The Rehabilitation of Executive Disorders: A Guide to Theory and Practice. Michael Oddy, Andrew Worthington, eds. Oxford University Press, 2008. 380 pages, $74.50, paperback: ISBN 978-0198568056, Reviewed by Patrick Swift, PhD, NYU School of Medicine.

The rehabilitation of executive disorders can be an exceptionally daunting task for brain injury survivors, clinicians, and family members alike. The elegance of Rehabilitation of Executive Disorders: A Guide to Theory and Practice by Oddy and Worthington can be found in its depth and thoroughness in addressing this challenge. It is an outstanding interdisciplinary text, and a remarkable one at that for being so comprehensive in just 380 information-packed pages. The book was written for both the emerging rehabilitation professional as well as the seasoned clinician wise enough to evaluate his or her own practice and decide whether it is consistent with current best practice.

The editors point out that "the concept of dysexecutive syndrome is still commonly used, but the notion of a discrete unitary syndrome is no longer tenable. Executive disorders is preferred because it implies a range of disorders rather than a single dysfunction or syndrome," page vi. From this paradigm-shifting perspective, the reader is presented with theoretical developments and evidenced-based models that can have a profound impact on a clinician's work addressing this challenging problem.

The Rehabilitation of Executive Disorders is divided into 4 parts written by leading researchers and clinicians. The first supplies information on cutting-edge theoretical developments in the field; the second addresses therapeutic interventions for executive functioning disorders from a wide array of disciplines spanning rehabilitation neuropsychology, physical therapy, occupational therapy, and vocational rehabilitation; the third encompasses professional issues ranging from psychopharmacological management for individuals with executive disorders to medicolegal considerations such as assessment of capacity and risk management; and the fourth is a moving personal account of an art therapy student who sustained a traumatic brain injury.

The first chapter of Part 1 (Theoretical Developments) presents a comprehensive theoretical framework for the rehabilitation of frontal lobe dysfunction centered on 4 areas of impairment: energization, executive dysfunction, behavioral/emotional dysregulation, and metacognition. The next chapter, on cognitive reserve, discusses issues related to neural reserve and neural compensation that have powerful implications for our understanding of neuroplasticity and neurorehabilitation. Chapter 3, by the editors and Elizabeth Francis, reviews the current concepts in motivational disorders following brain injury and offers a practical framework for understanding and managing these disorders. These chapters are useful not only to emerging and seasoned professionals, but also as a teaching tool for graduate students.

Moving to treatment issues, Part Two (Rehabilitation) covers a variety of clinical interventions of interest to professionals across disciplines ranging from pharmacotherapy to the use of technology. Chapter 4 provides an excellent overview of rehabilitation for executive functioning deficits followed by a chapter on the rehabilitation of prospective memory deficits resulting from acquired brain injury. Chapter 5 discusses the use of the Multiple Errands test as a therapeutic instrument, which has promising utility. Chapters 6 and 7 address assessing and treating patients with aggressive behavior, from identifying the neurobiological, cognitive, and functional underpinnings of aggression and how to assess and treat it to utilizing a practical approach to assist patients with emotional aggression on the basis of 2 levels of treatment: skill building and anger management. Going further into the clinical spectrum, there are 4 chapters addressing communication deficits, motor recovery, activities of daily living, and return to work for individuals with executive disorders. Chapters 13 and 14 address the advances and shortcomings found in the use of smart technology for individuals with brain injury, with a particularly interesting review of the advances in the use of virtual reality in rehabilitation.

Part 3 (Professional Issues) addresses some of the challenging situations that clinicians working in this field have to face, such as pharmacotherapy for executive disorders, assessing capacity for patients with executive disorders, and managing risk in these patients, although the topics covered are not exhaustive. Rickards presents 3 broad areas that can be addressed in the psychopharmacological treatment of executive disorders including problems with inhibition; problems with drive and initiation; and problems with organization, concentration, and mental focus. Chapter 16 addresses matters of assessing capacity with very helpful case vignettes provided. In chapter 17, Worthington and Archer wisely point out that"...effective management of risk is a delicate balancing act-one that improves with practice and should not be undertaken without a suitable safety net." Reading their chapter is one way of reinforcing one's "safety net" to limit professional liability and improve patient care. Chapter 18 addresses the experiences of brain injury survivors with executive disorders and those of their families. Chapter 19 deals with the much overlooked and underfunded matter of training support staff in the residential setting such as nurses' aides and home health attendants to work with patients who have executive disorders.

Finally, the last word is given to a brain injury survivor in Part 4, who brilliantly and eloquently depicts not only how a brain injury has impacted her own life, but also how clinicians caring for these individuals may better anticipate, understand, and address their needs. I applaud the editors' inclusion of a first-person narrative on the experience of living with executive dysfunction and wish more professional texts would make this laudable effort. Although this book is an excellent resource for seasoned professionals and students alike, this contribution by Ms Cook is a gem. It puts this book squarely in the center of the patient-centered care that providers and programs aim to achieve. As a reader, I found myself wishing that her story had been placed first instead of last.

For me, reading this book was like sitting around the table with fellow members of an interdisciplinary team and hearing what they had to say on the basis of best practice and a solid theoretical understanding of the problems that patients with executive disorders experience. The Rehabilitation of Executive Disorders is an excellent text and one that has utility for all clinicians who concern themselves with caring for these patients.

Patrick Swift, PhD

NYU School of Medicine