Cognitive Rehabilitation with NeuronUP at Ateneu Maestrat

Jose Segura Navarro, a neuropsychologist at the acquired brain injury association Ateneu Maestrat, describes in this article NeuronUP’s impact on the center and shares an example of a cognitive stimulation session.

What is Ateneu Maestrat?

Ateneu Maestrat is a nonprofit association made up of people with acquired brain injury and their families.

It was founded in 2008 to meet the rehabilitation needs of these people in the northern part of the province of Castellón, Spain. Over time, and to make the best use of material and human resources, we have extended our services to other related neurological conditions, such as multiple sclerosis (MS) and Parkinson’s. Most of our patients have suffered an acquired brain injury and live in the Alt and Baix Maestrat areas.

Ateneu Maestrat has been declared a public-interest organization and is accredited as a service for the promotion of personal independence.

Professional profiles at Ateneu Maestrat

Our center currently has the following professionals:

• neuropsychologist,
• physical therapist,
• speech-language pathologist,
• social worker,
• occupational therapist,
• psychologist,
• occupational instructor,
• occupational assistant,
• driver,
• director
• and administrative assistant.

What is Ateneu Maestrat’s approach?

At our center, we use the PCP (Person-Centered Planning) approach, since each person who comes to us is at a different stage of recovery from their injury.

Each person experiences the extent of their after-effects subjectively, and this subjectivity is largely shaped by deliberate activity (Javaloy and Rodríguez, 2010), that is, by how each person chooses to live with their personal or environmental circumstances.

Most people who come to our center do so in the subacute or chronic phase. We work from an interdisciplinary, multifaceted perspective, because the after-effects that persist after a brain injury (physical, cognitive, emotional, psychosocial, etc.) are so complex that they can’t be addressed by a single professional; they require the joint, coordinated participation of an interdisciplinary team.

In the subacute phase, our work focuses on individual sessions complemented by occupational workshops. In the chronic phase, to maintain the progress achieved, we hold more group sessions combined with workshops and community activities. We always look for ecological activities so that what is worked on in sessions can be applied to the patient’s basic and instrumental activities of daily living, promoting their independence.

NeuronUP at Ateneu Maestrat

The arrival of rehabilitation platforms such as NeuronUP has made the day-to-day work of neuropsychology professionals easier, since:

• the complexity of the task can be graded,
• results can be monitored quickly and reliably,
• sessions can be prepared and scheduled in advance, and we can work remotely with people who can’t come to the center every week.

This format is also very well received by young and middle-aged people, who may have associated cognitive stimulation with doing crosswords and word searches in puzzle books.

Telerehabilitation platforms keep improving and building on scientific evidence to offer a better service, so we can say that they now have the three key ingredients of cognitive training described by Álvaro Pascual-Leone, Álvaro Fernández Ibáñez, and David Bartrés-Faz in their book El cerebro que cura: novelty, challenge, and variety.

The format is very attractive, which encourages participation. For older people and people with hemiplegia who can’t use the affected hand, most devices have a touch screen, which makes them easier to use. 

At our center, the NeuronUP platform is used in neuropsychology, speech therapy, and occupational therapy, in both individual and group sessions. When a patient joins the program, all intervention areas carry out an assessment to set priorities. Improving attentional processes is always a goal in the early stages of the individual intervention plan, since attention is a prerequisite for understanding and performing any other task. We have sometimes seen people who, because of their attentional after-effects, are unable to properly follow the physical therapist’s instructions, for example, which has a negative impact on their progress.

Example of a NeuronUP session

Here we can see an example of an attention session based on the clinical model of attention (Sohlberg and Mateer, 1987, 1989).

It’s a 45-minute session that starts with some sustained attention exercises and continues with selective and alternating attention exercises. We end the session with a card game that also involves flexibility and planning (we always try to finish with an enjoyable activity, for example, a game we know the patient likes).

NeuronUP allows us to measure patients’ progress. The following image shows the results of a patient who came to the center earlier this year with recurrent memory loss. After seeing a doctor, they had several imaging tests that showed lesions consistent with mini-strokes.

In this case, we focused on memory exercises, but other cognitive areas are also worked on. The upper trend line is the overall one, and the lower one appears when “memory” is selected. It’s a very visual result, both for professionals and for patients, who can see their progress. These scores, together with standardized tests, serve as indicators of whether we are achieving the goals set, and they also give the patient good feedback.

In this photo, the patient, who has aphasia, is doing an exercise to identify emotions.

At our center, we also use the platform’s Kids and NeuronUP2GO options. Young children love working on the computer or tablet. People who use NeuronUP2GO do so because they temporarily can’t come to the center or because they have moved to another city but want to continue their cognitive stimulation sessions.

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“This article has been translated. Link to the original article in Spanish:”
Rehabilitación cognitiva con NeuronUP en Ateneu Maestrat