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Rehabilitation for Traumatic Brain Injury
Reviewed by DONALD M. HILTY
Am J Psychiatry 2006;163:1845-1846.
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   edited by Walter M. High, Jr., Ph.D., Angelle M. Sander, Ph.D., Margaret A. Struchen, Ph.D., and Karen A. Hart, Ph.D. New York, Oxford University Press, 2005, 384 pp. $69.50.

Rehabilitation for Traumatic Brain Injury, edited by psychologists Walter M. High, Angelle M. Sander, Margaret A. Struchen, and Karen A. Hart, is a book compiled from the proceedings of the National Institute on Disability and Rehabilitation Research Conference in 2003. The book’s foreword states that the conference was called to present empirical evidence and determine the future of research. The context described includes a change in reimbursement from managed care and the need for more evidence involving interventions. The chapters are geared toward 1) concisely summarizing data on a topic, 2) pointing out methodological difficulties, 3) identifying key research questions, and 4) recommending directions for research. While it is not a criticism of the book, the heterogenous nature of traumatic brain injury etiologies makes its study very difficult. The book is published by Oxford University Press in 2005, consisting of 362 pages, 5 sections, and 16 chapters.

I would like to mention some highlights on chapters and sections as well as minor suggestions for changes in subsequent editions.

Chapter 1, Overview, has a nice historical review of the field of traumatic brain injury, including its roots in World Wars I and II. It overlooks the pharmacological revolution, though that is plagued by inadequate research itself. Chapter 2 focuses on the effectiveness of interventions. It is written well and would benefit from tables of scales and outcomes.

Chapter 3, Rehabilitation of Specific Cognitive Impairments, focuses on awareness deficits, memory, executive function, communication and emotional disturbances. This is relevant, but the psychopharmacological approaches—though undifferentiated—are not mentioned. Chapter 7 is direct about this omission, but could offer references for the reader. Most clinicians would agree that without pharmacological treatments, many patients are not in a position to do well with other therapies.

Chapter 8, Factors Affecting Outcomes, on substance issues is complete, relevant, and elegant in terms of proposing models of psychosocial and rehabilitation interventions. This chapter serves as a great example of how effectiveness research is needed, more so than efficacy research. Chapter 9, on caregiver needs, is excellent, except for the omission of a meaningful case and screening for mental disorders, which has been pivotal for patients with Alzheimer’s disease.

The chapters on Rehabilitation with Specific Populations are helpful to rehabilitation physicians and staff regarding the nuances of age and traumatic brain injury. The most outstanding chapter discusses ethnic differences and outcome data.

Chapters 14–16, Medical Topics, focus on narrow areas of interest such as spasticity, consciousness, and imaging. These chapters are well written, although the reader might be left wondering why day-to-day practical topics such as mood, anxiety, apathy, and amotivation are not mentioned.

The book addresses a critical need for more effectiveness, and, in my opinion, efficacy, research on the epidemiology, diagnosis (including comorbidities), and treatment of traumatic brain injury. It has nice emphasis on caregivers and ethnic- and age-based groups. It also mentions a need for neuroimaging research, in both evaluating traumatic brain injury and charting its course. The authors are clearly trying to move the field forward and spent a great deal of time preparing the chapters, with references being quite good, in general. Attention to psychological and rehabilitation principles is very good, and the capacity of authors to discuss research methodology and principles is impressive. The chapters are basically easy to read and some of the tables (e.g., Chapter 3 and 9) are outstanding.

Although the National Institute on Disability and Rehabilitation Research conference might have been interdisciplinary, this book apparently is not written in that spirit. Only one author is not a psychologist or rehabilitation specialist—that being a physician—and titles indicate that no other disciplines are included except for two educators. This speaks to the trouble with such conferences, study sections, and other proceedings that have too narrow a focus or few attendees. The result is a good analysis of some of the issues in the field of traumatic brain injury but without a clinical and practical orientation. Medical, psychiatric, and pharmacological data are sparingly included. One impetus for the book was to provide data to justify treatment for managed care, but the depth of the research questions (and time to complete them) coupled with little clinical focus may not be helpful in the short-term. Perhaps a clinical case per chapter would have also given grounding to the data and made it applicable to more readers. The chapters’ foci are interesting, but not comprehensive, and like most proceedings, do not capture the best part of such conferences, which is the integrative and interactive dialogue.

Rehabilitation for Traumatic Brain Injury is a good summary of psychological and rehabilitation issues related to traumatic injury. It is good for those interested in these topics, researchers, and rehabilitation staff. Residents in psychiatry, medicine, neurology, and rehabilitation may find it to be a nice primer to get up-to-date. The regular clinician in psychiatry may not find it to be very helpful, however. The psychiatrist interested in psychosomatic medicine would agree with much of its content but not find it extremely useful. Psychologists, social workers, and other interdisciplinary staff might find the book useful if planning to enter rehabilitation or if they are interested in applying data from this area to another area of medicine.




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