accompanied by evaluation and not dictated by inflation. Increased knowledge and an increased appreciation of the subtleties of assessment may reduce rather than increase some aspects of our work. Clinical audit will improve the effectiveness and efficiency of clinical practice, and the role of physiotherapists in education and prevention should increase. There will still be areas of uncertainty, areas for further research, and we must remember the words of Maimonides, the philosopher and physician of the twelfth century: 'Teach thy tongue to say "I do not know".'

REFERENCES Baker, R (1990). 'Problem-solving with audit in general practice',

British Medical Journal, 300. 378 - 80. Clement, A J and Hubsch, S K (1968). 'Chest physiotherapy by the

"bag squeezing" method', Physiotherapy, 54, 10, 355-359. Connors, A F, Hammon, W E, Martin, R J and Rogers, R M (1980).

'Chest physical therapy: The immediate effect on oxygenation in acutely ill patients', Chest, 78, 4, 559-564.

Currie, D C, Munro, C, Gaskell, D and Cole, P J (1986). 'Practice, problems and compliance with postural drainage: A survey of chronic sputum producers', British Journal of Diseases of the Chest, 80, 249-253.

Flower, K A, Eden, R I, Lomax, L, Mann, N M and Burgess, J (1979). 'New mechanical aid to physiotherapy in cystic fibrosis', British

Medical Journal, 2, 630-631. Green, M and Moxham, J (1985). 'The respiratory muscles', Clinical

Science, 68, 1-10, Graham, W G B and Bradley, D A (1978). Efficacy of chest

physiotherapy and intermittent positive-pressure breathing in the resolution of pneumonia', New England Journal of Medicine, 299,

McDonnell, T, McNicholas, W T and FitzGerald, M X (1986). 'Hypoxaemia during chest physiotherapy in patients wi th cystic fibrosis', lrish Journal of Medical Science, 155, 10, 345-348.

Pryor, J A, and Webber, B A (1979). 'An evaluation of the forced expiration technique as an adjunct to postural drainage', Physiotherapy, 65, 10, 304-307.

Pryor, J A, Webber, B A and Hodson, M E (1990). 'Effect of chest physiotherapy on oxygen saturation in patients wi th cystic fibrosis', Thorax, 45, 77.

Selsby, D S (1989). 'Chest physiotherapy', British Medical Journal,

Sharp, J T, Drutz, W S, Moisan, T, Foster, J and Machnach, W (1980). 'Postural relief of dyspnea in severe chronic obstructive pulmonary disease', American Review of Respiratory Disease, 122, 201 -211.

Sutton, P P (1988). 'Chest physiotherapy: Time for reappraisal', British Journal of Diseases of the Chest, 82, 127-137.

Webber, B A (1990). 'The active cycle of breathing techniques', Cystic Fibrosis News, August iSe p tern ber, 10 - 1 1.

Webber, B, Parker, R, Hofmeyr, J and Hodson, M (1985). 'Evaluation of self-percussion during postural drainage using the forced expiration technique', Physiotherapy Practice, 1, 42-45.

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298, 541 - 542.

Video Reviews Pool Therapy for Amputee Patients, by Lorraine Moverley MCSP. Duration 15 minutes. 1991. Available from Medical I l lustrat ions Department, Hul l Royal Infirmary, Anlaby Road, Hull. f20.

This video shows group treatment for amputee patients in a swimming pool as opposed to treatment in a therapeutic pool. The pool is 17 metres by 9 metres and designed for use by disabled peopie.

The patients are transported to and from the hospital and, including treatment of 30-40 minutes, this takes 1% hours.

The treatment shown consists of specific exercises, free swimming and a variety of games.

The filming and Commentary are clear and well presented and the patients are obviously enjoying the pool session.

Although the exercises are not specifically corrected, each patient works through a whole body programme.

It is a pity that the commentary refers to 'gravity eliminated' and 'the resistance of the water' which sometimes is referring to the turbulence and sometimes viscosity of water.

