Neuropsychology is responsible for evaluating and rehabilitating people who have suffered some type of brain damage or injury. The problems that neuropsychology treats are many and varied, such as disorders of memory, language, attention, or diseases such as dementia.
In this article we are going to explain to you What kind of problems does neuropsychology treat? 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 whose purpose is to identify and describe the cognitive and functional problems or alterations due to a brain injury or disease, as well as to intervene therapeutically through the rehabilitation of people who suffer from their symptoms. consequences in all areas of your life.
The field of activity of this practice It extends to people who suffer from organic lesions of the central nervous system whose origin can be of different types: craniocerebral trauma, vascular accidents, tumors, dementia, 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., whether due to being secondary to some type of disorder (dementia or neurodegenerative diseases, for example), or due to cognitive impairment associated with age or of unknown origin.
A complete and correct neuropsychological intervention must be based on the application of the following phases or stages: diagnosis and evaluation, a first stage in which The person who comes to the consultation will have to specify what their problem consists of as well as what their history and background are, so that the professional, through the use of batteries and tests, can evaluate the different functions and capacities of the person to make a judgment and assessment.
The second stage consists of define goals and create a treatment plan or rehabilitation program With all the information collected above, the neuropsychologist will have to adapt the contents and the program to the specific needs of the patient. After this phase comes the third and most important stage: neuropsychological rehabilitation, to which we will dedicate a specific chapter below. The fourth and last will consist of the generalization of the results of the applied program.
Neuropsychological rehabilitation
Rehabilitation in neuropsychology aims to reduce or minimize the cognitive, emotional and behavioral deficits and alterations that may appear after brain damage, in order to achieve the patient’s maximum capacity and functional autonomy, both at a social, family and work level. .
A neuropsychologist can treat patients with a multitude of conditions among which are: cognitive deficits (memory, attention, executive functions, processing speed, gnosias, praxias, etc.), learning problems, language disorders, neurodegenerative diseases, stroke, epilepsy, attention deficit, mental disorders development, etc.
Next, we are going to describe the most common problems that neuropsychology must address.
1. Rehabilitation of acquired brain damage
The main causes of acquired brain damage are: tumors, cerebrovascular accidents or strokes, anoxia, infectious diseases and traumatic brain injuries. When an injury of this type occurs, there is a maxim in neuropsychology and that is that the nature, extent and location of the injury must be considered in order to determine the severity of the damage caused.
Along with the aforementioned characteristics, we must also take into account the time elapsed since the injury occurred, as well as the patient’s sociodemographic, medical and biological variables, since the success of the intervention will be greater if all of them are taken into consideration.
There is a “window of opportunity” after injury , in which the patient will be able to benefit from neuropsychological rehabilitation to a greater extent; That is why it must be carried out as soon as possible. It is necessary to know which functions are altered and which are not in order 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, gnosias, visual-perceptive skills or praxias; as well as possible emotional and behavioral disorders that could occur.
2. Memory rehabilitation
One of the most common problems that a neuropsychology professional usually encounters is memory impairment.
Memory can be divided into remote or long-term memory (LTM), a “warehouse” where we store lived memories, our knowledge of the world, images, concepts and action strategies; immediate or short-term memory (STM), referring to our ability to recall information immediately after being presented; and sensory memory, a system capable of capturing a large amount of information, only during a very short period of time (about 250 milliseconds).
Memory deficits are usually very persistent and, although they can help, repetitive stimulation exercises are not the only solution.
When rehabilitating memory, it is advisable to help the patient by teaching them organization and categorization guidelines for the elements to be learned; it is also useful teach you how to create and learn to-do lists or help you organize information into smaller parts or steps so you can remember them more easily.
Another way to improve the patient’s memory capacity is to teach him or her to focus attention and work on the control of attentional capacity on the task in progress or when learning something; and, also, elaborate details of what you want to remember (for example, writing them on paper or talking to yourself, giving yourself self-instructions).
3. Rehabilitation of care
When we talk about attention we usually refer to the level of alertness or vigilance that a person has when carrying out a specific activity; that is, a general state of arousal, of orientation towards a stimulus. But attention can also involve the ability to concentrate, divide, or sustain mental effort.
