Neuropsychological Rehabilitation: This Is How It Is Used In Patients
Possibly we know someone who has suffered some type of accident that has diminished their mental abilities, or we have seen it on occasion in a movie or read about it in a book. Car accidents, strokes, dementia… 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 they are not in danger, their capabilities are evaluated and when alterations are detected, they end up carrying out neurorehabilitation, or neuropsychological rehabilitation Throughout this article we are going to talk about this type of rehabilitation.
Neuropsychological rehabilitation is understood as therapeutic process through 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 said injuries.
The great brain plasticity that we have, especially in childhood but which continues in part during the rest of our lives, allows in many cases the partial or total recovery or improvement of lost functions to be possible. Of course, this will not always be possible, in which case other strategies can be used so that said loss does not generate a disability.
Rehabilitation is generally carried out by a multidisciplinary team of different health professionals who provide 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 their affects, to accompany the coping with 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 overcome the difficulties.
It is important that this neurorehabilitation or neuropsychological rehabilitation has ecological validity, that is, that what is carried out serves the patient for their daily practice.
Treatment must be personalized and be adjusted to the patient’s capabilities, 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 used, therefore, will vary greatly in each case. Sometimes it may be necessary to carry out, in addition to rehabilitation, a social skills training, vocational rehabilitation and behavior modification techniques, as well as therapy to alleviate disturbances derived from experiencing their condition 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 rather maintain your mental functions for as long as possible Finally, it must be taken into account that rehabilitation must be plastic and take into account the patient’s evolution: it will be necessary to carry out monitoring and evaluation to be able 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 rather they can overlap. Rather, it is about different ways of approaching treatment, focusing 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 restitution 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. We work through the stimulation of these functions, seeking to retrain the subject in their application and reconstruct the function. However recovery is not always possible especially when we talk about large brain injuries.
Feature Compensation
When it is not possible to recover lost functions, treatment will focus on optimizing and enhancing other skills so that they can compensate for those that have been lost and that said loss does not generate a disability. It is about using what the patient has preserved so that she can function.
In part similar to compensation strategies, substitution seeks to ensure that through different means and strategies the subject is able to compensate for cognitive and functional deficits using different alternative skills or even external means such as alarms or agendas.
Optimization
Beyond compensating or replacing lost skills, neuropsychological rehabilitation can act in a way that improves the capabilities and potential of the person for whom it is performed.
What is rehabilitated?
Neuropsychological rehabilitation is an element that must take into account the subject holistically, that is, as a whole. However, Rehabilitation generally focuses on specific skills some of the most common being the following.
1. Attention
Attention capacity may be diminished due to a brain injury requiring neuropsychological rehabilitation.
2. Memory
Memory is one of the basic abilities that are most important in our daily lives, and it is common that neuropsychological rehabilitation attempts to facilitate memory.
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
3. 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 achieve lead an autonomous and functional life
4. Psychomotor skills
Movement is another ability that can be affected due to a brain injury. From the emission of uncontrolled movements to immobility, also including apraxias or loss/decrease in the ability to execute more or less complex actions and carry out sequences of movements in a coordinated manner, they may require neurorehabilitation.
5. Language
Aphasias are losses or deficits in the ability to communicate through language due to a brain injury, being a common problem. The problem may be found in fluency and expression, comprehension or repetition This is a highly developed skill at the rehabilitation level.
6. Perceptual rehabilitation
It is very common that in the event of a brain injury, perceptual alterations, or some type of agnosia or lack of recognition of stimulation. Improvements in this aspect can occur 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.
A very common cause of brain injuries is craniocerebral trauma, frequently generated by traffic accidents, falls or even attacks. The symptoms and impaired functions will depend largely on the location and extent of the injury.
2. Strokes
Strokes, whether in the form of ischemia or hemorrhage, are a major problem that has become one of the main causes of death in the population. In them, either flooding or blockage and cessation of oxygen supply to part of the brain occurs. This causes a large number of neurons to die, which depending on the area in which neuronal death occurs will generate deficits that may be more or less permanent. Neuropsychological rehabilitation is of great help to recover or compensate for lost skills.
3. Cognitive impairment
Although it may not develop into dementia, Cognitive deterioration represents a decline in some functions that can be alleviated through neuropsychological rehabilitation.
4. Dementia 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 abilities are the main areas to rehabilitate, although language and psychomotor skills are also worked on. Alzheimer’s, dementia due to Parkinson’s disease, Pick’s disease, frontotemporal dementias or Huntington’s chorea are some of the best known.
5. Intellectual disability and neurodevelopmental disorders
Although technically we would not be talking about rehabilitation itself, the presence of intellectual disability or neurodevelopmental disorders may require this type of techniques in order to train and generate an optimization function
6. 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.
7. Neurosurgery
Sometimes it may be necessary to resort to neurosurgery in order to resolve some type of medical problem, as occurs for example in the case of the aforementioned epilepsy or a brain tumor. These interventions can save lives or avoid major problems derived from different conditions. However, they can cause difficulties and a decrease in some functions, which may require neurorehabilitation to return to normal.
8. Poisoning or effects of prolonged substance use
Some substances can also cause brain damage, we are talking about drugs of poisoning due to the consumption of some toxic element If such damage occurs, neuropsychological rehabilitation can be helpful in recovering to some degree the functionality and functions that may have been damaged.
