Co-ordination Difficulties: Practical Ways Forward.

Co-ordination Difficulties: Practical Ways Forward Lee MG. London, United Kingdom, W4 5TF, David Fulton Publishers, 2004, paperback, 124 pp, illus, ISBN: 1-84312-258-8, $20.

The purpose of this book is to provide a resource on examination (what the author calls "assessment") and structured treatment schemes for those working with children, ages 3 to 18 years, with dyspraxia or other coordination difficulties. The principal author is a pediatric-chartered physiotherapist in Great Britain. Contributing authors include an educational psychologist and 2 occupational therapists. The author's intended audience includes physical therapists, occupational therapists, teachers who work with children with coordination difficulties, and others with an interest in this area.

Chapter titles include: "Understanding the Problem," "Referral," "Assessment," and "Treatment." Another chapter discusses research on the effectiveness of treatment. The appendixes include standardized tests, several questionnaires, an example of a treatment record sheet, and a case study.

Chapter 1 provides a very basic explanation of what a developmental coordination disorder is, what the associated features are, and why it is important to start intervention early. This chapter also contains a good movement checklist that can be used by parents, teachers, and others who may not have a health care background.

Chapter 2 looks at referral sources--usually parents and teachers--and what they most likely will report, whereas chapter 3 recognizes that not all referrals will be given early in the child's life. This chapter discusses the examination process, including standardized and nonstandardized tools, clinical observation, and interpretation and documentation of test results. A table in this chapter lists a variety of clinical observation tasks, including the examination description and a "considerations" column, and provides illustrations to help the reader picture the task. The considerations column is in a question format (eg, "Is the head kept in midline?" and so on). The entire table format, including the accompanying photos, is very helpful for the therapist who is inexperienced at clinical observation.

Chapter 4 discusses intervention for the child with coordination dysfunction, and provides ideas for treatment programming, along with photos that illustrate the activity. This chapter is a terrific resource for those therapists who are "stuck in a rut," and it will give them ideas for varying the tasks within treatment sessions.

Chapter 5 cites 10 recent peer-reviewed articles on the effectiveness of both group therapy and individual treatment. Unfortunately, the author only summarizes the articles. A critical analysis would have been more beneficial to therapists.

The appendixes include summary charts of standardized tests typically used with this age group, various questionnaires (for parents, teachers, schools, and children), an example of a treatment record sheet, and a case study. The case study includes the general history of the child, general impressions, the examination summary, an intervention plan for an 8-week course of treatment, the actual activities attempted for each of the sessions, the summary report from the child's teacher regarding successes in the classroom, and a lengthy review of the child 3 months postintervention. The case study provides the reader with an organized format for documentation. A list of resources including addresses, phone numbers, and a bibliography conclude this text.

For physical therapists who are familiar with treating children with coordination dysfunction, this text would serve only as a reminder of the ways that they can help these children. For those who have not been treating children with these conditions or are thinking about working with school-aged children, this text would be helpful in organizing and creating effective treatment programs.

Overall, this book is well organized and meets its objectives of providing a resource on examination and structured treatment schemes for those working with children who have dyspraxia or other coordination difficulties. Co-ordination Difficulties is easy to read, and each chapter can stand alone. Examples of treatment ideas are accompanied by many photographs. This is not a text that should be required in physical therapist education programs; however, it is a good addition to a beginning pediatric physical therapist's professional resource library.

Jennifer L Lander, PT, EdD

Armstrong Atlantic State University 

Savannah, Ga

Dr Lander is an Associate Professor in the Department of Physical Therapy and provides evaluation and intervention services for "Babies Can't Wait," an early intervention, Part C program.