This literature section is about advocacy. It is here for two reasons:
- Education. To educate, by providing a source to acquire the leading texts in the field of brain injury; and
- Authority. To show that there is academic, peer reviewed literature, published by the best medical publishing companies in the world, to substantiate the information we provide elsewhere.
With respect to the goal of education, as these texts are written for medical professionals, they may be too technical for those just beginning in this field. Despite that, I believe they are worthy of purchase.
First, I find that those whose lives have been impacted by brain injury, often share my thirst for knowledge and very quickly learn the necessary medical knowledge and vocabulary to make it feasible to glean much from these academic works. Second, and most tied into my goals of advocacy, I am hoping that those of you who are most frustrated with the absence of understanding you encounter in the medical and psychological professions, may convince those who should know about this literature, to acquire this knowledge. It is a bizarre thing to buy a neurologist a book on neuropsychology like Lezak, yet the $72.50 such book will cost you, is a small amount compared to the potentially catastrophic cost of misdiagnosis.
Likewise, I believe that absolutely everyone who has to deal with the families of someone in a coma, should read Catastrophic Brain Injury, especially before they start talking about pulling the plug.
It is only through education that we eliminate the ignorance about the subtlety of brain injury. Why do it through the textbooks:? Because we advocates aren’t supposed to be the experts, they are. If they won’t listen to you, and they won’t listen to me, maybe they will listen to Muriel Lezak, Bryan Jennett and Thomas Gennarelli.
They might also listen to their peers, which is why I have included Injured Brains of Medical Minds with our offerings. Perhaps the best way to help understand the perspective of someone with brain related disability, is these first hand narratives of a series of medical professionals whose lives were changed by brain damage in some form. Included in this medley is the story of the “Neurosurgeon as a victim”, the case study of a neurosurgeon who was unable to continue in his profession as a result of a concussion.
One fascinating aspect of this book, is the way in which it uses anecdotal information as a call for the objective studies, upon which our future foundations of brain injury science may be based. Dr. Kapur ends his anthology with a call for research into the very issues which seem to recur again and again in our cases, at page 412 of Injured Brains of Medical Minds:
A number of articles in this book allude to difficulties that brain damaged patients have in performing more than one task at a time. We take it for granted that we can perform an over-learned skill, such as walking, and at the same time another overlearned skill, such as listening to a conversation. For an individual with a compromised brain, this automaticity of dual-task performance cannot be taken for granted. Difficulties become all the more evident when one of the skills is not as overlearned as walking/listening, where there are significant information demands within one or more of the skills (e.g. listening to a conversation involving several people discussing a complex topic), or where there may be additional tasks or background distractions.
It would seem that, in some neurological conditions, activities that were previously ‘automatic’ have now come under ‘conscious cortical control’. perhaps regulated by frontal lobe mechanisms. It is possible that this is equivalent to the active use of a ‘working memory system’, and that in such patients having to perform another activity at the same time mimics dual-task performance in an experimental setting. Another explanation is to ignore the possible involvement of a ‘supervisory’ or ‘executive’ system, and instead to view the brain as a ‘mass action’ system, whereby a cognitive or motor activity uses up a general reserve of brain capacity, in addition to particular demands on specific structures- the more tasks that are performed at any one time, the greater that such a general reserve neural capacity gets utilized. Whatever the precise neural mechanisms involved, some of the articles in this book, such as the one on the effects of a mild head injury (Marshall and Ruff), highlight the need for neuropsychologists to develop measures of cognitive dysfunction that will be sensitive to subtle sequelae of brain injury, and those measures that incorporate a dual-task performance component will probably be particularly useful in this regard.
I confess that my fascination with brain injury research is not strictly for its forensic value. I enjoy learning about the brain, because it helps me to connect the dots, with what I hear in my daily repartee with the Injured Brains of the Non-Medical Minds. Yet, I know that I am learning things about brain injury from my clients that are not in the authoritative literature. As Kapur calls for research to be directed by his anecdotal literature, it is my hope that we advocates can also have an impact upon the direction of that research. It is important not only that the issues that we battle forensically today are the settled fact of the future, but that those subtle aspects of brain injury which so disable our clients, are properly understood and addressed.