Starting Again: Early Rehabilitation After Traumatic Brain Injury or Other Severe Brain Lesion.

This is the third book written by Patricia Davies, a physical therapist with 30 years of experience working with patients who are neurologically impaired. Her prior books, Steps to Follow and Right in the Middle, address rehabilitation strategies for patients with stroke based on the concepts of Berta Bobath. The purpose of Starting Again is to provide therapeutic interventions for use by all those involved in die care of people who have sustained brain injury. The author feels strongly that secondary complications must be overcome and that those individuals with brain injury can progress with a positive approach and meaningful tasks facilitated by nurses, therapists, and family members.

The book consists of seven chapters, references, and a subject index. Over 600 excellent photographs of actual patients illustrate step-by-step treatment techniques. Case histories are used to emphasize the successful outcomes based on the perseverance of patients and therapists to systematically address contractures, postural deviations, and abnormal movement patterns.

Topics covered include disturbances of tactile input, bed and wheelchair positioning, moving in bed, neck and facial mobilization, facilitation of speech, management of heterotopic ossification, early standing, and ambulation training. The author also addresses turning that gradually incorporates active movement and decreases abnormal extensor tone for the patient who is unconscious and in the intensive care unit. Required materials, special considerations, and specific instructions for fabrication of serial casts and posterior standing supports are outlined. Selective movements, weight shift, and trunk control exercises that can be practiced as patients become more active and alert are detailed.

The author's belief that "the right treatment really does make a difference" is well substantiated in this book. She succeeds in providing a comprehensive and clinically relevant text for those persons working with individuals who have a brain injury and are in acute and rehabilitation settings. Some ideas, such as therapeutic guiding and eating techniques, are thought provoking and emphasize a patient-centered, multidisciplinary approach. I recommend this book not only for physical therapy practitioners, but also for other health care professionals that comprise the rehabilitation team.

Bonnie Bauer Swafford, PT Univ of Kansas Medical Center Kansas City, Kan

Ms Swafford is the director of the physical therapy department at the Univ of Kansas Medical Center, which provides services in areas including inpatient acute care, outpatient clinics, and general and traumatic brain injury rehabilitation.