Neuropsychology is responsible for assessing and rehabilitating people who have suffered some type of brain injury or injury. The problems that neuropsychology deals with are many and varied, such as impaired memory, language, attention, or diseases such as dementia.
In this article we will explain what kind of problems neuropsychology treats through rehabilitation.
What is neuropsychology and what problems does it treat?
Neuropsychology is a scientific discipline that studies the relationship between the brain and behavior, and its purpose is to identify and describe cognitive and functional problems or alterations due to brain injury or disease, as well as to intervene therapeutically by rehabilitating people suffering from its consequences in all areas of his life.
The field of activity of this practice it extends to people with organic lesions of the central nervous system, The origin can be of different types: head injuries, strokes, tumors, dementias, infectious diseases, metabolic disorders, etc.
Neuropsychology is also responsible for treating patients with problems that affect cognitive functions such as memory, attention, executive functions, etc., either because it is a secondary affectation to a certain type. a disorder (dementia or neurodegenerative diseases, for example), or by cognitive impairment related to age or of unknown origin.
A complete and correct neuropsychological intervention should be based on the application of the following phases or steps: diagnosis and evaluation, a first step in which the person participating in the consultation must specify what their problem is, As well as its history and background, so that the professional, through the use of batteries and tests, can assess the different functions and capacities of the person to make a judgment and an evaluation.
The second step consists of set goals and create a treatment plan or rehabilitation program. With all of the information gathered above, the neuropsychologist will need to tailor the content and program to the specific needs of the patient. After this phase comes the third and most important step: neuropsychological rehabilitation, to which we will devote a specific chapter below. The fourth and last will consist in the generalization of the results of the applied program.
Rehabilitation in neuropsychology aims to reduce or minimize the cognitive, emotional and behavioral deficits and alterations that can occur after brain damage, in order to achieve the maximum capacity and functional autonomy of the patient, both socially, as a family and work.
A neuropsychologist can treat patients with a multitude of conditionsAmong which: cognitive deficits (memory, attention, executive functions, speed of processing, gnosis, praxis, etc.), learning problems, language disorders, neurodegenerative diseases, stroke, epilepsy, attention deficit, developmental disorders, etc.
Next, we will describe the most common problems that neuropsychology faces.
1. Rehabilitation of acquired brain injuries
The main causes of acquired brain injury are: tumors, stroke or stroke, anoxia, infectious diseases and traumatic brain injury. When such an injury occurs, there is a maxim in neuropsychology and it is necessary to consider its nature, extent and location in order to determine the severity of the damage caused.
In addition to the mentioned characteristics, it is also necessary to take into account the time elapsed since the injury, as well as the socio-demographic, medical and biological variables of the patient, since the success of the intervention will be greater if they are taken into account. .examination of all.
There is a ‘window of opportunity’ after the injury, In which the patient may benefit more from neuropsychological rehabilitation; it must therefore be done as soon as possible. It is necessary to know which functions are altered and which are not in order to be able to intervene correctly.
In a patient with acquired brain damage, the usual thing is to have to rehabilitate specific cognitive functions such as attention, memory, executive functions, gnosis, visual abilities or praxis; as well as any emotional and behavioral disturbances that may be caused.
2. Memory rehabilitation
One of the most common problems that a professional neuropsychologist often encounters is memory impairment.
Memory can be divided into long-term or long-term memory (MLP), a “warehouse” where we store lived memories, our knowledge of the world, images, concepts and strategies for action; immediate or short-term memory (MCP), referring to our ability to recall information immediately after it is presented; and sensory memory, a system capable of capturing a large amount of information, only over a very short period of time (about 250 milliseconds).
Memory deficits are usually very persistent and, while they can be helpful, repetitive stimulation exercises aren’t the only solution.
When rehabilitating memory, the patient should be helped by teaching him guidelines for organizing and categorizing the items to be learned; it is also useful teach him how to create and learn a to-do list or help organize information into smaller parts or steps, So you can remember it more easily.
Another way to improve the patient’s memory capacity is to teach them to focus their attention and to work on controlling their ability to pay attention to the task at hand or to learn something; and also to work out details of what you want to remember (for example, writing them down on a piece of paper or talking to yourself, giving yourself instructions).
3. Rehabilitation of care
When we talk about attention, we are generally referring to the level of alertness or alertness of a person when performing a specific activity; that is to say, a general state of excitement, of orientation towards a stimulus. But attention can also involve the ability to focus, divide, or maintain mental effort.
It therefore seems that attention is not a unitary concept or process, but that it is made up of multiple elements such as orientation, exploration, concentration or alertness. And not only is it made up of these functional elements or sub-processes, but there are also multiple brain locations underlying these attentional processes.
