Cognitive rehabilitation: what is it and how does it help patients?

These are the main variants of cognitive rehabilitation, and how it works.

There are many causes that can lead to cognitive impairment in a person. That is why researchers are looking for new solutions.

Some of the best-known techniques in this area are cognitive rehabilitation.. Below we will be able to discover what are its main types and practical applications, what characterizes this methodology, and what are the advantages it brings compared to other systems.

What is cognitive rehabilitation?

When we speak of cognitive rehabilitation we refer to a series of techniques created to repair the different brain functions related to cognition.The brain's capacity for cognitive functions, such as attention, memory or the use of language, which were previously damaged due to some type of injury or deterioration inherent to some degenerative disease.

In this sense, injuries can be caused by traumatic lesions that affect the brain, whether external, such as an impact, or internal, such as a thrombus that generates an infarct in one of the veins of the brain. In the case of diseases, they usually refer to dementias, Alzheimer's being the most severe type.

Other psychological diseases, such as major depressive disorder, attention deficit hyperactivity disorder, and even schizophrenia, can also generate deterioration in some of the cognitive functions of the subject who suffers them, so that these effects may also be susceptible to be treated by these techniques.

The function of cognitive rehabilitation will be to slow down, slow down and even reverse, according to clinical possibilities, the deficits of brain functions caused in the person by the above-mentioned circumstances. caused in the person by the aforementioned circumstances. Logically, the program to be applied will depend on the characteristics of the subject as well as the pathology he/she suffers.

Therefore, cognitive rehabilitation programs must be individualized. It will be the health professional in question who will decide the pattern of techniques to be applied according to the criteria he/she determines appropriate to achieve the greatest possible effect in the improvement of the patient's cognitive functions.

Cognitive rehabilitation vs. cognitive training

It is important to keep in mind that cognitive rehabilitation is a different concept from cognitive training. Although both are related and can even be applied in a complementary manner, the truth is that their definitions are not exactly the same, as they contain important nuances that must be taken into account.

In the case of cognitive rehabilitation, we have already seen that it refers to any methodology designed to improve mental functions that have been previously weakened as a result of an injury or ailment suffered by the patient. because of an injury or ailment suffered by the person.

On the other hand, when we speak of cognitive training, it refers to the stimulation of certain cognitive functions of a person that have not been damaged, with the aim of achieving an improvement in their performance, superior to that of the individual's baseline.

Therefore, we could say that the fundamental difference between cognitive rehabilitation and cognitive training is that the former is used to try to repair the mental sequelae resulting from neurological damage that the subject has suffered, while the latter is aimed at improving abilities that have not been damaged, but which simply want to be improved, for whatever reasons.

Fundamentals of cognitive rehabilitation

The question arises as to how cognitive rehabilitation can be able to restore, even in part, functions that have been altered by such serious causes as damage to the subject's brain. the subject's brain. The reason why this is possible is precisely thanks to the plasticity of this organ.

Brain plasticity is a quality by which this viscera is able to restructure its functions after events such as an injury, so that other neuronal regions take over the tasks of those structures that have been compromised due to disease or trauma, as we have already seen.

Therefore, the key to the success of cognitive rehabilitation is that, through such techniques, different areas of the brain are stimulated so that they "learn" to perform the functions that were once performed by neural circuits that have now been destroyed or altered. or altered.

In any case, it is also important to know that not every injury to the brain necessarily implies damage to cognitive functions. This organ has the so-called cerebral reserve or cognitive reserve, another extraordinary capacity, by which the brain is capable of assuming certain changes in its structure, either due to an ailment or to aging itself, without generating clinical symptomatology.

This would be a case in which cognitive rehabilitation would not be necessary, since the subject, even if he/she had suffered a cerebral affectation, would not have seen his/her cognitive capacities diminished and therefore it would not make sense to initiate a process to recover them.

The main types of cognitive rehabilitation

Cognitive rehabilitation, as we saw at the beginning, is not limited to a single technique, is not limited to a single technique, but is rather a set of techniques aimed at a common goal. We have already indicated that it would be the doctor and/or the psychologist who would decide which of these tools are the most appropriate to help the patient in question to experience an improvement, according to his or her characteristics.

These techniques can be of a very diverse natureas we will see below. Some are limited to mere exercises while others require a medical infrastructure that is not accessible to all patients. Let us look at some examples in more detail.

1. Activity books and games

One of the most outstanding means of cognitive rehabilitation, due to its simplicity and effectiveness, is the use of exercises through activity workbooks and interactive games. Regarding the notebooks, different types can be found depending on the cognitive function that we are interested in repairing, such as memory, memory, cognitive function, etc.such as memory, attention or the use of language.

It is important to select a workbook that includes exercises of the appropriate level for the person who is to undergo cognitive rehabilitation, since a level below his or her current ability will not have any effect, while one that is beyond the range he or she can reach can triggerA level that exceeds the margin that can be reached may trigger a feeling of frustration that is counterproductive.

In the case of games and video games, we can find from physical puzzles that, likewise, vary depending on the difficulty, to complete programs available for different gaming platforms, computers or even smartphones, which propose a series of challenges to the user from entertainment.

These tools are especially useful for cognitive rehabilitation, as they appeal to the patient from the playful aspect and have very positive effects on the improvement of the mental faculties that are intended to be recovered. Of course, you should also games that propose challenges according to the capabilities of each individual should also be chosen..

2. Electrical stimulation

Taking a qualitative leap to a visibly more invasive technique, we find electrical stimulation for cognitive rehabilitation. Specifically, this technique is known as transcranial direct current stimulation, or tDCS.

As its name suggests the procedure is to apply an electric current to certain brain areas (those that have been damaged). (those that have been damaged).

The objective is to stimulate these regions in order to reverse the deterioration suffered. However, this is a relatively new technique and there are still certain contradictions about the results obtained, so further research is required to establish conclusions that will allow us to know the scope of this method of cognitive rehabilitation.

3. Neurotechnology

Finally, increasing even more the complexity of the selected tool, we find the so-called neurotechnology. These are devices by which a computer can establish a connection with a person's brain, measuring certain parameters and even altering them by means of electrical impulses.measuring certain parameters and even managing to alter them, by means of electrical impulses.

This is the most complex form of cognitive rehabilitation. It allows the development of specific programs to work on the specific damage suffered by an individual, which is a great advantage over other methodologies, which can be more general. Obviously, it also has a number of drawbacks, starting with the technological devices required for its application.

This conditioning factor means that neurotechnology can only be used in very specific places and therefore only for people with sufficient resources to be able to afford such an extraordinary treatment today.

Fortunately, technology is advancing at a frenetic pace and this also means a reduction in production costs.In the future, all people with brain damage may have easy access to cognitive rehabilitation based on neurotechnology.

Bibliographical references:

• Escolano, C., Navarro-Gil, M., García-Campayo, J., Congedo, M., De Ridder, D., Mínguez, J. (2014). A controlled study on the cognitive effect of alpha neurofeedback training in patients with major depressive disorder. Frontiers in behavioral Neuroscience.
• Ginarte-Arias, Y. (2002). Cognitive rehabilitation. Theoretical and methodological aspects. Journal of neurology.
• Horvath, J.C., Forte, J.D., Carter, O. (2015). Quantitative review finds no evidence of cognitive effects in healthy populations from single-session transcranial direct current stimulation (tDCS). Brain stimulation. Elsevier.
• Mateer, C. Introducción a la rehabilitación cognitiva. Avances en psicología clínica latinoamericana.