The 4 phases of neuropsychological intervention (and their characteristics)

The 4 phases of neuropsychological intervention (and their characteristics)

Neuropsychological intervention aims 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

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

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

First phase: Neuropsychological evaluation

The neuropsychological evaluation constitutes the first phase of the neuropsychological intervention . The objective of this evaluation is to describe and quantify the cognitive, behavioural and emotional alterations of the patient, resulting from the injury or acquired brain damage.

This task consists of carrying out a thorough and exhaustive evaluation of the person, by means of a neuropsychological analysis of the cognitive functions, both those that have been altered and those that the patient still has, as well as the daily life 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 to find the factors responsible for the neuropsychological syndrome that will later be used in the construction of the neuropsychological rehabilitation program. But, what other objectives should the evaluation process in the neuropsychological intervention fulfill?

Objectives of neuropsychological assessment

The process of neuropsychological evaluation is not only a tool for the health professional to gather information, but also an opportunity for the patient and those close to him/her to be informed about what is happening to the affected person and what can be done to improve their situation.

The main objectives of the neuropsychological evaluation are the following:

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

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

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

  • To contribute to the establishment of a differential and accurate diagnosis in certain neurological and psychiatric diseases

  • To determine the progress of each patient, as well as to evaluate the effectiveness of the different treatments.

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

Phase two: Definition of objectives and treatment plan

The next phase in the process of neuropsychological intervention is to define the objectives and the treatment plan or rehabilitation program.

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

With all the information collected during the assessment process, the objectives and goals of the rehabilitation should be planned. It is important to set specific goals that relate to the patient’s own activities and interests. For example, if one of the goals is to enable the patient to return to his/her favorite sport (long-term goal), we will need to set short-term goals to help achieve this.

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 (for example, memory or attention training), behavioral (such as aggression) and emotional aspects (for example, working on self-esteem and self-image).

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

In short, a rehabilitation programme must address the following key aspects:

  • Treatment and rehabilitation of impaired cognitive functions.

  • Modification of maladaptive behaviour.

  • Psychosocial support and emotional management

  • Social and labour re-adaptation

  • Cognitive rehabilitation

Phase three: Neuropsychological rehabilitation

Rehabilitation is the third and most important phase of neuropsychological intervention , since it is in 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 them assuming different principles based on the neural mechanisms underlying the cognitive changes.

Approaches to cognitive rehabilitation

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

  • Restoration of damaged functions
    This theory postulates that damaged cognitive processes can be restored through their stimulation. Cognitive rehabilitation techniques designed under this approach are based on the performance of tasks and exercises in a repetitive manner, with the aim of reactivating the brain circuits and, ultimately, recovering the 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 altered function is recovered, i.e. that there is neuronal regeneration, after the period of spontaneous recovery.

  • 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 functional purpose, through the use of alternative strategies or external aids that reduce or eliminate the need for cognitive requirements.

This approach has been shown to be especially useful when the brain damage is very extensive or the deterioration of cognitive function 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 aim of cognitive rehabilitation under this approach would therefore be to improve the performance of altered functions through the use of preserved cognitive processes, rather than 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, calculus, language, visuoconstructive skills and reading and writing.

Treatment also usually includes sessions of psychotherapy, generally cognitive-behavioral therapy , 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 adequately to his or her social and professional environment.

Fourth phase: The generalization of the results

The last phase of the neuropsychological intervention is the generalization of the results ; this is the capacity of the patient to finally apply and use in his daily life what he has learned in the rehabilitation program.

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

If, for example, a patient with memory problems is taught to use an external aid – such as a diary – to avoid certain forgetfulness, the intention is that he will then continue to use these aids at home, at work or in any other familiar environment. This is generalising the results.

And to encourage and strengthen this process of generalisation, the following aspects must be taken into account:

  • Try to include in the design of the intervention programme tasks aimed at favouring the generalisation of results.

  • Try to identify the enhancers in the patient’s natural environment.

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

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

  • 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, Perianez-Morales JA, et al. Cognitive stimulation and neuropsychological rehabilitation. Barcelona: UOC; 2009
  • Tirapu Ustárroz, J. and Muñoz Céspedes, J. (2008). Neuropsychological rehabilitation. Madrid: Editorial Síntesis.

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