Rehabilitation of the Severely Brain-Injured Adult: A Practical Approach.

This book is fifth in a series called I Therapy in Practice which will eventually include fifteen titles. The series editor, Jo Campling, aims the volumes at "therapists" in the broad sense of rehabilitation, and particularly includes occupational therapists, physiotherapists, and speech therapists. She also notes that certain titles would be of interest to teachers, social workers and all members of the rehabilitation team. This statement seems particularly true of this volume as the emphasis reiterated throughout the text is on the team approach when dealing with the rehabilitation of persons who are severely brain-injured.

The text includes eleven chapters as well as a very helpful introduction outlining the structure of the book and setting the tone for the coming chapters. The emphasis is a behavioral model for the rehabilitation of persons who are severely brain-injured. The introduction also states four points about which the reader should gain understanding: 1) rehabilitation techniques can be applied with success even in the most severe cases of brain injury; 2) a behavioral approach can help patients maximize their functional ability despite relatively fixed cognitive deficits; 3) behavioral disorders need not be a barrier to effective rehabilitation; and 4) a behavioral therapy approach can provide a model for interdisciplinary practice.

The opening chapter, "Models of Brain Injury Rehabilitation: From Theory to Practice," written by the text's editors, gives a nice overview of current models of rehabilitation, their shortcomings, theories of recovery, and sets up the reader to be very positive regarding a behavioral approach. Also discussed are the physiological assumptions on which other approaches are based. Readers from a non-medical discipline may want to keep their medical dictionaries handy. However, the authors are not being technical for the sake of being technical. In the long haul, it doesn't really matter if diaschisis or denervation supersensitivity is at play, but whether or not persons with brain injury can learn to feed themselves and thus enhance their independence and quality of life. The authors conclude that "rather than view the patient's deficits from the perspective of the cognitive impairments, and attempt to address these directly, it is possible to address the patient problems from the perspective of functional skills or behavioral change." An example given is to address the problem of washing or dressing directly, rather than the memory problem thought to underlie it. One of the longest and best chapters, entitled "Functional Skills Training," focuses on memory. Early treatment as the patient emerges from coma, managing memory dysfunction, a practical memory assessment, and overcoming memory deficits are all discussed. Later in the chapter, compensatory strategies for kitchen skills, shopping, mobility, and social skills are discussed in practical and usable terms. Very interesting case studies illustrating these points are scattered throughout the chapter.

Other interesting chapters are "Treating Communication Disorders in the Brain-Injured Adult," "The Psychological Management of Behavioral Disorders Following Brain Injury," and "Rehabilitation of Physical Deficits in the Post-Acute Brain-Injured: Four Case Studies."

The second to the last chapter is entitled "The Application of a Behavioral Model of Rehabilitation." This chapter discusses the effect of the time-honored techniques of the behavioral approach (i.e. shaping, modeling, prompting) on the brain-injured patient. It also addresses why behavioral management might fail. Under a passage headed Institutional constraints," it exhorts us to keep fighting the system and don't give up hope!"

The last chapter, entitled "The Future of Brain Injury Rehabilitation," is a brief summation by the editors and a discussion of the organization of patient care. The emphasis is on appropriate management using a team approach, and praises the transitional living center model.

The book's introduction notes that "this is not designed as a textbook." However, this reviewer feels the text would make an excellent adjunct to coursework and other readings in the education of future rehabilitation professionals. Professionals of any discipline engaged in working with the brain-injured would benefit from the practical and straightforward information presented in this book. Kyle Vohlken, CRC, CVE, Vocational Evaluator, Career Assessment Center, Holland, Michigan.