Traumatic brain injury (TBI) is a complex clinical entity with increasing prevalence1 that can impose impairments in a number of functional domains, necessitating care by a wide variety of professionals, including emergency department physicians, rehabilitation neuropsychologists, social workers, and intensive case managers. In addition, consequences of TBI can span the physiological, psychological, and social domains, raising a plethora of issues that professionals must understand to provide survivors with adequate care.
Few available texts address the full range of these issues. Now, the Manual of Traumatic Brain Injury Management joins their ranks. The Manual is a comprehensive, pocket-sized primer with 69 consistently clear, concise, and data-driven chapters that cover an impressive number of issues pertinent to the management of TBI. In addition, chapters are arranged so as to reflect those issues that are pertinent at different points along the typical postinjury timeline; that is, issues pertaining to diagnosis and acute care are addressed early, whereas those related to postinjury adjustment and psychosocial reintegration appear late. This organization should appeal to a wide audience, facilitating understanding for those unfamiliar with TBI issues while also providing an intuitive structure to make desired information readily accessible to experienced professionals.
The Manual begins with an introductory section that provides a good overview of TBI definitions and nomenclature to provide the reader with a framework within which to understand the rest of the volume. Epidemiology and primary prevention of TBI are then discussed, followed by 16 rich chapters focusing on mild TBI (mTBI) and related issues, for example, management and evaluation, sports-related injury, multiple impacts, and neuropsychological evaluation. This section clearly illustrates the heterogeneity of sequelae in mTBI but is especially notable for its lucid presentation of the controversies surrounding mTBI, including ongoing efforts to develop more valid diagnostic criteria, as well as for a chapter on neuroimaging in mTBI that includes rich, full-color photographs to enhance readers' understanding of advanced techniques, such as diffusion tensor imaging and single-photon emission computed tomography.
A section on moderate to severe TBI covers all topics one would expect from a compendium such as this: field assessment; emergency care; neuroimaging and neurosurgical techniques; early intervention for secondary conditions such as seizures and swallowing problems; each of the "big 3" rehabilitation therapies (occupational, physical, and speech) in separate chapters; neuro-optometric rehabilitation; and management of cognitive and behavioral symptoms. Equally well done are chapters on a number of less expected and highly valuable topics, including guidelines for prognostication, pain management approaches, nutritional considerations following TBI, postinjury sexuality, and community integration.
The Manual continues with a section covering secondary medical conditions that is a good reference for physicians and allied professionals. Highly prevalent and well-described complications, such as hydrocephalus, posttraumatic seizures, and chronic headache, are addressed, as are conditions that have been identified more recently, including TBI-related endocrine dysfunction and sleep disorders.
What follows is an especially praiseworthy section on TBI resources that will serve as an excellent primer for social workers and case managers as well as zealous rehabilitation psychologists hoping to gain information about practical issues in the care of those with TBI, including caring for Workers' Compensation patients, helping patients develop life care plans and other healthcare documents, and addressing medical-legal considerations in treatment. This collection of chapters succeeds very well in giving readers a flavor of the challenges that TBI survivors face in their efforts to return to activities of daily living after injury.
Special TBI-related issues, such as alcohol misuse, injury in older adulthood, military service injuries, and resources available for injured military personnel are then addressed. Standouts in this section include a chapter describing complementary medicine approaches for treating TBI-related symptoms as well as a chapter on return to work. But, perhaps, the most notable entry in the Manual comes in the final chapter: an account of living with brain injury written by a TBI survivor. The chapter vibrantly describes the at-once challenging and transformative process of recovery from TBI, adding a human element to fully round out the multitude of perspectives and issues provided by this book.
As any good edited work of its kind should, the Manual does a fine job overall of directing readers to other published resources focused on specific issues. Most chapters conclude with at least 1 additional reading suggestion in each of the following categories: textbook or chapter, journal articles, and electronic references, most of which are focused, comprehensive, often seminal works.
It is truly a challenge to suggest additional content for a book as comprehensive as the Manual, though a small number of issues were left unaddressed. Coverage of these will hopefully appear in future editions and only improve a book with already tremendous breadth. For instance, the existence of chronic post-mTBI cognitive and functional changes due to iatrogenic and/or psychogenic reactions is acknowledged but once and fleetingly. Despite the paucity of good literature on this issue, a phenomenon with such important implications for diagnosis and treatment is deserving of far greater emphasis. In addition, chapters or sections highlighting diagnosis and management of postinjury psychosis and TBI-related deficits in self-perception (eg, lack of awareness [agnosia] or indifference [anosodiaphoria] toward impairments) are missed. The chapters describing neuropsychological evaluations of persons with TBI will be helpful, especially for those without firsthand experience. However, a notable omission is a chapter describing how neuropsychological impairments typically translate into problems with everyday functioning.
Overall, the Manual provides an excellent road map to the many topics relevant in the diagnosis, treatment, and long-term management of individuals with TBI. As such, the book can serve either as a fine introduction for the uninitiated or as a valued reference for seasoned clinicians. I highly recommend the Manual to whoever encounters individuals with TBI in the course of his or her professional practice.
-Jason Krellman, PhD
Mount Sinai School of Medicine
New York, New York
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