Neuropsychological rehabilitation: this is how it is used in patients

We may know someone who has had some sort of accident that altered their mental abilities, or we have occasionally seen it in a movie or read in a book. Car accidents, strokes, dementia … all of these have or can have a big effect on our nervous system.

In these cases, after taking the person to the hospital and once their situation is stable and not in danger, their abilities are assessed and when alterations are detected, this is done. neurorehabilitation or neuropsychological rehabilitation. Throughout this article we will talk about this type of rehabilitation.

    What is neuropsychological rehabilitation?

    It is understood by neuropsychological rehabilitation in the therapeutic process by which people who have suffered some type of brain injury are treated so that they regain or at least improve the cognitive abilities and the functionalities of daily life that they have lost as a result of these injuries.

    The great cerebral plasticity that we have, especially in childhood but which subsists in part for the rest of our life, allows in many cases it is possible to recover or partially or completely improve the lost functions. Of course, this will not always be possible, in which case other strategies can be used so that this loss does not result in disability.

    Rehabilitation is usually carried out by a multidisciplinary team of different professionals in the health field who provide the knowledge and techniques of their respective disciplines to improve the patient’s situation. Among them are doctors, clinical psychologists and neuropsychologists, occupational therapists, speech therapists and physiotherapists, among others.

    Throughout the process, the objective is to generate an explanatory model that allows the patient and his environment to understand what happened and its effects, to support the management of this fact and finally to mitigate or to remedy deficits caused by injuries, or by healing. functions or by the application of different mechanisms to overcome the difficulties.

    The type of help given to patients

    It is important that this neurorehabilitation or neuropsychological rehabilitation has ecological validity, that is to say that what is achieved serves the patient for his daily practice.

    Treatment must be personalized and be adapted to the patient’s abilities and functional recovery. Some variables to consider are the type, area, severity and cause of the injury, cognitive and functional ability prior to it, and aspects such as gender or age.

    The ways of acting and the specific techniques used will therefore vary considerably in each case. Sometimes it may be necessary to perform more than 1 hour of rehabilitation social skills training, vocational rehabilitation and behavior modification techniques, as well as therapy to alleviate the disorders resulting from the experience of their condition and family orientation.

    Likewise, it should be borne in mind that sometimes the goal is not to improve the patient’s abilities or to recover them, but maintain their mental functions as long as possible. Finally, it should be kept in mind that the rehabilitation must be plastic and take into account the evolution of the patient: it will be necessary to monitor and evaluate in order to adjust the rehabilitation to the patient’s condition.

    Rehabilitation approaches

    In the context of neuropsychological rehabilitation, we can act in different ways so that the patient can regain functionality. These are not mutually exclusive ways of acting, but they can overlap. Rather, it is about different ways of approaching treatment, focusing on the possibility of regaining lost functions. Specifically, we can find the following three main approaches, although you can add optimization as a fourth approach to consider.

    Restoration or restitution of functions

    This is understood to mean the neurorehabilitation approach which focuses on the recovery of the same mechanisms that the subject has lost or seen diminished due to the brain injury suffered. We work through the stimulation of these functions, seeking to recycle the subject in their application and to reconstruct the function. however recovery is not always possible, Especially when talking about major brain damage.

    Function compensation

    Where it is not possible to regain lost functions, treatment will focus on optimizing and improving other skills so that they can compensate for those that have been lost and that loss does not result in a loss. handicap. It is about using what the patient has kept to develop.

    replacement

    Partly similar to compensation strategies, the substitution aims so that, by different means and strategies, the subject can compensate for cognitive and functional deficits, Using different alternative skills or even external means such as alarms or agendas.

    optimization

    Beyond the compensation or replacement of lost skills, neuropsychological rehabilitation can act in such a way as to improve the capacities and potentialities of the person executed.

    What is rehabilitated?

    Neuropsychological rehabilitation is an element that must be considered in the subject holistically, that is to say as a whole. However, rehabilitation is usually focused on specific skills, Being among the most common the following.

