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Neuropsychological Rehabilitation: Restoring and Optimizing Cognitive Functions, Study Guides, Projects, Research of Neuroscience

University of Minnesota (UMN) - DuluthNeuroscience

A comprehensive overview of neuropsychological rehabilitation, a therapeutic process aimed at helping individuals recover or improve cognitive skills and functionality in daily life after brain injuries. It discusses personalized and ecologically valid treatment, different rehabilitation approaches, and commonly targeted cognitive functions. The document covers various causes of brain injuries and how neuropsychological rehabilitation can be applied, highlighting the need to assess affected functions and maladaptive behaviors to design an effective program, while considering the impact on the patient's family.

Typology: Study Guides, Projects, Research

2023/2024

Available from 10/17/2024

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NEUROPSYCHOLOGICAL REHABILITATION PROGRAMS
INTRODUCTION
We may know someone who has suffered some kind of accident that has
diminished their mental capacities, or we have seen them on some occasion in a
movie or read about them in a book.Car accidents, strokes, dementias...All of this
has or can have a great 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 evaluated and when alterations are
detected, neurorehabilitation, or neuropsychological rehabilitation, is finally
performed.

WHAT IS NEUROPSYCHOLOGICAL REHABILITATION?
Neuropsychological rehabilitation is understood as the therapeutic process by
which people who have suffered some type of brain injury are treated in order for
them to recover or at least improve the cognitive skills and functionality in daily life
that they have lost as a result of these injuries.

The great brain plasticity that we have, especially in childhood but that remains in
force in part for the rest of our lives, allows that in many cases it is possible to
recover or partially or totally improve lost functions. Of course, this will not always
be possible, in which case other strategies can be used so that the loss does not
generate a disability.

Rehabilitation is generally carried out by a multidisciplinary team of different
professionals in the field of health who provide the knowledge and techniques from
their respective disciplines to improve the patient's situation. Among them we find
doctors, clinical psychologists and neuropsychologists, occupational therapists,
speech therapists and physiotherapists, among others.

Throughout the process, the aim is to generate an explanatory model that allows
the patient and their environment to understand what has happened and its effects,
to accompany the coping of this fact and finally to alleviate or remedy the deficits
produced by the injuries, either through the recovery of functions or through the
application of different mechanisms in order to make up for the difficulties.

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NEUROPSYCHOLOGICAL REHABILITATION PROGRAMS

INTRODUCTION

We may know someone who has suffered some kind of accident that has diminished their mental capacities, or we have seen them on some occasion in a movie or read about them in a book. Car accidents, strokes, dementias... All of this has or can have a great 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 evaluated and when alterations are detected, neurorehabilitation, or neuropsychological rehabilitation, is finally performed. WHAT IS NEUROPSYCHOLOGICAL REHABILITATION? Neuropsychological rehabilitation is understood as the therapeutic process by which people who have suffered some type of brain injury are treated in order for them to recover or at least improve the cognitive skills and functionality in daily life that they have lost as a result of these injuries. The great brain plasticity that we have, especially in childhood but that remains in force in part for the rest of our lives, allows that in many cases it is possible to recover or partially or totally improve lost functions. Of course, this will not always be possible, in which case other strategies can be used so that the loss does not generate a disability. Rehabilitation is generally carried out by a multidisciplinary team of different professionals in the field of health who provide the knowledge and techniques from their respective disciplines to improve the patient's situation. Among them we find doctors, clinical psychologists and neuropsychologists, occupational therapists, speech therapists and physiotherapists, among others. Throughout the process, the aim is to generate an explanatory model that allows the patient and their environment to understand what has happened and its effects, to accompany the coping of this fact and finally to alleviate or remedy the deficits produced by the injuries, either through the recovery of functions or through the application of different mechanisms in order to make up for the difficulties.

