Reviews

“If ever there was a book that truly could save your life, it would be this one. Drs. Rao and Vaishnavi have written a critical manual for patients, family, essentially anyone to help recognize and explain the warning signs of a TBI. Without visible symptoms, sufferers have long remained silent or been deemed “crazy,” but this important book not only details the physiological, cognitive and behavioral changes in the brain, it offers hope through treatment.” Bob Woodruff, ABC News Journalist

“Drs. Rao and Vaishnavi have written a valuable and timely book that is long overdue.  It not only contains an excellent summary of TBI and its effects, but also strategies to deal with them.  I highly recommend this excellent book.” Thom Mayer, MD Medical Director, NFL Players Association

“We are faced with an epidemic of traumatic brain injury (TBI) among victims of sports, accidents, and wars. The cognitive, emotional, and behavioral consequences of such injuries are varied and complex. Using a contemporary understanding cognitive neuroscience and a gift for distilling complex ideas, Drs. Rao and Vaishnavi present a clear and coherent picture of TBI. Informed by their own substantial clinical expertise, they also offer practical advice making this guide essential reading for caregivers and family members as well as the general clinical practitioner.”

Anjan Chatterjee, MD, FAAN

Elliott Professor and Chair of Neurology, Pennsylvania Hospital, The University of Pennsylvania. Author of “The Aesthetic Brain:  How We have Evolved to Desire Beauty and Appreciate Art”

“The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior after Brain Injury By Drs. Vani Rao & Sandeep Vaishnavi (Johns Hopkins Press, Baltimore, 2015) “While members of the US military may be the most visible of those with Traumatic Brain Injury (TBI), with over 235,000 service members diagnosed with a TBI from 2000-2011, they are but one group impacted. The Centers for Disease Control and Prevention (DC) estimates that in 2010 there were 2.5 million emergency department (ED) visits, hospitalizations, and deaths in this country, as a discrete brain injury or in combination with other injuries. For every individual with TBI there are family and friends who are also profoundly impacted. The Traumatized Brain is written especially for those with a loved one who has suffered a TBI and develops mental symptoms. T hat focus makes this book a unique and needed guide for those who are the most enduring and essential supports for people with a traumatized brain. The authors’ mission to “…give voice to this silent epidemic… [and] help readers recognize and understand the psychiatric symptoms that develop after TBI (p. 3)” is admirably achieved.This guide builds up the reader’s knowledge and understanding with a careful logic. First, we learn about the structures and functions of different parts of the brain. With clear and concise writing that eschews excessive technical terms and jargon, and is nicely supplemented by drawings, we learn how the brain is organized and works. We are also taught about the types, severity and signs of TBI.On this foundation, which is very helpful but not essential to what follows, the authors proceed to explain the psychiatric problems that derive from a traumatized brain. These include depression, anxiety (which includes PTSD), apathy and mania. As devastating as the injury may be, Drs. Rao and Vaishnavi take pains to emphasize that these mental problems are illnesses, not simply a “normal” response to a very bad event. They offer information on specific treatments and thoughtful ways for patients and families to adapt.Behavioral problems then are addressed. These include aggression, impulsivity, psychosis (including paranoia and hallucinations), and disordered sleep (which occurs in about half of those with TBI). These are problems that make extraordinary demands upon families and community living. Appreciating their nature, the limitations they produce, and ways to better function is another notable contribution of this text.Cognitive problems are the focus of the next section. We are taught the important differences between attention (and its variants of selected, sustained and divided attention); memory (explicit and implicit); motivation; language; and the brain’s executive functions (our abilities to plan, organize, sequence, monitor and modify). Impairments can and do occur across all these cognitive domains, so treatments need to be customized to each person’s individual deficits (and strengths). The book’s education about TBI concludes with a section that considers other common problems such as headaches, seizures and visual disturbances. Here too we are offered important and practical information about treatments and ways in which individuals and families can best manage the consequences of a traumatized brain.There is a useful glossary and a resources appendix. But what I found missing was a discussion and examples of monitoring tests that can be completed in an ongoing way by patients and family members. The authors offer one example, namely the Apathy Evaluation Scale, where a person’s functioning can be assessed over time. Families need to be able to monitor, in a reliable and quantitative way, their loved one’s condition. We do that for diabetes, hypertension, depression, OCD, hyperlidemia, PTSD, and many other conditions – with self-report, paper and pencil tests, not just blood tests and cuffs. This is termed measurement based care and enables everyone involved to keep their bearings on outcomes, and can be very useful in advocating for needed changes when treatment is not working. Throughout this smart and accessible book is the message that the brain has the capacity to recover. The term most often used is “plasticity” – the ability of our brains to “…find new ways of doing old things.” For families and those with TBI this is a message of hope. And hope is critical to bear the emotional trauma of TBI and to maintain the hard work of recovery. The book closes with a section that describes what helps recovery. The messages here summarize the practical and effective measures offered throughout the book.We can thank Drs. Rao and Vaishnavi ‎for this remarkable contribution to patients, families – and clinicians. Few professionals, doctors included, know how to deliver their highly informed knowledge and experience in ways that lay readers can comprehend and use. I hope the authors build a video library to complement this text. So many more people will be reached by visual and auditory communications that complement their text.” Lloyd Sederer, MD, Medical Editor for Mental Health for The Huffington Post, Adjunct Professor at the Columbia/Mailman School of Public Health, and Chief Medical Officer for the NYS Office of Mental Health. The opinions expressed here are entirely his own. www.askdrlloyd.com