Zeltia Veiga Roca, a psychologist and neuropsychologist at ZV Psicología l Neuropsicología, explains how her center applies neuropsychological rehabilitation and cognitive stimulation with the help of NeuronUP, including real examples that show the benefits for her patients’ cognitive recovery.
What is ZV Psicología l Neuropsicología and how does it approach cognitive rehabilitation?
ZV Psicología l Neuropsicología is a neuropsychological rehabilitation center in Ourense, Spain, that has been operating since 2020. Its main goal is to minimize cognitive and behavioral impairments and reduce the impact on the daily life of people with brain injury, always taking into account ongoing interaction with the family.
At ZV Psicología l Neuropsicología, we want to be at the forefront of neuropsychological rehabilitation because we know how important cognitive stimulation is for people as a way to achieve real, effective improvement in neural performance.
We care about the person and what they are going through. We want everyone to feel welcome and understood. That’s why we believe that our work with patients and our commitment to up-to-date training are key to this goal.
What does neuropsychological rehabilitation involve?
Neuropsychological rehabilitation includes four types of intervention:
- Cognitive rehabilitation,
- behavior modification,
- intervention with families,
- and vocational rehabilitation.
Through them, neuropsychologists aim to reduce cognitive and behavioral impairments so that brain injury has less impact on the lives of both the patient and their family.
Cognitive stimulation is an essential part of rehabilitation. To make it more effective, we need to design an individualized rehabilitation program tailored to the specific characteristics of each case: we must consider age, education level, type of injury, and each person’s particular needs, assessing the individual’s cognitive reserve (CR) with the CR questionnaire.
Cognitive reserve is an active, dynamic process acquired throughout life through which neurological damage is offset using the processing resources available to the person. The greater the CR, the greater the neural optimization, so it is extremely important for us to take it into account in order to predict outcomes and tailor our work plan to the person.
Given the financial and travel constraints that are often present, in-person training is usually not enough, so being able to continue rehabilitation at home becomes a much-needed option. This is the origin of telerehabilitation (TRHB), which allows neuropsychologists to create a broader, more specific intervention plan.
Neuropsychological rehabilitation intervention protocol at ZV Psicología l Neuropsicología
At ZV Psicología l Neuropsicología, we follow a detailed intervention protocol made up of several stages, which aims to ensure effective results:
1. Initial interview
First, an initial interview to gather the patient’s clinical history, including identifying information, personal history, medical and psychopathological history, and family history, as well as behavioral and emotional aspects, reports, and an assessment if appropriate.
2. Identifying and assessing deficits
Once the key areas to work on have been identified, we determine where to focus most and what needs to be reinforced, also considering whether substitution strategies or compensatory mechanisms are needed.
3. In-person sessions
Once all these considerations have been made, we propose an in-person schedule, which is weekly. Each session takes a dual approach that uses both NeuronUP digital activities and paper exercises. This lets us keep observing so that we can adapt the sessions again if necessary.
4. Telerehabilitation
Thanks to NeuronUP2GO, our patients continue their cognitive rehabilitation at home with 15–20 minute sessions every day.
NeuronUP2GO is an essential tool because it provides a precise, thorough record of every exercise they do. This means we can anticipate possible decline, because the data collected in the “Digital results” section can pick up even subtle changes.
5. Ongoing follow-up
Every seven to ten days, we carry out individual follow-up for each patient with NeuronUP2GO, analyzing their progress in the graphs.
NeuronUP has recently made reports very easy for professionals to create, including not only the progress graph but also progress by cognitive function. This also helps us stay in touch with the family and talk about the patient’s progress.
This creates feedback in both directions: families can have their questions answered, and we can learn how the patient is doing outside of sessions.
This two-way relationship with family members also has a direct positive impact on each patient, since it leads to greater treatment adherence.
NeuronUP, a key tool in personalized cognitive rehabilitation
This whole intervention process is possible thanks to the programs we have already created in NeuronUP.
NeuronUP has more than 170 different activities, which really helps keep patients from getting bored and makes it easier for them to adopt the routine needed for neurorehabilitation therapy.
From a professional point of view, the platform offers a large general base of stimulation that we can easily adapt to each person by adding more individualized sessions.
We divide them into blocks that we try to make varied and complete, covering all intervention areas, although we place more emphasis on the deficits of the type of injury we are treating.
Examples of personalized cognitive stimulation programs with NeuronUP
Personalized cognitive stimulation program for a person with Alzheimer’s disease (AD)
How do we work on visual and auditory memory in people with Alzheimer’s?
In the cognitive rehabilitation of people with Alzheimer’s disease (AD), it is essential to work on the three spheres of orientation and on declarative memory: both episodic memory, since they often have difficulty with long-term consolidation, and semantic memory, which affects naming, category fluency, and categorization.
