Neuropsychological rehabilitation focused on improving cognitive functions which further results in improving symptoms, functional ability which enhance overall quality of life.

1. NEUROPSYCHOLOGICAL
REHABILITATION
- PRAGYA
CLINICAL PSYCHOLOGIST
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2. WHAT IS NEUROPSYCHOLOGICAL
REHABILITATION ?
• Concerned with improvement of cognitive, emotional, psycho-
social and behavioral deficits caused by an insult to them
• Consist of task designed to reinforce or re-establish previously
learned pattern of behavior and to establish new compensatory
mechanism
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3. FACTORS AFFECTING
• Course of intervention is based upon:
1. DIAGNOSIS OF PATIENT
2. AGE
3. PREMORBID FUNCTIONING
4. EDUCATION
5. HISTORY OF ILLNESS/ INJURY
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4. INDICATION
• Applicable on several brain related conditions:
1. Traumatic Brain injury(TBI)
2. Tumors
3. Brain related infections
4. Neurodegenerative conditions
5. Psychiatric disorder
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5. FEATURES
• Team effort (patient’s awareness and motivation, family support
as well as therapist expertise)
• Aim is to restore premorbid function and to compensate lost
functions
• Ultimate goal is to facilitate meaningful and measurable
improvement in patient’s everyday functions
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6. NEED FOR NEUROPSYHCOLOGICAL
REHABILITATION
• Brain is chief organ which controls functioning of different parts of
body
• Recent advances in surgical techniques and pharmacotherapy have
considerably reduced the mortality after brain damage
• However, morbidity after brain damage continues to be high as
neurons do not regenerate like skin or bone
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7. NEED contd…
• The morbidity can be observed in physical and psychological
domains of functioning:
• Physical morbidity is easily perceived and addressed through
techniques of physiotherapy (neurological rehabilitation)
• Psychological morbidity is more subtle
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8. NEED contd…
• Psychological morbidity may arise due to impairment at basic level
of functioning (memory loss) or integrated functioning
(personality)
• Brain damage also affects family and society apart from patient
which needs to be addressed
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9. THEORIES
1. The role of neuronal plasticity
2. Restitution/ substitution/ compensation
3. Role of diastasis/unmasking
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10. NEURONAL PLASTICITY
• Refers to adaptation of brain as a result of several factors that
may produces changes in brain
• Modification of nervous system that occur in response to either
internal or external environmental demands
• It includes short-term modulation of functions and long term
structural changes
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11. RESTITUTION, SUBSTITUTION AND
COMPENSATION
• Three major principles of neuropsychological rehabilitation:
Restitution
• Process of
restoration of
lost or
impaired
functions
Substitution
• Replacement
of impaired
function by
alternate
strategies
Compensation
• To provide
cognitive aids
which support
patient in
everyday
functioning
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12. DIASCHISIS AND UNMASKING
• Sudden change of function or unmasking of latent function in a
portion of brain connected to distant but damaged brain area
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13. REGENERATION - reaction to injury
• If the cell body of neuron is lost or damaged, whole neuron is lost
as the axon will also degenerate and there is no cell division in
adult brain
• If the axon of neuron is lost or damaged
and cell body is intact, there is chance
that axon will regenerate
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14. REGENERATION IN PNS (Parasympathetic Nervous System)
• After degeneration , macrophage clean up the debris
• Macrophage release “Mitogens”, that include Schwann cells to
divide
• Schwann cells make “Laminin” and macrophage make
“Interleukin” which induce Schwann cells and make “NERVE
GROWTH FACTOR (NGF)”
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15. • Axons sprout and enter new Schwann cell tube and axonal growth
cones successfully grow
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17. REGENERATION IN CNS (Central Nervous System)
• Astrocytes and microglia form glial scars which physically block
axonal regeneration
• Oligodendrocytes produce NEURITE OUTGROWTH INHIBITOR
(NOGO) which inhibits axonal regeneration
• Regeneration in CNS occurs only when some branches of
presynaptic axons are damaged
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18. CNS RECOVERY
Synaptic hyper
effectiveness
• Large amounts of
Neurotransmitter released
to post synaptic receptor
Unmasking of silent
neuron
• Unused neuron become
active
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19. GOALS OF NEUROPSYCHOLOGICAL
REHABILITATION
• Primary goal is to restore functions/functional abilities of patient
