Cognitive and Behavioral Rehabilitation from Neurobiology to Clinical Practice. Jennie Ponsford (editor). New York: Guilford Press, 2004. 349 pages, hardcover: ISBN 1-57230-990-3.

This book is a "must read" for rehabilitation neuropsychologists and cognitive remediation specialists. Dr Ponsford, with the assistance of the chapter authors, summarizes in a single text what would otherwise require multiple texts and manuscripts to achieve. Summarizing information about physiological events associated with brain disorder and recovery is a daunting task in itself, magnified further by summaries of interventions in multiple areas of cognitive disorder. This is an ambitious undertaking that is accomplished very well.

There is a profound need for books such as this. Dr Ponsford sets the stage in the introduction by stating, "Unfortunately, however, these bodies of work in human rehabilitation, animal studies of mechanisms of injury and repair, and the development of the cognitive neurosciences have been conducted in parallel, with minimal communication between them." Many neuropsychologists and cognitive remediation specialists have forsaken detailed study of the structure of the nervous system and have even less knowledge concerning the physiology of the CNS. It seems sufficient to many that a practitioner is able to comprehend CT and MRI reports. Learning about structure and physiology of the CNS is difficult. The readings are often dense and involve terminology that is alien to the typical cognitive practitioner. However, physiology, including neurochemistry, is the pathway of injury and neural repair that is the basis for the practice of neuropsychology and cognitive remediation. As eloquently stated by Bryan Kolb, "The structure of the brain is not incidental to its function." This text, particularly in the chapters by Bryan Kolb, is able to explain complex processes and concepts in basic terms that the average practitioner will find very readable. Out of necessity there is simplification, but interested readers can obtain more information by examining the referenced articles.

The book takes a step into somewhat uncharted territory by trying to meld the structure and physiology of the brain with the cognitive deficits that result after injury and with the cognitive remediation strategies presently in use. This is a Herculean task that is better accomplished in some chapters more than others. The chapter "Disorders of Spatial Orientation and Awareness" by Anne Aimola Davies provides a good example of what Jennie Ponsford is trying to accomplish. There is a detailed review of models of attention followed by a review of the neuroanatomical and neurophysiological basis of disorders in the attention system, with a concluding section on rehabilitation of attentional disorders. A similar format is evident in other chapters ("Disorders of Memory" by Elizabeth Glisky, "Rehabilitation of Nonspatial Attention" by Jennie Ponsford and Catherin Willmott, and "Disorder of Executive Functioning and Self-Awareness" by Gary Turner and Brian Levine), but not to the same level of detail found in the chapter by Davies. The chapter on language disorders by Stephen Nadeau and Leslie Gonzalez Rothi is somewhat of an outlier because it does not follow this format and basically focuses on a single theory of language (parallel distributed processing). The in-depth explanation of the theory is enlightening, but it does not appear to fit the theme of this text. The information provided in this book refers to brain disorder in general. The most specific reference to traumatic brain injury (TBI) comes in a concluding chapter by Jennie Ponsford that is very general in describing rehabilitation following TBI and highlighting important principles. Even if the primary focus of this book is not TBI, the contents are of major interest to those engaged in rehabilitation of people experiencing TBI.

While this book is excellent in many respects, it also underscores the breakdown in theory and practice that bedevils cognitive rehabilitation. More information is surfacing daily regarding the physiological aspects of brain injury and recovery. This is very heartening to all of us, but it is difficult to make sense of the information without a theoretical framework that transitions basic neuroanatomical information into rehabilitation and behavioral outcome. At present, theories abound, but there is a lack of consensus. In the absence of a dominant theory, it is difficult to proceed to the next steps, which involve assessment and remediation. As a result, the newest findings about recovery of the CNS are not easily translated into remediation techniques, which will likely involve combinations of pharmaceuticals and cognitive remediation. We cannot yet adequately guide remediation efforts, at least to the extent that we would desire, on the basis of our developing understanding of brain physiology in the presence of injury. It would be inappropriate to fault Jennie Ponsford and the chapter authors for this shortcoming. The tantalizing promise inherent in this text is enough to warrant careful reading. This book is an excellent way station on the path, and hopefully future works will take us further.

Tom Novack, PhD, ABPP-CN

University of Alabama at Birmingham, Birmingham, Alabama