Medical Management of Adults With Neurologic Disabilities. Adrian Christian, ed. New York: Demos Medical; 2009. 448 pages, $95.00, ISBN-13: 978-1-933864-45-7, ISBN-10: 1-933864-45, EISBN 978-1-935281-03-0.
Clinicians caring for individuals with underlying neurologic impairment have a difficult task, given the complexities of the effects of neurologic injury on both the mind and the body. From the perspective of the primary internal medicine consultant for individuals with brain injury at McGuire VA Medical Center in Richmond, Virginia, I reviewed Medical Management of Adults With Neurologic Disabilities in hopes that it would provide me with a useful reference for managing common issues that I face each day on the inpatient rehabilitation unit and in clinic.
Although it is a tall task to take all forms of neurologic injury and disease across the spectrum of inpatient, outpatient, and transitional care settings and incorporate it into one cohesive text, Adrian Christian did a good job of selecting the important relevant issues, as well as recognizing important overarching themes that characterize the manner in which neurologic impairment can impact medical status and the treatment process. The book comprises a collection of 31 chapters written by subject matter experts and reviews pertinent anatomy and physiology and includes general recommendations for medical care. Included are chapters on autonomic dysreflexia, dental care, nutrition, gastrointestinal, genitourinary, cardiovascular, and respiratory complications, pharmacology, sexuality, sleep, vision, pressure ulcers, respiratory and urinary tract infections, musculoskeletal pain, and substance abuse and separate chapters on psychiatric complications in spinal cord injury and traumatic brain injury, among the many topics covered. Obstetric and gynecologic concerns in women with neurologic disability are addressed. Also included is a chapter on preventive medicine in the context of neurologic disability.
In addition, there are crosscutting chapters on patient safety and the effects of the aging process in this patient population. Most of the chapters address the educational needs of patients and their caregivers with respect to the chapter topic, recognizing that because of communication and cognitive impairments often associated with neurologic disability, this patient population is at increased risk for adverse events due to miscommunication and misunderstanding of instructions and directions related to medical management. The chapters are well-written, rooted in evidence-based medicine, and are useful, although from a variety of different backgrounds and perspectives. It is clear that the editor has pulled together some of the more prominent clinicians in the field of rehabilitation medicine as contributors for this book, and, when necessary, opinions are offered as expert opinion.
With that said, the chapters have little in the way of cohesiveness relative to each other. The book should be organized by relevant organ systems, rather than alphabetically, which is not an intuitive ordering that follows from content. Furthermore, although there are contributions from more than 50 subject matter experts across a variety of spectrums, the vast majority of perspectives offered seemed like they were done so in isolation, rather than in collaboration with the authors of the other chapters. At times, this gave the book a rather disjointed and incoherent feel.
In summary, this book proves to be a well written and very useful reference for clinicians who manage those with neurologic disability. As Dr Christian notes in the Preface, adults with significant neurologic disabilities "are living longer and often productive lives" and thus can present with various medical complications to which their disabling circumstances can make them vulnerable with diagnosis and treatment potentially having to be adjusted to take into account the effects of their chronic neurologic condition. The stated goal is "to provide a reference that busy clinicians can refer to in the daily management of the medical problems faced by this population with the hope that this will ultimately result in improved health for their patients." Although this book would benefit from more organization and improved cohesion and consistency across the chapters, as well as a more systematic approach to the general subject matter, overall it functions very nicely in meeting its stated goal and can serve as a very useful, quick, and accessible reference for busy physicians who are involved in the medical management of this challenging patient population.
-Aaron D. Fox, MD
McGuire VA Medical Center
Richmond, Virginia
[email protected]