What problems does neuropsychology treat?

Neuropsychology is responsible for evaluating and rehabilitating people who have suffered some type of brain damage or injury. The problems that neuropsychology treats are many and varied, such as disorders of memory, language, attention, or diseases such as dementias.

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

• Related article: "The 4 phases of neuropsychological intervention (and their characteristics)"

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 cognitive problems or alterations and functional due to a brain injury or disease, as well as intervene therapeutically through the rehabilitation of people who suffer its consequences in all areas of his life.

The field of activity of this practice extends to people with organic lesions of the central nervous system, whose origin can be of different types: head injuries, vascular accidents, tumors, dementias, infectious diseases, metabolic disorders, etc.

Neuropsychology is also in charge of treating patients with problems that affect cognitive functions such as memory, attention, executive functions, etc., either because it is a involvement secondary to some type of disorder (dementias or neurodegenerative diseases, for example), or due to cognitive impairment associated with age or origin a stranger.

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 to the consultation will have to specify what their problem consists of, as well as what is its history and background, so that the professional, through the use of batteries and tests, you can evaluate the different functions and capacities of the person to make a judgment and a assessment.

The second stage consists of define goals and create a treatment plan or rehabilitation program. With all the information collected 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 now dedicate a specific chapter. The fourth and last will consist of the generalization of the results of the applied program.

Neuropsychological rehabilitation

Rehabilitation in neuropsychology aims to reduce or minimize cognitive, emotional and behavioral deficits and alterations that can appear after brain damage, in order to achieve the maximum capacity and functional autonomy of the patient, both socially, as well as family and labor.

A neuropsychologist can care for patients with a multitude of conditions, among which are: cognitive deficits (memory, attention, executive functions, processing speed, gnosis, praxis, etc.), learning disabilities, language disorders, neurodegenerative diseases, stroke, epilepsy, attention deficit, developmental disorders, etc.

Next, we are going to describe the most common problems that neuropsychology has to face.

1. Rehabilitation of acquired brain damage

The main causes of acquired brain damage are: tumors, cerebrovascular accidents or stroke, anoxia, infectious diseases and head injuries. When an injury of this type occurs, there is a maxim in neuropsychology and that is that you have to consider the nature, extent and location of the same in order to determine the severity of the damage caused.

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

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

In a patient with acquired brain damage, the usual thing is to have to rehabilitate specific cognitive functions such as attention, memory, executive functions, gnosis, visual-perceptual abilities or praxis; as well as possible emotional and behavioral disorders that could be caused.

2. Memory rehabilitation

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

Memory can be divided into remote or long-term memory (MLP), a "warehouse" where we store lived memories, our knowledge of the world, images, concepts, and action strategies; immediate or short-term memory (MCP), referring to our ability to recall information immediately after it is presented; and sensory memory, a system capable of capturing a large amount of information, only for a very short period of time (around 250 milliseconds).

Memory deficits are often very persistent And while they can help, repetitive stimulation exercises are not the only solution.

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

Another way to improve the patient's memory capacity is to teach him to focus the attention and work on the control of the attention span on the task in progress or at the time of learn something; and, also, elaborate details of what you want to remember (for example, writing them on a piece of paper or talking to yourself, giving yourself self-instructions).

• You may be interested: "Types of memory: how does the human brain store memories?"

3. Attention rehabilitation

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, orientation towards a stimulus. But mindfulness can also involve the ability to focus, divide, or sustain mental effort.

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

The intervention of attention problems will depend on the etiology of brain damage, the phase in that the patient is within his recovery process and his cognitive state general. However, there are usually two strategies: a nonspecific and a more specific one aimed at specific attentional deficits.

The nonspecific intervention focuses on treating attention as a unitary concept and the types of tasks are usually of measurement of the reaction time (simple or complex), pairing of visual stimuli in multiple choice, auditory detection or type tasks Stroop.

In the specific intervention, they are identified and the deficits in the different attentional components are differentiated. A hierarchical model is often 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 attention sustained, selective, alternating and divided, which also combines methods and techniques of rehabilitation of brain damage, as well as educational psychology and clinic.

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 these types of functions make it difficult for the patient to make decisions and function in their day-to-day life.

In the clinical context, the term dysexecutive syndrome has been coined to mean define the picture of cognitive-behavioral alterations typical of a deficit in executive functions, which implies: difficulties to focus on a task and finish it without external environmental control; present rigid, persevering and stereotyped behaviors; difficulties in establishing new behavioral repertoires, as well as lack of ability to use operational strategies; and lack of cognitive flexibility.

To rehabilitate executive functions, the neuropsychologist will help the patient to improve his problems with: initiation, sequencing, regulation and inhibition of behavior; The solution of problems; abstract reasoning; and alterations in disease consciousness. The usual practice is to focus on preserved capabilities and work with those most affected.

5. Language rehabilitation

When treating a language problem, it is important to consider whether the impairment affects the ability to of the patient to use oral language (aphasia), written language (alexia and agrafia), or all of the above time. In addition, these disorders are sometimes accompanied by others such as apraxia, acalculia, aprosodia or dyslexia.

Treatment should be based on the result of a thorough evaluation of the patient's language and communication disturbances, the assessment of her cognitive state, as well as the communication skills of her relatives.

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

• Keep the person verbally active.
• Re-learn the language.
• Give strategies to improve language.
• Teach communication guidelines to the family.
• Give psychological support to the patient.
• Exercise automatic language.
• Reduce avoidance and social isolation of the patient.
• Optimize verbal expression.
• Enhance the ability to repeat.
• Promote verbal fluency.
• Exercise the mechanics of reading and writing.

6. Dementia rehabilitation

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

The symptoms of a person with dementia problems will not only be of a cognitive nature (attention, memory, language deficits, etc.), but also emotional and behavioral deficits, 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 rehabilitation.

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

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

The future of rehabilitation in neuropsychology

Improving cognitive rehabilitation programs in patients with acquired brain damage remains a challenge for neuropsychological professionals. The future is uncertain, but if there is one thing that seems obvious, it is that, over time, the weight of technologies and neurosciences will be increasing, with the implications that this will have when creating new intervention methodologies that are more effective and efficient.

The future is already present in technologies such as virtual reality or augmented reality, in programs assisted by computer and artificial intelligence, in neuroimaging techniques or in tools such as magnetic stimulation transcranial. Improvements in diagnostic and evaluation techniques that allow professionals to intervene on demand, with personalized programs really adapted to the needs of each patient.

The future of neuropsychology will involve borrowing the best of each neuroscientific discipline and assuming that much remains to be done. learn, without forgetting that to intervene better it is necessary to investigate more and that to have to intervene less it is necessary to be able to prevent best.

Bibliographic references:

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