Rehabilitation (neuropsychology)

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Rehabilitation
Specialty neurology

Rehabilitation of sensory and cognitive function typically involves methods for retraining neural pathways or training new neural pathways to regain or improve neurocognitive functioning that have been diminished by disease or trauma. The main objective outcome for rehabilitation is to assist in regaining physical abilities and improving performance. [1] [2] Three common neuropsychological problems treatable with rehabilitation are attention deficit/hyperactivity disorder (ADHD), [3] concussion, [4] and spinal cord injury. [1] Rehabilitation research and practices are a fertile area for clinical neuropsychologists, rehabilitation psychologists, and others.

Contents

Methods

Physical therapy, Speech therapy, occupational therapy, hot and cold therapy, and other methods that "exercise" specific brain functions are used. For example, eye–hand coordination exercises may rehabilitate certain motor deficits, or well structured planning and organizing exercises might help rehabilitate executive functions, following a traumatic blow to the head.

Brain functions that are impaired because of traumatic brain injuries are often the most challenging and difficult to rehabilitate. Much work is being done in nerve regeneration for the most severely damaged neural pathways.

Neurocognitive techniques, such as cognitive rehabilitation therapy, provide assessment and treatment of cognitive impairments from a variety of brain diseases and insults that cause persistent disability for many individuals. Such disabilities result in a loss of independence, a disruption in normal childhood activities and social relationships, loss in school attendance, and educational and employment opportunities. Injuries or insults that may benefit from neurocognitive rehabilitation include traumatic and acquired brain injuries (such as stroke, concussion, neurosurgery, etc.), cranial radiation, intrathecal chemotherapy and neurological disorders, such as ADHD. The rehabilitation targets cognitive functions such as attention, memory, and executive function (organization, planning, time management, etc.). Specific programs are tailored to develop and address an individual's challenges after a baseline assessment of abilities and challenges.

Concussion

Much research and focus has been given to concussion suffered frequently by athletes. While the severity of brain trauma has been standardized for immediate "sideline" assessment, much work needs to be done to understand how to rehabilitate or accelerate the rehabilitation of athletes' brain function following serious concussion—whether consciousness is lost or a dazed/confused feeling is experienced or not. Currently, rehabilitation of concussive brain injury is based on rest and gradual return to normal activities with as much involvement as can be tolerated. [5]

Various parts of the brain are responsible for different functions. Some brain areas.png
Various parts of the brain are responsible for different functions.

Methods & Tools

Standardized neuropsychological tests
These tasks have been designed so the performance on the task can be linked to specific neurocognitive processes. These tests are typically standardized, meaning that they have been administered to a specific group (or groups) of individuals before being used in individual clinical cases. The data resulting from standardization are known as normative data. After these data have been collected and analyzed, they are used as the comparative standard against which individual performances can be compared. Examples of neuropsychological tests include: the Wechsler Memory Scale (WMS), the Wechsler Adult Intelligence Scale (WAIS), Boston Naming Test, the Wisconsin Card Sorting Test, the Benton Visual Retention Test, and the Controlled Oral Word Association.
Brain scans
The use of brain scans to investigate the structure or function of the brain is common, either as simply a way of better assessing brain injury with high resolution pictures, or by examining the relative activations of different brain areas. Such technologies may include fMRI (functional magnetic resonance imaging) and positron emission tomography (PET), which yields data related to functioning, as well as MRI (magnetic resonance imaging) and computed axial tomography (CAT or CT), which yields structural data.
Global Brain Project
Brain models based on mouse and monkey have been developed based on theoretical neuroscience involving working memory and attention, while mapping brain activity based on time constants validated by measurements of neuronal activity in various layers of the brain. These methods also map to decision states of behavior in simple tasks that involve binary outcomes.
Electrophysiology
The use of electrophysiological measures designed to measure the activation of the brain by measuring the electrical or magnetic field produced by the nervous system. This may include electroencephalography (EEG) or magneto-encephalography (MEG).
Experimental tasks
The use of designed experimental tasks, often controlled by computer and typically measuring reaction time and accuracy on a particular tasks thought to be related to a specific neurocognitive process. An example of this is the Cambridge Neuropsychological Test Automated Battery (CANTAB) or CNS Vital Signs (CNSVS).

See also

Related Research Articles

<span class="mw-page-title-main">Aphasia</span> Inability to comprehend or formulate language

In aphasia, a person may be unable to comprehend or unable to formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in the Global North. Aphasia can also be the result of brain tumors, epilepsy, brain damage and brain infections, or neurodegenerative diseases.

<span class="mw-page-title-main">Neurocognition</span> Cognitive functions related to a brain region

Neurocognitive functions are cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain, ultimately served by the substrate of the brain's neurological matrix. Therefore, their understanding is closely linked to the practice of neuropsychology and cognitive neuroscience – two disciplines that broadly seek to understand how the structure and function of the brain relate to cognition and behaviour.

