Traumatic Brain Injury: Rehabilitative Treatment and Case Management. 2nd ed. Ashley MJ, ed. Boca Raton, Fla: CRC Press, 2004.

Mark Ashley, ScD, a speech/language pathologist and founder/CEO of Centre for Neuro Skills (a postacute brain injury rehabilitation and assisted living center) has updated his 1995 book1 into this revised edition. The target audience remains the same-the broad range of professionals providing traumatic brain injury (TBI) rehabilitation and care services. However, this edition is substantially expanded in content and informed by recent advances in diagnosis and rehabilitation interventions. Moreover, it attends to the current healthcare environment, where earlier discharges, higher levels of acuity, and an increasingly restrictive managed healthcare system intersect with an aging TBI population that places increasing burden on caregivers and support systems. Ashley offers this book toward the goal of meeting increasingly restrictive healthcare trends and family burdens with an informative resource book of succinct and effective treatments.2,3

The substantially broadened purview of this multidisciplinary text is accomplished by the addition of 10 new chapters. Forty-three authors are included that are representative of the broad range of brain injury rehabilitationists, including at least 15 psychologists, 10 physicians, and a collection of specialists from speech, physical, occupational, and behavior therapy and case management. The book's 24 chapters are neatly organized into 3 sections: medical, allied health, and case management. Each chapter is organized with an outlined table of contents, an introduction, and a summary. The page numbering in the outlined table of contents is a valuable feature that allows easy access to specific material in the chapter.

The section examining medical themes includes 10 chapters and more than 300 pages. It begins with an explication of the neurologic exam, followed by a solid overview of posttraumatic epilepsy with thorough attention to important differential diagnostic considerations, models, mechanisms, and evidence-based anticonvulsant prophylaxis. A nicely current review of neurotransmission and its alteration through major medications used to modify neurologic and behavioral functions is followed by a chapter outlining prevalence, development, diagnosis, treatment, and prophylaxis of heterotopic ossification. An especially good chapter on posttraumatic vestibular dysfunction provides a cogent, holistic, useful review of anatomy, pathophysiology, examination, and rehabilitation. This is a very important but relatively neglected area that represents frequent delayed complications and persistent disability. Two more chapters offer a detailed understanding of the visual system necessary for an accurate diagnosis of deficits that can affect a wide range of functional abilities. A highly useful model for matching and organizing multidisciplinary nonsurgical visual rehabilitation is offered, along with illustrative case studies. Additional chapters succinctly review auditory function assessment and relevant neuromedical factors and the current research examining the potential interplay between TBI and other neurological conditions associated with aging. The final chapter in this section reviews neuronal changes and brain plasticity that underlie rehabilitation interventions that involve some of the major learning procedures and processes.

The section addressing allied health themes encompasses 10 chapters and over 300 pages. Three chapters in this section focus on the important area of assessment and rehabilitation of language and cognitive disorders. The first chapter explicates the basis for discarding predominant but disproved modality misconceptions and redirecting cognitive language therapy according to a better-supported cognition, codification, communication, and expression model. The other 2 chapters address principles and models of cognitive rehabilitation on the basis of the neuropathology of the hierarchical structure underlying basic and complex cognitive systems. A useful hierarchical, task complexing, bottom-top approach for remediating basic cognitive skills is illustrated. An applied behavior analysis chapter provides a practical illustration of systematic integration of general management guidelines, principles, and components for effecting desired behavioral outcomes, including case samples and ethical guidelines. A comprehensive and very useful review of evaluative and a management protocols (including forms and checklists) for common post-TBI residual physical deficits is included. In addition, there is a succinct overview of history, models, trends, and components of critically important post-TBI vocational rehabilitation services, and a chapter reviewing the rationale, components, and importance of recreation therapy. Another chapter provides a practical and useful illustration of cognitive-communication challenges and rehabilitative strategies for facilitating classroom learning and behavior for transition through the education system. A neuropsychological chapter helps differentiate the integrated process of assessment and its utility in ecologically valid prediction and rehabilitative recommendations from overidentification with its testing component. Finally, guidelines for evaluation following acute rehabilitation, adjusted for time-limited demands imposed by recent healthcare changes, are offered.

Section 3 reviews case management themes and represents an expansion from a single chapter in the first edition to a 4-chapter section of over 100 pages. It retains a review of the components and process of case management (eg, roles and responsibilities, funding sources and benefits, continuum of care, facility assessment). It adds discussion of litigation and settlement options, bioethical principles, and discharge planning. Useful suggestions and guidelines are offered for coordinating medicolegal and public collateral source benefits, and for the important components of discharge planning. Especially useful is the inclusion of checklists to facilitate problem identification and follow-up, and planning for activity, family and caregiver concerns; home adaptations, finances, additional rehabilitation services, etc. In addition, a thoughtful, well-referenced chapter offers guidance in applying the 4 core bioethical principles to many of the key issues in everyday rehabilitation practice as well as healthcare policy. Notably, this is an especially important section given shorter length of stays, decreasing financial resources, and an increasingly restrictive healthcare environment.

Overall, Traumatic Brain Injury: Rehabilitative Treatment and Case Management is a solid text that mostly accomplishes its intended purpose. It is unusual to find a book where virtually every chapter is a useful assessment and/or treatment overview, an informative summary, or a useful clinical reference or resource tool. The scope and quality of the chapters is their particular strength. The chapters succinctly and competently review most of the important contents of this field and I expect to use most of them as recommended readings for their respective topic areas. This is clearly one of the more useful single source of multidisciplinary texts in the fields of rehabilitative treatment and case management.

This strong edition is not without weaknesses. Caretaker needs, especially the psychoemotional burdens, were not addressed in similarly comprehensive or practical manner as the other important topic areas. An additional chapter dedicated to offering guides for assistance in coping with demands inherent to family caregivers seems warranted. It would have further strengthened this text's utility as an informative resource book of succinct and effective treatments to address an increasingly restrictive healthcare environment and increasing family burdens.

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