To do this, NeuronUP allows us to work on visual and auditory episodic memory with exercises such as:
- Sticky Notes in Order, a game in which the person has to memorize the position of the numbers on the sticky notes.
- Home Delivery, a game in which users have to remember the order in which the buildings light up and reproduce it in reverse.
- Remember the Names, an auditory and text-based game that involves matching names with the photos of the people shown.
- Locate sounds, a game in which the person has to memorize the sounds that play and where they come from, and then tap where the sound that plays was located.
- Memorize the order, in which users have to put in order a series of visual items they memorized beforehand.
- Night at the Concert, a game for identifying the order of the musical instruments heard.
How do we work on semantic memory in people with Alzheimer’s?
For semantic memory, NeuronUP offers, among others:
- Pairs of elements and categories, an activity in which users have to match each item with the category it belongs to.
- Sort numbers according to value, available in digital and downloadable versions, in which users have to sort a series of numbers according to their value.
- Sort the words alphabetically, an activity focused on putting words in alphabetical order.
- Odd or Even, an exercise in which users have to sort numbers according to whether they are even or odd.
- Naming Objects with Phonological Cues, worksheets in which users have to name objects with the help of phonological cues.
For temporal orientation, every day the person starts their NeuronUP2GO session with Location in Time, worksheets that help users orient themselves to the time, day, month, year, and season.
For all patients, this start has been very helpful, and they even tell us how they notice the improvement. We also add more individualized sessions.
Personalized cognitive stimulation program for a person with logopenic Alzheimer’s disease
For example, for a person with logopenic AD, we place more emphasis on NeuronUP’s language-focused exercises. That is, we add sessions in which the main theme is language.
For example:
- Matching Adjectives to Images, a vocabulary activity in which users have to match each adjective with the image that represents that characteristic.
- Making Words, an exercise aimed at working memory and vocabulary, in which users have to form words by putting fragments, syllables, or individual letters in order.
- Forming words by combining letters, worksheets that work on working memory, flexibility, and vocabulary and involve forming words by combining different letters and syllables.
- Find a word by its definition, another vocabulary activity that involves figuring out the words that match the definitions given.
Cognitive stimulation for a person with dementia
If the dementia is still in its early stages, we try to get ahead of the course of decline by reinforcing selective attention, episodic, semantic, and procedural memory, and processing speed.
In cases of moderate dementia, we find it helpful to reinforce selective attention, working memory, and declarative memory every day.
Personalized cognitive stimulation program for a person with acquired brain injury (ABI)
How do we approach cognitive stimulation for people with mild neurocognitive damage?
This proposal is intended for people with mild neurocognitive damage and for those who want to use NeuronUP as cognitive training to stay in shape.
In this case, keep in mind that each program includes a wide variety of activities so that all cognitive areas can be exercised.
At ZV Psicología l Neuropsicología, we place a strong emphasis on:
- Processing speed, with activities such as Stop the Ball, in which the person has to work out when a ball passes a specific point.
- Episodic memory, with exercises such as:
- Home Delivery, to memorize the order in which some buildings light up and repeat it in reverse;
- and Press Conference, in which users have to remember the order in which several journalists speak and reproduce it.
- Semantic memory, with exercises such as Sort the words alphabetically.
- Executive functions, with different activities such as:
- Hit the Target Right, in which users have to find different ways to reach a given score on a target;
- Forming numbers, in which users have to combine numbers in different ways as requested;
- Moving cubes, in which users have to work out how several cubes would look after being moved;
- and Categories Against Time, in which users have to select the items that belong to a given category as quickly as possible.
How do we approach cognitive stimulation for people with moderate brain injury?
For people with moderate brain injury, daily selective attention and executive function exercises will predominate, especially working memory and planning.
For example:
- Bottle Caps, an activity in which the person has to put a sequence of letters or numbers in order.
- Linked operations, worksheets in which users have to complete a series of chained operations.
- Image Sequence Recognition, worksheets in which users have to memorize a series of images in order and then recognize that sequence.
- Task Sequencing, in its text and picture versions, for putting in order the different steps needed to carry out a specific activity.
- Balance the Bags, a game for balancing the weight of the bags in both arms.
- Additions, an activity for doing addition.
- Subtractions, an activity for doing subtraction.
- Color Lottery, an exercise in which users have to memorize the color of the balls in the drum and then figure out which one came out.
How do we approach cognitive stimulation for people with severe brain injury?
Finally, to work on the cognitive rehabilitation of people with severe brain injury, we try to have the person do selective and sustained attention exercises every day as a fixed part of their routine.
