Over the past 10-20 years there has been an explosion of work on the disturbance of motor control that is manifested as "spasticity." This work has been based on new insights from animal experiments into the basis of normal motor control and the development of experimental techniques that could be used in patients with neurological disturbances. For this reason, on the initiative of Alfred Thilmann, the editors of this volume organized a workshop on spasticity, held in Essen, Germany, in November, 1992. The intention of the meeting was to bring together leading scientists in an atmosphere that would generate discussion and hopefully consensus and ideas for future work. The attendance was restricted and deliberately selective, with a mix of basic scientists, clinical scientists and practicing clinicians. The product of their presentations and deliberations is this volume. The book is organized in the same sequence as the workshop, so that the discussion sessions could be summarized by the appropriate chairman.

Up until two decades ago, clinical interest in the etiopathogenetic interpretation of lumbo-radicular syndromes was prevalently concentrated on the pathology of the inter vertebral disc. This vision gradually changed and grew as a result of the affirmation of the concept of pathological narrowing of the osteoligamentous vertebral canal as a cause of compression of the lumbar nervous structures. Finally, in the last ten years, lumbar stenosis has become more and more a subject of current interest not only as a result of problems related to nosography, diagnosis, and therapy, but also as a result of the increasing frequency with which vertebral canal or nerve root canal stenosis syndromes are recognized and treated. At the same time there was a tendency to include in stenotic pathology other pathological conditions responsible for lumbo-radicular syndromes. This led to dilation of the concept of stenosis, which perhaps no longer responded to reality, and which was not useful from a practical point of view. The need to define stenotic pathology and to correctly locate it within the vast field of lumbar pathology inspired the writing of this volume. This monograph gathers many diagnostic and therapeutic concepts matured at our In stitution over the years. Some of these concepts have already been defined in scientific meet ings or in publications."

The volume contains papers presented at a workshop of held from September 28 - October 1st in Eibsee near Munich, Germany.
The aim of the workshop was to present results of interdisciplinary research which aims to help handicapped persons suffering from paraplegia or hemiplegia to regain the capability to stand or walk. The contributions cover both fundamental research and clinical applications.

In-patient treatment for alcoholism going beyond physical withdrawal from the drug has been available in Germany for more than 130 years. Particularly since the Second World War, treatment has broadened and changed in various ways. There are several reasons for this development. The recognition of alcoholism as a disease by the Supreme Court had widespread financial and administrative consequences. Since then in patient treatment has been funded mainly by the pension insurance institutions. Another reason is the strengthened influence of different psychotherapeutic schools on practice in treatment. At the present time in the Federal Republic of Germany there are about 250 treatment facilities (Suchtfachkliniken, or addiction centres), where around 25000 patients a year receive in-patient treatment. In addition to these, there are the addiction units in psychiatric and general hospitals, of which some offer withdrawal treatment, while others also offer rehabilit ation treatment. For out-patient treatment there are about 450 special addiction counselling and treatment centres, out-patient facilities available at local health authorities and university hospitals and, further to all this, there are thousands of self-help groups of various kinds. This system of interlocking treatment facilities of various kinds, from the first contact to the after-care stage, is called a treatment network or chain.

From 21-24 June 1989 the International Federation of Adapted Physical Activity (IF APA) held its 7th International Symposium "Adapted Physical Activity -An Interdisciplinary Approach" in Berlin (West). This was the first time that this symposium has been held in a German speaking country, and it presented unique challenges to the organizers. For example, neither the term nor the field of adapted physical activity was known in Germany before the symposium. Thus, at the outset, the organizers' task was to define the meaning of adapted physical activity as a concept and to identify areas and professionals associated with it. After lengthy and intense discussions we agreed on the following definition: Adapted physical activity refers to movement, physical activity, and sports in which special emphasis is placed on the interests and capabilities of individuals with limiting conditions, such as the disabled, health impaired or aged. Despite the fact that the use of an English term for a symposium in Germany would not be accepted by all German speaking professionals, it was decided to use this term because no translation appeared to be fully adequate. "Sports for the Disabled", "Modified Movement Activites", "Sport Therapy", or "Psychomotor Exercises" would have represented only single aspects of adapted physical activity and were thus incomplete.