<span class="mw-page-title-main">Neuropsychology</span> Study of the brain related to specific psychological processes and behaviors

Neuropsychology is a branch of psychology concerned with how a person's cognition and behavior are related to the brain and the rest of the nervous system. Professionals in this branch of psychology often focus on how injuries or illnesses of the brain affect cognitive and behavioral functions.

<span class="mw-page-title-main">Neuropsychological test</span> Assess neurological function associated with certain behaviors and brain damage

Neuropsychological tests are specifically designed tasks that are used to measure a psychological function known to be linked to a particular brain structure or pathway. Tests are used for research into brain function and in a clinical setting for the diagnosis of deficits. They usually involve the systematic administration of clearly defined procedures in a formal environment. Neuropsychological tests are typically administered to a single person working with an examiner in a quiet office environment, free from distractions. As such, it can be argued that neuropsychological tests at times offer an estimate of a person's peak level of cognitive performance. Neuropsychological tests are a core component of the process of conducting neuropsychological assessment, along with personal, interpersonal and contextual factors.

<span class="mw-page-title-main">Cognitive neuropsychology</span>

Cognitive neuropsychology is a branch of cognitive psychology that aims to understand how the structure and function of the brain relates to specific psychological processes. Cognitive psychology is the science that looks at how mental processes are responsible for the cognitive abilities to store and produce new memories, produce language, recognize people and objects, as well as our ability to reason and problem solve. Cognitive neuropsychology places a particular emphasis on studying the cognitive effects of brain injury or neurological illness with a view to inferring models of normal cognitive functioning. Evidence is based on case studies of individual brain damaged patients who show deficits in brain areas and from patients who exhibit double dissociations. Double dissociations involve two patients and two tasks. One patient is impaired at one task but normal on the other, while the other patient is normal on the first task and impaired on the other. For example, patient A would be poor at reading printed words while still being normal at understanding spoken words, while the patient B would be normal at understanding written words and be poor at understanding spoken words. Scientists can interpret this information to explain how there is a single cognitive module for word comprehension. From studies like these, researchers infer that different areas of the brain are highly specialised. Cognitive neuropsychology can be distinguished from cognitive neuroscience, which is also interested in brain-damaged patients, but is particularly focused on uncovering the neural mechanisms underlying cognitive processes.

<span class="mw-page-title-main">Clinical neuropsychology</span> Sub-field of neuropsychology concerned with the applied science of brain-behaviour relationships

Clinical neuropsychology is a sub-field of cognitive science and psychology concerned with the applied science of brain-behaviour relationships. Clinical neuropsychologists use this knowledge in the assessment, diagnosis, treatment, and or rehabilitation of patients across the lifespan with neurological, medical, neurodevelopmental and psychiatric conditions, as well as other cognitive and learning disorders. The branch of neuropsychology associated with children and young people is pediatric neuropsychology.

<span class="mw-page-title-main">Neuropsychological assessment</span> Testing to identify brain impairments, their severity & location

Neuropsychological assessment was traditionally carried out to assess the extent of impairment to a particular skill and to attempt to determine the area of the brain which may have been damaged following brain injury or neurological illness. With the advent of neuroimaging techniques, location of space-occupying lesions can now be more accurately determined through this method, so the focus has now moved on to the assessment of cognition and behaviour, including examining the effects of any brain injury or neuropathological process that a person may have experienced.

<span class="mw-page-title-main">Wisconsin Card Sorting Test</span> Neuropsychological test

The Wisconsin Card Sorting Test (WCST) is a neuropsychological test of set-shifting, which is the capability to show flexibility when exposed to changes in reinforcement. The WCST was written by David A. Grant and Esta A. Berg. The Professional Manual for the WCST was written by Robert K. Heaton, Gordon J. Chelune, Jack L. Talley, Gary G. Kay, and Glenn Curtiss.

Post-concussion syndrome (PCS), also known as persisting symptoms after concussion, is a set of symptoms that may continue for weeks, months, years after a concussion. PCS is medically classified as a mild traumatic brain injury (TBI). About 35% of people with concussion experience persistent or prolonged symptoms 3 to 6 months after injury. Prolonged concussion is defined as having concussion symptoms for over four weeks following the first accident in youth and for weeks or months in adults.

Edith F. Kaplan was an American psychologist. She was a pioneer of neuropsychological tests and did most of her work at the Boston VA Hospital. Kaplan is known for her promotion of clinical neuropsychology as a specialty area in psychology. She examined brain-behavioral relationships in aphasia, apraxia, developmental issues in clinical neuropsychology, as well as normal and abnormal aging. Kaplan helped develop a new method of assessing brain function with neuropsychological assessment, called "The Boston Process Approach."

Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.

