4rchiws of Clmmzl Neurop~ycholog.v. Vol 4, pp.

93-99, 1989 0806177189 $3 Oil + 00

Prmted I” the USA All rtghls reserved CopyrIght 5s’ 1989 National Academy of Neuropsychologws

Book and Test Reviews

Cecil R. Reynolds, Associafe Editor

Texas A & M UnwersQv

Neurobehavioral Recovery from Head Injury, by H. S. Levin, J. Grafman, and H.

M. Eisenberg. New York: Oxford University Press, 1987.

This edited text is an outgrowth of a conference held at the University of Texas

Medical Branch in Galveston in May 1985 entitled “Nemobehavioral Recovery from
Head Injury.” It is also a follow-up companion text to the previously published book
by Levin, Benson, and Grossman (1983) on the “Neurobehavioral Consequences of
Closed Head Injury,” also published by Oxford University Press.
With the emergence of regional trauma centers, improved acute and post-acute
treatment of the traumatic brain injury (TBI) survivor the emphasis in head trauma
is now with recovery, particularly long-term recovery. It is with this issue of recovery
that this text attempts to address. Its stated goals are to be an “informative guide to
both recent research and directions for future studies concerning the neurobehavioral
recovery from head injury.”
The book is divided into eight sections. Section I, entitled “Methodological Issues
in Clinicopathological Correlation of Head Injury in Outcome Studies,” is com-
prised of four chapters. By today’s standards of sophistication, it is difficult to
imagine a time when there was limited or no standardization for degree and type of
TBI or outcome. To put this in its historical perspective, Eisenberg and Weiner
(Chapter 2) review the development of the Glasgow Coma (GCS) and outcome scales
(GOS). Because of these rather straightforward standardizations, considerable
progress has been made towards assessing the degree of original brain injury and
potential outcome. Langfitt et al. (Chapter 3) interrelate the GCS, computerized
tomography (CT), Magnetic resonance imaging (MRI), positron emission tomogra-
phy (PET) and cerebral blood flow (CBF) studies with neuropsychological findings
in two patients with severe TBI. The cases presented in this chapter are extremely
informative and well illustrated. The only drawback with this chapter is the limita-
tion that occurs with any case study in terms of limited generalizability. The conclud-
ing chapter in this section is by Grafman and Salazar (Chapter 4) which provides an
erudite discussion of the differing effects of penetrating versus closed head injury
(CHI). These authors discuss the importance of distinguishing between penetrating
versus nonpenetrating head injury in research protocols because, despite their com-