Die grundlegend aktualisierte 2. Auflage bietet einen einzigartigen und fachA1/4bergreifenden Aoeberblick zu den Grundlagen, urologischen und orthopAdischen Details sowie psychosozialen und juristischen Aspekten der Spina bifida. Fallbeispiele machen das Buch besonders fA1/4r Studenten, praxisnah arbeitende A"rzte und auch Physiotherapeuten attraktiv. komplett A1/4berarbeitete und ergAnzte 2. Auflage praxisnah und aktuell neu gestaltete Abbildungen

In many cases of neuromuscular disorders the physician is faced with a complete lack of therapeutic approaches. This helplessness places the doctor in a position of conflict between his desire to help and his awareness that there is no treatment. In this situation it is tempting to indiscriminately use any procedure that avoids an admission of medical helplessness while satisfying the patient's demand for treatment. Electrical interventions are often used to avoid this situation. Due to the random use of therapeutic approaches it is not known what really happens. Presumptions and biased empirical observations have led to the exten sive use of different forms of electrical stimulation regimes in neuromuscular diseases. Due to this unsatisfactory situation it is necessary to know more about appropriate methods that are being used in particular disorders. The search for a better understanding of nerve-muscle interaction has shown that certain activity patterns can influence muscle. These experi mental results provide a rational basis for a possible therapeutic use of electrical stimulation of nerve and muscle. Previously most research has been conducted in normal tissue, and little is known regarding the re sponses of diseased muscle. In an interdisciplinary approach to this, it is our intention to present the current knowledge about basic principles of electrical stimulation in normal muscle. Before electrical stimulation can be accepted as a therapeutic tool, we felt it necessary to summarize the effects of activity in normal and diseased muscle and nerve."

The management of and attitudes toward children and adults with Down syndrome have undergone considerable changes in the course of the condi tion's long history (Zellweger, 1977, 1981, Zellweger & Patil, 1987). J. E. D. Esquirol (1838) and E. Seguin (1846) were probably the first physicians to witness the condition without using currently accepted diagnostic designa tions. Seguin coined the terms furfuraceus or lowland cretinism in contradis tinction to the goiterous cretinism endemic at that time in the Swiss Alps. Esquirol, as well as Seguin, had a positive attitude toward persons who were mentally ill or mentally subnormal. Esquirol pioneered a more humane treatment in mental institutions and Seguin created the first homes in France, and later in the United States, aimed at educating persons who were mentally subnormal. The term mongolian idiocy was coined by J. H. L. Down in England (1866). The term is misleading in several respects: (1) Down identified the epicanthic folds seen in many children with Down syndrome with the additional skin fold in the upper lid occurring particularly in people of Oriental (Mongolian) descent; and (2) Down also erred by assuming that Down syndrome represented regression to an ethnic variant of lower cultural standing. Such an interpretation might have been understandable at a time when the myth of Anglo-Saxon superiority was widely accepted by the British. Charles Darwin's then highly acclaimed theory of origin of the species may have contributed to such a concept."

Since the historieal conference held in Alma Ata in 1978, it has been possible to observe a reorientation of the medical profession. More and more, issues of health enter the stage and curative medicine is not just loosing ground but some interest. 'How effective is health education?' and 'Whose task is primary pre vention?' are questions which stimulate great concern and public debate. It seems also to be the first time since the last decades of the 19th century that the social dimension of health receives adequate consideration. Thus the reeent publication of the so-called Black Report on Inequalities in Health (Penguin 1982) led to a heated discussion in Great Britain, certainly of relevance to many other countries. The 6 years since 1978 are much too short a time to proceed far towards 'Health for All', as the slogan of the World Health Organization puts it, but the concepts are spelled out, vaguely but convincing to many of us. It is the right time to discuss first experiences and to move from philosophy to empiri eal work. This work - as it relates to the process evolving since Alma Ata - is characterized by participation, cooperation and prevention: Participation, because 'disease' concerns only the individual patient, his or her family and immediate social environment, while 'health' concerns everyone and should involve everyone. It is a task of the whole of society rather than the domaine of a single profession or party."