Raymond S. Dean was an American psychologist and George and Frances Ball Distinguished Professor of Neuropsychology and Professor of Psychology at Ball State University.

The Rivermead Post-Concussion Symptoms Questionnaire, abbreviated RPQ, is a questionnaire that can be administered to someone who sustains a concussion or other form of traumatic brain injury to measure the severity of symptoms. The RPQ is used to determine the presence and severity of post-concussion syndrome (PCS), a set of somatic, cognitive, and emotional symptoms following traumatic brain injury that may persist anywhere from a week, to months, or even more than six months.

The California Verbal Learning Test (CVLT) is one of the most widely used neuropsychological tests in North America. As an instrument, it represents a relatively new approach to clinical psychology and the cognitive science of memory. It measures episodic verbal learning and memory, and demonstrates sensitivity to a range of clinical conditions. The test does this by attempting to link memory deficits with impaired performance on specific tasks. It assesses encoding, recall and recognition in a single modality of item presentation (auditory-verbal). The CVLT is considered to be a more sensitive measure of episodic memory than other verbal learning tests. It was designed to not only measure how much a subject learned, but also reveal strategies employed and the types of errors made. The CVLT indexes free and cued recall, serial position effects, semantic clustering, intrusions, interference and recognition. Delis et al. (1994) released the California Verbal Learning Test for Children (CVLT-C). The California Verbal Learning Test-II (CVLT-II) is an updated version of the original CVLT, which has been standardized and provides normative data.

In psychology and neuroscience, executive dysfunction, or executive function deficit, is a disruption to the efficacy of the executive functions, which is a group of cognitive processes that regulate, control, and manage other cognitive processes. Executive dysfunction can refer to both neurocognitive deficits and behavioural symptoms. It is implicated in numerous psychopathologies and mental disorders, as well as short-term and long-term changes in non-clinical executive control. Executive dysfunction is the mechanism underlying ADHD Paralysis, and in a broader context, it can encompass other cognitive difficulties like planning, organizing, initiating tasks and regulating emotions. It is a core characteristic of ADHD and can elucidate numerous other recognized symptoms.

<span class="mw-page-title-main">Cognitive rehabilitation therapy</span>

Cognitive rehabilitation refers to a wide range of evidence-based interventions designed to improve cognitive functioning in brain-injured or otherwise cognitively impaired individuals to restore normal functioning, or to compensate for cognitive deficits. It entails an individualized program of specific skills training and practice plus metacognitive strategies. Metacognitive strategies include helping the patient increase self-awareness regarding problem-solving skills by learning how to monitor the effectiveness of these skills and self-correct when necessary.

Automated Neuropsychological Assessment Metrics (ANAM) is a library of computer-based assessments of cognitive domains including attention, concentration, reaction time, memory, processing speed, and decision-making. ANAM has been administered nearly two million times in a variety of applications and settings. ANAM provides clinicians and researchers with tests to evaluate changes in an individual’s cognitive status over time.

The Wechsler Test of Adult Reading (WTAR) is a neuropsychological assessment tool used to provide a measure of premorbid intelligence, the degree of Intellectual function prior to the onset of illness or disease.

Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence, functional status, health, and social participation of individuals with disabilities and chronic health conditions. Assessment and treatment may include the following areas: psychosocial, cognitive, behavioral, and functional status, self-esteem, coping skills, and quality of life. As the conditions experienced by patients vary widely, rehabilitation psychologists offer individualized treatment approaches. The discipline takes a holistic approach, considering individuals within their broader social context and assessing environmental and demographic factors that may facilitate or impede functioning. This approach, integrating both personal and environmental factors, is consistent with the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF).

Developmental neuropsychology combines the fields of neuroscience and developmental psychology, while drawing from various other related disciplines. It examines the relationship of behavior and brain function throughout the course of an individual's lifespan, though often emphasis is put on childhood and adolescence when the majority of brain development occurs. Research tends to focus on development of important behavioral functions like perception, language, and other cognitive processes. Studies in this field are often centered around children or other individuals with developmental disorders or various kinds of brain related trauma or injury. A key concept of this field is that looks at and attempts to relate the psychological aspects of development, such as behavior, comprehension, cognition, etc., to the specific neural structures; it draws parallels between behavior and mechanism in the brain. Research in this field involves various cognitive tasks and tests as well as neuroimaging. Some of the many conditions studied by developmental neuropsychologists include congenital or acquired brain damage, autism spectrum disorder, attention deficit disorder, executive dysfunction, seizures, intellectual disabilities, obsessive compulsive disorder, stuttering, schizophrenia, developmental aphasia, and other learning delays such as dyslexia, dysgraphia, and dyspraxia.

References

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  2. Henry, David. "Frequenzen" . Retrieved 14 October 2023.
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  5. "Recovering from Mild Traumatic Brain Injury/Concussion–A Guide for Patients and Their Families" (PDF).