Rehabilitation for Traumatic Brain Injury: Physical Therapy Practice in Context.

Rehabilitation for Traumatic Brain Injury: Physical Therapy Practice in Context

Campbell M. Philadelphia, PA 19106-3399, Churchill Livingstone Inc, 2000, hardcover, 271 pp, illus, ISBN: 0-443-06131-9, $39.95.

The book's subtitle truly describes the theme that is threaded through each chapter: physical therapy in context. The author represents the physical therapist as one element in the multifaceted rehabilitation of people with a traumatic brain injury (TBI). Through her own experience as a physical therapist working at the Head Injury Rehabilitation Center in the United Kingdom, Ms Campbell shares her expertise in and impressions of effective TBI rehabilitation.

The book gives an overview of TBI, and discusses the impact of the traumatic incident on the patient's life. She says that therapists must consider the previous life experiences, personality, social life, family roles, and life goals of the patient with TBI as well as those of the patient's family and friends. The book is explicit about the importance of collaboration among the members of the rehabilitation team (which includes the patient, family, friends, and medical professionals) for effective patient care and for the general advancement of TBI care, a collaboration that is achieved through shared knowledge and expertise.

The book then outlines a holistic patient examination in which information is gathered by the rehabilitation professionals and discussed by the team before goals are set or treatment commences. This facilitates a coordinated effort and focuses the team on the patient's priorities. The structure of the therapy program is based on these priorities; therefore, it is quite interesting to note that physical therapy sessions may occur every day if the physical issues are most important, or they may be postponed if other problems take precedence. The book describes possible findings in each examination area and some standardized tests are mentioned, particularly from the areas of psychology, speech, and language. I would have liked to read about the validity of these tests in more detail (along with some sample results and what they mean) without having to look up the references listed at the end of the chapter.

When planning the more specific therapy goals and treatment interventions, the therapist will want to influence future functional outcomes positively, such as facilitating useful movement strategies for use in bed mobility or walking. The therapist will also want to prevent any potential negative changes such as contractures. The book does not promote any particular intervention to accomplish this task, but it encourages therapists to use a variety of approaches while expanding their knowledge base by reviewing new research that may support or refute current practice.

The success of the physical therapy program is also influenced by many other nonphysical factors, such as the patient's cognitive limitations or behavioral difficulties. One chapter addresses these concerns, specifically controversial questions such as consent to treat patients with cognitive dysfunction and the management of patient behavior during a physical therapy session. I was surprised that the Rancho Los Amigos Cognitive Functioning Scale was not mentioned, because this scale is widely used in the United States and provides categories that aid in the approach to patient behavior.

Each chapter of Rehabilitation for Traumatic Brain Injury begins with an excessively detailed table of contents. I did find the key points listed at the beginning of each chapter to be a helpful preview to the chapter, and these might be useful to someone who is using the book as a reference. The case examples help illustrate main ideas in practical applications.

I believe a physical therapist with some clinical experience would most likely enjoy this book as an introduction to TBI rehabilitation. It is not an exhaustive text, and it would not be as interesting to students or to therapists who are highly experienced in managing patients with TBI.

Janice Bohn, PT, NCS
Rehabilitation Institute of Chicago at
  Alexian Brothers Medical Center
Elk Grove Village, Ill

Ms Bohn is Physical Therapy Clinical Facilitator and clinician primarily responsible for rehabilitation of patients with neurological conditions.