Brain, Vol. 126, No. 1, 261-262,
January 2003
© 2003 Guarantors of Brain
doi: 10.1093/brain/awg003
Book Review |
COGNITIVE REHABILITATION: AN INTEGRATIVE NEUROPSYCHOLOGICAL APPROACH
Oliver Zangwill Centre, Princess of Wales Hospital, Ely, UK
COGNITIVE REHABILITATION: AN INTEGRATIVE NEUROPSYCHOLOGICAL APPROACH
By McKay Moore Sohlberg and Catherine A. Mateer
2001. Andover: Taylor and Francis Books Ltd
Price £41.95. ISBN 1572306130.
This is a good book. For those starting out in the field of cognitive rehabilitation, or long in the tooth clinicians looking to ensure their knowledge is up to date, Sohlberg and Mateer provide a comprehensive review of the state of the science of cognitive rehabilitation. For me, the best bit of the book is the very first chapter. Many introductory chapters to books are disappointingly devoid of real content and can be skipped. This is not the case in this book. Sohlberg and Mateer’s description of the major developments and issues in cognitive rehabilitation is one of the most effective summaries of the essentials of contemporary cognitive rehabilitation I have come across. Combined with the third chapter, which focuses on variables contributing to recovery, with a strong emphasis on developments in cognitive neuroscience, the introductory chapters provide a compelling blend of clinical realism with theoretically driven possibilities. The thirteen ‘Principles of Cognitive Rehabilitation’ that conclude Chapter 1 should probably be pinned above the desks of all rehabilitation clinicians and indeed could form the basis of an audit process for most cognitive rehabilitation programmes.
The second chapter provides a straightforward, and probably necessary, summary of the major disorders that lead to cognitive impairments and the medical diagnostic techniques used to identify and quantify injury to the brain. For the new-to-the-field student this is fine, though for the more experienced clinician I would have liked to have seen a more critical appraisal of the limitations of some of the imaging techniques such as CT and MRI. The fourth chapter focuses on assessment of individuals with cognitive impairment. This too has the feel of being necessary for an introductory text, but limited in scope. For the multidisciplinary settings this book is relevant to, I felt that more detailed discussion of functional assessment approaches would have been beneficial, though the comments on the limitations of non-standardised assessments are useful. The sections on more formal psychometric assessments focus on general intellectual abilities, attention, memory and executive functions. These are most certainly the major domains of interest for the psychologist assessing individuals with head injury, but for completeness I would have liked to have more on visuospatial perception and language. The inclusion of a section on measures of disability and outcome is, however, welcome, particularly since a number of measures are specifically referenced and reviewed.
The book is organised in a straightforward, sensible manner, making it easily accessible. Having covered the general principles of cognitive rehabilitation and assessment in the first part, the book has three further sections on management approaches for specific cognitive impairments, interventions for behavioural social and psychosocial concerns and a final section on special populations (children and people who have suffered mild traumatic brain injury).
The second section provides the main meat of the book. The chapters on management of attention, memory and executive impairments each have useful summaries of the main anatomical and theoretical perspectives on these cognitive domains as well as addressing assessment and then management issues. Here particularly we see the desire to apply theory where possible combined with a very practical, clinically relevant approach that will be familiar to clinicians faced with trying to help clients with real-life day to day problems. Pulling the topic of insight and awareness out of a more general chapter on executive function is good in that it reflects how critical this issue is in the rehabilitation process. Sohlberg and Mateer acknowledge the great lack of awareness intervention research, but do draw on some of the studies that are available in the literature to support their prescription of several approaches that can be used in combination to facilitate the development of awareness.
Providing a separate chapter on the use of external aids is also very helpful. I am intrigued by the placement of this chapter after the chapters on attention and memory, but before the chapter on executive functioning (since the application of external aids is relevant to all three areas of impairment), but I accept that this is a rather minor complaint on my part. External aids continue to be one of the most widely used tools in rehabilitation. However, the application of such tools does not simply involve the prescription of, for example, a diary for the person with memory impairment. There are many factors that affect whether or not people will make effective use of such tools and this chapter will help clinicians to appreciate some these issues and provides some specific guidelines for intervention.
The chapter on communication issues provides a really useful focus on pragmatics and social communication. It highlights the interesting issue that there are probably many more interventions than there are tools for assessments in this area of functioning. The problem that this brings of course is that it makes the evaluation of interventions more difficult and reduces the link between theoretical perspectives and rehabilitation interventions. Sohlberg and Mateer note that the emphasis on pragmatics, or functional communication, reflects a general shift in treatments for aphasia away from remediating the underlying causes to socially based interventions that promote a person’s autonomy and control within naturalistic communication contexts. This makes much sense, though I have to admit that being the typical clinical neuropsychologist who tends to leave language to my much more experienced speech and language therapy colleagues, I would have liked to have read a little more about interventions for more basic aphasic disorders. This issue may also reflect a slight bias in the book towards problems most associated with traumatic head injury, rather than the more focal disorders more commonly seen after stroke or other conditions that result in more circumscribed lesions.
The inclusion of the third section of the book reflects an important development in brain injury rehabilitation. Three chapters are included that focus on managing challenging behaviours, depression and anxiety and working collaboratively with families. Each chapter contains a range of practical, clinically relevant tools as well as a more general discussion of the rationale for the application of particular psychological interventions. These issues are all critical to the success of brain injury rehabilitation and it is therefore pleasing to see them being integrated within the broader cognitive rehabilitation context. This does lead to the question of whether the title should really be ‘neuropsychological’ rehabilitation, or something similar, rather than ‘cognitive’ rehabilitation, but perhaps I am splitting hairs again.
The final section on ‘special populations’ includes a chapter on rehabilitation of children and another on mild traumatic brain injury. Here again are two very important topics that are dealt with effectively.
Perhaps one further issue on which I would have liked to have the views of Sohlberg and Mateer is the clinical service contexts in which the techniques they describe are best undertaken. In other words, how should the interventions be delivered? But that’s a big topic and so maybe we will hear from them on that issue another time.
Sohlberg and Mateer’s book is definitely a ‘must have’ for rehabilitation clinicians. I would agree with the cover comments that this book is more than just a revised version of their previous Introduction to Cognitive Rehabilitation. It is broader in scope and provides a much better integration of theory and clinical practice. The huge variety and complexity of physical, cognitive, emotional and behavioural problems that may follow injury to the brain makes it extremely difficult to provide a ‘how to do it’ book for brain injury rehabilitation. This is, however, close to being such a handbook. I am already looking forward to their next book.
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