Since the first edition of the Textbook of Traumatic Brain Injury was published in 2005, traumatic brain injury (TBI) has taken an increasingly prominent place in congressional debates, news headlines, and dinner table conversations. Traumatic brain injury is referred to as the "signature injury" of the wars in Iraq and Afghanistan or as an "invisible wound" carried by more than 5 million individuals in the United States, who live with long-term physical and psychological impairments resulting from TBI.1 Traumatic brain injury is also known as a "silent epidemic" that afflicts an inestimable number of individuals who live with undiagnosed TBI. Sports fans who once used terms such as "dinger" or "getting your bell rung" have begun to appreciate the potential seriousness of "mild traumatic brain injuries (mTBIs)," though the term "concussion" is still commonly used. The relevant lexicon may continue to evolve and expand, but the current prevalence, incidence, and awareness of TBI in the United States is unprecedented.

The need for a second edition of the Textbook of Traumatic Brain Injury is reflective of the significant advances in research and clinical care that have been accomplished in this rapidly growing field. Historical perspectives, ongoing controversies, and remaining questions are discussed alongside new information, providing readers with a context in which to consider new advancements. This revision allows the Textbook to continue to serve as a resource for those clinicians and researchers who are interested in achieving or maintaining interdisciplinary fluency in clinical issues relevant to TBI. The book is divided into 5 parts: Epidemiology and Pathophysiology, Neuropsychiatric Disorders, Neuropsychiatric Symptomatologies, Special Populations and Issues, and Treatment. This volume contains thoroughly revised chapters (with few exceptions) in addition to several newly added chapters, all written by veritable experts in each content area.

Part 1 (Epidemiology and Pathophysiology) covers the growing repertoire of methods and tools used to characterize TBI, including structural and functional imaging and electrophysiologic assessment. The chapter "Epidemiology" provides updated information on the incidence, prevalence, and consequences of TBI in the United States. "Neuropathology" begins with a brief discussion of the inadequacies of existing TBI classification systems, and goes on to provide detailed descriptions and images of TBI-related pathology. "Genetic Factors" is a new addition to the volume; it discusses potential mechanisms through which genetic responses may account for differential outcomes after neurotrauma, while acknowledging the infancy and complexity of this area of study. The chapter on "Neuropsychiatric Assessment" includes a section on post-TBI endocrine dysfunction, appropriately addressing an often-overlooked issue. "Neuropsychological Assessment" provides a detailed overview of the methods and essential contributions of this clinical subspecialty to diagnosing, characterizing, and treating TBI-related deficits.

Contributors to part 2 (Neuropsychiatric Disorders) describe a range of clinical disorders associated with TBI. "Delirium and Posttraumatic Confusion" details a growing understanding of acute recovery after TBI. The chapter on "Mood Disorders" addresses the prevalence, functional impact, and treatment (pharmacologic and behavioral) of post-TBI mood symptoms. "Personality Change" aptly discusses the effects of TBI on personality, recognizing that these changes are often distinct from personality disorders. The chapter "Posttraumatic Stress Disorder" provides a thorough review of recent literature on TBI and posttraumatic stress disorder, with particular emphasis on the complex overlap of these conditions seen in many returning military personnel. Equally comprehensive is the chapter on "Mild Brain Injury," which gives a balanced overview of the clinical sequelae of mild TBI and discusses the factors that may be associated with slowed recovery or poor outcomes. Remaining chapters review psychotic and aggressive disorders, and posttraumatic epilepsy.

