The 4 phases of neuropsychological intervention (and their characteristics)

We review each of the stages of the neuropsychological therapy process.

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

To be able to carry out an intervention of this type, 4 phases have to be followedEvaluation, definition of objectives and treatment planning, rehabilitation and, finally, generalization of results.

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

First phase: Neuropsychological assessment

The neuropsychological assessment is the first phase of neuropsychological intervention.. The objective of this evaluation is to describe and quantify the cognitive, behavioral and emotional alterations of the patient, as a result of the injury or acquired brain damage.

This task consists of carrying out a thorough and exhaustive evaluation of the person, by means of the neuropsychological analysis of the cognitive functions, both those 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 aim of which is the search for the factors responsible for the neuropsychological syndrome, which will then be used in the construction of the neuropsychological rehabilitation program. But what other objectives should the evaluation process in neuropsychological intervention meet?

Objectives of the neuropsychological evaluation

The neuropsychological evaluation process is not only a tool for the health professional to gather information, but also an opportunity for the patient and his or her relatives to keep informed about what is happening to the patient and what can be done to improve his or her situation.

The main objectives of the neuropsychological evaluation are the following:

• To describe in detail the consequences of the brain injury in terms of cognitive functioning, possible behavioral disorders and emotional disturbances.

• To define the clinical profiles that characterize the different types of pathologies with neuropsychological impairment.

• To establish an individualized rehabilitation program, based on the patient's preserved skills and abilities, aimed at improving the person's autonomy and quality of life.

• Contribute to the establishment of a differential and accurate diagnosis in certain neurological and psychiatric diseases.

• Determine the progress of each patient, as well as assess the effectiveness of different treatments.

• Medical-legal expertise and/or assessment of the level of cognitive and functional impairment of the person, with a view to possible compensation and disability assessment processes.

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 treatment program. and the treatment plan or rehabilitation program.

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

With all the information gathered during the assessment process, rehabilitation goals and objectives should be planned. It is important to set goals that are specific and related to the patient's own activities and interests. For example, if one of the objectives is for the patient to be able to return to his or her favorite sport (long-term goal), we will have to establish short-term goals to help achieve them.

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

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

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

• Treatment and rehabilitation of altered cognitive functions.

• Modification of maladaptive behaviors.

• Psychosocial support and emotional management

• Social and occupational rehabilitation

• Cognitive rehabilitation

Third phase: Neuropsychological rehabilitation.

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

In neuropsychological rehabilitation it is possible to distinguish different trends or orientations, each of them assuming different principles based on the neural mechanisms underlying 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. when it comes to approaching the rehabilitation process. Each of them assumes different principles in relation to the neural mechanisms underlying cognitive changes.

• Restoration of impaired functions This theory postulates that damaged cognitive processes can be restored through stimulation. Cognitive rehabilitation techniques designed under this approach are based on the repetitive performance of tasks and exercises, with the aim of reactivating brain circuits and, ultimately, recovering altered cognitive functions.

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 recovers, that is, that there is neuronal regeneration, after the period of spontaneous recovery.

• Compensation of impaired functions This other approach is based on the principle that damaged brain mechanisms and cognitive processes can hardly be recovered. This is why cognitive rehabilitation should emphasize the performance of tasks and activities that have a functional purpose, using alternative strategies or external aids that reduce or eliminate the need for cognitive requirements.

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

• Optimization of residual functions This approach postulates that cognitive processes are not usually completely damaged after a brain injury, but are reduced in their effectiveness and efficiency, so it is advisable to develop other brain structures or circuits that are not affected, in order to ensure their functioning.

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

Areas of work in neuropsychological rehabilitation

The areas most frequently worked on in a rehabilitation program are: spatial-temporal 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 using behavior modification tools.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 orientation, as well as the return or reintegration into the community are usually addressed more intensively, with the aim of enabling the patient to develop as a person and adapt properly to his or her social and professional environment.

Fourth phase: Generalization of results

The last phase of the neuropsychological intervention is the generalization of the results.The patient's ability to finally apply and use what he or she has learned in the rehabilitation program in his or her daily life.

In the clinical setting, it is well known that many brain-damaged patients have difficulty applying the principles and skills learned in neuropsychological rehabilitation program sessions to their daily lives.

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 or she will then continue to use these aids at home, at work or in any other familiar environment. This is to generalize the results.

In order to promote 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 during rehabilitation that are similar to those used in the real context.

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

Bibliographical references:

• 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.