Neuropsychological rehabilitation: how it is used on patients

This set of techniques and approaches helps to preserve mental functions in vulnerable situations.

We may know someone who has suffered some kind of accident that has diminished mental capacities, or we may have seen it in a movie or read about it in a book. Car accidents, strokes, dementia... all of these have 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, we proceed to evaluate their abilities and when alterations are detected, we end up carrying out neurorehabilitation, or neuropsychological rehabilitation.. Throughout this article we are going to talk about this type of rehabilitation.

What is neuropsychological rehabilitation?

Neuropsychological rehabilitation is understood as the therapeutic process by which people who have suffered some kind of brain injury are treated in order to recover or at least improve the cognitive skills and functionality in daily life they have lost as a result of such injuries. 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 continues in part during the rest of our lives, allows that in many cases it is possible the recovery or partial or total improvement of the lost functions. However, this will not always be possible, in which case other strategies can be employed so that such loss does not generate a disability.

Rehabilitation is generally carried out by a multidisciplinary team of different health professionals. who bring knowledge and techniques from their respective disciplines to improve the patient's situation. Among them are physicians, 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 his or her environment to understand what has happened and their affections, 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 to say that what is carried out is useful to the patient for his daily practice.

The treatment must be personalized and be adjusted to the patient's capabilities, as well as aimed at his or her functional recovery. Some variables to be taken into account are the type, area, severity and cause of the injury, the cognitive and functional capacity prior to the injury 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, occupational rehabilitation and behavior modification and behavior modification techniques, as well as therapy to alleviate disturbances derived from the experience of their condition and family orientation.

Likewise, it must be taken into account that sometimes the aim is not to improve the patient's capacities or to recover him/her, but rather to 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 monitor and evaluate 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, but can overlap. It is rather a matter of different ways of approaching the treatment, focusing it towards the possibility of recovering the lost functions. Specifically, we can find the following three main approaches, although optimization can be added as a fourth approach to be taken into account.

Restoration or restitution of functions

It is understood as such 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 function. However, recovery is not recovery is not always possibleespecially when we are talking about large encephalic lesions.

Compensation of functions

When it is not possible to recover lost functions, the treatment will focus on optimizing and enhancing other skills so that they can compensate for those that have been lost and that such loss does not generate a disability. It is a matter of using what the patient has preserved so that he/she can function.

Substitution

Partly similar to compensation strategies, substitution seeks that through different means and strategies the subject is capable of compensating for cognitive and functional deficitsusing 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 enhances the capabilities and potential of the person to whom it is performed.

What is rehabilitated?

Neuropsychological rehabilitation is an element that must take into account the subject holistically, i.e. as a whole. However, rehabilitation generally focuses on specific skills, some of the most common beingSome of the most common ones are the following.

1. Attention

Attentional capacity may be diminished as a result of a brain injury, requiring neuropsychological rehabilitation.requiring neuropsychological rehabilitation.

2. Memory

Memory is one of the most important basic abilities in our daily lives, and it is common in neuropsychological rehabilitation to try to facilitate recall.

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

3. Executive functions

The set of executive functions is one of the aspects in which more neuropsychological rehabilitation is performed, being these skills practically essential to achieve to lead an autonomous and functional life.

4. Psychomotor skills

Movement is another of the abilities that may be affected due to a brain injury. From the emission of uncontrolled movements to immobility, as well as apraxias or loss/decrease of the ability to execute more or less complex actions and to carry out sequences of movements in a coordinated manner, may require neurorehabilitation.

5. Language

Aphasias are losses or deficits in the ability to communicate through language due to a brain injury, being a frequent problem. The problem can be found in fluency and expression, comprehension or repetition.. It is a skill that is often worked on in rehabilitation.

6. Perceptual rehabilitation

It is very frequent that before a cerebral lesion there are perceptual alterations, or some type of perceptual alterations, or some type of agnosia or lack of or lack of recognition of stimulation. Neuropsychological rehabilitation can improve this aspect.

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.

1. Cranioencephalic traumas

A very frequent cause of brain injury is traumatic brain injury, frequently caused by traffic accidents, falls or even assaults. or even assaults. The symptoms and impaired functions will depend to a great extent on the location and extent of the injury.

2. Cerebrovascular accidents

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 these cases, there is either flooding or blockage and cessation of oxygen supply to part of the brain. This causes a large number of neurons to die.Depending on the area in which neuronal death occurs, this will generate deficits that may be more or less permanent. Neuropsychological rehabilitation is of great help to recover or compensate for lost abilities.

3. Cognitive impairment

Although it may not develop into dementia, cognitive impairment involves a decline in some functions that can be alleviated by neuropsychological rehabilitation. through neuropsychological rehabilitation.

4. 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 abilities are the main areas to be rehabilitated, although language and psychomotor skills are also worked on. Alzheimer's disease, 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 per se, the presence of intellectual disability or neurodevelopmental disorders may require this type of techniques in order to training and generating an optimization of functions..

6. Epilepsy

The suffering of epileptic seizures can cause alterations and decreases in cognitive functions and in daily life functioning. Neuropsychological rehabilitation may be necessary in some cases.

7. Neurosurgery

Sometimes it may be necessary to resort to neurosurgery in order to solve some kind of medical problem, such as in the case of epilepsy or a brain tumor. These interventions can save lives or avoid major problems derived from different affections. However, they can generate 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 generate brain damage, we are talking about drugs of poisoning by the consumption of poisoning due to the consumption of some toxic element.. If such damage occurs, neuropsychological rehabilitation can be of help to recover to some degree the functionality and functions that may have been damaged.

Bibliographical references:

• Santos, J.L. and Bausela, E. (2005). Neuropsychological rehabilitation. Papeles del Psicólogo, 26 (90): 15-21. Consejo General de Colegios Oficiales de Psicólogos. Madrid, Spain.
• Tirapu, J. (2007). Neuropsychological assessment. Psychosocial Intervention, 16 (2). Madrid, Spain.