Language depends on a normally functioning left hemisphere. This central fact of human cerebral dominance was well established by 19th century aphasiologists and has been repeatedly confirmed by subsequent investiga tions. Predominance, however, does not imply exclusivity. As demonstrated by the commissurotomy patients studied by Eran Zaidel and associates, the right hemisphere is also capable of subserving some linguistic functions. The question, then, is not whether the right hemisphere can process language, but how and when it does so. This volume focuses on the right hemisphere's contribution to one important aspect oflanguage, lexical semantics. Although the right hemisphere may well be involved in other linguistic functions, such as prosody, the greatest evidence for right hemisphere language competence has been obtained for the processing of word meanings. In addition, cognitive psychology and psycho linguistics have provided us with well-developed models of the lexicon and lexical access to guide our inquiry. Finally, there are techniques available for studying lateralized lexical processing in the normal as well as in the brain injured hemispheres. For these reasons, a focus on the lexicon is likely to yield the greatest number of insights about right-hemisphere language processing."

Back in September of 1974, I acquired much valuable information while attending the International Conference on Total Knee Replacement in London, which was organized by The Medical Engineering Working Party and the Tribology Group of the Institution of Mechanical Engineers, and the British Orthopaedic Association. I was greatly inspired by the conference, and it formed the beginning of my studies on total knee replacement. The co-editors of this proceedings, Prof. J. Paul and Dr. S. Yamamoto, are both acquaintances made originally at that conference. The International Symposium on Total Knee Replacement held in Nagoya, Japan, on 18-19 May 1987 was attended by many participants, including Prof. Walker, who had presented his studies earlier in London. During the past decade and a half, remarkable technical progress has been made in total knee prostheses. In this symposium, cemented total knee replacement (TKR), noncemented TKR, design considerations of total knee prostheses, problems concerning the patello femoral joint, and the newly developed total knee prosthesis were the main topics discussed. I believe that much new information, including that about the challenges which still remain, along with a fresh view towards continuing studies, are presented here for the reader. I would like to express my sincere gratitude to the support of the Knee Joint Research Society in Japan and to the participants in the symposium for their great help in publishing this book."

The spinal cord has a characteristic structure and functions that are distinct from those of the brain. Its functions are tremendously important since it modulates the peripheral sensory inputs to the dorsal horn, and it gives rise to the ascending pathways transmitting peripheral afferent inputs to the brain, and conveys the descending pathways from the brain both to the lower motor neurons, the final common pathway, and to dorsal horn sensory neurons. In spite of these vital functions, the spinal cord constitutes only a small percent age of the mass of the human central nervous system and is located far from the skin surface, which has obstructed the recording of its electrical activity. Recently, however, important advances have been made in several recording techniques, including epidural recording or averaging methods, allowing both sensory and motor evoked spinal cord potentials in man to be recorded. This volume is based on the papers presented at the Fourth International Symposium on Spinal Cord Monitoring and Electrodiagnosis. Each of these international symposia has brought together many of the specialists involved in this research, with an important increase in the number of participants since the first symposium was held in Toyko in 1981. At the past symposia several attempts were made to standardize data, techniques, and clinical applications and to integrate the new findings into patient care."

