Cognitive dysfunction is the sine qua non of brain injury. Rehabilitation of cognitive deficits is therefore central to the treatment of persons with brain injury. Nevertheless, advances in the treatment of various cognitive functions have been slow to occur. In all likelihood this slow pace reflects the complex nature of brain function and brain injury as well as the challenges that researchers encounter when they conduct research with real world populations whose condition may be evolving. Yet, brain injury treatment shows promise. After reading both of these books, the reader will have the sense that our approaches are becoming more scientific, that there are large gaps in our knowledge, with variability in knowledge across cognitive domains, and that there is still much art in the treatment of cognitive deficits. These two books provide valuable information of a complementary nature on the status of brain injury care.

Although each has distinctive chapters, the two books cover similar ground. Both books offer chapters on executive, memory, language, and apraxic dysfunction. They address visual, visuoperceptual, and neglect difficulties, but divide these topics differently. There are also areas of less overlap. Neuropsychological Interventions includes a section with chapters on basic topics such as the theory of cognitive change, neuropsychological assessment and research design, and pharmacological treatment. Cognitive Rehabilitation has unique chapters on the history of cognitive rehabilitation and on cognitive rehabilitation with persons with schizophrenia plus chapters on broad based global programmatic approaches and the lessons for cognitive rehabilitation from motor control theory.

Neuropsychological Interventions is perhaps the more fundamental of the two texts. It begins with a section entitled “Foundations of Neuropsychological Interventions.” The initial chapter, “Approaching Interventions Clinically and Scientifically,” explains that the aim of the book is to present conceptualizations that are advancing the field and to relate the results of research to treatment. Next, “Theoretical Bases for Neuropsychological Interventions,” argues for a broad-based definition of cognitive rehabilitation as “efforts to promote maximal adaptive cognitive functioning in patients with neurologically induced cognitive deficits” (p. 17), not limited by etiology, method, or technology. It then gives an overview of the rationale of treatment from synaptic, neurochemical, and neuroanatomical perspectives. That neuropsychological assessment is important to the rehabilitation process is stressed in Chapter 3, “Neuropsychological Assessment for Treatment Planning and Research,” further noting that assessment of mood, personality, motivation, awareness and other psychological states must be included in a comprehensive evaluation for rehabilitation planning.

The chapter titled “Pharmacological Treatment of Cognitive Impairments: Conceptual and Methodological Consideration” advises on how to conceive of medication treatment and then proceeds to review obstacles to drug therapy, concluding with a discussion of experimental designs in pharmacological research. The last chapter in this section, “Design and Evaluation of Rehabilitation Experiments,” is devoted to research design covering such topics as control groups, randomization, outcome measurement, etc., as well as a review of particular research designs.

Taken as a whole, this section is sufficient for a brief introduction to the topics it covers, but it is cursory. Most of the subject matter deserves far more in-depth consideration to be of true value. If the reader is a neophyte to the fields of brain injury, neuropsychology, research, or medications, then this section may begin to increase awareness and exploration of the section's subjects; for readers with a moderate background in these areas, the information should already be well-learned. Parenthetically, the chapter on pharmacological treatment might have been better placed in the next section, “Models of Intervention for Neuropsychological Impairments.”

The second section of Neuropsychological Interventions contains chapters on the treatment of various dysfunctions. Chapter 6, “The Rehabilitation of Attention,” describes how to classify attentional processes and offers some information on anatomical correlates and assessment. Treatment of neglect is given as an example, but the review of techniques, particularly for “nonspatial” attentional problems, such as contingencies, computerized tasks, or experimental presentation of a tone would benefit from more in-depth discussion. In “Learning and Memory Impairments” in chapter 7, four approaches are delineated: restoration, optimization of residual functions, compensation, and substitution. The treatment procedures summarized here are practice and rehearsal, mnemonics, environmental supports, and domain-specific learning using implicit memory and errorless learning: the important point is that treatment needs to be customized through the determination of which techniques work for which subset of memory or learning problems for which patients. As spatial neglect is discussed elsewhere, chapter 8, “Visuospatial Impairments,” covers other defects of visual processing suggesting use of restorative techniques though commenting that there is limited empirical support for them yet—and compensatory strategies.

The next chapter, “Models of Language Rehabilitation,” differs form the other chapters in summarizing a literature search for language rehabilitation that resulted in 522 articles of which 44 were judged pertinent and empirical in nature. The articles are sorted and compared by treatment approach (i.e., cognitive neuropsychological, cognition and learning, compensation, linguistic, social, and neurological). These findings are then summarized thus: (1) “Theoretical foundations differ across these treatment models, and as mentioned throughout the chapter, many language rehabilitation studies and models do not necessarily specify the underlying theory” (p. 209); and (2) “Finally, we are no further along in the identification of theories that can explain and predict the mechanism of change” (p. 210).

