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The effectiveness of brain injury rehabilitation from early stages of recovery through acute, post-acute and community care is well documented.1 Clinical guidelines recommend early assessment and rehabilitation from specialist multidisciplinary teams.2–5 Key aspects of the multidisciplinary approach are highlighted as holistic and maximising the available resources (knowledge, experience, financial and physical) to work towards a common goal.2 The British Society of Rehabilitation Medicine (BSRM) guidelines point to the benefits of an interdisciplinary team working towards an agreed set of goals and recommends systems for co-ordination of disciplines, communication with patients and families and education and training with teams.
The cognitive consequences of traumatic brain injury are wide ranging in severity and presentation. Early assessment of cognition can give indication of severity of injury, prognosis, can guide communication with the patient and inform rehabilitation. At later stages in recovery, cognitive assessment, as part of a wider evaluation, can be used to identify neuroanatomical areas of injury, quantify areas of cognitive deficit and discriminate between influences on cognitive functioning (e.g. primary impact of the brain injury, psychological disturbance, impact of other physical factors such as pain or fatigue). Cognitive assessment can also assist in predicting recovery and the likely future impact on daily living skills, inform adjustments that may need to be made to rehabilitation programmes and measure change as the patient recovers and responds to rehabilitation.
The role of the family in recovery from brain injury is of central importance. Family members provide emotional and practical support, advocate for the patient and assist in rehabilitation. The experience of observing a family member following a traumatic injury is extremely challenging and families can experience high levels of distress, anger, guilt and denial in the early post-traumatic phase. These features are followed, in the longer term, by increasing social isolation, depression and anxiety about the future1–3 and can persist for many years after discharge from hospital. Cognitive and personality changes in the individual with the brain injury are reported as the main causes of family distress than other consequences.
Advocating a pragmatic and multidisciplinary approach to the management of patients with brain injuries, Traumatic Brain Injury provides a detailed description of care along the whole-patient pathway. Delivering an evidence-based update on the optimal care of both adult and paediatric patients who have sustained injuries ranging from mild to severe, information from on-going multi-centre studies in neurotrauma is included. The basic scientific principles of neuropathology, head injury research and scoring systems are presented before detailed sections on emergency department care, patient transfer, intensive care and longer-term care. Rehabilitation is reviewed in detail with chapters discussing the aims and roles of physiotherapy, occupational therapy and neuropsychology amongst others. Discussing medico-legal issues in detail, the effect of injury on the individual and their family are also examined. Emphasising a holistic approach to caring for patients with brain injuries, this is an essential guide for all involved.
Objectives: The negative effect of changes in social behavior following traumatic brain injury (TBI) are known, but much less is known about the neuropsychological impairments that may underlie and predict these changes. The current study investigated possible associations between post-injury behavior and neuropsychological competencies of emotion recognition, understanding intentions, and response selection, that have been proposed as important for social functioning. Methods: Forty participants with TBI and 32 matched healthy participants completed a battery of tests assessing the three functions of interest. In addition, self- and proxy reports of pre- and post-injury behavior, mood, and community integration were collected. Results: The TBI group performed significantly poorer than the comparison group on all tasks of emotion recognition, understanding intention, and on one task of response selection. Ratings of current behavior suggested significant changes in the TBI group relative to before the injury and showed significantly poorer community integration and interpersonal behavior than the comparison group. Of the three functions considered, emotion recognition was associated with both post-injury behavior and community integration and this association could not be fully explained by injury severity, time since injury, or education. Conclusions: The current study confirmed earlier findings of associations between emotion recognition and post-TBI behavior, providing partial evidence for models proposing emotion recognition as one of the pre-requisites for adequate social functioning. (JINS, 2017, 23, 400–411)
The management of patients with head injury requires a pragmatic, multi-professional approach, as exemplified in this book. The content includes chapters on epidemiology, experimental models, pathology, clinical examination, neuroimaging and trauma scoring systems. A large section of the text then deals with the management of the head-injured patient along the whole patient pathway, addressing issues such as emergency department care, transfer of the patient, intensive care and surgical aspects. Rehabilitation is reviewed in detail with chapters that discuss the aims and roles of physiotherapy, occupational therapy, speech and language therapy and neuropsychology. Finally, medico-legal issues are evaluated. The practical approach to management is emphasized throughout. This book will be of interest to all doctors looking after patients with head injury: emergency physicians, neurosurgeons, anaesthetists, intensivists, and members of the rehabilitation team. Allied specialists such as nurses, physiotherapists, speech and language therapists, occupational therapists, and neuropsychologists will also find this book useful.