The aim of this study was to explore and compare the experiences of tilt-in-space wheelchair use and conventional wheelchair use in severely disabled clients with multiple sclerosis and significant spasticity. The research design was a descriptive qualitative approach, using in-depth audio-taped interviews in clients' homes carried out over a 9-month period. A total of 23 clients (7 tilt-in-space wheelchair users and 16 conventional wheelchair users) were recruited from three adjacent district wheelchair services in South-East England. The criteria for recruitment were that the clients were severely disabled with multiple sclerosis, had significant spasticity and were full-time wheelchair users, usually requiring hoisting. Their carers were also interviewed. The majority of tilt-in-space wheelchair users (6 out of 7) reported that their chairs were comfortable compared with only half of those in conventional wheelchairs (8 out of 16). The positive aspects of tilt-in-space wheelchair provision included comfort, improved postural support, enhanced seating stability, relief of pressure and being able to rest sitting out of bed for prolonged periods, often for more than 6 hours a day. One person reported improved catheter drainage and another reported reduced spasms. The negative aspects of tilt-in-space wheelchairs included their bulky size and lack of manoeuvrability compared with conventional wheelchairs. All the wheelchair users had experienced difficulty with transport and many had relied on family and friends to help with the purchase of expensive adapted vehicles. In conclusion, the majority of the tilt-in-space users were satisfied with their wheelchair, particularly in terms of comfort.

Despite the problems posed by diversity of condition and the lack of agreement among researchers over what outcome to measure, there is now increasingly robust evidence for the effectiveness of rehabilitation in brain-injured populations. Meta-analysis has demonstrated clearly that stroke units provide a better outcome than management on a general medical ward, at the level of survival, discharge destination and dependency. The extent of this advantage may be summarized in the following terms. For every 100 patients treated in a stroke unit, four deaths and two institutional admissions are avoided, and five patients are discharged home. This benefit appears to arise from a combination of good-quality acute management and the coordinated input of a multidisciplinary team. Therapy programmes are shown to be of benefit and intensive therapy programmes of somewhat greater benefit. Smaller numbers and heterogeneity among the head-injured population tend to confound randomized controlled trial designs, but there is no good reason to suppose that brain injury resulting from trauma should be less responsive to similar good management principles than that arising from stroke. In any event, we have progressed to a stage where the weight of evidence supports the notion that rehabilitation is effective, and nontreatment controls are ethically no longer acceptable. It is time now to unravel the threads of rehabilitation and consider which are the critical components. There are still many opportunities for comparison of different models for delivery of care, and the existing evidence for these is discussed.

Psychiatry 1995;58:27-30)

SUMMARY. Cerebrospinal fluid and serum from 192 patients was analysed for the presence of intrathecally synthesized oligoclonal IgG bands using isoelectric focusing in an immobilized pH gradient pH 7-10. The sensitivity of this method for the diagnosis of multiple sclerosis (MS) was 95% (21 of 22), or 750/0 if patients with suspected MS were included. The specificity for the diagnosis of MS was 98%, or 96% if the suspected MS patients were included. The very high specificity may be because the intrathecally synthesized oligoclonal IgG associated with MS is more alkaline than IgG from serum and is better detected in an immobilized alkaline pH gradient.

These results suggest that the multidisciplinary inpatient approach in neurological rehabilitation has identifiable short-term benefits for the majority of patients. A randomized trial with longer follow-up is required to confirm this.

Urethral stricture is well recognized as a complication of urethral catheterization. The occurrence of urethral stricture after acquired brain injury is not commonly recognized. Two cases are described.

This study showed that PESCI is a simple, safe, and effective technique for distal antegrade irrigation in the management bowel dysfunction for selected patients with central neurologic disease. A successful PESCI is very likely to continue functioning satisfactorily for a long time without technical problems or local complications.

LL. In-vitro contracture tests in patients with various neuromuscular diseases. BrjAnaesth 1992;68:72-5. 2 Brownell AKW. Malignant hyperthermia: relationship to other diseases. Br_Aniaesth 1988; 60:303-8. 3 European Malignant Hyperthermia Group. A protocol for the investigation of malignant hyperpyrexia (MH) susceptibility. Br .7 Anaesth 1984;56:1267-9. 4 Ellis FR, Halsall PJ, Christian AS. Clinical presentation of suspected malignant hyperthermia in 402 probands. Aniesthesia 1990;45: 38-41. 5 Larach MG. Should we use muscle biopsy to