In chapter 10, “Apraxia,” the author notes that “… the literature on recovery and treatment is very minimal.” (p. 229), and that “there is not one accepted taxonomy or classification of the forms of apraxia” (p. 222); which perhaps explains why the chapter is organized by type of research design and the pragmatic conclusion that “therapy should be geared to help patients function more independently despite the probably lasting presence of apraxia” (p. 241).

“The Enigma of Executive Functioning” may be a misnomer for chapter 11 since it provides a useful synthesis of different theories to find commonalities, giving a sense of advancement toward a unified conceptualization of brain function for this cognitive domain. The four theories are Teuber's corollary discharges, Luria's self-regulation and Shallice's supervisory system, Duncan's goal neglect, and Damasio's somatic markers, reviewed with treatment studies associated with each theory. The conclusion that all the theories incorporate anticipatory processes, matching of action and intended effect, and error detection for adaptation indicates that treatment works through “overt predictions, verbal mediation and adaptive problem solving, and formal self monitoring strategies” (p. 262). Chapter 12, “The Rehabilitation of Neurologically Based Social Disturbances,” tackles social problems and includes an array of psychotherapeutic treatments for self-regulation, sensitivity, problem solving and awareness, with the recommendation that treatment interventions “be implemented by a mental health professional” (p. 267). This chapter would be stronger if it explored further the relationship between social dysfunction, particular neuropsychological processes and related organic damage sites, and the success of various interventions. The following chapter, “Emotion-Related Processing Impairments,” presents models of neural networks and functions, as they relate to emotional processing, including frontal networks, an emotional motor system, cortical and subcortical regulation, hemispheric specialization, and central versus distributed processing. Assessment is considered in experimental models of emotional elicitation and expression and emotional and personality inventories. Research on emotional perception and expression is presented along with a general overview of therapeutic approaches to emotional disturbances.

The final chapter, “Summary and Analysis of Emerging Intervention Models,” provides a synopsis of the preceding chapters such that a reader wishing to glean the arguments made in the book could do so from reading it. However, throughout the book experienced readers may find themselves wishing for further exploration of topics that the chapters only touch upon.

Cognitive Rehabilitation is generally a more detailed book than Neuropsychological Interventions. The book consists of 13 chapters, each beginning with an outline, a helpful feature because a roadmap is useful with the additional complexity. Chapter 1, an introduction to the book, provides a synopsis similar to that found in the last chapter of Neuropsychological Interventions.

Chapter 2, “An Overview of Neuropsychological Rehabilitation: A Forgotten Past and a Challenging Future” tells the history of the field up to present times that might be particularly valuable for readers new to rehabilitation, concluding with questions regarding outcomes and challenges, both current and future.

The chapters that follow address models of rehabilitation, cognitive deficits, and one particular diagnostic category. The first of two chapters on global integrated approaches, chapter 3 notes the importance of “indirect” symptoms: difficulties that arise as a person copes with “direct” brain changes, “Part of the reason that neuropsychological rehabilitation is not adequately progressed is precisely because clinicians and researchers have not taken the need to separate out direct and indirect symptoms seriously” (p. 54). The ingredients of a holistic approach are summarized with particular attention to indirect symptoms and with staff functioning noted. The remainder of the chapter focuses on outcome in terms of efficacy of treatment, research findings regarding clinical improvement and risk of further decline, and models of change, with emphasis throughout on how people adapt after injury. The second chapter on global integrated approaches reads like an extended research paper as it compares two Dutch programs: “Cognitive Rehabilitation” and “Intensive Neuropsychological Rehabilitation.” The former is individualized therapy over a maximum of 2 years with some group therapy; the latter consists of 20 hours of group treatment per week for 16 weeks. The strength of this chapter is the degree to which it explains the programs as the outcome data is either descriptive or analysis of within program change.

Chapter 5, “Cognitive Rehabilitation of Central Executive Disorders,” the first chapter to focus on specific brain dysfunctions, briefly describes the elements of executive dysfunction followed by an examination of four types of rehabilitation procedures: intellectual training in problem solving, behavioral training for emotional dysfunction, combination approaches, and external supports. It concludes by noting the lack of standard protocol for the treatment of executive disorders and bemoaning the lack of evidence for generalization to the real world of some treatments.

The reader must shift gears to absorb chapter 6 on schizophrenia. On one hand, the book is not otherwise organized by diagnosis; on the other hand, this chapter provides a valuable perspective for clinicians who work with brain injury to contemplate how their techniques might apply to “mental health” populations. That persons with schizophrenia have cognitive deficits is increasingly recognized; treatment efforts include the typical list of medication, cognitive training, and skills training. Readers may wish for more detail on how information from other chapters might apply to schizophrenia.

Chapter 7, “Cognitive Rehabilitation of Memory Disorders,” begins a sequence of six chapters organized by particular dysfunctions. The chapter reviews five treatment approaches: psycho-educational, external aids, repetitive practice, internal strategies, and compensation through intact processing, with recommendations at least for those persons with mild to moderate memory deficits, to attend to these individuals subjective experience and training in use of external aids and techniques for specific situations.

