Science and Motor Disorders MADAM - It is timely and appropriate that the question: 'What is normal movement?' (Letters, April) should be followed closely by the challenging article by Carr and Shepherd (July). Wide reference is made therein to work which should form a more scientific basis to the rehabilitation of movement disorders.

As pointed out by Carr and Shepherd, the spastic state of the muscle is not causally linked to poor performance. Spasticity as a reliable indicator of treatment efficacy has also been questioned (Grimm, 1983; Hare, 1984). Increasing evidence of plasticity within the neuromotor system demonstrates the interdependency of the physiology of the system with the external environment in which it operates; form versus function (Kidd, 1980).

There is a need to be even more explicit, one cannot approach the management of motor disorders without reference to the biomechanics as an integral part of any movement. A classic work on posture and movement in 1966 by Martin recognised this fact, a view further substantiated during the 1970s (IBRO Symposium, 1979) and ongoing during the 1980s.

The components common to normal movement are as follows: 'anchorage' of the body to its supporting surface giving a balanced and stable base; 'core stability' giving control of the centre of mass over the area of support; adjustment within the system to allow movement to occur. This has long been practised and taught by Noreen Hare.

These principles when fully understood lead naturally to analysis of the problems of many motor disorders, and to effective management in rehabilitation as well as those severe neurological conditions otherwise doomed to 'failure' (Pope, 1988).

We have been a long time in heeding the call for change!

PAULINE M POPE MSc BA MCSP London SW15

Council - Voice of the Majority MADAM - In response to Mr White's letter regarding Council's reply to the NHS White Paper ('The squeaking mouse and the roaring lion', August, page 459), I am concerned that this gentleman really does believe that Council has spoken out of turn and against the membership's opinion on this matter.

All of my colleagues and many more feel very strongly about the effects that the White Paper is going to have on physio- therapy services - a recent meeting of the North East Board on this matter was attended by 100 plus, and Council is helping to bring that majority feeling to the attention of the public and the Government.

As for the campaign inviting super-

intendents to turn their departments into centres of propaganda - it is individual therapists with minds of their own who are taking action, and it is not against the policy of this elected Government, but a fight to save a Health Service which is slowly being fragmented and destroyed.

It saddens and also greatly annoys me to think that physiotherapists such as Mr White feel that these steps are against our interests and I can only assume that he is in complete agreement with the White Paper, or he is indeed a 'squeaking mouse'.

KERRY LYNCH MCSP King George Hospital llford

Solution to Branch Solvency MADAM - In reply to Monika Brown's letter in the July Journal ('Can Branches stay solvent?', page 389), I would like to assure her Branch that Salisbury and District Branch is also unable to run Branch activities on CSP capitation fees alone.

We are an active Branch holding bi- monthly meetings with lectures to promote interest and discussion among our members, but this financial year with increasing costs we are forced to spend more time organising events to pay for our activities than we actually commit to the meetings themselves. We feel it should not be necessary to rely on jumble sales and cake making to enable a professional body to function at a local level.

Several of our members are also members

of Wessex ACPIN who pay a regional subscription of €7.50 of which €4 is received by the local branch in capitation fees, and this is found to be a more realistic figure with which to plan meetings.

We have just heard that next year's membership fee will be increased to €77. If the CSP finds itself unable to release any of this large increase to the Branches perhaps it should round the figure up to f80 and send us an adequate amount of €3.75 per member to run our activities, which after all we do voluntarily in our own time unlike the officials we pay at CSP headquarters.

VIV HARPER MCSP Honorary Secretary Salisbury and District Branch

Help with Stress Incontinence MADAM - Many physiotherapists, and other health care professionals, are endeavouring to improve the lot of women with stress incontinence. The teaching of pelvic floor exercises is not always done as well as it might be. The Association of Chartered Physiotherapists in Obstetrics and Gynaecology and the Association of Continence Advisers are working hard to improve this situation.

Increasing numbers of health authorities are employing continence advisers, and more hospitals now run continence clinics. Schools of nursing are extending their range of postgraduate courses for nurses and health visitors. One such is the ENB course 978 for the promotion of continence and treatment of stress incontinence.

Is this course being run by your local school of nursing, and if so, is a physio- therapist being asked to contribute to the teaching? Here is an excellent opportunity to improve the teaching of pelvic floor exercises and bladder training, and to inform others in the field of the other modalities offered in physiotherapy departments.

lnterferential therapy seems to help some women but there is still a place for the use of pelvic faradism, using a vaginal electrode, for the woman who has severe muscle weakness, or one who has lost sensation in the pelvic floor and cannot feel the contraction, provided there is no underlying neurological problem. Cones are proving useful for some women but they do need to be very well motivated to use them.

Stress incontinence is a subject which is now being widely discussed in women's groups, on radio and television and in the press, and increasingly women are becoming aware that help is available and are asking for that help. Are we prepared for the increasing demand for help from this unfortunate group of women? MARILYN MOORE MCSP Chichester

REFERENCES

Grimm, R A (1983). Program Disorders of Movement, Advances in Neurology 39, Raven Press, 1-11.

Hare, N (1984). ldeas Developed at the Cheyne Centre 1969-1983, available from Friends of The Cheyne Centre, 63 Cheyne Walk, London SW3 5LT.

Kidd, G and Brodie, P (1980). 'The motor unit - A review', Physiotherapy, 66, 5,

Martin, J P (1966). The Basal Ganglia and Posture, Pitman Medical, London.

'Proceedings of an IBRO Symposium held at Pisa, Italy, September 11-14, Brain,

Pope, P M (1988). 'A model for evaluation of input in relation to outcome in severely brain damaged patients', Physiotherapy,

146-152.

1979, 50, 219-226.

74, 12, 647-650.

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