Neurogenic Communication Disorders: A Functional Approach. (2000). Edited by Linda E. Worrall & Carol M. Frattali. Thieme, 333 Seventh Ave., New York, NY 10001. 358 pages, $59. Reviewed by Hariklia Proios, University Hospital of Zurich, Switzerland.

This book gives an illuminating account of the functional aspects of neurogenic communication disorders. With contributions from leaders in their fields from around the world, this book focuses on current issues in neurogenic disorders, including aphasia, right CVA, and dysphagia. Like speech-language pathology itself, functional outcome measures are effective means to objectify the degree and scope of recovery. Nonetheless, for many years the study of functional outcome measures has been the affair of the individual with the impairment and not the practitioner at large. In the preface, the authors note that the most recent model of disablement-the Beta-2 draft of the International Classification of Impairments, Activities, and Participation (ICIDH-2)-provided the foundation for the organization of this book.

The book is arranged in five sections. Section 1 consists of six chapters. It includes an overview of functional communication assessment in specific populations. These chapters have useful information and make a great attempt to provide a broad overview of the small but relevant body of literature in this area. Section 2 provides an overview of functional communication therapy approaches. Although this section provides an interesting overview of real-life situations, it lacks a historical account of how functional therapy has evolved and what impact it has had on the communicatively disordered population at large. Sections 3 and 4 are easy to read. They contain eight entertaining chapters that describe the assessment and treatment of functional communication in various settings and with specific populations. These sections have useful anecdotal accounts of the contributors' work in the area. Finally, Section 5 provides a brief overview of future directions and research needs. What is interesting is that ICIDH-2 has revived the term functional communication-it is now embraced as the basic measurement of all therapy approaches in the area of communication disorders.

Perhaps a negative aspect of this book is that, although it provides an interesting overview of present day theories of functional approaches to communication disorders, it lacks historical analysis and critical evaluation of much past work. For example, the inclusion of many models and assumptions toward the end of Chapter 16 (Assessment and Treatment of Functional Communication) is not adequate by itself as these models are not always backed by scientific validation studies. For instance, it is true that interrelationships exist among cognitive communicative processes in right CVA, but as the authors admit "a functional orientation to treatment requires task specific materials that offer meaning to the patient." Such a statement does not give much insight into the methodological flaws in choosing and using deficit specific therapy materials (Weniger et al., Aphasiology 1(3), 1987). It would have been more interesting if the various models influencing functional therapy practice outcomes were described in conjunction with retrospective efficacy studies (Wertz et al. J. Speech Hear. Res. 24, 1981). The lack of reference to works of such scientists as Wertz, Howard, Chapey, and others is notable and unjustified given the fact that the practice of speech-language pathology has been ongoing for years. In addition, recent advances in the use of today's computer technology and language software programs could have been mentioned in the chapter on "finding, defining real life functionality today."

Overall, this book does provide insight into the functional approach and could be used as a supplemental textbook for graduate students in speech-language pathology and clinical practitioners. The authors take a broad view of subjects ranging from dysphagia to aphasia so that specific chapters could be used in teaching. Various clinical vignettes such as "the workplace and functional communication" could be used as illustrative examples of functional outcome efficacy.