Chapters
1. An Overview of Traumatic Brain Injury Rehabilitation: The Field Evaluation
The chapter on field evaluation is particularly novel. Patients are often evaluated for potential admission to a facility by staff who travel to the patient. Many times, training for this important work is minimal. This chapter strives to provide a framework from which the evaluator can attempt to collect information which will address most areas of deficit, providing valuable orienting information for a treatment staff who may become involved with the patient. Additionally, the chapter emphasizes the comprehensive overview of the patient's condition which should underscore not only diagnosis but treatment as well.
2. The Neurological Examination of the Traumatically Brain Injured Patient
This chapter provides valuable information pertaining to the neurological examination addressing the traumatically injured patient. Since such patients rarely have small, discrete lesions, the examination must focus on numerous areas which are not often evaluated in a more abbreviated examination. The chapter alerts the practicing neurologist to the range of frequently observed deficits, discusses their identification and treatment, and discusses the role of allied health professionals in the management of these cases. This chapter serves another important role in that it describes the facets of the neurological examination for the non-neurologist. Since this field is made up of almost equally represented allied health, medical and case management professionals, the portrayal of the neurologist's role is particularly valuable for the non-neurologist team member. Finally, the chapter serves the important role of cautioning all readers regarding the all too frequent assumption that all problems observed are a direct result of the original trauma rather than an ongoing, as yet undiagnosed complication such as post-traumatic epilepsy, hydrocephalus, degenerative neurological condition, or iatrogenic complication.
3. Posttraumatic Epilepsy and Neurorehabilitation
This chapter is a natural follow-up to the chapter on neurological examination. As with much in the field of traumatic brain injury, information has been gleaned from associated areas. We are in our infancy, however, in understanding the role and nature of posttraumatic epilepsy. Many conditions are inappropriately attributed to seizure conditions with still another group of seizure-related problems being treated psychiatrically or behaviorally without success. Pharmacological management of seizures is dependent upon a thorough understanding of the nature of the seizure condition itself. This chapter addresses epidemiology, description, diagnosis, and treatment of posttraumatic epileptic conditions. It offers insights into physiological, behavioral, and psychiatric manifestations of posttraumatic epilepsies. This information is crucial to all treating professionals in that the diagnosis of posttraumatic epilepsy is often begun through clinical and behavioral observation. The case manager and allied health professional, together with the physiatrist, psychiatrist, psychologist, and neurologist must all be able to provide information as to what occurs during "apparent episodes" as well as what changes occur following initiation of a treatment protocol. Diagnostic and pharmacologic procedures are discussed in detail.
4. Neurotransmitters and Pharmacology
In keeping with the medically-oriented beginnings of the text, this chapter follows well. The chapter is complex and thorough in its treatment of the subject matter. It is intended to serve as a reference tool for the prescribing physiatrist, neurologist, neurosurgeon, and/or psychiatrist. The information offers insights for allied health professionals as to the neuropsychological consequences associated with pharmacological management of behavioral, attention, arousal, motor, or psychiatric conditions observed in the TBI population. The chapter is intended to provide the prescribing physician with an armamentarium of rationale for sound implementation of pharmacological management rather than the all too often utilized approach of intuitive prescription of medications based upon suggested usages derived from alternative populations.
5. Heterotopic Ossification in Traumatic Brain Injury
Early on in the development of this field, heterotopic ossification (HO) became known as a frustrating clinical entity. As HO formed, the logical solution was surgical resection; however, re-growth was more frequently observed than not. Dr. Garland has researched and published extensively in the area. The chapter is designed to educate the reader as to variables which impact incidence, review prevalence, and discuss diagnosis and treatment protocols. As managed care takes hold in the USA, clinicians will need to recognize the appropriate management of this condition and the financial benefits to same. This chapter will be important to the physiatrist, orthopedist, physical therapist, occupational therapist, and case manager.
6. Vestibular Dysfunction After Traumatic Brain Injury: Evaluation and Management
Vestibular dysfunction following traumatic brain injury represents a frequently overlooked and under-diagnosed sequela. This clinical problem can be seen in a vast array of patients regardless of the severity of brain injury. The symptoms associated with vestibular dysfunction can mimic many other problems including those associated with psychiatric, emotional, visual, and perceptual disorders. The chapter begins with a review of literature and moves on to provide a review of the basic anatomical and physiological underpinnings of the vestibular system. A review of signs and symptoms associated with vestibular dysfunction is provided, together with extensive information about clinical evaluative and laboratory diagnostic procedures. Therapeutic and pharmacologic treatment procedures for vestibular rehabilitation are reviewed in detail, with relative application strengths and weaknesses discussed. This chapter provides valuable information for the physiatrist, otolaryngologist, neurologist, psychiatrist, psychologist, physical therapist, occupational therapist, and case manager.
7. Visual Dysfunction Following Traumatic Brain Injury
This chapter begins with an extensive review of the anatomy of the eye and the neuroanatomical substrates to visual and visual motor dysfunction. Considerable emphasis is placed on lesion localization. Therapeutic intervention options such as lens design and manipulation, visual motor therapies, visual perceptual therapies, and surgery are discussed. Rehabilitation of the visual motor and visual perceptual system is emphasized.
