How the Abriendo Puertas Association works with NeuronUP: practical sessions for children and adults

Raquel Gómez León, a neuropsychologist at the Abriendo Puertas Association, shares the association’s experience using NeuronUP as a cognitive stimulation and rehabilitation tool, along with two examples of real sessions with its patients.

About the Abriendo Puertas Association

The Abriendo Puertas Association is a nonprofit organization founded in 1996 by a group of parents in the town of Moguer (Huelva, Spain) who wanted to offer their children and family members with disabilities the services they needed to improve their quality of life. 

Since then, the association has expanded its services and now serves everyone from young children to older adults. 

The Abriendo Puertas Association professional team

We currently have the following professional profiles:

• Manager.
• Adult day center director.
• Social workers.
• Clinical psychologists.
• Psychologist specializing in neuropsychology.
• Speech-language pathologists.
• Physical therapist.
• Special education teachers.
• Educational specialists.
• Occupational instructors.
• Driver.
• Administrative assistant.

Services offered by the Abriendo Puertas Association

Early Childhood Intervention Center (CAIT)

Our association offers an early intervention service for children aged 0 to 6 with developmental difficulties or delays. Its goal is to meet these children’s developmental needs, promoting their optimal, well-rounded development, and to provide support and guidance to families.

This service has the professionals needed to meet patients’ needs: a physical therapist, speech-language pathologists, psychologists, and therapeutic educators.

Educare

This service is intended for children and young people aged 6 to 21 with special educational needs, whether or not they have a disability.

Speech therapy

This service supports children aged 3 and up who have language difficulties or delays in acquiring language, and communication difficulties. 

Psychology

The psychology service supports people of any age, whether or not they have a disability. It provides psychological support, cognitive stimulation, and behavior modification, as well as neuropsychological rehabilitation and stimulation, among other services.

ASD classroom

A specialized service for children over 3 with mild to moderate autism, aimed at promoting their independence in basic activities of daily living (ADLs). 

Occupational day center

This center serves people with disabilities over 21. We have both private places and places funded by the Andalusian regional government. The center’s goal is to promote the independence and social inclusion of people with disabilities by providing training resources and social skills, encouraging activities of daily living (ADLs), and offering support and advice to families. 

The main difference between private and funded places is that funded places run from 9:00 a.m. to 5:00 p.m., so participants have breakfast and lunch at the center, while private places run from 9:00 a.m. to 1:00 p.m.

Special employment center (CEE) 

Our staff are people with intellectual, motor, and/or sensory disabilities. At this special employment center, we handle plastic fruit containers, label them, and deliver and ship packages and letters. 

Job placement agency

We work with both the Spanish Public Employment Service and the Andalusian Employment Service, specializing in helping people with disabilities in the province of Huelva who want to enter the workforce.

Profile and conditions of Abriendo Puertas Association patients 

Our patients have a very diverse profile. While the Early Childhood Intervention Center (CAIT) serves children aged 0 to 6 with a developmental warning sign, the Educare and Speech Therapy services serve children with special educational and language needs, with or without a diagnosis. 

There is no specific profile for the Psychology service either; anyone who requests it can access it. 

The Occupational Day Center, the Special Employment Center (CEE), and the Job Placement Agency have a single inclusion criterion: the person must have an officially recognized disability, and they may or may not have another condition. Some examples are autism, schizophrenia, Down syndrome, and Prader-Willi syndrome.

NeuronUP at Abriendo Puertas

NeuronUP is a tool the association has been using for two years now. This rehabilitation and stimulation platform has made it easier to work with the people we support in the Educare, Speech Therapy, and Psychology services, as well as at the Adult Day Center and the Occupational Center. 

The tool’s main advantage is its game-based electronic format, which motivates our patients to do the tasks using tablets. 

It also has other advantages: 

• It allows you to register patients and their clinical history. 
• It allows you to schedule sessions in advance. 
• You can grade the complexity of the task, adapting it to each person. 
• Results are recorded while the patient works, which allows the professional to pay attention to other aspects of the session. 
• It allows for both stimulation and rehabilitation. 

Since implementing NeuronUP, we have seen our patients more willing to work, and we have seen improvements in their cognitive functions, such as attention and memory. 

Examples of NeuronUP sessions 

At our association, NeuronUP is used with children as well as with adults and older adults.

Below are two different success stories from our association’s work with NeuronUP: the first is a session with an adult with intellectual disability, and the second is a session with a child with adrenoleukodystrophy.

Example of a NeuronUP session for intellectual disability 

One example of how we have used this tool is the case of a 36-year-old man with intellectual disability who needed neuropsychological rehabilitation after surgery for drug-resistant right mesial temporal epilepsy (MTE). 

This rehabilitation was coordinated with a neuropsychologist at the private hospital where the surgery took place. While we handled the intervention, our patient was assessed at the private center where he had the surgery by both his doctor and his neuropsychologist.

A bottom-up approach was used in this case, and a program of function restoration and retraining was established, so that repeated practice of specially designed exercises aimed to strengthen some basic processes (attention, memory, executive functions, etc.) (Sohlberg and Mateer, 2021; Mateer, Sohlberg, and Youngman, 1990). 

