LITERATURE REVIEW: Manual of Traumatic Brain Injury Assessment and Management 2nd Edition

Zollman cover

By Felise S. Zollman, MD, FAAN, FAAMA

The Manual of Traumatic Brain Injury Assessment and Management 2nd Edition lives up to its claim of being a comprehensive, evidenced-based guide for the diagnosis, treatment, and long-term management of traumatic brain injury (TBI). This thorough, rehabilitation-focused book will serve as a detailed reference for physicians, nurses, psychologists, counselors, physical and occupational therapists, speech-language pathologists, and case managers, amongst others. The content is applicable to experienced providers and early-career practitioners alike, as well as medical and graduate students. Indeed, given the easily digestible yet extensive content, it would be a welcome addition to the syllabus of any medical or graduate school course focused on TBI rehabilitation.

The book’s organization lends to its ready usefulness as a clinical guide and educational text. The individual chapters are succinct, with clearly marked sub-sections that facilitate information gathering. At the conclusion, each chapter also includes key points and additional readings, which further facilitates learning. There is some redundancy between chapters, but this is not extensive and is a commonality in most multi-author compendiums. The chapters are also formatted to parallel the continuum of rehabilitation care, starting with acute injury and spanning to community reintegration, which creates a logical flow of information.

The 2nd edition contains updated content, formatting, and several new chapters. Chapter content has been revised to include the most recent evidence-based research and current best practices. The references are up-to-date and from peer-reviewed journals and respected sources such as the CDC, with only a few less traditional sources such as Wikipedia. New chapters include anoxia in TBI, assistive technology, screening for emotional distress, and neurobehavioral sequelae. The exceptional quality of content is supported by the contributing authors, who include internationally renowned clinicians and researchers on TBI management.
The editor has done an excellent job at providing empirically-supported information on a variety of clinical issues encountered across the spectrum of TBI rehabilitation. The book is divided into five broad content areas. Part I – Core Concepts – covers fundamental concepts such as nomenclature, epidemiology, severity classification, and neuropathology. Part II – Mild Traumatic Brain Injury – includes chapters on diagnosis and evaluation, sports-related concussion, second impact syndrome, postconcussion syndrome, imaging, somatic disorders, and PTSD. Part III – Moderate to Severe Traumatic Brain Injury – contains chapters addressing pre-hospital care, neurosurgical management, disorders of consciousness, nutritional issues, rehabilitation therapies, cognitive impairment, visual dysfunction, behavioral management, and prognosis, amongst others. Part IV – Complications and Long-Term Sequelae – addresses common complications and long-term rehabilitation challenges, including endocrine dysfunction, spasticity and movement disorders, posttraumatic seizures, headache, neuropsychiatric sequelae, and sleep disturbances. Part V – Special Considerations and Traumatic Brain Injury Resources – addresses issues such as life care planning, return to work, forensic involvement, alcohol use, and issues pertaining to specific populations such a military personnel, pediatric patients, and older patients.

There are several unique content areas that are commonly neglected in other TBI references, including highly relevant chapters on injury prevention, sexuality, community resources, and community for football, boxing, soccer, baseball, ice hockey, and cheerleading. One particularly unique aspect of this book’s content is the inclusion of a chapter written by a survivor. The author, a 40-year-old woman, sustained a severe TBI at age 17 consequent to a motor vehicle accident. Her eloquent narrative of physical and emotional recovery serves as a powerful reminder of the deeply personal and profound journey that underlies TBI rehabilitation. As practitioners, it is all too easy to focus on the myriad of symptoms and sequelae that overshadow the individuals we help. Her words serve as a powerful reminder that practitioners and patients alike are motivated by hope y integration. There is also a detailed, multi-chapter discussion of sports-related concussion that includes sports-specific recommendations

– “My position, borne of experience, persistence, and hard work, is that you don’t have to just live with the devastation of traumatic brain injury. There are always options. There is always hope. There is always possibility.”

Although an overall excellent resource, there are several relevant topics that are underemphasized or absent in this edition. A revision of the book would be strengthened by including a more substantive discussion of malingering and symptom magnification in mild TBI. This topic is only briefly discussed in the chapter on confounding factors in postconcussive disorders. The chapter on post-injury alcohol abuse would be strengthened by expanding the discussion to include abuse of prescription medication and illicit substances, which is an increasingly common problem, particularly for opioid medications. In addition to return to work, a well-rounded discussion of return to productivity would ideally include return to academics, a topic that is highly relevant to young adults. Finally, TBI is a shared experience that affects family, caregivers, and community. Ideally, the book should include a chapter devoted to the impact of injury on family and caregiver functioning, as high levels of distress are well-documented in this population. Notwithstanding these minor issues, the overall content is quite thorough.
In sum, the Manual of Traumatic Brain Injury Assessment and Management 2nd Edition is an excellent clinical text for both experienced and early-career practitioners, as well as students. Readers have the expertise of world-renowned clinicians and researchers at their fingertips. The succinct format allows for ready access of complex information. Perhaps of greatest value is the book’s practical focus on assessment, treatment, and prevention, which makes it an invaluable resource for practitioners. This text should be a welcome addition to the bookshelf of any practitioner working with individuals with TBI.


About the reviewer

Ana Mills is a clinical psychologist and assistant professor in the Department of Physical Medicine & Rehabilitation at Virginia Commonwealth University Medical Center. Dr. Mills specializes in neuropsychological assessment  and psychotherapeutic treatment of individuals with acquired brain injury. Her research activities include investigating the efficacy of promoting resiliency after TBI. She has authored a number of peer-reviewed articles, book chapters, and presentations on neuropsychology and TBI rehabilitation.