Neuropsychological rehabilitation: how it is used in patients

Possibly we know someone who has suffered some type of accident that has decreased mental capacities, or we have seen it on some occasion in a movie or read in a book. Car accidents, strokes, dementias... all this has or can have a great effect on our nervous system.

In these cases, after taking the person to the hospital and once her situation is stable and does not run danger, their capacities are evaluated and when alterations are detected, they end up carrying out neurorehabilitation, or neuropsychological rehabilitation. Throughout this article we are going to talk about this type of rehabilitation.

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What is neuropsychological rehabilitation?

Neuropsychological rehabilitation is understood as therapeutic process by which people who have suffered some type of brain injury are treated in order for them to regain or at least improve the cognitive abilities 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 which remains partly in force during the rest of our life, allows in many cases the recovery or partial or total improvement of the functions losses. Of course, this is not always going to be possible, in which case other strategies can be used so that said loss does not generate a disability.

Rehabilitation is generally carried out by a multidisciplinary team of different professionals in the field of health that contribute the knowledge and techniques from their respective disciplines to improve the patient's situation. Among them we find doctors, clinical psychologists and neuropsychologists, occupational therapists, speech therapists and physiotherapists, among others.

Throughout the process, it is intended to generate an explanatory model that allows the patient and her environment to understand what has happened and her affections, accompany the coping with this fact and finally 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 supply 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 serves the patient for their practice on a day-to-day basis.

Treatment must be personalized and be adjusted to the capabilities of the patient, as well as aimed at his functional recovery. Some variables to take into account are the type, area, severity and cause of the injury, the cognitive and functional capacity prior to it, and aspects such as gender 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, job rehabilitation Y behavior modification techniques, as well as therapy to alleviate disturbances derived from the experience of their state and family orientation.

In the same way, it must be borne in mind that sometimes it is not intended to improve the capacities of the patient or recover them, but maintain your mental functions as long as possible. Finally, it must be taken into account that the rehabilitation must be plastic and take into account the evolution of the patient: it will be necessary to carry out a follow-up and evaluation to be able to adjust the rehabilitation to the state of the patient.

Approaches within rehabilitation

Within neuropsychological rehabilitation we can act in different ways so that the patient can regain functionality. These are not mutually exclusive ways of acting, but may overlap. Rather, it is about different ways of approaching treatment, focusing it towards the possibility of recovering lost functions. Specifically, we can find the following three main approaches, although optimization can be added as a fourth approach to take 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 its application and rebuild the function. However recovery is not always possible, especially when we talk about large brain injuries.

Feature compensation

When it is not possible to recover lost functions, treatment will focus on optimizing and enhancing other functions. skills so that they can make up for those that have been lost and that such loss does not lead to disability. It is about using what the patient has preserved so that she can function.

Substitution

In part similar to compensation strategies, substitution seeks that through different means and strategies the subject is capable of compensate for cognitive and functional deficits, using 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 improves 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, that is, as a whole. However, rehabilitation generally focuses on specific skillsSome of the most common being the following.

1. Attention

Attentional ability may be impaired due to brain injury, requiring neuropsychological rehabilitation.

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2. Memory

The memory It is one of the most important basic abilities in our day to day life, and it is common in neuropsychological rehabilitation to try to facilitate memory.

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

3. Executive functions

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

4. Psychomotor skills

Movement is another of the abilities that can be affected due to a brain injury. From the emission of uncontrolled movements to immobility, also passing through the apraxia or loss / decrease of the ability to perform more or less complex actions and carry out coordinated sequenced movements, 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 highly developed skill at the rehabilitation level.

6. Perceptual rehabilitation

It is very common for a brain injury to occur perceptual disturbances, or some type of agnosia or lack of recognition of the stimulation. Neuropsychological rehabilitation can bring about improvements in this regard.

• You may be interested: "Visual agnosia: the inability to understand visual stimuli"

Problems in which it is usually applied

There is 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. Head injuries

A very common cause of brain injuries is head trauma, frequently generated by traffic accidents, falls or even for assaults. Symptoms and impaired functions will largely depend on the location and extent of the injury.

2. Strokes

Strokes, whether in the form of ischemia or hemorrhage, are a great problem that has become one of the main causes of death in the population. In them there is either waterlogging or blockage and cessation of oxygen supply to part of the brain. This causes a large number of neurons to die, which depending on the area in which neuronal death occurs, will generate deficits that can be more or less permanent. Neuropsychological rehabilitation is of great help to recover or compensate for lost skills.

3. Cognitive impairment

Although it may not turn into insanity, cognitive impairment involves a decline in some functions that can be alleviated 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 rehabilitate, although language and psychomotor skills are also worked on. Alzheimer's, Parkinson's disease dementia, 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 a rehabilitation itself, the presence of disability intellectual or neurodevelopmental disorders may require this type of technique in order to train and generate a function optimization.

6. Epilepsy

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

• You may be interested: "Epilepsy: definition, causes, diagnosis and treatment"

7. Neurosurgery

Sometimes it may be necessary to resort to neurosurgery in order to solve some type of medical problem, as occurs for example in the case of the aforementioned epilepsy or before a brain tumor. These interventions can save lives or avoid big problems derived from different conditions. However, they can cause difficulties and decrease in some functions, which may require neurorehabilitation to return to normal.

8. Poisoning or effects of long-term substance use

Some substances can also cause brain damage, let's be talking about drugs of poisoning from the consumption of a toxic element. If such damage occurs, neuropsychological rehabilitation can help to recover to some degree the functionality and functions that may have been damaged.

Bibliographic references:

• Santos, J.L. and Bausela, E. (2005). Neuropsychological rehabilitation. Papers of the Psychologist, 26 (90): 15-21. General Council of Official Colleges of Psychologists. Madrid Spain.
• Tirapu, J. (2007). The neuropsychological evaluation. Psychosocial Intervention, 16 (2). Madrid Spain.