Neuroscience: Fundamentals for Rehabilitation, 2d ed. .

Lundy-Ekman L. Philadelphia, PA 19106, WB Saunders Co, 2002, paperback, 559 pp, illus, ISBN: 0-7216-9373-3, $54.95.

The stated purpose of this book is to serve as a neuroscience textbook for beginning occupational therapists and physical therapists. Furthermore, the book's goals are "[to avoid] excessive detail and [to emphasize] clinically relevant neuroscience." Toward this end, the book is largely successful; I am not aware of any other neuroscience book that incorporates more clinically relevant information for physical rehabilitation.

It should also be noted, however, that this book does contain a substantial amount of detail, perhaps more than may be required for entry-level physical therapists. For example, it goes to great length to distinguish neurotransmitters from neuromodulators; it gives a detailed explanation of long-term potentiation; and it discusses G-proteins, their subunits, and second-messenger systems. However, it is better to have a textbook that contains too much detail rather than to have one that contains too little.

The scope of this edition of the book has been broadened to include additional information on a variety of subjects (eg, basal ganglia, cerebellum, and vestibular system). Furthermore, the book also covers new topics such as brain tumors, neural stem cells, and psychological disorders. In general, most of this book is focused on matters dealing with somatomotor and somatosensory systems, whereas other areas that may be of less interest to therapists, such as the diencephalon, are barely mentioned.

In general, the content of this book is extremely scholarly. Each chapter contains numerous, recent references from peer-reviewed journals. The book also does a nice job explaining relatively new concepts and debunking old ones (eg, the relationship between gamma motor loop activity and spasticity). Most of the time the evidence provided to support a novel concept is well established. However, on page 220, the author states that "the function of the caudate is primarily cognitive, not motor." In my opinion, the reference (Alexander GE, Crutcher MD, DeLong MR. Basal gangliathalamocortical circuits: parallel substrates for motor, oculomotor, "prefrontal" and "limbic" functions. Prog Brain Res. 1990;85:119-146.) given to support this point of view is inadequate. This reference is highly conjectural and depends primarily on anatomical studies that show that different parts of the cerebral cortex seem to project preferentially to specific parts of the basal ganglia. Alexander et al, however, actually suggested that the caudate nucleus, in addition to cognitive function, may also be involved in motor functions related to eye movement.

This book is very well written and, although 3 of the chapters were written by contributing authors, it is easy to read throughout. The book is refreshingly well illustrated, incorporating color into illustrations that are comprehensive yet easy to follow. In a cursory review of these figures, I could only find one questionable figure label (in the figure on page 335 the accessory cuneate nucleus is labeled as a "visceral motor" nucleus). This nucleus projects to the cerebellum and is generally considered to have a somatomotor function, not a "visceral motor" function. When I first saw this, I assumed that it was a "typo." According to the figure's legend, however, the nucleus is shaded green because the author thinks that it has "autonomic" (visceral motor) functions. I carefully scanned the text to see if there was some explanation for this divergence from traditional neuroscience; however, I could not find one.

The book is organized in a nontraditional manner, so that "systems" (eg, somatosensory) are presented before "regions" (eg, spinal cord). Because the systems involve and traverse various regions of the nervous system, the author had to make an abbreviated presentation of the regions when discussing the systems. Toward the end of the book, more in-depth presentations of these regions are made. This method of organization, although unusual, does have some advantages. The later presentation of "regions" is well designed for the discussion of lesions and other clinical disorders that are associated with particular regions of the nervous system. This book also contains clinical histories (told in the first person), clinical notes, and review questions, which augment its value as a text.

In summary, this book is the most clinically relevant book on neuroscience that I own. I heartily recommend its use as a reference book to anyone with an established interest in neuroscience. I also believe that this book may be an excellent textbook; however, taken as a whole, it may be too detailed for most entry-level physical therapist students in professional education programs and beginning physical therapists. On the other hand, this may be an excellent text for physical therapists who are in a graduate program.

SG Patrick Hardy, PT, PhD
University; of Mississippi Medical Center
Jackson, Miss

Dr Hardy is Professor in the Physical Therapy Program, where he teaches neuro-anatomy and gross anatomy. He conducts basic neuroscience research pertaining to cortical and subcortical influences on blood pressure. He also conducts clinical research on spinal motor neuron excitability and muscle strength.