At the beginning of the century the average life span in developed societies was less than 50 years. It is now more than 70 years and will continue to increase in the near future. Aging is a challenge to science and society. There are several theories of aging. The programmed aging hypothesis suggests that aging cannot be altered by any external influence, that aging is programmed from the beginning of life until the end of senescence. Another theory is based on genetic instability, with repair processes correcting errors in the cells that cause aging. Aging processes manifest themselves at the molecular and cellular level, in different organs, and in the whole organism. Most older persons acquire multiple diseases, primarily chronic ones. The multimorbidity of the elderly raises many questions as to nutrition, metabolism, immunity, drug therapy, and rehabilitation. Nutrition may be able to intervene in the aging process. Aging is associated with dec lining immunity and reduced resistance to many diseases, and it is pos sible that nutritional changes in old age contribute to the declining immunity in the elderly. The elderly take 40% of the prescription drugs in Germany and adverse drug reactions are more frequent in geriatric patients. There are not only problems in drug therapy for elderly pa tients, but also in their rehabilitation. The aim of rehabilitation is the restoration of geriatric patients to their former functional and environ mental status."

Effective Technology: Integration for Disabled Children: The Family Perspective explores microcomputer-based special education intervention programs aimed at advancing mildly handicapped children and empowering their parents. The book applies the stress, resources and coping model to families with disabled children, examining specific components of the pro posed model through family surveys and studies, and presenting future directions for research and experimentation. The book also offers an overview of the research related to effective integration of computers into the special education system, with particular attention to a cognitive approach to skill development through various software programs. Effective Technol ogy: Integration For Disabled Children is intended for researchers and practitioners in a wide range of fields interested in family research and parent-empowering interventions as well as for those involved in technology integration within special education contexts."

In summary, considerable controversy and research have been generated from the automatic/effortful distinction. Hasher and Zacks (1979) initially stated that all manipulations (e. g. , practice, individual differences such as age, orienting instructions) must produce null effects in order to satisfy the criteria that a process is "automatic. " However, Zacks et al. (1984) have more recently noted that automatic processes may range in degree from relative insensitivity to task and subject variables (e. g. , frequency processing) to those that are more vulnera- ble to disruptive effects (e. g. , temporal processing). A review of the literature reveals that individuals are sensitive to frequency information even if manipUla- tions alter the slope of the judgments. Perhaps the application of dual-task metho- dology to the measurement of capacity demands will be useful in classifying processes along an attentional continuum. Moreover, there has been a tendency to dichotomize automatic/effortful processes rather than to characterize them as ranging from low to high attentional demands. Recent evidence (Maki & Ostby, 1987) suggests that attention may be important only in the initial (early) stages of processing frequency information. Therefore, a major difference that may emerge between automatic and effortful processing could be the degree of sus- tained attention required from individuals. In the following section, we review the findings obtained in the application of the automatic/effortful framework to the elderly and neurological/psychiatric populations.

As a graduate student a decade ago, I recall vividly reading the inaugural issue of the Journal of Behavioral Medicine when it appeared in 1978. Its purpose was described as "a broadly conceived interdisciplinary publication devoted to fur thering our understanding of physical health and illness through knowledge and techniques of behavioral science: ' The articles in that first issue addressed such topics as the biofeedback treatment of neuromuscular disorders, anxiety manage ment of Type A behavior, and premorbid psychological factors related to cancer incidence. At that time, coursework in behavioral medicine was in its infancy at my university, and I, along with many classmates, was eager to learn more of this "new and emerging field: ' Thinking back to those times, it is astonishing for one to reflect on the rapid evolution of behavioral medicine and its current status as a clinical and scientific discipline. Organizations such as the Society of Behavioral Medicine now include a broad-based membership that is convened yeady at a major convention. In addition to the Journal of Behavioral Medicine, professionals can avail them selves of several other specialty journals (Annals of Behavioral Medicine, Behavioral Medicine Abstracts, Journal of Developmental and Behavioral Pedi atrics) as well as the numerous articles on behavioral medicine that appear regu larly in the clinical psychology, psychiatry, rehabilitation, and behavior therapy literature. And behavioral medicine services and training programs are encoun tered with increasing frequency within clinic, hospital, and academic settings."