8. Rehabilitation and Management of Visual Dysfunction Following Traumatic Brain Injury
This chapter provides for a thorough review of both the evaluative and treatment aspects of visual motor and visual perceptual disturbances to complete the text's address of visual system sequelae to TBI. The chapter provides a review of the physical substrates of vision together with the prevalence of visual dysfunction in the TBI population. A model is provided for organization of visual rehabilitation. Sensory input and reception, perception and integration, and motor output and behavior are discussed separately and as they relate to one another. Useful case studies are incorporated for the reader's consideration.
9. Neurophysiological Substrates to Learning
This chapter addresses the neurophysiological mechanisms which are active during learning. The chapter attempts to introduce the information to the non-neuroscientist for the purpose of developing an understanding of the interplay between therapy, learning, pharmacology, and neuronal anatomy and physiology. The chapter provides for a transition from the "hard sciences" of the early chapters to the "soft sciences" of the therapeutically-oriented chapters which follow. Correlations are drawn between issues of sensitization and habituation and behavioral schemas associated with learning. These are later approached in detail in the chapter on behavior modification. In its final pages, the chapter provides insights into the importance of neurodevelopmental issues as they relate to design and implementation of therapeutic plans. This chapter is excellent for physiatry, neurology, psychiatry, psychology, social work, physical therapy, occupational therapy, speech/language pathology, educational therapists, special educators, and case management professionals.
10. The Use of Applied Behavior Analysis with the Traumatic Brain Injury Patient
This chapter is written to illustrate and simplify the concepts, techniques, and uses of applied behavior analysis with the TBI population. Disordered behavior is a common correlate to TBI and management options consist of pharmacology and behavior modification. As a process, behavior modification is not well understood by medical and allied health professionals. It is frequently observed to have been attempted, though with little to no success. This chapter provides information necessary to understand principles of behavior modification and to successfully implement behavioral programs. It provides information to allow integration of pharmacological and behavioral approaches. This chapter will serve as an invaluable reference tool for program directors, allied health professionals, physiatrists, psychologists, and psychiatrists. Case managers will be able to critically evaluate the sophistication of behavioral programs as they consider their efficacy and the need for further intervention. Useful forms for program implementation are provided as well as a concise group of tables which allow for easy conceptualization of behavioral programming prior to and during program design.
11. Language, Cognition, and Communication: A Unifying Perspective
This chapter addresses the relationships existing between language and cognition. It provides a review of literature hallmarking the existence of ties between language, cognition, and communication. The chapter is provided to encourage treaters to understand the incredible wealth of information available about the cognitive systems through use and review of language systems. Language can be used as a diagnostic and therapeutic modality for cognitive rehabilitation interventions. The chapter is of particular interest to psychologists, speech/language pathologists, cognitive therapists, educational therapists, special educators, physiatrists, and neurologists. The chapter also serves as an introduction to the chapter on cognitive disorders which follows.
12. Cognitive Disorders: Diagnosis and Treatment in the TBI Patient
This chapter provides a review of neuroanatomical substrates to basic cognitive functions. The chapter focuses on frequently impaired cognitive skills and does not elaborate on diagnostically labelled deficits, but rather on functionally inter-related processes amenable to therapeutic intervention. It provides theoretical constructs for an approach to cognitive rehabilitation which is remediative in nature versus compensatory. The chapter provides information encouraging the view of cognition as a process rather than an entity and provides useful insight into the relationships between attention, perceptual feature identification, categorization, and cognitive distance skills. The chapter gives a detailed treatment approach for cognitive rehabilitative efforts. The chapter will be of interest to educational therapists, special educators, speech/language pathologists, cognitive rehabilitation therapists, psychologists, and neuropsychologists. Case managers will find that the chapter provides insights into how cognitive rehabilitation can be viewed, measured, and monitored.
13. Management of Residual Physical Deficits
This chapter provides for an historical overview of the development of effective physical therapy interventions for the traumatically brain injured patient. A focus is placed of developmental issues with a review of diagnostic categories often seen in TBI. The chapter emphasizes aggressive rehabilitative efforts designed to approach normalization of function as opposed to compensation for dysfunction. This chapter is of primary interest to physiatry, neurology, physical and occupational therapy, and exercise physiology. It provides useful information for the case manager as well.
14. Vocational Rehabilitation
This chapter deals with application of vocational rehabilitation practice to the brain-injured patient. The chapter reviews pre-vocational counseling and preparation. It deals extensively with identification of prerequisites to initiation of vocational rehabilitation services. Specifics of vocational testing, work evaluation, and vocational rehabilitation planning and execution are discussed. An appendix is provided reviewing tests utilized and recommended. This chapter will be of appeal to vocational rehabilitation counselors, case managers, physiatrists, neurologists, and psychologists.
15. Case Management of Brain Injury: An Overview
The field of case management is in its comparative infancy. This chapter is designed to provide information to the new as well as experienced case manager about program evaluation for TBI patients. The chapter reviews various payer types and their respective priorities. Information is imparted about funding sources, overview of the brain-injured patient's care from injury through recovery, and facility/program evaluation criteria. The role of the case manager is discussed as it pertains to the patient, family, funding source, and facility staff. This chapter will be of primary interest to case managers, physiatrists, program directors, and allied health professionals interested in understanding the role of case management in TBI.
