Pathophysiology of the Motor Systems: Principles and Clinical Presentations.

Fredericks CM, Saladin LK, eds. Philadelphia, PA 19123, FA Davis Co, 1996, 594 pp, illus, $39.95.

The editors of this textbook have designed a book for the disciplines of physical therapy, occupational therapy, and other health care professions associated with rehabilitation. The book contains five sections. Each section presents basic anatomy and the role of the system in motor control.

The first section is entitled "Basic Components of the Motor System: The Cells and Tissues." The four chapters included in this section focus on the basic neuromuscular principles. The content, presented in the traditional manner found in all basic science textbooks, includes the structure and function of neurons, skeletal muscles, the neuromuscular junction, and sensory receptors. Each chapter is well referenced and contains abundant illustrations that assist the reader with the difficult concepts. Because this textbook is oriented primarily toward physical therapy and occupational therapy students, a more comprehensive discussion of proprioception, vision, and the vestibular system would strengthen this section.

Section 2, entitled "Control of Motor Activity: Systems that Regulate and Coordinate movement," is a hierarchial presentation of various brain areas. Clinical implications of damage in the various areas of the brain are presented. The last two chapters in this section are "Theories of Motor Control" and "Motor Learning." Theories of motor control, including the reflex hierarchy, systems, and dynamical systems are presented. The section on dynamical systems presents basic concepts and references for students to expand their knowledge in this newer model of motor control. An area that needs to be included in the chapter on motor control is motor programming and the concepts of emergent properties and distributed function. The organization of the book does not lend itself to discussion of integration of function associated with movement. The chapter on motor learning is a welcome addition to the textbook. Basic concepts related to practice, feedback, and clinical applications are discussed.

Sections 3 and 4, "Clinical Manifestations of Motor Dysfunction" and "Disorders of the Motor Unit," describe disorders at the muscle and spinal level affecting motor control. Disorders of the motor unit, muscle, peripheral nervous system, and anterior horn cell are included. Injuries due to physical and chemical agents are an excellent addition to the section.

Section 5, "Disorders of Central Motor Control," includes basic neurology of disorders of the spinal cord, basal ganglia, and cerebellum. In addition, traumatic brain injury, stroke, and multiple sclerosis are included. These chapters are presented in the traditional manner found in neurology textbooks, including the signs and symptoms associated with each disorder. These chapters do not address the loss of function in terms of the contemporary theories of motor control. Section 6, "Consequences of Immobilization," addresses the effects of immobilization on the musculoskeletal system and, more importantly, on visceral function.

The textbook is an excellent resource as it incorporates basic neuroscience and neurology. The text includes introductory remarks associated with contemporary concepts related to motor function. Each chapter contains a listing of recommended readings and references, thereby permitting the reader to increase knowledge in a particular area. All chapters include illustrations and tables that are complementary to the text. The textbook is recommended for students in various health care professions and for health care professionals as a basic reference. The reader would need to go to other texts for contemporary theories of motor control as they apply to clinical conditions.

Roberta A Newton, PT, PhD Temple University Philadelphia, Penn

Dr Newton is Associate Professor and Director of Advanced Graduate Studies in Physical Therapy. She has presented and written research articles on balance abilities in the individual with brain injury and on topics in geriatrics.