt. Open University Press, Celtic Court, 22 - 26 Ballmoor. Buckingham MK18 lXW, 1994 (ISBN 0 3355 09643 3). Ilus. 176 pages. f12.99 paperback, f37.50 hardback. At the heart of this interesting book is a discussion of the relationship between health care professionals and the man- agement processes of the NHS. This is an important issue, and one on which there will necessarily be a number of different perspectives. Harrison and Pollitt attempt to reflect these different per- spectives, and do so with some success. They assume a basic familiarity with the structure of the NHS, and with the history of the various changes since 1974; but they cover a considerable amount of ground, covering not only formal changes in the participation of professionals in NHS structures but also the way that initiatives such as resource management and quality assurance have affected relationships between managers and professionals. Although managers may have achieved an increasing degree of control over health professionals they do not see this as a process for the long-term future. For them, independent clinical practice is more important. This is reflected in physiotherapy by the decimation in recent years of professional managers; but we still have much to do in coming to terms with the professional and employment implications of increas- ingly fragmented and isolated profes- sional structures. It is noteworthy that this index has no entry for professional education, and the implications of these changes for development of future health professionals are not explored. This would be a useful book as a course text for discussion about management in the NHS and the role of professionals, and offers a very suitable introduction to these issues. At the price it offers only moderate value for money, and it is disappointing that all the figures are at least two years out of date. Nevertheless, I think this is probably one of the better books that I have read recently on management in the NHS. Toby Simon MA Physical Principles Explained by John Low and Ann Reed. Butterworth Heinemann. Oxford, 1993(ISBN 0 7506 0748 3). Illus. 238 pages. f 14.95. This is a good basic textbook suitable not just for physiotherapy students, but for anyone involved in the use of electro- therapeutic modalities and who is unsure of the basic physical principles underlying their use. This suitability should extend not just within the physiotherapy profession, but also include other pro- fessions associated with either the use or retail of such equipment. The book is divided into chapters which lead readers from an introduction to the basic concepts of energy and matter, to more applied sections dealing with the peculiarities of different energy forms. These energy forms correspond to the means by which we as physiotherapists may attempt to impart energy to our patients and include electrical currents, sound, heat and electromagnetic radiations. The text is supported by many line drawings which are accurately titled and labelled, and provide visual prompts to sections of text. Occasionally there is perhaps the need for greater explanation of the diagram within the title, although generally the text and diagram are mutually supportive in explaining the concepts. Further information is offered in tabular form, and again this is presented in a clear and concise manner. While tables of information, and figures periodically appear on different pages to the text to which they relate, this is not a fault peculiar to this book, and only inconveniences the reader momentarily. Following the eight chapters there are a number of appendixes, which are useful in illustrating several concepts; a further addition to this section would be a glossary of terms encountered throughout the book. Although most terms are explained where introduced, it is often useful to have a list to refer to at other times. Although the reference list is brief, with articles varying in age from 40 years to one year old, it may be combined with the bibliography to provide readers with a number of informative and well-rounded references with which to extend their reading and hopefully their understanding. This text is written with the assumption that the readers have no significant prior knowledge of physics, and the authors have purposely set out to present the concepts with the minimum of formulae and calculations. The completely naive may struggle with some of the concepts, but certainly not all. In conclusion, this book is a readable physics text which complements the earlier publication by the same authors Electrotherapy Explained. Any individuals wishing to develop an understanding of the basic physical concepts, and thus their understanding of the use and effects of electrotherapeutic modalities would find this book of use. Certainly all undergraduate courses should find a place for this text in their libraries. Grahame D Pope MCSP DipTP If you have come across a new book which might help other readers, and it has not been reviewed in Physio- therapy, please let us know. Control of Human Voluntary Movement by John Rothwell. Chapman and Hall. London (2nd edn) 1993 (ISBN 0 4 12 47700 9). Illus. 506 pages. f35. The aim of this book is to provide a concise account of the anatomy and function of the central nervous system in controlling voluntary movement. This issue updates the 1987 edition. The sub- headings of the 11 chapters are now more succinct and easier to target when you want to find the answer to specific questions. The reference list at the end of each chapter has been updated. There is a new chapter on posture. The format of the book is now more digestible; each chapter follows a similar outline starting with anatomy, physiology, effects of lesions, models or theories and ending with dysfunction in humans. In my view there are two minor omissions: a lack of a summary of the keypoints at the end of each chapter and a separate list of abbreviations following. the index. This book has much to offer graduate physiotherapists specialising in neurology. The author provides a comprehensive, unbiased review of current experimental evidence and theories. Chapter 1 is an easy-to-read introduc- tion to movement control. Chapter 2 reviews the mechanical properties of muscles; chapter 3 the motor unit. It is essential to have a good grasp of basic anatomy and physiology to benefit from this text. For this reason undergraduate physiotherapists may feel overloaded with too much detail. Chapter 4 on proprioceptors is disappointing as the author does not really shed any new light on their role; this question is of particular interest to physiotherapists who use the manipula- tion of afferent input via receptors in the management of neurological patients. Chapters 5,6 and 7 focus on the spinal cord with discussion of reciprocal inhibition, the effects of descending activity on excitability of spinal mechanisms, spasticity and deafferenta- tion. Chapter 8 on posture is an excellent review. Chapter 9 on the cortex presents evidence of particular interest to physio- therapists discussing issues such as plasticity and the differences between internally and externally guided move- ments. The book ends with chapters on the cerebellum and the basal ganglia. The author outlines very clearly what is fact, what is a matter for debate, and what is unknown. This textbook is highly recommended for postgraduate physio- therapists and research students who seek to improve their understanding of human voluntary movement. John Rothwell does an excellent job of integrating animal and human experi- mental physiology with clinical knowledge. Sheila Lennon MSc MCSP DipTP Physiotherapy, December 1994, vol80, no 12
