Neurological Assessment During the First Year of Life.

Neurological Assessment During the First Year of Life. This textbook was written as a detailed clinical manual for the neurological assessment of preterm and full-term infants. Additionally, the text presents an overview of the maturational changes that occur in preterm babies, as well as normal development, during the first year of life.

The first chapter of the textis focused on developmental neurology and the various disciplines involved in the study of neurologic development. The chapter is particularly of interest because the roles of disciplines such as obstetrics, neonatology, physical therapy, and neuropsychiatry in the management of the infant at risk are discussed in some detail. Physical therapy is recommended in the text as a means of eliminating any gaps in the treatment of children in whom a definite cerebral motor disability is eventually confirmed.

The next two chapters present standard neurologic assessments of neonates and infants during the first year of life. The chapters are particularly well written and easy to read. Examples of "normal" responses and abnormal variations from normal responses are presented. These chapters are illustrated with photographs demonstrating postures, reflexees, and maneuvers in the physical examinations and with line drawings that further clarify the postures.

In the fourth chapter, a complimentary neuromotor examination (CNME) that was developed by the authors is presented. This new examination is designed to expand and enrich the findings of the classical neuromotor examination. It involves a new approahc to the assessment of the infant, with the examiner creating situations of observation through which the infant can be led. The infant is observed for motor performance and for interactional skill. The goal of the assessment is also to aid in predicting outcomes in both motor and cognitive function as early as possible during the first three to four months of life. The child's reactions in supported sitting, side propping, rolling, and standing on one foot are particularly emphasized. Of interest to physical therapists is the assessment of the child's reaction to lateral shifting. The authors state that 20 years of experience have shown that lateral abduction of the trunk and leg always is absent in children with a motor handicap, even in the newborn period before the handicap can be confirmed clinically.

The last three chapters of the book are somewhat disappointing. An extremely brief and superficial evaluation tool for neurological functioning of children at 12 months of age is presented in Chapter 5. The authors' personal comments on the significance of transient neuromotor anomalies and the correlation of these deviations with difficulties at school age are presented in the next chapter. A study the authors conducted with a small group (N = 15) of infants who exhibited abnormal neurological signs during the first week of life revealed a correlation between transient neuromotor anomalies in the first year and minimal brain dysfunction at school age. Questions still may be raised on this issue, however, because of the study's small sample size.

The last chapter presents a short discussion of developmental scales and the predictive validity associated with early assessments of children. A brief section is also included on visual and auditory defects found in newborn infants at risk for developmental problems.

Record forms for monthly assessments of the infant during the first year of life are presented in the appendix and provide a guide for the examiner.

I highly recommend this text for those therapists involved in the assessment of neonates and infants who are at risk for development problems. The CNME could be incorporated easily into the standard physical therapy assessment of infants and could provide information about those children who are at risk for later problems.