The 4 phases of neuropsychological intervention (and its characteristics)

Neuropsychological intervention aims to assess and rehabilitate cognitive and functional disorders produced in an individual by a brain injury or disease.

In this article we will see what are the phases of the neuropsychological intervention and what objectives they pursue in each case.

The phases (or stages) of the neuropsychological intervention

In order to perform such an intervention, 4 phases must be followed: Evaluation, definition of goals and treatment planning, rehabilitation and, finally, generalization of results.

Let’s see, in more detail, what each of them consists of.

First phase: neuropsychological assessment

Neuropsychological assessment is the first phase of neuropsychological intervention. The aim of this assessment is to describe and quantify the cognitive, behavioral and emotional alterations of the patient, as a result of the injury or acquired brain damage.

This task consists of carrying out an in-depth and exhaustive assessment of the person, through the neuropsychological analysis of cognitive functions, both altered and still preserved by the patient, as well as the skills of daily life which are preserved and those which are not. are not.

A series of diagnostic tests and trials are used for this task, the aim is to find the factors responsible for the neuropsychological syndrome which will then be used in the construction of the neuropsychological rehabilitation program. But what other goals should the neuropsychological intervention assessment process achieve?

Objectives of the neuropsychological assessment

The neuropsychological assessment process is not only a tool for the healthcare professional to gather information, but also an opportunity for the patient and their loved ones to stay informed about what is happening to the affected person and what may be. done to improve his situation.

The main objectives of the neuropsychological assessment are:

  • Describe in detail the consequences of brain injury in terms of cognitive functioning, possible behavioral disturbances and emotional disturbances.

  • Define the clinical profiles that characterize the different types of pathologies that present with neuropsychological deterioration.

  • Set up an individualized rehabilitation program, based on the patient’s skills and abilities, the aim being to improve the person’s autonomy and quality of life.

  • Contribute to the establishment of a differential and precise diagnosis of certain neurological and psychiatric diseases.

  • To determine the progress of each patient, as well as to evaluate the effectiveness of the various treatments.

  • Expertise and / or forensic assessment of the person’s level of cognitive and functional impairment, with a view to possible compensation and disability assessment processes.

Second phase: Definition of goals and treatment plan

The next phase of the neuropsychological intervention process is to set goals and the treatment plan or rehabilitation program.

One of the basic principles of neuropsychological rehabilitation is to rely on preserved skills, so that they can serve as a support or support to intervene in others who are affected.

With all the information gathered during the assessment process, the goals and objectives of rehabilitation should be planned. It is important to set specific goals related to the patient’s own activities and interests. For example, if one of the goals is for the patient to be able to practice their favorite sport again (long term goal), we will need to set short term goals that will help them achieve it.

The programs designed should be individualized and focused on the needs of each patient. It is advisable to conduct individualized sessions to work on specific cognitive (eg, memory training or attention), behavioral (such as aggression) and emotional (eg, work on self-esteem and awareness) aspects. self-image).

But there must also be group sessions in which individually tested techniques and strategies are tested, so that the results can then be generalized to more ecological and common situations (generalization of results).

In short, a rehabilitation program should address the following key aspects:

  • Treatment and rehabilitation of impaired cognitive functions.

  • Modification of inappropriate behavior.

  • Psychosocial support and emotional management

  • Social and occupational rehabilitation

  • cognitive rehabilitation

Third phase: neuropsychological rehabilitation

Rehabilitation is the third and most important phase of neuropsychological interventionBecause it is at this stage that the techniques and strategies necessary to rehabilitate the patient are applied.

In neuropsychological rehabilitation, it is possible to distinguish different tendencies or orientations, each of them assuming different principles based on the neural mechanisms underlying cognitive changes.

Approaches to cognitive rehabilitation

As in almost all disciplines, in the field of neuropsychological rehabilitation, different tendencies or orientations are also used to approach the rehabilitation process. Each of them assumes different principles in relation to the neural mechanisms underlying cognitive changes.

  • Restoration of damaged functions This theory postulates that damaged cognitive processes can be restored through their stimulation. The cognitive rehabilitation techniques designed as part of this approach are based on performing repetitive tasks and exercises, with the aim of reactivating brain circuits and ultimately recovering impaired cognitive functions.

Although cognitive rehabilitation by this approach has been useful in some areas of intervention, such as attention or motor functions, in processes such as memory, there is no evidence that impaired function is recovered, that is, there is neuronal regeneration, after the period of spontaneous recovery.

  • Compensation for damaged functions This alternative approach is based on the principle that damaged brain mechanisms and cognitive processes can hardly be recovered. That is why cognitive rehabilitation should emphasize the performance of tasks and activities that have a functional purpose, through the use of alternative strategies or external aids that reduce or eliminate the need for demands. cognitive.

This approach has been shown to be particularly useful when brain damage is very extensive or impaired cognitive function is important. For example, technical aids have been used as computer-assisted voice systems for patients with severe verbal difficulties; or the use of alarms and logs for people with memory problems, etc.

  • Optimization of residual functions In this approach, it is postulated that cognitive processes are usually not completely damaged after brain injury, but are reduced in their efficiency and effectiveness, so it is advisable to develop other brain structures or circuits that are not affected, thus ensuring their functioning.

The objective of cognitive rehabilitation within the framework of this approach would therefore be to improve the performance of functions altered by the use of preserved cognitive processes, and not so much by the use of external aids.

Areas of work in neuropsychological rehabilitation

The areas most frequently worked on in a rehabilitation program are: spatiotemporal orientation, attention, memory, executive functions, arithmetic, language, visual and constructive skills, and literacy.

Treatment usually also includes sessions of psychotherapy, usually cognitive behavioral therapy.And fight against inappropriate behaviors through behavior modification tools. In addition, it is important to work side by side with the patient’s family, so that they are also part of the rehabilitation process.

In the final stages of treatment, improvement of social skills, vocational and vocational guidance, as well as return or reintegration into the community, with the aim that the patient can develop as a person and adapt from manner appropriate to their social and professional environment.

Fourth phase: generalization of the results

The last phase of the neuropsychological intervention is the generalization of the results; that is, the patient’s ability to finally apply and use in his daily life what he has learned in the rehabilitation program.

In the clinical setting, the difficulty experienced by many brain injury patients in applying the principles and skills acquired during the sessions of neuropsychological rehabilitation programs to their daily life is well known.

If, for example, a patient with memory problems is taught to use an external aid – such as a diary – to avoid certain oversights, he is expected to then continue to use these aids at home, at work or in the workplace. any other known environment. It is a question of generalizing the results.

And to encourage and enhance this process of generalization, it is necessary to take into account the following aspects:

  • Try to include in the design of the intervention program tasks aimed at promoting the generalization of the results.

  • Try to identify reinforcers in the patient’s natural environment.

  • Use plenty of examples when re-educating and learning the skill in question.

  • Use during the rehabilitation of materials and situations similar to those used in the real context

  • Follow up that assesses the level of generalization achieved.

Bibliographical references:

  • Muñoz-Marró I, Blázquez-Alisente JL, Galparsoro-Izagirre N, González-Rodríguez B,
  • Lubrini G, Periáñez-Morales JA, et al. Cognitive stimulation and neuropsychological rehabilitation. Barcelona: UOC; 2009
  • Tirapu Ustárroz, J. and Muñoz Céspedes, J. (2008). Neuropsychological rehabilitation. 1st ed. Madrid: Editorial Síntesi.

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