1. McCulloch, Karen PT, PhD, NCS

Article Content

Purpose: This text addresses rehabilitation issues after traumatic brain injury (TBI) through contributions from more than 50 authors on a wide range of topics. As the text has evolved since its first edition 14 years ago, new topics have been added that extend the breadth of the text, somewhat to the detriment of maintaining a cohesive whole. The text draws expertise from a mix of academicians and individuals working in rehabilitation, many from the Centre for Neuro Skills, a postacute TBI rehabilitation enterprise for which the editor is founder and chief executive officer. The combination of academic authors with individuals who are "in the trenches" delivering care on a day-to-day basis makes for diverse perspectives that are beneficial.


Audience: The audience for the text is not described in preface, but the organization of the book in sections addressing medical, allied health, and case management perspectives suggests a focus on rehabilitation professionals who provide or manage care for survivors of TBI.


Organization/Structure: Thirty-one chapters are organized into major sections titled medical themes (14), allied health themes (13), and case management themes (4). The designation of chapters between medical and allied health themes seems somewhat arbitrary, with some intervention topics (eg, both balance and visual dysfunction rehabilitation) falling under the medical category instead of the allied health theme. Several chapters appear a misfit for the book in general, including 1 on "The TBI Literature: Scholarship" and another on "Ethical Challenges in Funding Treatment and Care in TBI: An Argument for National Health Insurance." While there are many topics of significant interest, the sequence of their presentation is sometimes unexpected and detracts from the flow of the text (eg, Chapter 21 addresses neuropsychological interventions, but the neuropsychological evaluation is not addressed until Chapter 26).


Information: New information drafted for this edition includes topics as diverse as metabolic and bioenergetic factors, blast injury, ethical issues, dietary and exercise factors, and intervention for the minimally conscious patient. The editor is clearly enthusiastic in authoring chapters that address the complexities of cognitive impairments after TBI and the potential for neuroplasticity to contribute in functional improvements. The "Medical Theme" section of the book does not comprehensively cover medical issues post-TBI but does provide an in-depth analysis of such challenging issues, such as posttraumatic seizures, neurobehavioral manifestations of blast injury, and pituitary dysfunction. Key impairments that influence function, including vision, auditory, and balance function, are addressed in this section, although the chapter on balance disturbance may have been better titled "Vestibular Dysfunction and Rehabilitation."


"Allied Health Themes" focus on cognitive and behavioral dysfunction and rehabilitation, physical deficits, issues related to school participation, the roles of vocational rehabilitation, and therapeutic recreation in recovery from TBI. These chapters offer a historical perspective on intervention as well as a description of current practice. One of the most valuable parts of the book is the chapter on applied behavioral analysis that provides a comprehensive summary of approaches used in postacute rehabilitation, with many case scenarios and practical solutions. The chapter addressing return to school issues is also very practical, highlighting key issues for children and adolescents.


Throughout the text, there are chapters on very similar topics that are presented by authors from different backgrounds (eg both an MD and optometrist writing on visual impairments and rehabilitation; 5 chapters that address cognition, neuropsychology, or cognitive rehabilitation from different perspectives). While views shared by different disciplines are interesting, this approach creates some unnecessary redundancy that might have been remedied by collaborative writing teams combining clinician writers with academic experts.


There are several chapters that cover topics that might be better designated as "emerging concepts" so that the speculative nature of the chapter is clearly defined. "Bioscience Frontiers in Neuromedical Interventions" describes neuroendocrinimmunology and emerging interventions that could hold promise for future care, as does "Therapeutic Potential of Diet and Exercise on Brain Repair," even though the evidence cited is from animal literature and other populations besides TBI.


The final section of the book, "Case Management" themes, is particularly instructive to describe the complexities of long-term issues after TBI. Chapters address external case management, issues with litigation and settlement, funding for health care, and discharge planning.


Summary: This text covers many topics of interest to therapists who specialize in the care of individuals with TBI. Sections of the text are outstanding, but the organization of the text as a whole, and the inclusion of multiple chapters covering similar topics reduce its usefulness somewhat. For the physical therapist reader, the text offers insight into the role of other disciplines in rehabilitation but maintains a fairly narrow impairment focus on physical function. As a resource for professionals working in postacute rehabilitation, the text has value, since many of the authors draw from their experience in that context.


Karen McCulloch, PT, PhD, NCS


Professor and Assistant Director for Distance and Continuing Education


University of North Carolina at Chapel Hill


Chapel Hill, North Carolina