This theoretical basis rests on the idea that stimulating the different components of cognitive processes will lead to better processing and automation of those processes (Anderson, Winocur, and Palmer, 2003). 

Intervention plan design

There were two weekly sessions lasting 45–50 minutes. Each session worked on different cognitive functions, but NeuronUP sessions always began with sustained attention stimulation. 

Duration	Day 1	Day 2
2 minutes	Time and place orientation	Time and place orientation
5 minutes	Rapport (also intended to work on spontaneous language)	Rapport (also intended to work on spontaneous language)
5 minutes	Sustained attention (NeuronUP)	Sustained attention (NeuronUP)
5 minutes	Selective attention (NeuronUP)	Flexibility (NeuronUP)
5 minutes	Naming (phonological cue) (NeuronUP)	Long-term episodic memory (NeuronUP)
5 minutes	Planning (NeuronUP)	Reading comprehension (NeuronUP)
5 minutes	Episodic memory (nonverbal memory + short-term memory) (NeuronUP)	Expression (NeuronUP)
5 minutes	Semantic memory (NeuronUP)	Alternating attention (NeuronUP)
5 minutes	Following instructions (NeuronUP)	Semantic fluency
5 minutes	Verbal expression (describing pictures)	Constructional praxis and psychomotor skills

The first weekly session with this person with intellectual disability included the following NeuronUP activities:

• Copy Letter Matrixes: worksheets for working on sustained attention that involve completing incomplete grids based on a model grid. 
• Pair up the figures: worksheets for training selective attention in which users have to match each figure with its pair. 
• Naming Objects with Phonological Cues: worksheets for working on naming that involve naming objects with the help of phonological cues.
• Maze: an activity aimed at planning and sustained attention in which users have to get from one point to another inside a maze. 
• First to Fly: an episodic memory game that involves memorizing which butterfly in a moving series flapped first. 
• Relate Characteristic-Item: worksheets for training episodic memory in which users have to mark the characteristics of different items in a table. 
• True or false spoken sentences: worksheets for working on comprehension that involve saying whether sentences presented verbally are correct or incorrect in relation to the picture shown. 

In the second weekly session, we worked with these other NeuronUP activities: 

• In or out: worksheets for working on processing speed and sustained attention in which users have to determine the position (in or out) of different shapes in relation to others. 
• Varied combinations: a game for training planning that involves organizing different items into different groups. 
• Illuminated Windows: a game for episodic memory and selective attention in which users have to memorize the position of the windows and then reproduce it.  
• True or false written sentences: as explained above, these are worksheets for training comprehension.
• Maze with Alternate Instructions: worksheets for alternating and selective attention that involve going through a maze of figures following different instructions alternately. 
• Form Sentences: a game for working memory, flexibility, planning, and comprehension in which users have to put the words shown in order to form coherent structures. 

Thanks to NeuronUP, we were able to measure the patient’s progress, which made it easier to share information with the other professionals. The scores provided by NeuronUP, together with the results of standardized tests, gave us complete information and good feedback on the patient’s situation. 

The graphs show downward trends related to the withdrawal of the medication prescribed after the surgery.

Example of a NeuronUP session for adrenoleukodystrophy

As mentioned above, we also use NeuronUP at the association for cognitive stimulation with children to improve their academic and social skills. 

One example is the case of a 10-year-old boy diagnosed with X-linked adrenoleukodystrophy. This patient comes to our association 3 times a week for psychology, speech therapy, and educational therapy sessions. NeuronUP is used in all of them. 

In this case, given the characteristics of his diagnosis, the goal is to maintain and/or improve his cognitive functioning. 

Here is an example of the sessions carried out with him.

Below is the overall graph of his cognitive performance over the last two years during which he has been treated with NeuronUP.

As we can see, it shows a positive trend in his cognitive performance compared with when he began NeuronUP sessions a year ago.

Conclusion

NeuronUP is a useful tool for both children and adults, presented in an attractive format that motivates patients to work with it. It can also be used for both rehabilitation and cognitive stimulation, so it adapts to each patient’s needs.

At our association, it has improved the care we provide, since our patients have very diverse characteristics and needs, and it gives us almost immediate feedback on our patients’ performance and progress.

References

• Anderson, N.D., Winocur, G., y Palmer, H. (2023).Principles of cognitive rehabilitation.  In P.W. Halligan, U. Kischka y J.c. Marsahall (Eds.), Handbook of clinical neuropsychology (pp.  48-69). Oxford: Oxford University Press. 
• Mateer,C.A., Sohlberg, M.M., y Ypungman, P. (1990). The management of acquired   attention and memory disordes following mild closed head injury. In R. Wood (Ed.), Cognitive  rehabilitation in perspective (pp. 68-95). London: Taylor and Francis. 
• Sohlberg, M. M. y Mateer, C.A. (2001). Cognitive Rehabilitastion. An integrative   neuropsychology approach. New York: Guildford Press.

If you enjoyed this blog post on how the Abriendo Puertas Association works with NeuronUP, you may also be interested in these NeuronUP articles:

“This article has been translated. Link to the original article in Spanish:”
Así trabaja la Asociación Abriendo Puertas con NeuronUP: sesiones prácticas para niños y adultos