Here is a book for clinicians, clinical investigators, trainees, and graduates who wish to develop their proficiency in the planning, execution, and interpretation of clinical and epidemiological research. Emphasis is placed on the design and analysis of research studies involving human subjects where the primary interest concerns principles of analytic (cause-and- effect) inference. The topic is presented from the standpoint of the clinician and assumes no previous knowledge of epidemiology, research design or statistics. Extensive use is made of illustrative examples from a variety of clinical specialties and subspecialties. The book is divided into three parts. Part I deals with epidemiological research design and analytic inference, including such issues as measurement, rates, analytic bias, and the main forms of observational and experimental epidemiological studies. Part II presents the principles and applications of biostatistics, with emphasis on statistical inference. Part III comprises four chapters covering such topics as diagnostic tests, decision analysis, survival (life-table) analysis, and causality.

On one of my returns to California, I attended the "Disabilities Expo 88" at the Los Angeles Convention Center. Among the various marvels oftech nology for the wheelchair disabled were stair-climbing wheelchairs, self raising and lowering kitchen cabinetry, and even a completely accessible "dude ranch" experience. At the same time, as a guest of the Southern California Chapter of the National Spinal Cord Injury Association, I was part of a small booth (among the more than two hundred exhibitors) in which we had spinal cord injured people up and walking with a lower extremity bracing system (the reciprocating gait orthosis) used at the PEERS Spinal Injury Program in Los Angeles. I had a young man, a C6/7 level quadriplegic, walking with electrical muscle stimulation and lower extremity bracing. The system is reviewed in Chapter 8 of this book. As these "disabled" persons walked erect and upright among their wheel chair bound colleagues and took long, confident strides past exhibits extol ling the latest technological virtues of yet another "new" wheelchair (Fig. 1), I reflected on the paradox of it all. What a majority of these paralyzed people W0re really looking for was an alteration oftheir disability so that they could more normally function (in an unaltered environment). What the great majority of the exhibitors were offering was an alteration of the environment so that they could more normally function (with an unaltered disability)."

Habilitation Planning for Adults With Disabilities presents a comprehensive approach to habilitation planning and service delivery for adults with disabilities. This book investigates the increased demands and expectations by adults with disabilities regarding personalized service and quality of life, including independence, productivity, and community integration, and discusses historical and current treatment and trends. This book is presented in five main sections: definitions and background material; lifestyles and living, work, and recreational environments; habilitation strategies; personal growth and quality of life for the affected adult; and the present and future trends in habilitation planning. Rehabilitation personnel in the areas of administration, assessment/training, case management, or evolution; applied psychologists; and professionals and students in special education, rehabilitation counseling, human service or health adminstration will be interested in this volume.

For some time now, the study of cognitive development has been far and away the most active discipline within developmental psychology. Although there would be much disagreement as to the exact proportion of papers published in develop mental journals that could be considered cognitive, 50% seems like a conservative estimate. Hence, a series of scholarly books devoted to work in cognitive devel opment is especially appropriate at this time. The Springer Series in Cognitive Development contains two basic types of books, namely, edited collections of original chapters by several authors, and original volumes written by one author or a small group of authors. The flagship for the Springer Series is a serial publication of the "advances" type, carrying the subtitle Progress in Cognitive Development Research. Each volume in the Progress sequence is strongly thematic, in that it is limited to some well-defined domain of cognitive developmental research (e.g., logical and mathematical development, development of learning). All Progress volumes will be edited collections. Editors of such collections, upon consultation with the Series Editor, may elect to have their books published either as contributions to the Progress sequence or as separate volumes. All books written by one author or a small group of authors are being published as separate volumes within the series."