    1. Attention

    Attention deficit may be altered due to brain injury, which requires neuropsychological rehabilitation.

      2. Memory

      Memory is one of the most important basic skills in our daily life, and it is common in neuropsychological rehabilitation to try to facilitate memory.

      He may not remember what happened in the past, the ability to record new information, forward-looking memory (which I will do later) or recognition, among others . Different programs and techniques, such as reminiscence, can help maintain or exercise memory.

      3. Executive functions

      The set of executive functions is one of the aspects in which more neuropsychological rehabilitation is carried out, these skills being practically essential to achieve lead an independent and functional life.

      4. Psychomotor skills

      Movement is another of the abilities that can be affected by brain injury. From the emission of uncontrolled movements to immobility, via apraxia or the loss / decrease in the ability to perform more or less complex actions and to perform coordinated sequences of movements, they may require neuroreeducation.

      5. Language

      Aphasias are losses or deficits in the ability to communicate through language due to brain damage, a common problem. The problem can be found in fluency and expression, comprehension or repetition. It is a skill very worked on at the level of rehabilitation.

      6. Perceptual rehabilitation

      It is very common for brain damage to occur alterations in perception, or a kind of agnosia or lack of recognition of the stimulation. Through neuropsychological rehabilitation, they can make improvements in this aspect.

        Problems in which it is generally applied

        There are a large number of problems in which brain injury is generated and in which the application of neuropsychological rehabilitation may be necessary. Among them, some of the most common are as follows.

        1. Cranioencephalic trauma

        The head injuries are a very common cause of head injuries, frequently caused by traffic accidents, falls or even for assaults. Alteration of symptoms and function will largely depend on the location and extent of the injury.

        2. Strokes

        Stroke, whether in the form of ischemia or hemorrhage, is a major problem that has become one of the main causes. death among the population. They cause flooding or blockage and stop the supply of oxygen outside the brain. This causes the death of a large number of neurons, Which depending on the area in which neuronal death occurs will generate more or less permanent deficits. Neuropsychological rehabilitation is a great help in recovering or compensating for lost skills.

        3. Cognitive impairment

        While it doesn’t turn into dementia, cognitive impairment is a decline in certain functions that can be alleviated thanks to neuropsychological rehabilitation.

        4. Dementias and neurodegenerative diseases

        In this case, neuropsychological rehabilitation does not focus on the recovery of functions but on their preservation as long as possible.

        Memory, attention and executive skills are the main areas to be rehabilitated, although language and psychomotor skills are also worked on. Alzheimer’s disease, dementia due to Parkinson’s disease, Pick’s disease, frontotemporal dementias or Huntington’s Korea are among the best known.

        5. Intellectual disability and neurodevelopmental disorders

        Although technically we would not speak of rehabilitation per se, the presence of an intellectual disability or neurodevelopmental disorder may require such techniques in order to train and generate optimization of functions.

        6. Epilepsy

        Suffering from epileptic seizures can lead to impaired and reduced cognitive functions and functioning in everyday life. Neuropsychological rehabilitation may be necessary in some cases.

          7. Neurosurgery

          Sometimes it may be necessary to resort to neurosurgery to solve some type of medical problem, as happens for example in the case of said epilepsy or in the face of a brain tumor. These interventions can save lives or avoid major problems resulting from different conditions. However, they can cause difficulty and decrease some functions, which may require neuroreeducation to return to normal.

          8. Poisoning or effects of prolonged substance use

          Some substances can also cause brain damage, let’s talk about drugs poisoning by consuming a poisonous substance. If such damage does occur, neuropsychological rehabilitation may be helpful in recovering to some extent functionality and functions that may have been damaged.

          Bibliographical references:

          • Sants, JL and Bausela, E. (2005). Neuropsychological rehabilitation. Psychologist Articles, 26 (90): 15-21. General Council of Official Colleges of Psychologists. Madrid, Spain.
          • Tirapu, J. (2007). Neuropsychological assessment. Psychosocial intervention, 16 (2). Madrid, Spain.

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