Rehabilitation for Traumatic Brain Injury. Walter M. High, Jr., Angelle M. Sander, Margaret A. Struchen, Karen A. Hart, eds. New York: Oxford University Press, 2005. 368 pages, $69.50, hardcover: ISBN 0-195-17355-4.

Although it might seem that there has been almost a plethora of books on brain injury rehabilitation in recent years, making it difficult to come up with new thinking in this area, this latest book covers some topics that are not routinely included in the other books on this topic, thus making it a useful addition to one's personal collection. For example, there is a chapter on substance abuse by John Corrigan, one on multicultural perspectives by Jay Uomoto, and another on neuroimaging and rehabilitation by Harvey Levin and Randall Schiebel. The book is in 5 sections: the first supplies an overview containing the history of rehabilitation and a discussion of the effectiveness of traumatic brain injury (TBI) programs; the second covers the traditional topics, namely rehabilitation of specific cognitive deficits; the third discusses factors affecting outcome; the fourth deals with specific populations (children, older adults, and multicultural perspectives); while the final section addresses medical topics, concentrating on pharmacological management of spastic hypertonia, an area that as far as I know has never been written about in other books on TBI, the rehabilitation of people with disorders of consciousness, and the aforementioned chapter on neuroimaging. Besides inclusion of topics not found in other publications in this field, this book's other strength is in its provision of discussions of peer-reviewed articles in most of the chapters, the studies themselves being rated as class 1, 2, or 3 according to the methodology employed. These constitute useful literature reviews.

I particularly welcomed the chapter on substance abuse as this is increasingly relevant to current rehabilitation practice. Corrigan, the author of this chapter, observes that about 75% of adults in brain injury rehabilitation programs are at risk of developing or resuming a substance abuse disorder. This large number is a surprise, and I wonder if these figures refer to the situation in all developed countries or whether they apply more specifically to the United States? I know that there are programs that exclude people with substance abuse problems, but the reality is that most of us would have very few clients if we followed this policy. A sad fact noted by Corrigan is that "While descriptive information is beginning to accumulate about the scope and nature of substance use and TBI, research on interventions for this problem is almost nonexistent" (page 145).

The chapter by Sander on interventions for caregivers is very informative and one of the best written in the book. It has depth to it, addresses an often-ignored topic, and has encouraged me to conduct my own research study comparing traditional help given to families at our rehabilitation centre with the additional help advocated by this particular author. In fact, I found myself nodding in agreement several times during my reading of this book. Boake and Diller's account of the history of rehabilitation concludes with a discussion of evidence-based studies. They say that "gaps between research findings and clinical practices may be hard to close. While researchers focus on theory-driven studies with narrow outcomes, rehabilitationists are confronted with patients who seldom show single impairments and have cognitive deficits in the absence of emotional problems" (page 10). This view is close to my own heart as argued in a recent article.1

I found myself also agreeing with Ylvisaker's view when he states, in his chapter on children, "When all is said and done, good clinical and educational decisions are not made on the basis of diagnostic labels, but rather on the basis of the individual's presenting strengths and needs, context barriers and potential supports, and informed, disciplined, person-specific hypothesis testing" (page 226). One of my favorite quotes from this chapter was that from Detterman (1993) who said, when discussing transfer of skills and information, "The lesson learned from studies of transfer is that, if you want people to learn something, teach it to them. Don't teach something else and expect them to figure out what you really want them to do" (page 216).

The disorders of consciousness chapter by Giacino was welcome. It is not the first book to include discussion of patients in coma or the vegetative or minimally conscious state, but it is true to say that until recently these patients were rarely considered in books about rehabilitation. Giacino suggests that the reason for this is "therapeutic nihilism," an apt phrase I thought. Attitudes are changing quite dramatically, however, as indicated by a recent special issue of Neuropsychological Rehabilitation on the subject of "The assessment and rehabilitation of vegetative and minimally conscious patients,"2 Giacino himself being senior author of the first article in this special issue.

One final thought-provoking chapter I wish to comment on is that by Malec on the subject of vocational rehabilitation. This author provides pertinent reasons why vocational rehabilitation counselors are not necessarily the best people to provide vocational rehabilitation for people with TBI. I also appreciated this author's table listing the characteristics of 2 different models of vocational rehabilitation.

Inevitably, some chapters are better than others, as is always the case with an edited volume, but my head nodded in agreement much more than it shook from side to side in disagreement, so despite minor grumbles about the occasional uncorrected typing error, and a friendly admonition to Prigatano for being too modest when he suggests that treatment of emotional and motivational problems has "not progressed substantially in the past 50 years" (pages 124/5) when so much progress has been made as a result of his own admirable work, I recommend this volume to psychologists, speech and language therapists, and occupational therapists working in the field of brain injury rehabilitation.

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