Textbook of Traumatic Brain Injury. Jonathan M. Silver, Thomas W. McAllister, and Stuart C. Yudofsky, eds. Arlington, Va: American Psychiatric Publishing Inc, 2005. 792 pages, $99, hardcover: ISBN: 1585621056.
In their new Textbook of Traumatic Brain Injury, editors Jonathan Silver, Thomas McAllister, and Stuart Yudofsky have assembled an outstanding group of authors in the field of traumatic brain injury (TBI) rehabilitation resulting in a wonderful resource for almost all professionals in the area. It is unclear whether the editors meant this text to be the "second edition" of their 1994 book Neuropsychiatry of Traumatic Brain Injury. Although the editors make it quite clear in the preface that their focus is on neuropsychiatric issues in TBI, dropping "neuropsychiatry" from the title fails to acknowledge a significant limitation of the text-that it does not address the medical and physical management of TBI. Because of this, the text would not serve well as a primary reference for physicians and therapists managing the day-to-day neuromedical and physical issues following TBI. Nonetheless, the text is an extremely valuable neurobehavioral resource for the entire rehabilitation team.
After a thoughtful foreword by Sarah and James Brady, the text is laid out in 7 main sections with 2 to 9 chapters each. The first section contains 8 chapters comprising an impressively comprehensive discussion of the epidemiology and pathophysiology of TBI. Particularly noteworthy are excellent treatises on the increasingly important topics of structural imaging by Erin Bigler, PhD, and functional imaging by Karen Anderson, MD, and colleagues. Both chapters include several images in full color. An international authority in the area, Dr Bigler includes discussions on diffusion tensor imaging and brain-behavioral relationships. Dr Anderson includes sections on single photon emission computed tomography, positron emission tomography, functional magnetic resonance imaging, and magnetic resonance spectroscopy, with the indications, limitations, and a review of data from both the psychiatric and rehabilitation literature for each technology. The section is completed with solid discussions of epidemiology, neurosurgical management, and electrophysiological assessment, among other topics.
The next 2 sections cover neuropsychiatric disorders and symptoms. I was disappointed to encounter a surprisingly cavalier treatment recommendation for haloperidol in an otherwise excellent chapter on posttraumatic delirium. The remainder of the "Disorders" section includes familiar topics and names: mood (Robinson), mild TBI (McAllister), and aggression (Silver and Yudofsky), among others. Dr Robinson provides a succinct overview of mood disorders in TBI, including data from his group at the University of Iowa. He also includes a discussion of the often-overlooked impact of mood on functional outcomes. The chapter on aggression is well developed and logical in its presentation, including a more cautious discussion of haloperidol and emphasizing the use of third-generation antipsychotic agents. The "Symptomatologies" section is very practical since rehabilitation professionals will likely have etiological, diagnostic, and management questions related to a specific behavioral or cognitive manifestation: apathy, fatigue, chronic pain, decreased balance, visual deficits, headache, awareness, etc. The chapter on visual deficits fully addresses the pathophysiology and clinical presentation but includes little on the actual treatment strategies so poorly understood by most rehabilitation professionals, except occupational therapists.
The "Special Populations and Issues" section contains a thorough discussion of sports-related TBI, including sport-specific concerns (boxing, football, soccer, snowboarding, etc), the neurophysiology of concussion, on-the-field assessment, and return-to-play guidelines. Age-specific and substance abuse chapters complete the section. The "Social Issues" section covers the expected topics of family, ethical, and legal issues. The chapter on "Systems of Care" is provided by Drs Nathan Cope and William Reynolds. Both authors are very well known in the area and have a substantial body of experience with the clinical, financial, and public policy implications of care for persons with TBI.
The "Treatments" section addresses pharmacological, psychotherapeutic, cognitive, and behavioral interventions. In addition to an enlightening discussion on alternative and nutritional supplements, Dr Sliver and colleagues contribute a well thought out chapter on psychopharmacology. The treatment discussion is presented both by neurotransmitter (catecholamines, acetylcholine, etc) and by symptom (depression, cognitive impairment, apathy, post-traumatic stress disorder, etc). The text ends with a 2-chapter section on "Prevention," including a superb discussion from the Traumatic Brain Injury Laboratory at the University of Pennsylvania on the clinical and experimental efforts to identify acutely administered pharmacological agents to ameliorate the sequelae of TBI.
Overall, the editors have synthesized a marvelous textbook focusing on the behavioral and cognitive aspects of TBI. In the next edition, serious consideration should be given to choosing a title that emphasizes its neuropsychiatric focus. The editors anticipated that each chapter would "stand alone," even at the risk of some redundancy in the text. The readability and clinical usefulness of the final product more than justifies this tradeoff.
-Michael W. O'Dell, MD
Associate Chief, Department of Rehabilitation Medicine New York-Presbyterian Hospital, New York, NY
Professor of Clinical Rehabilitation Medicine, Weill Medical College of Cornell University Adjunct Professor of Clinical Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York, NY
Adjunct Professor of Clinical Rehabilitation Medicine Columbia University College of Physicians and Surgeons, New York, NY