The video is well worth viewing because it shows what can be achieved by a hospital without the facilities of a therapeutic pool and giving benefit to a large number of patients at once.

ALISON SKINNER BA MCSP DipTP

The Ar t i f i c ia l L imb Centre, Video Communication Services, Northampton Health Authority, Highfield, Cliftonville Road, Northampton NN1 5ND, 1991. VHS. 22% minutes. f55 purchase, f10 per week hire, both plus VAT.

This video is designed to inform and familiarise new amputees about the procedures and treatment they will receive at a limb fitting centre.

The concept of an informative video is an excellent idea and Northampton Health

Authority should be congratulated on attempting this project. It is a pity that some of the impressions and activities shown are misleading.

The first part of the flm is misleading as the amputation level of the amputees interviewed is not mentioned. This could cause unrealistic expectations for some amputees as it gives the impression that all amputees of any level will talk easily.

The average primary amputee in the UK is aged between 60 and 85 years of age whereas the patient mainly depicted in the video is in a much younger age group. This patient is shown being cast using a specific casting technique for a self-suspending total contact socket which would not normally be issued to a primary amputee of any age group.

I feel it would have been more informative if more time were given to showing the procedure, including the multidisciplinary team, at the Disability Services Centre and to include the necessity of gait training. An explanation of the general capabilities of the different levels of amputation would give patients a more realistic impression of their own situation.

PENNY BUTTENSHAW MCSP

The BBC Pregnancy and Post-natal Exercise Video with Rosemary Conley and Jane Ashton MCSP. No: BBC V 4639. Duration 90 minutes. 1991. f 10.20 approx.

This 90-minute video of ante-natal and post-natal exercise sequences to music was made by the BBC in collaboration wi th t w o obstetric physiotherapists, Jane Ashton and Margie Polder, and was approved by the Association of Chartered Physiotherapists in Obstetrics and Gynaecology. It was carefully designed to be effective and safe for use in pregnancy and post-partum, not only for women who normally work-out to music two or three times a week, but also for those who usually take little specific exercise.

The video starts wi th a short introduction by Rosemary Conley of 'Daytime Live' fame, a brief explanation of the changes of pregnancy by midwife Mary McNabb, and

a clear statement by consultant obstetrician Helen Tebbutt as to what exercising in pregnancy can and cannot achieve. Examples are given of when exercise may need to be moderated or even discontinued.

The video is then divided into two parts, ante-natal and post-natal. Jane Ashton demonstrates, instructs the viewer through the movements, and gives a special authenticity to the whole in that the filming was scheduled to coincide appropriately with her own third pregnancy and post-natal period.

The ante-natal section is chiefly an enjoyable exercise work-out consistint of,a warm-up plus stretches, gentle a robic exercises, a cool down, more stretches, strengthening floor exercises, final stretches, and a relaxation period. But first good posture and back care in pregnancy are demonstrated and emphasised, then pelvic floor contractions - 'the world's most neglected female exercise' - are taught and reinforced.

The post-natal section is in three parts wi th specific graduated exercises for up to t w o weeks post delivery, t w o to six weeks, and nine weeks to four months.

The importance of rest is well shown, and other mothers and their babies join Jane Ashton and Lucy in these sequences. The video closes with Rosemary Conley and a group of mothers demonstrating stronger maintenance exercises to continue once the body has substantially recovered its shape and strength.

The quality of the professional input is evident throughout, most particularly in the excellent scripting, written by the physio- therapists, which nicely balances caution wi th positivism, but also in the perceptive choice of exercises and their demonstration. Jane Ashton and Margie Polden make a powerful team, one as the attractive image of the profession and of young motherhood in front of the camera, the other not seen or heard but present in the wealth of wisdom, and mother ing and clinical experience which so obviously underpins the whole presentation.

JILL MANTLE BA MCSP DipTP

Physiotherapy, December 1991, vol 77, no 12 804