It seems, then, that attention is not a unitary concept or process, but is composed of multiple elements such as orientation, exploration, concentration or vigilance And not only is it composed of these functional elements or subprocesses, but there are also multiple brain locations that underlie said attentional processes.
The intervention of attention problems will depend on the etiology of the brain damage, the phase in which the patient is in their recovery process and their general cognitive state. However, there are usually two strategies: a non-specific one and a more specific one aimed at specific attention deficits.
The non-specific intervention focuses on treating attention as a unitary concept and the types of tasks are usually reaction time measurement (simple or complex), pairing of visual stimuli in multiple choice, auditory detection or Stroop-type tasks.
In the specific intervention, they identify and deficits are differentiated in the different attentional components A hierarchical model is usually used and each level is more complex than the preceding one. A typical example is Attention Process Training, a program for the individualized application of attentional exercises with different complexity in sustained, selective, alternating and divided attention, which also combines methods and techniques for rehabilitation of brain damage, as well as educational and clinical psychology.
4. Rehabilitation of executive functions
Executive functions are a set of cognitive skills that allow us to anticipate, plan and set goals, form plans, initiate activities or self-regulate. Deficits in these types of functions make it difficult for the patient to make decisions and function in their daily lives.
In the clinical context, the term dysexecutive syndrome has been coined to define the picture of cognitive-behavioral alterations typical of a deficit in executive functions , which involves: difficulties focusing on a task and completing it without external environmental control; present rigid, persistent and stereotyped behaviors; difficulties in establishing new behavioral repertoires, as well as lack of ability to use operational strategies; and lack of cognitive flexibility.
To rehabilitate executive functions, the neuropsychologist will help the patient improve their problems with: initiation, sequencing, regulation and inhibition of behavior; The solution of problems; abstract reasoning; and alterations in disease awareness. The usual thing is to focus on the preserved capacities and work with the most affected ones.
5. Language rehabilitation
When treating a language problem, it is important to take into account whether the alteration affects the patient’s ability to use oral language (aphasia), written language (alexia and agraphia), or all of the above at the same time. Sometimes, in addition, these disorders are usually accompanied by others such as apraxia, acalculia, aprosody or dyslexia.
The treatment must be based on the result of a thorough evaluation of the patient’s language and communication disorders the assessment of their cognitive state, as well as the communication skills of their family members.
In a cognitive language stimulation program the neuropsychologist must set a series of objectives:
6. Dementia rehabilitation
In the case of a patient with dementia, the objectives of a neuropsychological intervention are: to stimulate and maintain the patient’s mental abilities; avoid disconnection with her environment and strengthen social relationships; give the patient security and increase her 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 her family.
The symptoms of a person with dementia problems are not only going to be cognitive (attention, memory, language deficits, etc.), but also emotional and behavioral deficits, so performing only cognitive stimulation will be insufficient. Rehabilitation must go further and include aspects such as behavior modification, family intervention and vocational or professional rehabilitation.
It is not the same to intervene in an early phase, with mild cognitive impairment, as in a late phase of Alzheimer’s disease, for example. Hence, it is important to graduate the complexity of the exercises and tasks depending on the intensity of the symptoms and the evolutionary 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 of keep the person active and stimulated , to slow down cognitive decline and functional problems, by stimulating the areas still preserved. Inadequate stimulation or the absence of it could cause confusion and depressive symptoms in patients, especially if they are elderly subjects.
The future of rehabilitation in neuropsychology
Improving cognitive rehabilitation programs in patients with acquired brain damage continues to be a challenge for neuropsychology professionals. The future is uncertain, but if there is one thing that seems evident, it is that, over time, The weight of technologies and neurosciences is going to be increasing with the implications that this will have when creating new intervention methodologies that are more effective and efficient.
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 evaluation techniques that allow professionals to intervene on demand, with personalized programs truly adapted to the needs of each patient.
The future of neuropsychology will involve borrowing the best from each neuroscientific discipline and assuming that there is still much to learn, without forgetting that to intervene better it is necessary to do more research and that to have to intervene less it is necessary to be able to prevent better.
