Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment. R. P. Granacher. Boca Raton, FL: CRC Press, 2003. 501 pp, hardcover. ISBN 0-8493-1429.
Forensic issues associated with traumatic brain injury (TBI) are the focus of an increasing number of articles and books available to rehabilitation professionals. In Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment, the author attempts to provide "not only methods for clinical examination but also the forensic evaluation of traumatically brain-injured persons" (author's Preface). While the author intended to divide the information into 2 sections (ie, clinical and forensic), the result is a very comprehensive 3-fold overview of TBI, clinical assessment and treatment, and disciplined and supportable forensic applications.
The first portion of this book provides a detailed overview of TBI including the epidemiology and pathology along with a subsequent chapter focusing on the broad spectrum of neurologic, cognitive, and psychiatric difficulties that may develop. These 2 chapters are very thorough and could stand alone as a primer on the neuroanatomy, neuropathology, and primary and secondary symptoms associated with TBI. This section is followed by chapters focusing on the clinical assessment of TBI including systematic "how to" sections on obtaining appropriate history, completing a thorough mental status and neurologic examination, utilizing information from neuroradiological examinations and neurocognitive evaluations, and incorporating behavioral assessment.
Each of these sections includes a balanced overview of assessment techniques and their relative strengths and weaknesses. The behavioral assessment portion provides a good blending of the psychological, psychosocial, and community impact that TBI can have on survivors and their families. Again, the information provided is very complete while remaining clear and concise, allowing for easy reading and application. The section's closing chapter, framed around several case examples, provides a model for data analysis, which neatly integrates this clinical material. Also notable are descriptions of various pharmacologic agents used to treat neurobehavioral and neuropsychiatric problems as well as individual psychotherapy strategies, family interventions, and cognitive rehabilitation.
Strengths of this "clinical section" include the clear and concise format of information, strong distinctions between adult and pediatric populations, a practical and rehabilitation-oriented focus to assessment and treatment planning, a blending of information from a variety of disciplines, and very comprehensive reference lists.
The final section of this text focuses on forensic issues and applications. Basic forensic concerns including role differentiation, ethics, boundaries, and admissibility of testimony/evidence are addressed briefly as an introduction followed by an overview of detection of cognitive and psychological malingering using a variety of measures. The chapter "Causation, Damages, Outcome, and Impairment Determination Following Traumatic Brain Injury" is arguably the most useful in the book. The chapter's clear definitional narratives and many useful references regarding disability and competency determination are of great value. While the chapter is presented from a medical model utilizing American Medical Association guides, the resulting approach to impairment determination is very holistic and appropriate for both clinical and forensic settings. The text closes with a model for conceptualizing conclusions about causation, outcome, and impairment determination, and formulating a defensible forensic report.
Overall, Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment is an excellent resource for professionals working in the area of TBI whether or not the focus of their practice is in the forensic arena. The text provides a very thorough overview of TBI and a compelling data acquisition and analysis model to guide assessment and treatment. The forensic issues are presented in a very "user-friendly" mode and provide information pertinent to any one working with persons with TBI. An additional benefit of this book is that each chapter is written in a "stand alone" manner, allowing readers to pick and choose aspects of the text that fit their needs. For those who practice regularly in forensic arenas, the information may at first seem basic or introductory, but nuances of this book may provide important additional insights into advanced clinical forensic practice.