The neuropsychology team of the Neurolleida center explains in this article how they approach the different neuropsychological rehabilitation treatments in neurological diseases and how NeuronUP helps them with the achievement of the therapeutic objectives.

Neurolleida: Who are we?

Neurolleida is a center specialized in the care of children and adults with difficulties derived from acquired or maturational alterations of the nervous system. We are specialized in the treatment of diseases affecting the nervous system. Such as acquired brain damage (traumatic brain injury, stroke, brain tumors), neurodegenerative diseases (Alzheimer’s, Parkinson’s, etc.) and neurodevelopmental disorders (dyslexia, ADHD, specific language disorder, etc.).

The main objectives of the treatments we apply at Neurolleida are the following:

• To help our patients develop strategies to minimize the disability they may present due to the neurological disease.
• To work together with the patient and his or her environment to help him or her achieve the maximum possible autonomy in activities of daily living, productivity and leisure.
• To provide the highest possible level of quality of life for the patient.

Our methodology is based on a holistic approach to the person, taking into account all spheres of the person and their environment, as well as their motivations and interests. The treatment we apply is based on a prior comprehensive assessment of the person’s needs and capabilities. In addition, the treatment is in all cases as individualized and adapted to each person as possible.

The Neurolleida team is formed by 3 neuropsychologists, 2 physiotherapists, 2 speech therapists, 2 occupational therapists and 1 health psychologist.

Neuropsychological rehabilitation in people with neurological diseases

The neuropsychological treatment of our patients is based on the application of personalized programs, which seek maximum functionality in the patient, setting short and medium term goals. In all cases we take into account the patient’s interests and motivations. Also, we always use activities based on evidence and scientific models that have demonstrated their effectiveness. Among the different methodologies we use is the NeuronUP program, both in its paper and digital versions.

NeuronUP is a tool that allows us to provide an enjoyable and meaningful cognitive stimulation, both individualized and in groups. At Neurolleida we currently use NeuronUP in many of our programs. Here we give you a glimpse of each of them so that you can know a little bit about what we do and how NeuronUP helps us to achieve our therapeutic objectives.

The different treatments that we approach from the discipline of neuropsychology in Neurolleida can be grouped into the following four that we present below:

1. Neuropsychological rehabilitation in adults with acquired brain injury
2. Neuropsychological rehabilitation in children with neurodevelopmental disorders
3. Group cognitive stimulation in people with mild cognitive impairment and dementia
4. Group cognitive stimulation in people with acquired brain injury

1. Neuropsychological rehabilitation in adults with acquired brain injury

Acquired brain injury is caused by sudden brain lesions due to cerebrovascular accidents (CVA or stroke), cranioencephalic trauma, cerebral anoxias, tumors or brain infections. It often becomes a problem of great personal, family and social significance, due to the important long-term repercussions that it can generate.

The evidence of rehabilitation in acquired brain injury highlights the importance of taking into account the following aspects:

• Start of the intervention as early as possible,
• intensity of treatment,
• specialized teams,
• bringing neurorehabilitation closer to the patient’s environment,
• holistic approach (professionals, patient and family),
• integrating the family in the treatment.

In relation to neuropsychological intervention it is essential to always start with an evaluation to determine the cognitive profile of the patient, as well as his emotional and behavioral state. Based on the results of the evaluation and the information gathered by the therapist from the patient and the family, objectives are determined. These can be specific or personalized, and will determine the method and way of proceeding of the sessions. All activities will be designed based on the achievement of these objectives, in a structured, systematized and personalized way, whenever possible.

Patients who have suffered an acquired brain injury may present very diverse cognitive deficits, depending on the characteristics of the injury. Thus, they may present attentional alterations, memory problems, language and communication disorders. Also, in executive functioning, they may present visuoperceptive problems, or cognitive slowing, among some of the symptoms. These symptoms can be addressed by means of paper-and-pencil tasks, manipulative games, use of computerized platforms, etc.

NeuronUP for neuropsychological rehabilitation in adults with acquired brain injury

NeuronUP provides us with a pleasant and intuitive cognitive intervention tool, which allows us to work both in session and at home. This platform contains a wide range of activities that allow working on different cognitive processes with the possibility of modifying several parameters that promote a personalization of the task in terms of the patient’s age (adult or child), difficulty and speed.

Although we usually use NeuronUP in several patient profiles, today we would like to talk about a specific case in which we have used this platform for the rehabilitation of a patient with left visuospatial hemineglect due to a brain hemorrhage.

Visuospatial hemineglect is defined as the inability to detect, orient or respond to novel or significant stimuli from contralateral spatial regions due to brain injury (Heilman 1979). In these cases, patients with this condition have severe difficulties in attending to all stimuli occurring on the contralateral side of their lesion. In the case of our patient, this difficulty occurs on the left spatial side. Thus, any stimulus coming from her left side will imply difficulties in her attention, processing and reaction.

We have used NeuronUP to stimulate attentional and visuospatial functions, both in session and at home, thus promoting a more intensive and continuous approach. And this has allowed us to generalize more easily all the guidelines and instructions trained in the compensation of deficits at home. To do

NeuronUP activities for neuropsychological rehabilitation in adults with acquired brain injuryso, we recommend some examples of tasks that we have found to be very useful.

1. Bottlecaps with Letters

This exercise consists of selecting the letters that appear following the alphabetical order. It requires a good visuo-spatial tracking, a correct ability to maintain and mentally manipulate the alphabet and to search and select the stimulus we need. It is important to accompany the patient during the exercise in order to provide adequate tracking guidelines that the patient must integrate and use autonomously. If we are looking for a similar but less complex activity, we can use the activity “bottlecaps with numbers“.