The intervention of care problems will depend on the etiology of the brain injury, the phase in which the patient is in their recovery process and their general cognitive state. However, there are generally two strategies: a non-specific and a more specific aimed at specific attention deficits.
The nonspecific intervention focuses on treating attention as a unitary concept and the task types typically measure reaction time (simple or complex), combine visual stimuli in multiple choice, auditory sensing, or Stroop type.
In the specific intervention, I am identified the deficits of the different attentional components are differentiated. A hierarchical model is generally used and each level is more complex than the previous one. A typical example is Attention Process Training, an individualized application program of attentional exercises with different complexity in sustained, selective, alternating and split care, which also combines methods and techniques of brain injury rehabilitation, as well as educational psychology and the clinic.
4. Rehabilitation of executive functions
Executive functions are a set of cognitive skills that allow us to anticipate, plan and set goals, make plans, initiate activities, or self-regulate. Deficits in this type of function make it difficult for the patient to make decisions and develop in their daily life.
In the clinical context, the term dysexecutive syndrome has been coined to refer to define the image of cognitive-behavioral alterations typical of a deficit in executive functions, This implies: difficulty concentrating on a task and completing it without external environmental control; exhibit rigid, persevering and stereotypical behaviors; difficulties in establishing new repertoires of behaviors, as well as the lack of capacity to use operational strategies; and lack of cognitive flexibility.
To rehabilitate executive functions, the neuropsychologist will help the patient to improve his problems with: initiation, sequencing, regulation and inhibition of behavior; problem solving; abstract reasoning; and alterations in disease awareness. The most common is to focus on the preserved capacities and to work with those most affected.
5. Linguistic rehabilitation
When it comes to a language problem, it is important to consider whether the impairment affects the patient’s ability to use oral language (aphasia), written language (alexia and agraphia), or all of the above in same time. Sometimes, in addition, these disorders are often accompanied by others such as apraxia, acalculia, aprosody or dyslexia.
Treatment should be based on the outcome of a thorough assessment of the patient’s language and communication disorders, Evaluate their cognitive state as well as the communication skills of those close to them.
in one cognitive language stimulation program, The neuropsychologist must set a number of goals:
- Keep the person verbally active.
- Relearn the language.
- Give strategies to improve the language.
- Teach the family communication models.
- Offer psychological support to the patient.
- Practice automatic language.
- Decrease patient avoidance and social isolation.
- Optimize verbal expression.
- Improve the ability to repeat.
- Encourage verbal fluency.
- Practice reading and writing mechanics.
6. Rehabilitation of dementias
In the case of a patient with dementia, the objectives of a neuropsychological intervention are: to stimulate and maintain the mental capacities of the patient; avoid disconnection from their environment and strengthen social relations; give the patient security and increase their personal autonomy; stimulate one’s own identity and self-esteem; minimize stress; optimize cognitive performance; and improve the mood and quality of life of the patient and his family.
The symptoms of a person with dementia problems will not be just cognitive in nature (Attention, memory, language deficits, etc.), but also emotional and behavioral, only carrying out cognitive stimulation will therefore be insufficient. Rehabilitation must go further and include aspects such as behavior modification, family intervention and vocational or vocational rehabilitation.
Intervening at an early stage, with mild cognitive impairment, is not the same as at an advanced stage of Alzheimer’s disease, for example. That is why it is important to note the complexity of the exercises and tasks depending on the intensity of the symptoms and the course and phase of the disease in which the patient is.
In general, most rehabilitation programs for moderate and severe cognitive impairment are based on the idea keep the person active and stimulated, To slow cognitive decline and functional problems, by stimulating areas that are still preserved. Inadequate stimulation or its absence can result in patients, especially in the elderly, confusional states and depressive images.
The future of rehabilitation in neuropsychology
Improving cognitive rehabilitation programs in patients with acquired brain injury remains a challenge for neuropsychological professionals. The future is uncertain, but if there is one thing that seems obvious, it is that over time, the weight of technologies and neurosciences will increase, With the implications this will have when creating new, more effective and efficient intervention methodologies.
The future is already present in technologies such as virtual reality or augmented reality, in computer-assisted programs and artificial intelligence, in neuroimaging techniques or in tools such as transcranial magnetic stimulation. Improvements in diagnostic and assessment techniques that allow professionals to intervene on command, with personalized programs adapted, really, to the needs of each patient.
The future of neuropsychology will be to borrow the best of each neuroscientific discipline and to assume that there is still a lot to learn, without forgetting that to intervene better we must seek more and to intervene less it is necessary to be able to prevent better.
- Antoni, PP (2010). Introduction to neuropsychology. Madrid: McGraw-Hill.