Part 3 (Neuropsychiatric Symptomatologies) includes chapters on a broad array of cognitive, behavioral, and physical symptoms often seen in TBI survivors. An understanding of these symptomatologies, which can have both neurologic and psychiatric features, allows the clinician to appreciate the diverse clinical manifestations of TBI. The chapter on "Cognitive Changes" describes the cognitive domains commonly affected by TBI, including more recent neuroimaging research that has advanced our understanding of the neuroanatomic and neurochemical underpinnings of these deficits. A brief section on the treatment of cognitive impairments focuses almost exclusively on pharmaceutical interventions, which unfortunately may create the misimpression that pharmacotherapy alone can effect lasting functional improvements in individuals with complex TBI-related deficits. "Disorders of Diminished Motivation" provides astute guidelines for assessment and differential diagnosis of motivational disorders. The chapter on "Awareness of Deficits" is a must-read for clinicians working with individuals with TBI, as it discusses the many dimensions of unawareness after TBI and their implications for treatment and outcomes. The chapters on "Sleep Disturbance and Fatigue" and "Headaches" discuss the prevalence and potential mechanisms underlying diverse clinical manifestations of these symptoms and present pharmacologic and nonpharmacologic options for their treatment and management. Chapters "Dizziness, Imbalance, and Vestibular Dysfunction" and "Vision Problems" are equally thorough, and include a discussion of recent advances in rehabilitation of these symptoms. A holistic biopsychosocial approach to conceptualizing and treating pain after TBI is achieved in the chapter "Chronic Pain." The final chapter in part 3 deals with the often-overlooked but very important topic of "Sexual Dysfunction," providing a thorough review of neuroanatomic and neurophysiologic mediators of sexual function in addition to a brief discussion of relevant counseling and family planning considerations.

Part 4 of the text covers Special Populations and Issues, leading with a new addition to this revision: "Traumatic Brain Injury in the Context of War." The authors present the military's screening and TBI management protocols but do not discuss the limitations to these protocols (see "Epidemiology" in part 1). "Sports Injuries" is updated to include the return-to-play guidelines established in 2008 at the International Conference on Concussion in Sports, though the authors underscore the importance of dynamic assessment and individualized management. "Children and Adolescents" provides a nice review of the neuropsychiatric symptoms that can develop after TBI in children, with clinical vignettes to illustrate how these symptoms may present in young people. The chapter called "Elderly" is strengthened by a thorough discussion of age-related physiologic changes that can complicate the injury and contribute to poorer outcomes in this population. The final chapter "Alcohol and Drug Disorders" describes substance use as a cause of TBI, which warrants specialized treatment, but the authors do not discuss substance misuse that may develop in the years after TBI.

Part 5 (Treatment) rounds out this revised volume with an overview of the myriad modalities and targets of treatment after TBI. The chapter on "The Family System" addresses the long-term impact of TBI on the family and advocates for meaningful involvement of family members throughout the course of recovery. "Systems of Care" similarly highlights the long-term care needs of many TBI survivors, reviews funding sources and advocacy groups, and reiterates the importance of comprehensive care by a multidisciplinary treatment team. The chapter on "Psychotherapy" provides a nuanced and thorough roadmap for psychotherapeutic interventions that will be tremendously useful for novice and experienced clinicians alike. A historical perspective on cognitive interventions is provided in "Cognitive Rehabilitation," and the chapter describes the current state of the field's progress and remaining challenges. Other chapters address social services and public policy, pharmacological interventions for neuropsychiatric sequelae of TBI, interventions and supports to manage problematic behaviors, and a comprehensive overview of legal issues. The final chapter outlines "Complementary and Integrative Treatments," which have not been widely studied in TBI but may offer alternatives approaches when standard treatments are ineffective or intolerable.

Research and clinical practice relevant to TBI have come a long way in the last 7 years, and the Textbook of Traumatic Brain Injury chronicles this progress. Despite growth in the field, there continues to be a mismatch between the number of individuals with TBI and the number of clinicians who are well trained to treat them. This volume makes a laudable contribution to closing that gap. Many sections of this book would be well placed as core components of clinical training across multiple disciplines, but the Textbook is highly recommended for novice and seasoned clinicians alike. The chapters are concise and readable, each sufficiently comprehensive to be consumed as a standalone resource. Thorough indexing allows the reader to quickly find information on nearly every aspect of TBI. The authors, as leaders in their respective fields, translate discipline-specific terminology for wider audiences, paving the way for a truly interdisciplinary approach to identifying and managing TBI.

-Kristen Dams-O'Connor, PhD

Department of Rehabilitation Medicine

Mount Sinai School of Medicine

New York

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