to premorbid level. Attempts made to improve overall cognitive
function so that it will generalize to everyday functioning
• Secondary goal is to improve functions at least to the extent that
patient become productive and to continue with family or social
responsibility
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20. GOALS contd…
• Tertiary goal is to provide cognitive aids which support patient in
day-to-day functioning. Aim is to execute functions optimally,
reduce burden on support system and to minimize residual
impairment
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21. APPROACHES
1. BASIC FUNCTION APPROACH :
• Aims is to restitute deficient function or deals with
environmental manipulation
• Expectation is improved deficient function leads to reduction
of symptoms which improved behavior mediated by that
function
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22. 2. SKILL TRAINING APPROACH :
• Focused on the skill needed for day-to-day functioning of
patient which are deficient following brain damage
• Approach is more direct and targeted behavior is specific and
narrower
• No expectation about generalization of improvement
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23. 3. HOLISTIC APPROACH :
• Includes both basic function approach and skills training
approach
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24. MODEL OF NEUROPSYCHOLOGICAL
REHABILITATION
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25. Pre-morbid function
Patient & family member
Current problem
Assessment
Nature of brain injury
Cause, changes overtime
and expected recovery
Neurocognitive Emotional/psychosocial Behavioral observation,
self report & interview
Decide on treatment
Process
Evaluation
Reassessment
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26. METHODS
• In brain-related injuries, initial perspective focused on acute
management and intensive medical care targeting basic survival
• Later perspective addresses outcome of injury in terms of basic
functioning and quality of life
• Deficient component are improved by using tasks target specific
component which is being introduced at several level of difficulty
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27. • Tasks can be presented through:
1. Computer-based tasks
2. Paper-and-pencil tasks
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28. COMPUTER-BASED TASKS
• Advantages:
1. Uniformity of administration of tasks
2. Commence task at level of difficulty most suitable to patient
3. Difficulty level would be increased in real time as per
patient’s performance on a trial-by-trial basis
4. Objective record of patient’s performance
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29. COMPUTER-BASED TASKS contd…
• Disadvantages:
1. Tasks are too structured
2. Do not permit changes depending on patient’s deficit
3. Consuming time of program designed for every patient’s need
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30. PAPER AND PENCIL TASKS
• Advantages:
1. Inexpensive and easily obtained
2. Improve functions at several levels
3. Includes number of tasks for a single domain
• Grain sorting used to improve information processing speed and
focused attention
• Task difficulty was increased by mixing different types of grains,
based on size/shape/color
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31. • Letter cancellation in newspapers or magazine articles increased
sustained attention
• Divided attention was improved by giving two tasks simultaneously
which do not combine same stimulus modality, response or nature
of processing
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32. • Improvement of memory functions include tasks which improve
automatic encoding of temporal, frequency and spatial
information
• These components provide contextual cues to recall
• Their improvement helps in improving memory
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33. • Frequency encoding- list with repetitions of words were read out.
Frequency of repetitions had to be encoded by patient
• Temporal encoding- asking patient to identify words which were in
beginning, middle or end of list
• Spatial encoding- asking patient to remember location of
individual objects which were arranged on table
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34. • Studies also reveal development of EEG neuro-biofeedback
training is used to modify brain waves using operation
conditioning methods
• Neuro-feedback has been used to improve physical balance,
incontinence, memory and learning improvement
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35. PRACTICE PRINCIPLES
• Mateer (2005) outlined several practice principles:
1. Tailored to the individual
2. Collaboration between client, therapist and family/ caregiver
3. Focused on mutually set and functionally relevant goals
4. Evaluation of efficacy and outcome should incorporate and capture
changes in functional abilities
5. Eclectic and use multiple approach
6. Address affective and emotional component of cognitive deficits
7. Self-evaluative
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