Neuropsychology is in charge of evaluating and rehabilitating people who have suffered some kind 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 kind of problems neuropsychology treats through rehabilitation.

What is it and what problems does neuropsychology treat?

Neuropsychology is a scientific discipline that studies the relationship between the 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 who suffer organic lesions of the central nervous system , whose origin may be of different types: head injuries, vascular accidents, tumours, 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 of a secondary affectation to some type of disorder (dementias 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/her problem consists of , as well as his/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 to make a judgment and assessment.

The second stage consists of defining the objectives and creating 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 dedicate a specific chapter. The fourth and last one will consist of the generalization of the results of the applied program.

Neuropsychological rehabilitation

The objective of rehabilitation in neuropsychology is to reduce or minimize the deficits and cognitive, emotional and behavioral disorders that can appear after brain damage, in order to achieve the maximum capacity and functional autonomy of the patient, both socially and in terms of family and work.

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

In the following, we will 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, strokes, anoxias, infectious diseases and head injuries. When an injury of this type occurs, there is a maximum in neuropsychology and that is that one must consider the nature, extension and location of the same in order to determine the severity of the damage caused.

Along with the mentioned 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 injury , in which the patient will be able to 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 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-perceptive abilities or praxias; as well as possible emotional and behavioural disorders that could be caused.

2. Memory rehabilitation

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

Memory can be divided into remote or long-term memory (LTM), a “storehouse” where we keep our lived memories, our knowledge of the world, images, concepts and action strategies; immediate or short-term memory (ICM), referring 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 period of time (about 250 milliseconds).

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

When rehabilitating the 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 how to create and learn task lists or to help him/her organize the information in smaller parts or steps , so that he/she can remember them more easily.

Another way to improve the patient’s memory capacity is to teach them to focus their attention and work on controlling their attention capacity on the task at hand or when learning something; and also to work on details of what they want to remember (for example, by writing them down on a piece of paper or talking to themselves, giving themselves instructions).

3. Rehabilitation of care

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

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

The intervention of the 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: one non-specific and another more specific one aimed at specific attention deficits.

Non-specific intervention focuses on treating attention as a unitary concept and 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, the deficits in the different attentional components are identified and differentiated . A hierarchical model is usually used and each level is more complex than the previous one. A typical example is the 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 rehabilitation of brain damage, 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 their self-regulation. Deficits in these types of functions make it difficult for the patient to make decisions and carry out his or her day-to-day activities.

In the clinical context, the term disjunctive syndrome has been coined to define the picture of cognitive-behavioral alterations characteristic of a deficit in executive functions , which implies: difficulties in focusing on a task and completing it without external environmental control; presenting rigid, persistent and stereotyped behavior; 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 improve problems with: initiation, sequencing, regulation, and inhibition of behavior; problem solving; abstract reasoning; and alterations of disease consciousness. The usual approach is to focus on preserved abilities and work with those most affected.

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. Sometimes these disorders are accompanied by others such as apraxia, achalculia, aprosody or dyslexia.

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 relatives.

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

  • Keep the person verbally active.
  • Re-learning language.
  • Give strategies to improve language.
  • Teach communication skills to the family.
  • Give psychological support to the patient.
  • Exercise automatic language.
  • Decrease patient avoidance and social isolation
  • Optimize verbal expression.
  • Enhance repeatability.
  • Encourage verbal fluency.
  • 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 capacities; to avoid disconnection with their environment and strengthen social relations; to give the patient security and increase their personal autonomy; to stimulate their own identity and self-esteem; to minimize stress; to optimize cognitive performance; and to improve the mood and quality of life of the patient and their family.

The symptoms of a person with problems of dementia will not only be of a cognitive type (deficits in attention, memory, language, etc.), but also emotional and behavioural, so that performing only cognitive stimulation will be insufficient. Rehabilitation must go beyond this and include aspects such as behaviour modification, family intervention and vocational or professional re-adaptation.

It is not the same to intervene at an early stage, with a mild cognitive impairment, as it is 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 course and phase of the disease in which the patient finds himself.

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

The future of rehabilitation in neuropsychology

Improving cognitive rehabilitation programs in patients with acquired brain damage remains a challenge for neuropsychology professionals. The future is uncertain, but if there is one thing that seems obvious it is that, with time, the weight of technologies and neurosciences is going to be greater and greater , with the implications that this is going to have when it comes to 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 computer-assisted programs and artificial intelligence, in neuroimaging techniques or in tools such as transcranial magnetic stimulation. Improvements in diagnostic and assessment techniques that allow professionals to intervene on demand, with personalised programmes that are truly adapted to the needs of each patient.

The future of neuropsychology will involve borrowing the best from each neuroscientific discipline and assuming that there is still much to learn, without forgetting that better intervention requires more research and that less intervention requires better prevention.

Bibliographic references:

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