Confronting Traumatic Brain Injury : Devastation, Hope and Healing

Warning of a virtual epidemic in traumatic brain injury (TBI) in the United States, the author explains in layman's terms the causes of TBI, how it affects the brain, and ways of treating it. He offers a number of recommendations towards alleviating the problem, including increasing investment in basic and clinical research, redirecting research efforts towards a greater emphasis on rehabilitation, meshing broad federal guidelines with state latitude in instituting programs for providing and regulating brain injury-related services, and raising the driving age. Annotation c. by Book News, Inc., Portland, Or.

"The primary cause of accidents is our fatalistic acceptance of them," says Winslade, who also points out that traumatic brain injury--TBI--kills 60 percent more people than AIDS does and afflicts a group of victims of an even younger average age, for it is a common result of driving accidents that seat belts, air bags, helmets for motorcyclists, and daytime running lights ought to reduce considerably. Hearing of a few striking recoveries from TBI, most people don't realize that the usual TBI rehabilitation program is lengthy and often restores only minimal functioning. Strongly interested in the law, bioethicist Winslade emphasizes that the U.S. TBI death rate ranks badly on the world list, that the U.S. generally doesn't have the necessary transportation ready for TBI emergencies, that there is nothing obliging state and federal legislatures to provide sufficient funds for trauma centers and research, and that the rampant waste, fraud, and abuse in some (especially for-profit) rehabilitation centers are overlooked. A book that may provoke considerable discussion. William Beatty

Medical philosopher Winslade has written a readable and broad overview of head injury: causes, treatment, rehabilitation, and health and public policy implications. The medicine and science of brain injury, however, are secondary in this book to discussions of rehabilitation and policy issues. The author survived a brain injury as a child, and that story, as well as high-profile cases such as Reagan aide James S. Brady and the Central Park "wilding" victim, inform the book and give it a personal touch. Hard to categorize, finally: this book will certainly be of interest to those who work with victims of head injury and their families; its readability, organization, and practical information make it a reasonable choice for community collections and collections in healthcare and social service settings.?Mark L. Shelton, Univ. of Massachusetts Medical Ctr., Worcester
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