THE TYPE OF HELP GIVEN TO PATIENTS

It is important that this neurorehabilitation or neuropsychological rehabilitation has ecological validity, that is, that what is carried out serves the patient for its practice on a day-to-day basis. Treatment must be personalized and adjusted to the patient's abilities, as well as aimed at their functional recovery. Some variables to take into account are the type, area, severity and cause of the injury, the cognitive and functional capacity prior to it and aspects such as sex or age. The ways of acting and the specific techniques that are used, therefore, will vary greatly in each case. Sometimes, in addition to rehabilitation, it may be necessary to carry out training in social skills, occupational rehabilitation and behavior modification techniques, as well as therapy to alleviate disturbances derived from the experience of their state and family orientation. In the same way, it must be taken into account that sometimes the aim is not to improve the patient's abilities or recover them, but to maintain their mental functions for as long as possible. Finally, it must be taken into account that rehabilitation must be plastic and take into account the evolution of the patient: it will be necessary to carry out a follow-up and evaluation in order to adjust the rehabilitation to the patient's condition. APPROACHES WITHIN REHABILITATION Within neuropsychological rehabilitation we can act in different ways so that the patient can recover functionality. These are not mutually exclusive ways of acting, but they can overlap. Rather, it is a matter of different ways of approaching treatment, focusing it on the possibility of recovering lost functions. Specifically, we can find the following three major approaches, although optimization can be added as a fourth approach to take into account. Restoration or restoration of functions This is understood as the neurorehabilitation approach that focuses on the recovery of the same mechanisms that the subject has lost or seen diminished due to the brain injury suffered. It works through the stimulation of these functions, seeking to retrain the subject in their application and reconstruct the

The memory of what happened in the past, the ability to record new information, prospective memory (which I have to do later) or recognition, among others, may fail. Different programs and techniques, such as reminiscence, can help maintain memory or exercise it.

  1. Executive functions The set of executive functions is one of the aspects in which most neuropsychological rehabilitation is carried out, these skills being practically essential to lead an autonomous and functional life.
  2. Psychomotor skills Movement is another ability that can be affected due to a brain injury. From the emission of uncontrolled movements to immobility, including apraxia or loss/decrease in the ability to execute more or less complex actions and carry out sequences of movements in a coordinated way, they may require neurorehabilitation.
  3. Language Aphasia is a loss or deficit in the ability to communicate through language due to a brain injury, which is a frequent problem. The problem can be found in fluency and expression, comprehension or repetition. It is a skill that has been worked on at the rehabilitation level.
  4. Perceptual rehabilitation It is very common for a brain injury to produce perceptual alterations, or some type of agnosia or lack of recognition of the stimulation. Improvements in this aspect can be achieved through neuropsychological rehabilitation. PROBLEMS IN WHICH IT IS USUALLY APPLIED There are a large number of problems in which a brain injury is generated and in which the application of neuropsychological rehabilitation may be required. Among them, some of the most common are the following.
  5. Head injuries

A very common cause of brain injuries is head trauma, frequently generated by traffic accidents, falls or even assaults. The symptoms and functions impaired will depend to a large extent on the location and extent of the injury.

  1. Strokes Strokes, whether in the form of ischemia or haemorrhage, are a major problem that has become one of the main causes of death in the population. In them, either flooding occurs or the blockage and cessation of oxygen supply to part of the brain. This causes a large number of neurons to die, which depending on the area in which neuronal death occurs will generate deficits that can be more or less permanent. Neuropsychological rehabilitation is of great help in recovering or compensating for lost skills.
  2. Cognitive impairment Although it may not turn into dementia, cognitive impairment involves a decline in some functions that can be alleviated through neuropsychological rehabilitation.
  3. Dementias and neurodegenerative diseases In this case, neuropsychological rehabilitation does not focus on the recovery of functions but on their preservation for 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, Parkinson's disease dementia, Pick's disease, frontotemporal dementias or Huntington's chorea are some of the best known.
  4. Intellectual disability and neurodevelopmental disorders Although technically we would not be talking about rehabilitation per se, the presence of intellectual disability or neurodevelopmental disorders may require this type of technique in order to train and generate an optimization of functions.
  5. Epilepsy Suffering from epileptic seizures can cause alterations and decreases in cognitive functions and functioning in daily life. Neuropsychological rehabilitation may be necessary in some cases.
  6. Neurosurgery Sometimes it may be necessary to resort to neurosurgery in order to solve some type of medical problem, as is the case, for example, in the case of epilepsy or a brain tumor. These interventions can save lives or prevent major problems arising from different conditions. However, they can generate difficulties and decrease in some functions, which may require neurorehabilitation to return to normal.

All the information that the family member receives and puts into practice will also help the patient to have a better recovery. Apart from this psychoeducation, the family member will need psychological support and a safe space where they can express everything they think and feel. The family member of the person with brain injury also becomes affected, even if it is at another level. In them, we must not lose sight of their perspective of the situation, desires, demands with the patient and future prospects. It is also important to work with the patient's environment (associations, support groups, etc.), to have a support network nearby.