Children With Traumatic Brain Injury: A Parents' Guide.

Schoenbrodt L, ed. Bethesda, MD 20817, Woodbine House, 2001, paperback, 493 pp, ISBN: 0-933149-99-9, $17.95.

This book is written primarily for the parents of children with a traumatic brain injury (TBI) secondary to a closed head injury. It follows in the footsteps of other parent guides published by Woodbine House (for children with cerebral palsy, Down syndrome, and spina bifida) and uses a similar format. This useful text describes each stage of recovery from TBI in detail, taking the reader from the acute care hospital to rehabilitation and community re-entry. Numerous clear diagrams and photographs of children engaged in a variety of activities as well as helpful reading and resource guides add to the appeal of this book.

Children With Traumatic Brain Injury is divided into 10 chapters written by a variety of health care professionals, including physicians, social workers, psychologists, and speech and language pathologists. The chapters are well written and clear and follow a similar format, that contributes to a sense of continuity throughout the book. Parents will find the empathetic style of the text and the parent statements at the end of each chapter to be very reassuring, and professionals may gain a new level of insight into the parents' perspective. The use of a single case study throughout many chapters allows the reader to see the practical application of the material covered and highlights the "typical" issues many families face during the recovery process.

The first chapter of the book provides an introduction to the structure and function of the central nervous system (CNS). This chapter defines relevant medical terminology and succinctly describes highly complicated neuro-anatomy and physiology in terms that most parents will understand. It also describes the mechanisms of brain injury and the various medical tests and scales that are used to classify the severity of brain injury. Overall, this chapter is well written and should help parents to better comprehend the issues facing their child. However, parts of this chapter were written in terminology that seems unnecessarily complex given the primary audience of this book.

Chapter 2 discusses medical and rehabilitation concerns and covers issues that are most likely to be of concern to physical therapists. Because this is the only chapter that discusses motor concerns in any great detail, I would have liked to have seen physical therapists and occupational therapists among the chapter authors. That being said, the author of this chapter does a thorough job of describing the rehabilitation process as well as the specific concerns that may arise, including neurological effects, abnormal muscle reflex activity, orthopedic problems, adaptive equipment, and other medical complications.

Chapters 3 and 4 provide a comprehensive summary of the psychosocial issues that parents, siblings, and the patients themselves must face following brain injury. Concerns and emotions that arise during the acute phase, the rehabilitation phase, and homecoming are thoroughly discussed and concrete suggestions for coping during each of these periods are provided. The authors of these chapters are to be commended for the way in which they balance sensitivity for the very real suffering of families with a sense of optimism for the future.

Chapters 5 through 8 discuss the behavioral, cognitive, and language sequelae of TBI and help parents and professionals alike to understand the complicated and sometimes frustrating behaviors that people with brain injuries exhibit. Because these chapters provide suggestions that can be used during therapy sessions to enhance learning and behavior, they may prove particularly helpful to physical therapists.

Parents will find the information contained in chapters 9 and 10 to be extremely helpful when they are planning their child's re-entry into school and the community. These chapters describe the general provisions of various public laws designed to protect people with disabilities from discrimination, including IDEA (Individuals With Disabilities Education Act) and the ADA (Americans With Disabilities Act). Specific information such as the special education process and samples of program modifications are included in chapter 9 and may help parents identify the types of accommodations they can request for their child. Chapter 10 also covers basic information regarding litigation and applying for Social Security income (SSI) and Medicaid, which may ease the financial stresses facing families following injury. Other important issues such as establishing guardianship, life care plans, and durable power of attorney are also discussed.

Finally, the resource guide to advocacy organizations and the suggested reading list found at the end of the book will be able to direct parents appropriately when more information in a particular area is needed.

In summary, this comprehensive book covers almost every issue that parents will face after their child's brain injury. It is essential reading for parents and should be found in hospitals, rehabilitation departments, and schools. Although it will not provide health care professionals with the detailed information needed to make treatment decisions, the general overviews should prove helpful, particularly when they are trying to find information that is outside their primary area of expertise.

Michelle Brodersen Broggi, PT, MS
Quinnipiac University
Hamden, Conn

Ms Broggi is Assistant Professor in the Department of Physical Therapy and is a doctoral student at the University of Connecticut. Her teaching, research, and practice interests are m pediatric physical therapy.