The issue of “Compensation versus Restoration in the Rehabilitation of Language Disorders” is the focus of chapter 8. The author asserts that a theory of reconnection of partially damaged neural circuits is the best model for explaining recovery, concluding that (1) treatment inducing learning to cause reconnection of partially damaged neural circuits may help moderately impaired individuals and that this could explain their improvement, and (2) otherwise, compensation efforts account for improvement and ought to be the basis for treatment. The atheoretical nature of most aphasic rehabilitation is noted along with and then a review of various treatments asking whether compensation could account for the changes.

“Therapy of Apraxia—Implications for Cognitive Rehabilitation,” chapter 9, is an extended research report presenting the author's research with the purpose of determining whether apraxia affects a basic aptitude and whether treatment of one manifestation of apraxia will generalize to other manifestations of apraxia, supposedly because therapy affects a general aptitude. The author concludes from his research that apraxia can affect multiple manifestations, but that training still might not generalize. Multiple aptitudes may contribute to a particular failure.

Chapter 10 reviews the “Rehabilitation of Unilateral Neglect,” offering two clinically evaluated methods (i.e., scanning training and limb activation training) and four other approaches (i.e., prism utilization, dorsal/ventral system interaction, manipulation of egocentric space, and arousal/attention methods). While the chapter is relatively short, it provides a useful summary of the techniques. The following chapter, “Visual Rehabilitation in Homonymous Hemianopia and Related Disorders,” discusses field deficits with regard to spontaneous recovery, rehabilitation, and restoration, including use of optical devices and a detailed description of saccadic compensation training. The authors observe that “treatment for hemianopic field loss should more often be the focus of systematic rehabilitation efforts than it is at present” (p. 251), a viewpoint that likely bears repeating at many rehabilitation centers. Chapter 12, “What Cognitive Rehabilitation May Learn From Motor Control Theory,” takes the perspective that cognitive treatments and motor learning ought to be integrated during rehabilitation as motor learning requires knowledge of results, knowledge of performance, variability of practice, and linkage with application, variables considered essential for all rehabilitation. Linking actual physical therapy to cognitive work is recommended.

The last chapter, “Evaluation of Neuropsychological Rehabilitation,” discusses the evaluation of the effectiveness of neuropsychological treatment by summarizing recent reviews and defining neuropsychological rehabilitation as “a systematic, behavior-oriented set of interventions for people with brain dysfunctions, which is based on knowledge of the relations between brain lesions and cognitive, emotional, and behavioral problems” (p. 272). Much of the chapter is devoted to research and design considerations.

So, what can readers conclude from these two books? To begin, both books highlight that there are on-going attempts to conceptualize intervention in theoretical frameworks. Unfortunately, chapters in both books tend to conclude with statements that reflect broad generalizations, are fairly obvious, or reflect that we do not yet know enough: these observations are limited in their helpfulness. Furthermore, neither book relates how well actual practices in typical rehabilitation centers are linking treatment with theory. In that sense, while our scientific knowledge is increasing there is still much art in cognitive treatment. Both books, at various times, do provide clinicians with useful information on intervention, but readers should know that these are not cookbooks. Of course, they do not intend to be.

Therefore, one can ask who will benefit, and in what way, from these books. The difficulty in answering that question is due to the uneven nature of both books. Sometimes the information is clearly introductory level material; sometimes it is quite precise and advanced. Some authors survey the field; other authors provide mostly research reports. There are chapters that are primarily theoretical, and there are chapters that are relatively applied. Both books would have benefited from further editing across chapters to achieve consistency and, perhaps, integration. Moreover, both books suffer from organizational problems: chapters seem misplaced.

Hence, whether readers find each book helpful depends upon their interest (e.g., visual disturbance versus memory versus apraxia), their background (e.g., neuropsychologist vs. other disciplines; researcher vs. clinician), and their experience (e.g., novice vs. expert). Any given reader will find a particular chapter valuable or not depending upon that reader's needs. The uneven nature of both books makes prediction about satisfaction impossible. That said, in general readers will probably find Neuropsychological Intervention to be the more basic of the two books, and Cognitive Rehabilitation to be the more detailed and advanced.

A final thought regarding titles, terms, and conceptualization seem apropos at this point. Both books take a fairly broad view of their content area. The content ranges from memory, apraxia, and language disturbances, for example, at one end of the spectrum through social disturbances and emotional-related processing to even pharmacological treatment in the case of Neuropsychological Intervention. For Cognitive Rehabilitation the field includes such topics as memory, apraxia, and language, too, but then spans global treatment models and treatment of schizophrenia.

To some extent, such breadth is to be applauded. Artificial walls between cognition, emotion, and behavior are often detrimental. But it does raise an interesting set of questions that could be the focus of a future book: What is the difference, if any, between psychotherapy and cognitive rehabilitation for persons with cognitive impairment? Does it matter if the recipient has “brain injury” or “mental illness”? Finally, for the clinicians, what do the answers to these questions imply for who provides what service to whom and who will pay for what treatment?