Developmental Motor Disorders: A Neuropsychological Perspective.

Developmental Motor Disorders: A Neuropsychological Perspective Dewey D, Tupper DE, eds. New York, NY 10012, The Guilford Press, 2004, hardcover, 501 pp, illus, ISBN: 1-59385-064-6, $70.

This text is written for scientists and clinicians in various disciplines who work with children with developmental or acquired movement disorders. It consists of 21 chapters and is organized into 4 parts. As the fifth volume in the series The Science and Practice of Neuropsychology, this book focuses on integrating theory, research, and practice in the area of motor disorders. It extensively reviews the literature and proposes future directions for research in establishing relationships between motor disorders and the cognitive, perceptual, social, and emotional aspects of development.

The first 4 chapters describe a selection of neurodevelopmental disorders from a historical perspective. For example, chapter 2 describes current neuroimaging techniques and their application in neurodevelopmental disorders for the purpose of relating brain morphology to function. The authors of chapter 3 then propose that the neurobehavioral mechanisms associated with motor impairments can be investigated by either a product dimension or a process dimension of performance. The product dimension focuses on task performance, such as accuracy or time, compared with established normal values. These measurements include the traditional neurological examination and neuropsychological assessment batteries. The process dimension refers to the means by which the person achieves the outcome. The chapter authors conclude that an integration of product and process dimensions does not exist and is essential for comprehensive assessment.

Part I concludes by presenting a discussion of motor proficiency assessment batteries. No specific tests are discussed. Instead, the reader is guided in appropriate test selection through a review of the purposes, practical considerations, measurement principles, and psychometric properties of testing.

Part II is tided "Clinical Disorders" and consists of 6 chapters, each devoted to a specific diagnostic group presenting with movement disorders. The major theme in this part is the relationship of motor and perceptual-motor skills to higher level cognitive functions. The final chapter in this part provides a comprehensive review of the balance control system from the perspectives of both normal development and aging.

Part III addresses the neuropsychological basis and characteristics of visual-perceptual disorders, developmental motor learning disability, attention disorders, and developmental phonological and written language disorders. The comprehensive reviews include current motor learning models, the role of attention in motor development and execution, and the effect of visual-perceptual and kinesthetic processes on motor planning and error correction. The authors focus on developmental coordination disorders and emphasize Willingham's modes of "control-based learning theory" as unique explanations of motor learning in terms of motor control processes.

Part IV, "Issues and Applications," consists of 6 chapters that focus on manual skill development, comorbidities of disorders, social-emotional effects, and current interventions. In chapter 17, "Constraints on Neuromotor Development," dynamical systems theory is used to explain motor development. This concept flows into the next chapter on comorbidity, which concludes that comorbidities are common because of the close interconnections of the various brain regions involved in motor and cognitive functions. When people are limited in environmental interaction, their emotional, social, and physical well-being suffers. These children do not adopt any one specific coping mechanism, but they are drawn toward sedentary--and possibly more isolated--lifestyles.

The final chapter in this part addresses intervention in order to provide an overview of the literature from an evidence-based perspective. Treatments are organized into the process-focused approaches of neurodevelopmental treatment and sensory integration techniques and the performance-focused approaches of conductive education, cognitive approaches, compensatory approach, and exercise therapy. The majority of the literature on treatment is descriptive or opinion-based and, at this time, it is impossible to draw any conclusions about the effectiveness of any approach. The authors recommend more rigorous empirical evidence to support the treatment approaches that are widely used by clinicians.

Judith A Verbanets, PT Sharp Rees Stealy Medical Group San Diego, Calif

Ms Verbanets works as a Neurology Specialist for the Sharp Rees Stealy outpatient clinics. Her role involves direct patient care, staff development, participating as a clinical instructor, and teaching within the system.