The Neuropsychology Casebook was developed to fill the existing gap in the cur rent body of literature on clinical neuropsychology. Although texts are available that describe neuropsychological tests and others provide information on syn dromes, this volume provides descriptions of neuropsychological test perform ance for individuals with various syndromes. It was designed to illustrate the process of clinical interpretation of test findings and report writing for the individual case. Our aims are to provide both the student and practicing profes sional with a collection of actual neuropsychological case studies that typify many of the cardinal disorders or syndromes frequently seen by practicing clini cal neuropsychologists. We have not provided an exhaustive survey of case studies representing many of the disorders commonly seen in neuropsychology; rather, we have focused on a few select cases that illustrate some of the more common disorders. This book includes detailed case reports complete with referral questions, historical information, relevant neuroradiological findings, actual neuropsycho logical test data, and clinical interpretations that take into account all available information on the patient. The cases are discussed in the chapter commentaries with reference to how each compares and contrasts with the prototypic case for that disorder or syndrome. Such case studies help to highlight the various types of behavioral and cognitive sequelae associated with common clinical disorders. The case studies, which are examined through an hypothesis-testing approach, are also aimed at demonstrating how neuropsychological principles and methods are applied."

Sonography is an ideal real-time imaging technique for the evaluation of muscles and tendons of the extremities, and this book is a useful reference for both the technique of examination and normal ultrasound anatomy. The first part considers technical aspects of the examination such as sonographic equipment, water-path systems, and dynamic maneuvers. The basic sonographic patterns of normal muscles, tendons, and other components of the extremities are then presented. Emphasis has been placed on pitfalls and artifacts. The other available imaging techniques for muscles and tendons are also discussed. The second part comprises an atlas of normal ultrasound scans of shoulder, arm, elbow, forearm, wrist, hand, thigh, knee, leg, ankle, and foot, with accompanying explanatory line drawings.

Written by an international board of experts, this comprehensive text provides an in-depth review on the treatment and rehabilitation of the most common sports-related injuries according to the latest scientific developments in functional rehabilitation and the most clinically relevant features of pathophysiology of sports lesions. The management of acute and overuse sports lesions are classified by body area -- spine, upper and lower extremity.

Each year in the United States, an estimated 40,000 persons lose a limb. Of these amputees, approximately 30% lose a hand or an arm. This loss is most frequently related to trauma occurring in the healthy young adult male and is often work related. Approximately 3% of all amputees are born with congenital limb absence. In children, the ratio of congenital to acquired amputation is 2: 1, and the ratio of upper-limb to lower-limb amputees is 1. 2: 1. Therefore, since relatively few amputations result in upper-limb loss, only a small number of health practitioners, even those specializing in amputee rehabilitation, have the opportunity to provide services for a significant number of arm amputees. As a result, clinicians need to share their experiences so that the full range of options for optimum care and rehabilitation of the patient population may be considered. To meet this challenge for wider communication of clinical experience, a group of upper-limb amputee specialists met in Houston, Texas, in 1981 to serve as the core faculty for a course entitled "Contemporary Issues in Upper Extremity Amputation and Prosthetic Function. " This program provided the opportunity for surgeons, physiatrists, engineers, prosthetists, social workers, psychologists, occupational therapists, and physical therapists from the United States and Canada to discuss their extensive experience in working with upper extremity amputees. A second conference continuing the discussion of upper limb amputee rehabilitation was held one year later."

Edited by the respected pediatric orthopaedic surgeon Ali Kalamchi, M.D. with contributions from other experts in the field, Congenital Lower Limb Deficiencies is a single source reference guide for rare complex congenital defects of the lower limb. The text is divided into three sections. The first section discusses normal limb development; the genetic, familial, and historical nature of lower limb defects; and the evaluation and categorization of such defects in pediatric patients. The second section characterizes and classifies the congenital defects and covers early long-term planning of patient management based on clinical and radiographic findings. The third section analyzes the treatment modalities, including several chapters on the relationship of sports therapy to the treatment plan. In addition, the authors contribute their wealth of expertise by sharing their experiences and preferences in the treatment of congenital lower limb defects. The team approach for geneticists, pediatricians, orthopedists, therapists, prosthetists and other health care professsionals involved in each case is emphasized.