Practical Neuropsychological Rehabilitation in Acquired Brain Injury: A Guide for Working Clinicians is the third book in the Karnac Brain Injury series, and distinguishes itself from the previous books in the series by focusing nearly exclusively on neurorehabilitation of brain injury. The aim of the book is to provide a practical, “hands-on” guideline to working with patients with acquired brain injury (ABI) in a rehabilitation setting. Both practicality and “real-world” applications are emphasized, and the importance of inter-disciplinary and family collaborations are stressed. All of the authors practice in the United Kingdom (UK), and the book is clearly tailored for neuropsychologists and rehabilitation psychologists working in the National Health Service system. For providers in the United States (US) or other countries that do not have a single-payer health care model, the difference in health care systems may make the books’ goal of “practicality” less likely, as the differences between single-payer and multiple-payer reimbursement may be too big of a gap to cross. Often, what is considered standard of care in the UK model is virtually unheard of in the United States, except for those with excellent insurance coverage in private hospital settings. Thus for the US audience, many of the treatments noted in the book remain aspirational, rather than typical, and not easily applied in the US health care setting.

While this is an edited book with multiple author contributions, the majority of chapters are written by a small number of authors, giving it a more cohesive feel than other edited volumes. For example, the senior editor, Newby, is the primary author or co-author in 8 of the 15 chapters. Coetzer, another editor, is the primary or co-author in 3 chapters. The book is divided into four sections, with an expanding focus from basic skills, to assessment in specific contexts and, finally, to working within professional/organizational systems. The focus is on practical application, and by and large, the volume delivers. Most chapters include one or more case examples to emphasize the information presented earlier in the chapter. For example, in Chapter 3, “Therapy and Engagement,” a case vignette is presented followed by case conceptualization and treatment in five different psychotherapeutic modalities – all of which incorporated the patient's brain injury and subsequent cognitive limitations into respective theoretical frameworks.

The multiple skill sets of a neuropsychologist in addition to cognitive assessment are highlighted throughout the book. For example, chapters in Part I address the multiple skills needed by a neuropsychologist working with acquired brain Injury (ABI) patients, including chapters on assessment, therapeutic skills, and rehabilitation in community and social environments. A weakness of the section is the initial chapter on behavioral neuroanatomy, which appears to be written at the level of an educated layperson or a clinical psychologist who does not work with neurologically impaired patients on a regular basis. While the goal of limiting jargon is a good one in general; for neuroanatomical terms, specificity is important. Chapter 4 is somewhat oddly titled “Social Consequences and Social Solutions: Community Neurorehabilitation in Real Social Environments” given that the chapter is specifically geared towards executive dysfunction, and how it manifests in community settings. While it provides a good overview of strategies used with patients with executive dysfunction, it does not provide information beyond what can be found elsewhere. This chapter, in particular, may highlight the differences between single-payer and multi-payer systems, as many of the interventions suggested (e.g., rehabilitation coaches, vocational counseling) remain more aspirational than standard-of-care in multiple-payer settings (e.g., the US healthcare system).

In Part II, the emphasis is on specific contexts commonly seen in working with patients with brain injury, including low awareness states, assessment of capacity, driving, vocational rehabilitation, and parenting, to name a few. This section comprises the bulk of the book, and again embraces the running theme of being practical and “real-world” in the application of the principles discussed. Chapter 5 on low awareness conditions is well-written and presents an overview of the literature, as well as a framework for assessment. Chapter 6 focuses on the assessment of capacity, but this is relative to the legal definitions of capacity according to UK law, and may not be applicable in other countries; reducing its generalizability. However, the core tenets thought to underlie capacity should be familiar to most practitioners who have dealt with similar cases. Thus, while some of the legal technicalities may not translate, the overall concepts and approaches to assessment are widely applicable. Again the cases presented in this chapter (for 4 different types of capacity) are helpful in elucidating the process of determining capacity and the subtleties involved. Chapter 7, about driving, is a good summary of the literature and of the difficulties involved in evaluating ability to drive following ABI, but again the legal subtleties of the UK system may not be applicable in other countries. Chapter 8 discusses the role of vocational rehabilitation both in terms of assessment for readiness to return to work and the psychological impact of working. Chapter 9 focuses on the development of support groups. It provides good examples, but is light on the research indicating efficacy and cost-effectiveness of these programs; something that is increasingly required in a strained financial health care system. Chapter 10 discusses the use of texts and emails in rehabilitation. While it makes a compelling case for implementing electronic media, the downsides of this medium (e.g., confidentiality, time constraints, billing) are given short shrift.

The final sections of the book, Part III: “Working with Professional and Organizational Systems” and Part IV: “Making Sense of it All,” focus on the administrative details of running a brain injury rehabilitation service. This section will be of value to a practitioner in the position of establishing or expanding a rehabilitation service. This section is light on research, but heavy on nuts and bolts aspects of leadership (e.g., when presenting leadership tips, Fisher writes “Tip 4: Ask yourself what you can stop doing- good delegation is a key skill for successful management”).

The book is at its best when discussing the social and emotional consequences of ABI. This includes chapters on psychotherapy with patients with ABI (Chapter 3), change in family/ partner relationships following ABI (Chapter 11) and changes in parenting ability following injury (Chapter 12). These chapters will likely feel familiar to neuropsychologists or rehabilitation psychologists working in inpatient or sub-acute settings, as the family tends to be intimately involved in all aspects of a patient's recovery. These chapters in particular can provide good insights into how best to manage these complexities. In general, the book focuses less on assessment and cognitive rehabilitation, and tends to take a more psychotheraputic approach to rehabilitation following ABI. This is an area lacking in both literature and practice, although the authors do acknowledge that there is not a great deal of research looking at long-term outcomes of these interventions.

In sum, Practical Neuropsychological Rehabilitation in Acquired Brain Injury: A Guide for Working Clinicians more than lives up to its title of “practical” neuropsychological rehabilitation, with its focus on real-world patient complexities, use of case examples, and a less formal writing style. The most significant limitation of the book is the potential lack of applicability for providers in a different type of health care system (e.g., many of the services discussed in this book do not exist, or are extremely limited in a US-based health care model). Also, there are frequent references to UK laws that may not be applicable in other countries; most notably, in the driving and capacity chapters. However, many of the ideas and concepts presented could be generalizable to different health care models and applicable laws. This book is probably best suited for a neuropsychologist or rehabilitation psychologist working in an inpatient rehabilitation setting, or working in an outpatient rehabilitation setting with more severely impaired patients.