What problems does neuropsychology treat?

What kind of problems does neuropsychology deal with? Let's take a look at a summary of its modes of intervention.

Neuropsychology is in charge of evaluating and rehabilitating people who have suffered some kind of brain damage or injury. The problems that neuropsychology deals with are many and varied, such as memory disorders, language, attention, or diseases such as dementia.

In this article we will explain what kind of problems neuropsychology treats through rehabilitation. through rehabilitation.

What is neuropsychology and what problems does it treat?

Neuropsychology is a scientific discipline that studies the relationship between brain and behavior, and whose purpose is to identify and describe the cognitive and functional problems or alterations due to a brain injury or disease, as well as to intervene therapeutically through the rehabilitation of people who suffer its consequences in all areas of their lives.

The field of activity of this practice extends to people suffering from organic lesions of the central nervous system, the origin of which can be of different types.whose origin can be of different types: cranioencephalic trauma, vascular accidents, tumors, dementia, infectious diseases, metabolic disorders, etc.

Neuropsychology is also responsible for treating patients with problems affecting cognitive functions such as memory, attention, executive functions, etc., either because of a secondary affectation to some type of disorder (dementia or neurodegenerative diseases, for example), or because of a cognitive impairment associated with age or of unknown origin.

A complete and correct neuropsychological intervention must be based on the application of the following phases or stages: diagnosis and evaluation, a first stage in which the person who comes for consultation will have to specify what his or her problem consists of, as well as his or her historyThe first stage consists of a diagnosis and evaluation, a first stage in which the person who comes for consultation will have to specify what his or her problem is, as well as his or her history and background, so that the professional, through the use of batteries and tests, can evaluate the different functions and capacities of the person in order to make a judgment and an assessment.

The second stage consists of define the objectives and create a treatment plan or rehabilitation program.. With all the information gathered above, the neuropsychologist will have to adapt the contents and the program to the specific needs of the patient. After this phase comes the third and most important stage: neuropsychological rehabilitation, to which we will dedicate a specific chapter below. The fourth and last stage will consist of the generalization of the results of the applied program.

Neuropsychological rehabilitation

The aim of neuropsychological rehabilitation is to reduce or minimize the cognitive, emotional and behavioral deficits and alterations that may appear after brain damage, in order to achieve the patient's maximum functional capacity and autonomy, both at the social, family and occupational levels.

A neuropsychologist can treat patients with a multitude of conditionsThese include: cognitive deficits (memory, attention, executive functions, processing speed, gnosias, praxias, etc.), learning disabilities, language disorders, neurodegenerative diseases, stroke, epilepsy, attention deficit, developmental disorders, etc.

The following is a description of the most common problems that neuropsychology has to deal with.

Rehabilitation of acquired brain injury

The main causes of acquired brain damage are: tumors, cerebrovascular accidents or strokes, anoxias, infectious diseases and cranioencephalic trauma. When an injury of this type occurs, there is a maxim in neuropsychology that the nature, extent and location of the injury must be considered in order to determine the severity of the damage caused.

Along with the aforementioned characteristics, the time elapsed since the injury occurred must also be taken into account, as well as sociodemographic, medical and Biological variables of the patient, since the success of the intervention will be greater if all of them are taken into consideration.

There is a "window of opportunity" after the lesionThere is a "window of opportunity" after the injury in which the patient can benefit from neuropsychological rehabilitation to a greater extent; this is why it should be carried out as soon as possible. It is necessary to know which functions are altered and which are not in order to be able to intervene correctly.

In a patient with acquired brain injury, it is usual to have to rehabilitate specific cognitive functions such as attention, memory, memory such as attention, memory, executive functions, gnosias, visuoperceptive skills or praxias; as well as possible emotional and behavioral disorders that may occur.

Memory rehabilitation

One of the most common problems that a neuropsychology professional often encounters is memory impairment.

Memory can be divided into remote or long-term memory (LTM), a "storehouse" where we keep the memories we have experienced, our knowledge of the world, images, concepts and action strategies; immediate or short-term memory (ITS), which refers to our ability to evoke information immediately after it is presented; and sensory memory, a system capable of capturing a large amount of information, only for a very short time (about 250 milliseconds).

Memory deficits are often very persistent and, although they can be helpful and, although they can help, repetitive stimulation exercises are not the only solution.

When rehabilitating memory, it is advisable to help the patient by teaching him/her guidelines for organizing and categorizing the elements to be learned; it is also useful to teach him/her to create and learn task lists or to help him/her organize information in smaller parts or steps. to create and learn task lists or help him/her to organize the information in smaller parts or steps, so that he/she can remember them more easily.so that he/she can remember them more easily.

Another way to improve the patient's memory capacity is to teach him/her to focus attention and work on the control of the attentional capacity on the task in progress or when learning something; and, also, to elaborate details of what one wants to remember (for example, writing them down on paper or talking to oneself, giving oneself instructions).

3. Rehabilitation of attention

When we speak of attention we usually refer to the level of alertness or vigilance that a person has when performing a specific activity; that is, a general state of arousal, of orientation towards a stimulus. But attention can also imply the ability to concentrate, divide, or sustain mental effort.