93
94 Book and Test Reviews

munalities, there are sufficient differences that can bias research results if the two
groups are combined.
Section II is on “Design, Management, and Analysis of Neurobehavioral Out-
come Studies.” This section is comprised of three chapters that provide routine
reviews in this area, but little new information is provided. Brooks (Chapter 5) argues
that because of the heterogeneity of brain injury that some large N studies are
probably more of a limitation than advancement. Thus, the longitudinal, single case
design may be the most appropriate design for some outcome studies. On the other
hand with increased standardization that can be achieved by utilizing GCS and GOS
in combination with brain imaging technology (e.g., CT, MRI, PET), better group
selection may be achieved that will facilitate large N studies. Dikmen and Temkin
(Chapter 6) review the various problems with effective study of CHI patients with so-
called “minor” to moderate level injuries. Unlike the patient with more severe dam-
age, patients in this category represent research obstacles because practice effects
often taint outcome research. Strauss and Allred (Chapter 7) review research in the
context of differentiating specific impairments from poor performance due solely to
the generalized effects of TBI. Although not new, these are important methodologi-
cal issues.
Section III, which is the largest, deals with “Neuropsychological Assessment of
Head-Injured Patients.” Benton (Chapter 8) has a brief chapter where he discusses
some “Thoughts” on neuropsychological assessment issues and associated advance-
ments that have occurred in this area. Lezak (Chapter 9) provides a standard review
of current neuropsychological measures and how to make neuropsychological find-
ings relevant. Newcombe (Chapter 10) stresses the need for “ecological” validity of
neuropsychological tests when assessing TBI patients. As she points out “psychomet-
ric scores provide an informative but inadequate basis for reliable prognosis” (p.
142). This is a very critical point. The majority of current neuropsychological tests
were developed during the 1940s through the 1960s. Some current assessment tech-
niques are simply outdated and not ecologically valid. Diller and Ben-Yishay (Chap-
ter 11) review their seminal contribution to rehabilitation with a focus on the future
and the need to adopt uniform criteria and measures for defining improvement,
validating and systematizing new treatments and establishing well-coordinated net-
works of collaborative rehabilitation programs. Stuss (Chapter 12) specifically fo-
cuses on frontal damage in CHI and its effects on behavior. Oscar-Berman (Chapter
13) concluded this section with a synthesis of research on nontraumatic neurologic
disorders in human and nonhuman subjects and how this relates to our understand-
ing of cognitive deficits in CHI.
Section IV is very brief and very basic comprised of two chapters, one by Alexan-
der (Chapter 14) and the other by Marshall (chapter 15). These two chapters deal
with “The Physician’s Point of View” in the neurobehavioral outcome of head injury.
Section V deals with “Psychiatric Sequelae of Head Injury: Conceptual and
Methodological Problems.” Prigatano’s excellent Chapter (16) focuses primarily on
personality change in the TBI patient. This chapter is followed by Grant and Alves’
Chapter (17) on the psychiatric and psychosocial disturbances in head injury. Their
review is succinct yet comprehensive. The last Chapter (18) in this section is by Levin
et al. and deals with that important issue of minor head injury and the so-called
“post-concussion syndrome.” The issue of minor cerebral trauma has been mired
 Book and Test Reviews 95

with a myriad of methodological problems and this chapter addressed many of these
issues.
Section VI deals with “Developmental Issues” and is comprised of only one
Chapter (19) by Fletcher, Miner, and Ewing-Cobbs. This excellent chapter reviews the
importance of understanding the timing of brain injury as it occurs in the context of
emergent developmental stages. As Fletcher et al. state “ . . . recovery of function is
an issue involving not only sparing and restoration of various behaviors, but also the
complex issues of how growth and development proceed in an abnormal brain” (p.
289).
Disturbance in memory function is the ubiquitous post traumatic symptom with
all types of brain injury. Thus, it is only fitting that an entire section (Section VII) is
devoted to “Memory Disturbance.” Baddeley et al. (Chapter 20) provide a thorough
review of memory dysfunction in general with specific attention to the most common
deficits typically associated with CHI. This is followed by a Chapter (21) by Corkin
et al. that reviews research from the Massachusetts Institute of Technology Clinical
Research Center Data Bank on the head injury survivors from the Korean Conflict.
Their research suggests that penetrating injuries may have a more substantial effect
on memory. This section on memory disorders concludes with two chapters by
Crovitz (22) and Tulving (23) dealing with methodological issues.
The last section (Section VIII) deals with “Attention After Head Injury” and
focuses on advances in measurement of attention and integration of experimental
models of attentional mechanisms with attentional deficits associated with TBI.
Gronwall (Chapter 24) reviews her important research in this area. The Chapters by
Buchtel (Chapter 25) and Papanicolaou (Chapter 26) briefly review attention and
vigilance from behavioral and electrophysiological indices. The two concluding
chapters of this section and the book deal with theoretical concepts of selective
attention (Chapter 27 by Posner) and different dimensions of attention (Chapter 28
by Zomeren and Brouwer).
This is an excellent text and essential reading for the researcher and clinician who
deals with traumatic brain injury. It is very readable and well edited. This text can be
highly recommended.
Erin D. Bigler
Austin Neurological Clinic and
University of Texas at Austin

Encyclopedia of Special Education, by Cecil R. Reynolds and Lester Mann (Eds.).

New York: John Wiley & Sons, 1987. 1793 pp., $250.00.*

The Encyclopedia of Special Education is a 3 volume reference set concerned with a

broad range of issues relative to special education. The publication of such a com-
pendium reflects the expansion of a field from the early attempts to meet the needs
of a few children, to a discipline concerned with a wide range of disorders and

*Editorial decisions on this paper were made by the Edltor-in-Chief.