Book Review

Acquired Brain Injury: An Integrative Neuro-Rehabilitation Approach

N Engl J Med 2007; 357:2415-2416December 6, 2007

Article

Acquired Brain Injury: An Integrative Neuro-Rehabilitation Approach
Edited by Jean Elbaum and Deborah M. Benson. 298 pp. New York, Springer, 2007. $69.95. ISBN: 978-0-387-37574-8

Damage to only part of the brain has the potential to result in complex impairments that can disrupt life in innumerable ways. Neuroplasticity — the brain's capacity to repair itself — makes possible considerable recovery after a neurologic insult. The field of neurorehabilitation seeks to create an enriched environment for patients that will act synergistically with the neuroplastic activity of the brain to maximize improvement in brain function. This process requires the skills of experts and the integration of their efforts to optimize the patient's recovery. The aim of this book is to provide the background that will enable effective communication and coordination of services for patients and their families along the continuum of care.

This concise overview of the care of patients with acquired brain injury covers a broad range of disciplines, including neurosurgery, physiatry, neuropsychiatry, neuropsychology, neurology, urology, neuro-optometry, nursing, case management, balance and vestibular rehabilitation, occupational therapy, speech–language pathology, and counseling. The book includes practical techniques for assessment and clear descriptions of treatment options. Strangely omitted, however, is a chapter on physical therapy, which is generally considered to be a key part of neurorehabilitation.

In some of the chapters, both stroke and acquired brain injury are discussed. This overlap is relatively unusual, since the two distinct areas have been separated in the literature historically and often in practice. However, given the common elements of impairment in both conditions, it seems reasonable in some cases to merge discussions of them.

The book does not attempt to be an exhaustive review but does give suggestions to clinicians based on the best available evidence and widespread practice patterns. It is densely worded, with few tables and even fewer diagrams to illustrate the authors' points. Throughout the book, case scenarios concisely illustrate clinical situations that are related to the text, giving the reader an approach to diagnosis and available treatments. However, anyone interested in becoming an expert in the areas described would require more instruction than this book provides.

Acquired Brain Injury is a good resource, but readers will need some background knowledge of the field. I found its approach to be less integrative than the title suggests. Most of the chapters target a specific discipline, rather than take an interprofessional approach. In particular, members of the six medical specialties that are described in the book appear to function in isolation instead of as an integrated team. Exceptions to this are the chapters on occupational therapy, speech–language pathology, and case management, in which the authors describe teams working together to maximize the function of each complex patient.

Nora Cullen, M.D., M.Sc.
University of Toronto, Toronto, ON M5G 2A2, Canada