Neuropsychological Rehabilitation: Fundamentals, Innovations and Directions

Patients with acquired brain injury have extended and comprehensive rehabilitative needs. As these are becoming recognized on an international scale, there is increased collaboration of American and European researchers on definitional and programmatic approaches to specialized rehabilitation programs for this population. Neuropsychological Rehabilitation, edited by José León-Carrión, a professor of neuropsychology at the University of Seville (Spain) and vice president of the International Brain Injury Association, is a comprehensive text that offers international perspectives on subjects ranging from acute medical management to long-term community reintegration.

As noted by George Zitnay, president of the National Brain Injury Association, who contributed the foreword, the strength of this text lies in its breadth of topics and in its integration of ideas from authors of different cultural backgrounds. The text is designed to be useful for all professionals and students concerned with rehabilitation following acute brain injury. Professor León-Carrión contributes several chapters on a wide array of topics, displaying both dedication and optimism as to the ultimate efficacy of holistic, neuropsychologically informed rehabilitation techniques. He implores colleagues and practitioners to remain creative and set hopeful goals to help people with brain injury achieve a new constellation of adaptive capacity following injury.

The book is divided into five sections. Part l involves a review of fundamentals, including historical development, ideas, and methods in the field, as well as methodological issues of design and program evaluation. For physicians, a chapter is included on neuroimaging assessment and its relevance for acute and postacute treatment.

Part 2 concerns itself with treatment issues particularly relevant to acute recovery phases. There are interesting chapters reviewing assessment and treatment of the minimally responsive patient, as well as a chapter on neuropharmacological treatment by Perino and Rago from the Centro De Medicina Rehabilitiva in Torino, Italy. This chapter is notable for its honest evaluation of idiosyncratic factors in treatment with and evaluation of pharmacological modalities for brain injury, as well as a discussion of specific clinical issues and practical guidelines for therapeutic decision making. There are also thought-provoking chapters on emerging technologies such as gene therapy and neurotransplants, which may offer hope in the mitigation of long-term cognitive sequelae.

Part 3 concerns the specialized topic of cognitive rehabilitation and contains a wide sampling of therapeutic approaches. Mateer presents a clinical discussion of rehabilitation techniques helpful with patients with dysexecutive function attributable to frontal lobe impairment. Prigatano contributes a well-integrated chapter on anosognosia, explaining the interplay of psychological and organic variables as they contribute to impaired self-awareness and rehabilitation outcome. Of particular interest is a group of chapters covering specialized topics such as aphasia rehabilitation, reading and writing impairments, and rehabilitation of acalculia.

Part 4 concerns itself with rehabilitation of personality and behavioral issues as they pertain to community stabilization. Dr. León-Carrión reviews the literature on affective disorders and suicidal behavior following traumatic brain injury, with particular focus on the potential role of impaired serotonergic systems. Practical guidelines for behavioral management of depressed and suicidal patients are offered. Unfortunately, this chapter suffers from a limited review of the behavioral literature on this topic and does not mention the critical role of premorbid psychiatric factors in the prediction of suicidality following TBI. The following chapter on management of aggression provides an overview of pharmacologic and behavioral techniques and describes the author's integrated milieu approach. Other helpful chapters cover social skills training and vocational/avocational rehabilitation programs. The section concludes with an excellent chapter by Condeluci on community inclusion in a sociocultural context.

Part 5 covers special topics such as TBI in children and specific challenges for academic reentry. There is an important chapter on clinical considerations in the rehabilitation of brain injury in Hispanic patients. The book concludes with a chapter on legal and economic issues.

At times, the text suffers from minor translation errors, and León-Carrión's chapters, in particular, seem to lack conceptual clarity. Despite these factors, the book is informative in many areas and reflects the continued propagation, and importance, of neurorehabilitation programs on an international level.

Dr. Carnevale is Assistant Director, Psychology and Neuropsychology, Kessler Institute for Rehabilitation, and Assistant Professor, University of Medicine and Dentistry of New Jersey/New Jersey Medical School.