Body Image and Perceptual Dysfunction in Adults.

Van Deusen J. Philadelphia, PA 19106-3399, WB Saunders Co, 1993, paperback, 253 pp, $29.95.

The author intends this book for experienced health professionals so they can more accurately observe patients in evaluation and carry out research with patients who may have body-image dysfunction. Deficits in perception and body image associated with various diagnoses are the focus, rather than the wide range of rehabilitation procedures that may be relevant to specific diagnoses. The content, therefore, is limited to body-image, visual-perceptual, and somesthetic discrimination deficits.

Each chapter addresses the assessment categories of screening tools, specific clinical tools, batteries, and functional tools. Each chapter also addresses the forms of treatment including environmental change, patient change, and the principle of gradation. Both compensatory treatment and restorative treatment are considered, with an emphasis on adaptive, remedial, cognitive, and combined forms. Numerous research citations substantiate the information and lend credibility to the discussion.

The author adopts Adamovich's definition (1985) of perception as the "integration and interpretation of information received from the sense organs that is based on an internal representation (ie, classification abilities) of the stimulus." The interrelationship of the senses and the mental processes suggests that an individual's perception is a subjective experience of judging the external environment. The succeeding chapters that focus on visual-perceptual dysfunction cover cerebrovascular accident, traumatic brain injury, alcohol abuse, and neurobehavioral perspectives on schizophrenia.

In part 2, body schema is defined as the integration of proprioceptive, tactile, and pressure stimuli that constitute the neural postural model, allowing for perception of body position and recognition of relationships of body parts. Body image is the result of a synthesis of body schema and information from the environment that contributes to emotional and conceptual formulations of the body. Dysfunction may result from neural lesions alone or in combination with psychological or sociological problems. The chapters in this section include unilateral neglect from brain lesion, anorexia nervosa, phantom limb pain, mastectomy, and the adult who is physically challenged.

In the final chapter, the author summarizes the literature on assessment and treatment and discusses the need for research in this important aspect of patient treatment. She identifies popularly used assessment tools in both visual perception and body image and suggests that refinement of the existing instruments, rather than developments of new ones, would serve treatment and research needs better. The review of the literature suggests that very little empirical research on interventions exists. The author explicitly does not address therapies for patients with psychiatric disorders, but does include approaches to psychosocial intervention, including group therapy and cognitive therapy.

This is a readable text intended for the practitioner and advanced student. It assumes basic understanding of anatomy, neuroanatomy, psychology, and practice technology. The style and content are most suitable for physical therapists, occupational therapists, and psychologists. The text also assumes a readiness to work with and develop skill in using the many varied evaluation tools and treatment methods. The book is useful as a resource in any rehabilitation setting and in acute care settings. Someone in the environment should be familiar with the material to guide the user through the learning process and facilitate access to assessment tools.