It seems, then, that attention is not a unitary concept or process, but is composed of multiple elements, such as orientation, scanning, concentration or vigilance.. And it is not only composed of these functional elements or subprocesses, but also of multiple brain locations underlying these attentional processes.

The intervention of attention problems will depend on the etiology of the brain damage, the phase in which the patient is in his recovery process and his general cognitive state. However, there are usually two strategies: a non-specific one and a more specific one oriented to specific attentional deficits.

The non-specific intervention focuses on treating attention as a unitary concept and the task types are usually reaction time measurement (simple or complex), multiple-choice visual stimulus matching, auditory detection or Stroop-type tasks.

In the specific intervention, deficits are identified and deficits in the different attentional components are identified and differentiated.. A hierarchical model is usually used and each level is more complex than the preceding one. A typical example is Attention Process Training, a program of individualized application of attentional exercises with different complexity in sustained, selective, alternating and divided attention, which also combines methods and techniques of brain injury rehabilitation, as well as educational and clinical psychology.

4. Rehabilitation of executive functions

Executive functions are a set of cognitive skills that allow us to anticipate, plan and set goals, form plans, initiate activities or self-regulation. Deficits in this type of functions make it difficult for patients to make decisions and manage their daily life.

In the clinical context, the term "dis-executive syndrome" has been coined to define the picture of cognitive define the picture of cognitive-behavioral alterations typical of a deficit in executive functionsIt involves: difficulties in focusing on a task and completing it without external environmental control; presenting rigid, perseverative and stereotyped behaviors; difficulties in establishing new behavioral repertoires, as well as a lack of capacity to use operative strategies; and a lack of cognitive flexibility.

To rehabilitate executive functions, the neuropsychologist will help the patient to improve problems with: initiation, sequencing, regulation and inhibition of behavior; problem solving; abstract reasoning; and alterations in disease awareness. The usual approach is to focus on the preserved abilities and work with the most affected ones.

5. Language rehabilitation

When treating a language problem, it is important to consider whether the impairment affects the patient's ability to use oral language (aphasia), written language (alexia and agraphia), or all of the above at the same time. Sometimes these disorders are also accompanied by other disorders such as apraxia, acalculia, aprosody or dyslexia.

The treatment should be based on the result of a thorough evaluation of the patient's language and communication disorders.The assessment of their cognitive status, as well as the communication skills of their family members.

In a cognitive language stimulation program, the neuropsychologistthe neuropsychologist should set a series of objectives:

• Keep the person verbally active.
• Re-learn the language.
• To give strategies to improve language.
• To teach communication guidelines to the family.
• To give psychological support to the patient.
• Exercise automatic language.
• Decrease avoidance and social isolation of the patient.
• To optimize verbal expression.
• To enhance repetition capacity.
• To favor verbal fluency.
• To exercise the mechanics of reading and writing.

6. Rehabilitation of dementias

In the case of a patient with dementia, the objectives of a neuropsychological intervention are: to stimulate and maintain the patient's mental abilities; to avoid disconnection with his environment and strengthen social relationships; to give the patient security and increase his personal autonomy; to stimulate self-identity and self-esteem; to minimize stress; to optimize cognitive performance; and to improve the mood and quality of life of the patient and his family.

The symptoms of a person with dementia problems will not only be of a cognitive nature (deficits in attention, memory, language, etc.), but also emotional and behavioral, so performing only cognitive stimulation will be insufficient. Rehabilitation must go further and include aspects such as behavior modification, family intervention and vocational or professional readaptation.

It is not the same to intervene at an early stage, with mild cognitive impairment, than in a late stage of Alzheimer's disease, for example. It is therefore important to graduate the complexity of the exercises and tasks according to the intensity of the symptoms and the evolutionary course and stage of the disease in which the patient is.

In general, most rehabilitation programs for moderate and severe cognitive impairment are based on the idea of keeping the person active and stimulatedto slow cognitive decline and functional problems by stimulating the areas that are still preserved. Inadequate stimulation or the absence of stimulation could lead to confusional and depressive states in patients, especially if they are elderly.

The future of rehabilitation in neuropsychology

Improving cognitive rehabilitation programs in patients with acquired brain injury remains a challenge for neuropsychology professionals. The future is uncertain, but if there is one thing that seems clear it is that, over time, the weight of technologies and neurosciences is going to become increasingly important, with the implications that this is going to have for the future of neuropsychology.with the implications this will have for the creation of new intervention methodologies that are more effective and efficient.

The future is already present in technologies such as virtual or augmented reality, computer-aided programs and artificial intelligence, neuroimaging techniques and tools such as transcranial magnetic stimulation. Improvements in diagnostic and assessment techniques that allow professionals to intervene à la carte, with personalized programs that are truly adapted to the needs of each patient.

The future of neuropsychology will depend on borrowing the best of each neuroscientific discipline and assuming that there is still much to learn, without forgetting that in order to intervene better, more research is needed and that in order to intervene less, better prevention is needed.

Bibliographical references:

• Antonio, P.P. (2010). Introduction to neuropsychology. Madrid: McGraw-Hill.