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Neurobehavioural disability and social handicap following traumatic brain injury

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    Neurobehavioural disability and social handicap following traumatic brain injury. Edited by rodger ll wood and tom m mcmillan (Pp 315, £39.95). Published by Psychology Press, Hove, 200. ISBN 0 863 77889 5.

    This book is one of a series entitled Brain damage, behaviour and cognition. It comprises 13 chapters in three parts. The first part covers “the nature and impact of neurobehavioural disability”; the second addresses “rehabilitating neurobehavioural disability” and the final part is concerned with “models of service delivery”. Although the contributors come from the United Kingdom, North America, and Australia, the focus (to a large extent) is on British rehabilitation.

    To my mind the best section, overall, was part three, “models of service delivery”. I found chapter 12 by McMillan and Oddy “service provision for social disability and handicap after acquired brain injury” helpful and informative and full of common sense. The previous chapter by Giles “the effectiveness of neurorehabilitation” was also useful, not least because of the many outcome studies referred to. Of the treatment chapters, chapter 8 by Alderman and chapter 9 by Evans on “challenging behaviours” and “the dysexecutive syndrome” are well worth reading. Parts of the book came over as either rather bland or less useful for readers of this Journal.

    The main take home message is captured in chapter 12—namely that “Brain injury rehabilitation is best conducted in services dedicated to those with acquired brain injury, for the majority of whom personality changes and cognitive impairments are the primary disabilities”. Given firstly, the low priority of rehabilitation for people with cognitive and personality changes after acquired brain injury; secondly, the fact that many with traumatic brain injury are sent to any ward that has an empty bed; and thirdly, that many are under the care of orthopaedic surgeons or rheumatologists rather than specialists in brain injury, it is to be hoped that neurologists, neurosurgeons, psychiatrists, and health service providers will pay heed to this message.

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