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Book Forum: Neuropsychiatry and Neurology   |    
Cognitive Neurorehabilitation
SANJAY GUPTA, M.D.
Am J Psychiatry 2001;158:670-671. doi:10.1176/appi.ajp.158.4.670
View Author and Article Information
Olean, N.Y.

Edited by Donald T. Stuss, Gordon Winocur, and Ian H. Robertson. New York, Cambridge University Press, 1999, 385 pp., $110.00.

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Brain dysfunction and resulting problems afflict a large number of patients and their families. These problems may occur following a variety of processes including normal aging, stroke, and degenerative conditions such as Alzheimer’s disease. This book is a comprehensive review of cognitive rehabilitation, bridging the various issues from basic science to clinical outcome. Theoretical concepts and methodological issues are reviewed systematically. It also provides a view of the future of cognitive neurorehabilitation, presenting the concept of "smart houses" that will use technology to help patients with altered brain function live independently.

This book provides an updated review of the concept of brain plasticity. In reading the first chapter I realized that there was a considerable degree of new information on the degree of brain plasticity. There is an excellent presentation of injury-related structural changes, including the concept of increasing connections of the surviving neurons. The book provides evidence to link dendritic growth with functional recovery. These new concepts, although quite complex in nature, are presented in an easy to understand fashion.

The chapter on intracerebral transplantation presents a powerful strategy to study plasticity and regeneration in the brain. Various techniques used in this area, such as animal models, lesion models, and fetal tissue implants, are discussed with reference to the cholinergic system in the brain. Despite the fact that these techniques are still in the experimental stages, the book provides hope and insights into the future.

Neuroimaging is a technique that has greatly improved our understanding of brain function in the recent past and continues to provide new insights into the brain. This book presents the application of neuroimaging to cognitive neurorehabilitation.

I was particularly impressed by the chapter on the psychosocial environment and the elderly, which presents practical strategies for reversing age-associated cognitive decline that could be applied to the aging population. This chapter presents a rehabilitation program that includes a psychosocial component to enhance feelings of control, cognitive training to teach practical strategies, and activities for overall well-being. These programs, in conjunction with those described in other chapters in the book focusing on training techniques to improve cognitive function in neurological patients, have significant potential for use in relatively healthy older adults.

I found the chapter on memory rehabilitation in the elderly and brain-injured people and the chapter on rehabilitation of executive disorders to be so fascinating that I skipped to them first. I think they would benefit clinicians from various disciplines. Techniques for improving problem-solving abilities, attention, and awareness are discussed very well. There is focus on the caregiver, an important component in the planning of care for these patients.

Traumatic brain injury accounts for the major share of costs for rehabilitation of neurological injuries in the United States. Chapter 18 presents the dilemma professionals face today between cost criteria and the lack of clear clinical guidelines and the fear that cost might prevail as the driving force in selection of those who receive rehabilitation. The importance of secondary mood disorders in patients with brain dysfunction is also presented in this book; these disorders need to be addressed for a comprehensive management of these patients.

High technology has been harnessed to improve the quality of life for patients with brain dysfunction. The use of "smart houses" was news to me. Technology is used in such houses to maintain independence for patients with cognitive impairments. The concept of a "neuro-page," a simple portable paging system that reminds memory-impaired individuals to complete certain tasks, was also interesting to learn about. The interactive task guidance system provides a set of cues to guide subjects through everyday tasks. This book gives an excellent overview of these concepts in the section dealing with brain-injured people.

This book is not exactly light reading, but it is easy to understand. It requires that attention be paid to the concepts presented, so they can be assimilated and used. Overall, the information in this book is excellently organized and covers the wide range of issues involved in cognitive neurorehabilitation. This book will be of immense value to professionals and paraprofessionals working in the area of cognitive deficits following brain dysfunction. It will be particularly useful to occupational therapists and physiotherapists, neurologists, psychiatrists, psychologists, neuroscientists, and those involved with basic science research.

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