In NeuronUP, these exercises can include:
- Counting and Selecting, worksheets in which users have to point to the indicated number of objects.
- Seek and Find, a game that involves choosing several items from a group.
- Search for consecutive stimuli, worksheets in which users have to find the given key among a set of stimuli.
- Repeated words, worksheets in which users have to point out the words that are repeated.
- Copy Letter Matrixes, an activity that involves completing incomplete grids by looking at a model grid.
- Organize the Bookcase, a game for copying the position of the objects in the model.
Subscribe
to our
Newsletter
Real success stories at ZV Psicología l Neuropsicología thanks to NeuronUP
Below are four similar, current cases we have treated at ZV Psicología l Neuropsicología. All of them are cases of dementia in an early to middle stage, with clear symptoms.
To analyze these cases better in this article, we have considered 3 variables:
- diagnosis,
- cognitive reserve (CR),
- and MoCA score.
In the first graphs, we compare overall performance and memory, while in the second graphs, we compare attention and language.
Success story 1: Woman with typical Alzheimer’s disease
A 72-year-old woman diagnosed two years ago with typical Alzheimer’s disease. She has been coming to ZV Psicología l Neuropsicología every week for 12 months to work with NeuronUP as part of her cognitive rehabilitation. After the initial interview, we set her cognitive reserve at 10, in the medium-high range. Her MoCA score was 11/30.
This progress is clear, and both her family and I can see that the decline has slowed, and some aspects have even improved. Her neurologist also confirms that progression has slowed, and her family feels that although the disease began with rapid decline, they haven’t noticed any new symptoms or any worsening of existing ones for a year.
Success story 2: Woman with logopenic Alzheimer’s disease
A 69-year-old woman diagnosed three years ago with logopenic Alzheimer’s disease. She has been coming to ZV Psicología l Neuropsicología every week for 11 months to work with NeuronUP as part of her cognitive rehabilitation. She has a cognitive reserve of 7, in the medium-low range, and her MoCA score is 12/30.
In this case, we can see how consistent training with NeuronUP has achieved favorable progress, even in a dementia that clearly affects language.
The benefit has been significant: her neurologist confirms that the disease has stabilized, and her family has noticed a great improvement in her language. Her anomia has decreased, she is more fluent, and when she can’t find what she wants to say, she is much more successful at finding alternative routes to the information.
Success story 3: Man with dementia
This man has been using NeuronUP for just 6 months. He has a cognitive reserve of 15, which is a high level. His MoCA score is 17/30. When he came to ZV Psicología l Neuropsicología, there was already clear decline.
Although the type of dementia has yet to be determined, from the start of therapy it was clear that he had difficulty with short-term memory, his speech was not fluent, and he repeated the same things over and over, while his family had already noticed that running a routine errand was a problem.
However, neurorehabilitation therapy brought about a remarkable change: he is more active, he feels better, and his family notices that he “does more things than before” and is more engaged in conversations.
This graph shows how this man, who had many difficulties, has made practically parallel progress in overall performance and memory.
His language has progressed very well, considering that expressing himself had become a problem and he was starting to become somewhat dependent in his ADLs.
Success story 4: Man with typical Alzheimer’s disease
Here is the case of a man who has been using NeuronUP for just 3 months. His cognitive reserve is 14, in the medium-high range, and his MoCA score was 18/30.
His overall score went from 20 to 60, and in memory, where there is clear decline, the improvement has also been almost 60 points.
In language, where anomia predominated, he has progressed to almost 70, starting from the minimum. Attention, however, is where we see less progress: it is steadier, with little variation, which shows that we need to keep working on this aspect to help improve the other cognitive areas. He notices that he speaks more fluently and feels more able to do the exercises we suggest as part of his neurorehabilitation.
Benefits of NeuronUP in cognitive rehabilitation at ZV Psicología l Neuropsicología
When a person comes to ZV Psicología l Neuropsicología with acquired brain injury (ABI), a neurodegenerative disease, or dementia, after the initial information-gathering stage, we start doing exercises on paper and on a tablet or computer with NeuronUP’s digital platform. This helps the person become familiar with it so they can move on to doing daily exercises at home with NeuronUP2GO.
Rehabilitation can cover all cognitive areas, and cognitive stimulation can combine digital and paper activities. This way, we make sure that happens.
It’s just as important to work with the patient on the areas where there are deficits as on those that are still preserved, and that’s why we need NeuronUP’s resources; otherwise, it would be very difficult and, in some cases, impossible.
When consistency and frequency are right, neurological progress becomes evident. But for this to happen, neuropsychologists need tools not only to carry out the tasks but also to objectively quantify any progress that may occur.
Effects of chemotherapy on the brain: Chemobrain
Leave a Reply