What is Neuropsychology?

Neuropsychology is a specialist area of psychology which is concerned with the relationship between the brain and individuals, especially in people who have suffered a brain injury and therefore have a loss of higher mental functions.

What are the higher mental functions?

Higher psychological functions are those cognitive abilities that allow us to face, effectively and efficiently, the demands of everyday life to which we are exposed through people throughout our lives. We can highlight the following:

The attention enables the person to focus on any proposed activity, without losing the course of same, allowing them to be kept immersed for a period in a given activity (studying, driving, reading a book, watching television, following a conversation, performing a routine domestic or household task, etc.).

The language is the faculty that allows us to communicate with each other, allowing us to understand the messages conveyed and in turn allowing us to issue our own messages. That is, it is the basis of personal relationships and social communication. However, language is a tool for intellectual activity (thinking, memorizing, representing reality, etc.) and for the organization and regulation of mental processes (planning, scheduling, etc.).

Reading and writing are special forms of comprehensive and expressive language.
Therefore, people with language impairment (aphasia) will have difficulty expressing many of their thoughts or understanding instructions and what is happening in their social and family environment.

Memory is largely what makes us different as people. “We are what our memory is”, from the moment we are born we accumulate experiences and memories, and when they disappear through injury, we erase all of our personal history. It is as if our personal computer had a computer virus and we lost all data (photos, music, videos, bank account numbers, etc. leading to anguish and helplessness regarding our ability to function minimally.

Moreover, the memory impairments can be rendered visible in daily life, presenting difficulties in retaining information managed by the person, directly or indirectly, (what he has done the previous day, who he has called on the phone, conversations, movies, reading newspapers and books, and can even lead to repetition due to having forgotten that the subject has already been mentioned, etc.), as well as prospective memory (what to do tomorrow, what to buy, what food do I have to make today, etc.).

Similarly, memory problems may lead to the inability to recognize familiar faces and people (you can mistake the wife and children for strangers), or the immediate area in which we live (become disoriented and lost in a familiar place).

Executive functions and reasoning abilities allow the proper handling of the information that we receive, which allows us to understand and efficiently integrate with the demands of daily life, acting in a planned and programmed manner, anticipating the consequences of our behaviour (preparing food, household activities, shopping, etc.).

Higher visual functions are needed to handle all the information in visual form that we perceive on a daily basis, and which can be reflected in the daily lives of patients that have difficulty understanding drawings and complex visual information for a communicative purpose (signs, warnings, instructions, etc.) there being some susceptibility to topographical disorientation (the person can get lost as they walk around their own neighbourhood, they may not be able to find the exit when in a new location), among other things.

Can the emotional and behavioural aspects be altered by brain damage?

Affective and emotional aspects play a key role. Our conduct is guided by our feelings, desires and necessities. After brain damage, these aspects play an important role in the life of the patient and, above all, in the life of the patient’s family. Problems may arise with regard to control and behavioural regulation, irritability, aggressiveness, impulsiveness, indifference and general demotivation (even the things they liked before are no longer of interest to them, or with respect to the most basic activities such as hygiene and food) depressive feelings may occur, (crying, despair, etc.), infantilism (interests and inappropriate behaviour for the age of the patient), general disinhibition (they may talk a lot and may not keep track of the conversation, they may not respect interpersonal distances, behave according to their needs and may not care about the opinion of others) or sexual disinhibition (display an attitude oriented towards sexuality), among other problems.

Why does the family has to be taken into account along with the patient?

In the event of unexpected brain damage, especially in young people, it knocks the family for six, and can destabilise the balance within the family, since they are taken unawares and are without any kind of preparation.

The effects are mainly developed within the family, so this is the place where emotional problems are most noticed. But it is also within the family that affects can be redressed. To do so, the family has to be properly advised on how to handle situations that may arise and even on how to manage their own emotions and feelings.

Who can benefit from neuropsychological intervention?

Anyone who has suffered an injury to the brain and as a result has presented a loss of neuropsychological abilities (attention, memory, language, emotions and behaviour) as well as the patient’s family.

What other interventions can be made from neuropsychology?

In addition to the assessment and rehabilitation treatment of psychological functions after brain injury, neuropsychology intervenes in other areas, and for other purposes, such as:

– Early detection of degenerative processes (Alzheimer’s and other dementias) in order to establish palliative stimulation programmes that delay the progression of the disease.

– In the legal sphere, it seeks to objectively establish injuries and limitations after a brain injury, so that fair and appropriate financial compensation can be established. It also seeks to clarify whether the symptoms and problems are due to a brain injury or, conversely, due to other causes, such as simulation, feigning or exaggeration.

– The differential diagnoses are also common within the activity of the neuropsychologist. It is clarified whether the symptoms presented by a patient are due to brain damage or, conversely, are processes of psychological origin (for example, in the early stages of dementia, the disease may present with emotional symptoms which can be confused with depression).

How is the process of neuropsychological intervention?

The first action is aimed at carrying out an evaluation, assessment and diagnosis of the neuropsychological status of the patient, in order to meet and answer questions such as what problem has presented? What is the cause ? What are the implications for their psychological and social functioning? What is the prognosis? among other things.

In a second stage, a neuropsychological rehabilitation programme is developed, with therapeutic objectives, which is out in a way that is individual and adjusted to the needs and characteristics of the patient.

Finally, when the  neuropsychological rehabilitation programme ends, a new evaluation is performed to verify the achievement of the objectives and the neuropsychological status of the patient.

How do you get the information required in order to know what happened to a person?

To evaluate and diagnose the problems of a patient, the neuropsychologists obtain information from different sources and techniques:

– Interviews with the patient and the family.
– Collection of information from medical records.
– Patient observation.
– Use of tests and specific psychological and neuropsychological testing.

What techniques and tools are used in neuropsychological rehabilitation?

The neuropsychologist can use any of the standard techniques and procedures that are habitual in clinical psychology, and that are appropriate in a personalized way and suitable to a given situation.

In addition, there are specific techniques and therapeutic procedures that come from neuropsychology, directed towards the idea that the problems caused by the brain damage should have the least negative impact on the individual’s life, and aim at getting the patient to function properly from a psychosocial point of view. For example, if a person has difficulty memorizing the events of daily life, they may be able to remember after a regime of scheduled training or, ultimately, if memory does not become effective, the patient will be trained to use compensation mechanisms such as teaching them to keep a diary, or notes scattered around the home, etc. The same goes for other functions, so if, for example, the problem at hand is expressive language (aphasia), the development of this function will be sought, and when this is no longer possible, compensation techniques will be carried out to achieve effective communication on the part of the patient.

That is to say, with neuropsychological rehabilitation it is possible that the brain areas that are undamaged can work on the functional recovery of the patient, so that the areas that remain intact compensate, make up for, or assume their own functions of the damaged areas concerned.

The procedures and neuropsychological techniques are as follows:
– Discursive method.
– Pencil and paper tasks.
– IT programs.
– NeuronUP web platform.