The 4 phases of neuropsychological intervention (and their characteristics)

The neuropsychological intervention Its purpose 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 are the phases of neuropsychological intervention and what objectives are pursued in each case.

The phases (or stages) of neuropsychological intervention

In order to carry out an intervention of this type, 4 phases have to be followed: the evaluation, the definition of objectives and planning of the treatment, the rehabilitation, and, finally, the generalization of results.

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

Phase One: Neuropsychological Assessment

The neuropsychological evaluation constitutes the first of the phases of the 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, through the neuropsychological analysis of the functions cognitive, both those altered and those that the patient still retains, as well as the skills of daily life that are preserved and those that not.

For this purpose, a whole series of tests and diagnostic tests are used, the objective of which is to search for the factors responsible for the neuropsychological syndrome that will later be used in the construction of the rehabilitation program neuropsychological. But, what other objectives must the evaluation process meet in neuropsychological intervention?

Goals of the neuropsychological evaluation

The neuropsychological assessment process is not only a tool for the healthcare professional to gather information, but it also constitutes a opportunity given to the patient and those close to him to keep informed about what happens to the affected person and what can be done to improve his situation.

The main objectives of the neuropsychological evaluation are the following:

• Describe in detail the consequences of brain injury in terms of cognitive functioning, possible conduct disorders, and emotional disturbances.

• Define the clinical profiles that characterize the different types of pathologies that present with neuropsychological deterioration.

• Establish an individualized rehabilitation program, based on the abilities and capacities of the patient conserved, whose objective is to improve the autonomy and quality of life of the person.

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

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

• Expert opinion and / or medico-legal 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 rehabilitation program.

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

With all the information gathered during the evaluation process, the objectives and goals of the rehabilitation should be planned. It is important to establish specific objectives related to the activities and interests of the patient. For example, if one of the objectives is for the patient to be able to practice their favorite sport (long-term goal), we will have to establish short-term goals that help to achieve it.

The programs designed must be individualized and focused on the needs of each patient. It is convenient to carry out individualized sessions to work on specific cognitive aspects (for example, training of memory or attention), behavioral (such as aggressiveness) and emotional (for example, working on self-esteem and self-image).

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

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

• Treatment and rehabilitation of impaired cognitive functions.

• Modification of maladaptive behaviors.

• Psychosocial support and emotional management

• Social and work readjustment

• Cognitive rehabilitation

Third phase: Neuropsychological rehabilitation

Rehabilitation is the third and most important of the phases of neuropsychological intervention, since 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 tendencies or orientations, each of they assuming different principles based on the neural mechanisms that underlie cognitive changes.

Approaches to cognitive rehabilitation

As in almost all disciplines, different trends or orientations are also used in the field of neuropsychological rehabilitation when approaching the rehabilitation process. Each of them assumes different principles in relation to the neural mechanisms that underlie cognitive changes.

• The restoration of damaged functions. This theory postulates that damaged cognitive processes can be restored through their stimulation. The cognitive rehabilitation techniques designed under this approach are based on the performance of tasks and exercises in a repetitive, with the aim of re-activating brain circuits and, ultimately, recovering cognitive functions altered.

Although cognitive rehabilitation through this approach has been useful in some areas of intervention, such as attention or motor functions, in processes Like memory, there is no evidence that altered function recovers, that is, that there is neuronal regeneration, after the recovery period spontaneous.

• Compensation for damaged functions. This other approach starts from the principle that damaged brain mechanisms and cognitive processes can hardly be recovered. That is why cognitive rehabilitation should emphasize the performance of tasks and activities that have a goal functional, through the use of alternative strategies or external aids that reduce or eliminate the need for cognitive requirements.

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

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

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

Areas of work in neuropsychological rehabilitation

The areas that are most frequently worked on in a rehabilitation program are: spatio-temporal orientation, attention, memory, executive functions, calculation, language, visuoconstructive skills and literacy.

Treatment also usually includes psychotherapy sessions, usually cognitive behavioral therapy, and addressing maladaptive behavior through behavior modification tools. In addition, it is important to work side by side with the patient's family, so that they are also part of the rehabilitation process.

In the final stages of treatment, the improvement of the social skills, vocational and professional orientation, as well as the return or reintegration to the community, with the objective that the patient can develop as a person and adapt adequately to their social environment and professional.

Fourth phase: Generalization of the results

The last phase of the neuropsychological intervention is the generalization of the results; that is, the ability of the patient to finally apply and use in their day-to-day life what they have learned in the rehabilitation program.

In the clinical setting, it is known the difficulty that many patients with brain damage show when applying the principles and skills learned in sessions of neuropsychological rehabilitation programs to your life daily.

If, for example, a patient is taught with memory problems to use external help -such as an agenda- to avoid certain oversights, it is intended then continue to use these aids at her home, at work or in any other environment known. This is generalizing the results.

And 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 favoring the generalization of results.

• Try to identify reinforcers in the natural environment of the patient.

• Employ numerous examples during rehabilitation and acquisition of the skill in question.

• Use during rehabilitation materials and situations similar to those used in the real context.

• Follow up to assess the level of generalization obtained.

Bibliographic 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.