Rehabilitation After Traumatic Brain Injury. 1st ed. Blessen Eapen, David Cifu, eds. Elsevier; 2018. eBook ISBN: 9780323544573, hardcover ISBN: 9780323544566.
Among individuals suffering injuries that require rehabilitation, patients who have suffered a traumatic brain injury (TBI) are among the most complex and challenging to manage. Clinical decision-making in these cases is often thought of as more of an art form than an evidence-based practice, despite a significant amount of existing research has been conducted within the field. Clinical guidelines remain difficult to establish due to the broad heterogeneity of TBI patients as well as the inherent complexity of the relationship between the neurophysiology of the injured brain and alterations in neurocognitive, behavioral, and emotional function that patients exhibit. Much of the existing literature provides a great deal of information regarding brain injury, but often tends toward the theoretical, the observational, and the general. These resources provide ample food for thought and material for attempting to understand the nature of the brain and brain injury, but perhaps do not always answer the pragmatic, context-dependent question of how do I manage the issues I am encountering in this particular patient?
Rehabilitation After Traumatic Brain Injury manages to provide a succinct, yet fairly comprehensive, review of the state of the art of the clinical management of TBI patients. It is at its essence practical, with most chapters providing specific information regarding a range of medical and therapeutic treatment options, with guidance toward current recommendations based on practical clinical situations. I personally found that parts of many chapters in the book directly stated aspects of management that I had thought were only to be learned through gradual clinical experience and training with experts in the field, consolidating expert opinion and research findings into relatively brief, yet surprisingly thorough, explorations of relevant topics.
This book is divided into 18 chapters, discussing the range of TBI patient management throughout a spectrum of settings, from acute care to inpatient then outpatient and longitudinal rehabilitation. The first chapters of the book discuss early moderate-to-severe TBI patient management, including elements of neurosurgical acute care management that are relevant to rehabilitation physicians as well as common clinical issues that arise in the acute and early inpatient rehab settings for these patients. The next chapters then discuss special considerations for pediatric, geriatric, and military populations in these settings and throughout the TBI rehabilitation spectrum. Subsequent chapters then switch gears to cover the outpatient management of mild TBI/sports concussion patients as well as special clinical considerations regarding patients throughout the severity spectrum presenting with hypoxic-ischemic (anoxic) brain injury.
The next part of the book covers different aspects of TBI patient care more firmly within the rehabilitation setting, and includes chapters dealing with such topics as the neuropsychiatric sequelae of TBI, a comprehensive review of TBI pharmacology, the management of posttraumatic pain, neuroimaging and its role in TBI patient management, and special considerations for patients with disorders of consciousness. The final chapters discuss cognitive/behavioral interventions in the later outpatient course of TBI patient rehabilitation, a separate chapter for nascent technological interventions for the same, prognosis and outcome measures for TBI, and a discussion of community and vocational rehabilitation.
Each of these chapters is a very reasonable read in a single sitting, and many of the chapters include novel charts or outlines consolidating essential and useful information into an easily digestible and practical format for direct use. The authors of individual chapters include many well-known names within the TBI community and represent a range of individual management styles within a thorough consideration of evidence- and consensus-based practice.
Rehabilitation After Traumatic Brain Injury is succinct and to the point, yet it manages to contain a wide range of useful information for the management of TBI patients in practical situations. It fills a gap in existing literature through the provision of a text for those interested in TBI rehabilitation but not in a position to commit to the well-known major, reference textbooks regarding TBI. I feel that this book is an excellent text for a thorough introduction to TBI for the interested resident, the general physiatrist who finds him- or herself managing patients who have suffered a TBI, or for individuals on the path of fellowship training in the rehabilitation management of TBI patients. It is also valuable as a starting point reference for questions regarding TBI patients in a variety of situations on the floor or in clinic.
In summary, this book is an excellent synopsis of practical care for traumatic brain injury patients. While a few of the chapters wander into the general and observational (ie, less directly useful territory), a large portion of the material presented is realistically helpful in terms of specific guidance in physician management for the types of patients that one is likely to see when taking on the TBI population. I highly recommend this book for all but those who are already the utmost experts on the subject, although they may find themselves learning a thing or two from it as well.
-Samuel Clanton, MD, PhD
Hunter Holmes McGuire VA Med Center
Richmond, Virginia