The 4 Phases of Neuropsychological Intervention (and Their Characteristics)

The purpose of neuropsychological intervention is to evaluate and rehabilitate the cognitive and functional alterations produced in an individual by a brain injury or disease.

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

The phases (or stages) of neuropsychological intervention

In order to carry out an intervention of this type, 4 phases must be followed: evaluation, definition of objectives and treatment planning, rehabilitation, and, finally, the generalization of results.

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

First phase: The neuropsychological evaluation

The neuropsychological evaluation constitutes the first phase of the neuropsychological intervention The objective of this evaluation is to describe and quantify the cognitive, behavioral and emotional alterations of the patient, resulting from the injury or acquired brain damage.

This task consists of carrying out a thorough and exhaustive evaluation of the person, through the neuropsychological analysis of the cognitive functions, both those that are altered and those that the patient still retains, as well as the daily living skills that are preserved and those that are not.

For this purpose, a whole series of tests and diagnostic tests are used, the objective of which is to search for the factors responsible for the neuropsychological syndrome that will later be used in the construction of the neuropsychological rehabilitation program. But what other objectives should the evaluation process meet in neuropsychological intervention?

Objectives of neuropsychological evaluation

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

The main objectives of the neuropsychological evaluation are the following:

Second phase: Definition of objectives and treatment plan

The next phase in the neuropsychological intervention process is to define the objectives and the treatment plan or rehabilitation program.

One of the basic principles of neuropsychological rehabilitation is the fact of being based on preserved skills, so that they can serve as support or support to intervene in those others that are affected.

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

The programs designed must be individualized and focused on the needs of each patient. It is advisable to carry out individualized sessions to work on specific cognitive aspects (for example, memory or attention training), behavioral (such as aggression) and emotional aspects (for example, working on self-esteem and self-image).

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

In short, a rehabilitation program must address the following fundamental aspects:

Third phase: Neuropsychological rehabilitation

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

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

Approaches in cognitive rehabilitation

As in almost all disciplines, In the field of neuropsychological rehabilitation, different trends or orientations are also used when approaching the rehabilitation process. Each of them assumes different principles in relation to the neural mechanisms that underlie cognitive changes.

Although cognitive rehabilitation using 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 the altered function is recovered, that is, that there is neuronal regeneration, after the spontaneous recovery period.

This approach has proven especially useful when brain damage is extensive or impairment of cognitive function is significant. For example, technical aids such as computer-assisted voice systems have been used for patients with severe difficulties in verbal expression; or the use of alarms and agendas for people with memory problems, etc.

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

Areas of work in neuropsychological rehabilitation

The areas that are most frequently worked on in a rehabilitation program are: space-time orientation, attention, memory, executive functions, calculation, language, visuoconstructive skills and reading and writing.

Treatment also usually includes psychotherapy sessions, usually cognitive behavioral therapy, and addressing maladaptive behavior through behavior modification tools. In addition, it is important to work closely with the patient’s family, so that they are also part of the rehabilitation process.

In the final phases of treatment, the improvement of social skills, vocational and professional guidance, as well as return or reintegration into the community are usually addressed more intensively, with the aim that the patient can develop as a person and adapt. appropriately 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 what she has learned in the rehabilitation program in her daily life.

In the clinical setting, the difficulty that many patients with brain damage show when applying the principles and skills learned in the sessions of neuropsychological rehabilitation programs to their daily life is known.

If, for example, a patient with memory problems is taught to use an external aid – such as an agenda – to avoid certain forgetfulness, it is intended that he will then continue using these aids at home, at work or anywhere. another known environment. This is generalizing the results.

And to encourage and enhance this generalization process, the following aspects must be taken into account:

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

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

• Use numerous examples during rehabilitation and acquisition of the skill in question.

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

• Carry out a follow-up that assesses the level of generalization obtained.

• Muñoz-Marrón E, 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 Síntesis.