Clinical Applications for Motor Control.

Clinical Applications for Motor Control Montgomery PC, Connolly BH, eds. Thorofare, NJ 08086, Slack Inc, 2003, paperback, 405 pp, illus, ISBN: 1-55642-545-7, $43.95

The challenge to the editors of this book was monumental. Motor control is an enormous field of study in both healthy and pathologic systems. How then do the editors bring the field of physical therapy up-to-date in basic science anatomy and physiology, review the relevant scientific literature that forms the basis of our examination and intervention strategies, provide explicit case studies, and fit it all within the framework of the Guide to Physical Therapist Practice (Guide)? The organizers of the III Step Conference have this arduous task to complete; therefore, they should read this book to get a preview of what the outcome their efforts might look like and whether this task can be accomplished successfully.

Clinical Applications for Motor Control is organized into 14 chapters. With the exception of 3 chapters written by the editors, each chapter is written by a contributing author. The contributors to this book are well-known and respected physical therapist educators, researchers, and clinicians. The first chapter sets the framework for the book and provides an organizational structure that is repeated throughout the text. In chapter I, the history of neurofacilitation therapies is reviewed, and the Guide is identified as the framework for the book. Case study examples conclude the chapter and are a good way for the reader to confirm the chapter's primary emphasis.

The chapters that follow cover a range of topics and are written with varying depths of analysis. Chapter 2 is a basic introduction to concepts relevant to the fields of motor control and learning and development, whereas chapter 4 contains a very in-depth analysis of neuroplasticity as it relates to fine motor skill acquisition and rehabilitation. where are chapters on neural systems underlying motor control (chapter 3), musculoskeletal considerations to motor control (chapter 5), sensory and perceptual issues (chapter 9), cognition (chapter 10), balance (chapter 11), spasticity (chapter 12), and gait (chapter 13).

Most chapters conclude with a case study, which highlights or demonstrates the main points of the chapter. The cases are initially presented in chapter 6. This chapter is devoted to case studies, filling this book with patient cases across the life span. Most educators will be happy with this useful addition. The case studies throughout the book, however, do not consistently reinforce the Guide's emphasis on the use of standardized and validated examination tools in the case descriptors. The cases that were preceded by probing questions of statements were helpful in focusing the reader on particular points of emphasis. The cases that had prognosis and intervention sections assisted the reader to "complete/carry through to completion" the physical therapy episode of care in their mind. Clarity of functional goals is essential, but this book sometimes fails to elucidate certain aspects of disablement. Occasionally, for example, impairment level was confused with functional limitations, and some cases had unmeasurable or unquantifiable goals.

Two chapters focus on the Guide. Chapter 7 takes the reader through the nomenclature of the Guide and the disablement process. Some of the Preferred Physical Therapist Practice Patterns[SM] for the neurologic population are identified, and case studies that take the reader through the processes of examination, evaluation, diagnosis, prognosis, and intervention are provided. The current disablement model being used by flee World Health Organization is the International Classification of Functioning, Disability, and Health (ICF). This classification provides a standardized, common language for communication about Health and health care around the world and among health care disciplines and sciences. It therefore would have been helpful to update the model used by APTA (Nagi model) as other authors have attempted to do in their texts. Chapter 8 is a nice chapter on assessment tools, and it concludes with patient cases. These cases are very informative, because of the use standardized assessment tools. The reader has a very clear picture of the impairments and activity limitations affecting each patient.

This book is probably intended for professional physical therapist students. I would recommend that educators using the book assign it in sections. Chapters 1, 6, 7, 8, and 14 discuss the Guide and how to use it as a framework for patient management. Chapters 5 and 13 are about movement analysis with respect to gait. All the other chapters can be read individually, as those topics are discussed in lecture. Some chapters can stand alone because they are comprehensive, where as others require additional reading.

Clare C Bassile, PT, EdD

Columbia University 

New York, NY

Dr Bassile is Assistant Professor of Clinical Physical Therapy in the Program in Physical Therapy.