2. Organize the Bookcase

This activity is another example of how we can work on hemineglect. In this case, the patient has to make a mirror copy of the model shelf. That is to say, the copy will not be correlative, but will have to be made in reverse, having to place the last stimulus of the first row of the model in the first place on the shelf and so on consecutively. Thus, apart from requiring correct visuo-spatial tracking, it also involves attentional capacity and the spatial relationship between stimuli.

It is very important that, whatever activity we use, we provide the person with compensatory strategies for the deficit so that he/she can autonomously, in his/her daily life, give him/herself this type of self-instructions and achieve optimal functionality.

2. Neuropsychological rehabilitation in children with neurodevelopmental disorders

Neurodevelopmental disorders encompass all those disorders caused by an alteration or difficulty in the normative neurodevelopment of the child.

Its affectation can give from delays to important alterations in the motor, cognitive, communicative and social areas.

As in the case of intervention in acquired brain injury, a neuropsychological evaluation should be performed prior to treatment. This should determine the child’s intellectual performance, strengths and weaknesses, affective state and the existence of disruptive behaviors. Based on the results of the evaluation and the information gathered in the anamnesis, the therapeutic objectives are established.

NeuronUP activities for neuropsychological rehabilitation in children with neurodevelopmental disorders

In interventions with children, it is very important to provide them with motivating tasks and activities that promote the involvement and good adherence of the child. For this reason, NeuronUP allows us to perform a specific cognitive stimulation, personalized and with an attractive and fun design, ideal for the child to learn in a motivating way.

Below are some of the tasks that we like the most to work on attention and concentration in children:

1. Find the Lost Matches

This activity consists of selecting those visual elements that are equal to the model. Thus, it is ideal for working on selective attention. We use it with children with difficulties in selecting only the target stimuli and/or with a tendency to impulsivity. It allows modulating the degree of difficulty that will depend on the amount of target stimuli and distractors that are presented (the easier the screens, the lesser the amount of stimuli).

2. Counting sounds

This activity allows us to work on the ability to attend to auditory stimuli by performing a sound counting task. In addition, it has an attractive format that children love and allows us to modulate the difficulty so that it can be as personalized as possible.

We use it with children with attentional focus control difficulties and with a tendency to be distractible. We often start the activity with easy levels and with external aids (e.g. counting with fingers or counting out loud). Progressively, and depending on the child’s evolution, we use more complex levels and withdraw the aids.

3. Group cognitive stimulation in people with mild cognitive impairment and dementia.

It is aimed at people with mild cognitive impairment, mild dementia or moderate dementia. The program is developed in a group format, with small groups of between 4 and 8 people, and homogeneous according to the degree of cognitive impairment. Currently, we have 1 group of people with mild cognitive impairment, 2 groups with mild dementia and 1 group of people with moderate dementia.

The main objective of the program is to maintain and stabilize as efficiently as possible the cognitive and functional abilities of the participants and slow the course of deterioration. In addition, its objectives also include improving the psychological well-being and quality of life of the patient and family caregivers.

It is a multicomponent program, because it includes cognitive, physical and occupational activities, which always include a psychoeducational component and a social and recreational base. The program is carried out by professionals in neuropsychology, occupational therapy and physiotherapy.

All program activities are designed through a systematic, structured planning, adapted to the different abilities of the participants, in order to seek the maximum benefit for each participant.

NeuronUP activities for group cognitive stimulation in people with mild cognitive impairment and dementia

One of the main components of the program is the cognitive stimulation activities, which consist of an orderly and systematic performance of structured cognitive tasks. These tasks address different cognitive processes and skills, with levels of complexity adapted to different groups and degrees of cognitive impairment.

Thus, in the mild cognitive impairment group, the cognitive skills worked mainly address episodic memory, attentional functions and executive functions (working memory, abstraction, cognitive flexibility, inhibition).

In the mild dementia group, the tasks performed include attentional functions, language, visuoperceptive functions, episodic memory, working memory and numerical reasoning. In the moderate dementia group, the activities performed focus mainly on oral and written language, praxias, attention, visual gnosias and autobiographical memory. These activities combine pencil and paper exercises and computerized activities.

The NeuronUP program has been of great help to us. The stimuli are very attractive and the feedback provided by each exercise helps to motivate the participants.

Below, we see participants in the mild dementia group performing very dynamic episodic memory activities that they find very interesting.

1. Memorize the Order

Order the sequence is a NeuronUP activity that consists of memorizing the images shown in order and then placing them in the same way. It is used to work on episodic memory.

2. Press Conference

This activity consists of remembering the order in which journalists have asked for their turn to ask questions and reproducing it. In addition to episodic memory, it works working memory.

4. Group cognitive stimulation in individuals with acquired brain injury

The functional rehabilitation program is aimed at adults who have suffered brain damage or who suffer cognitive and physical deficits as a consequence of a neurodegenerative disease.

It consists of a group program of 3-5 people and with the participation of three specialized disciplines: neuropsychology, physiotherapy and occupational therapy. They also have a common goal: to improve the functionality and autonomy of people in all areas (personal, family and social) and ensure maximum personal satisfaction.

Participants come to the center twice a week for two hours. In addition, an important component of this program are the activities that once a month are carried out in the community with visits to public facilities and resources and/or cultural interest in the area.

NeuronUP activities for neuropsychological intervention in people with acquired brain injury

The NeuronUP program, having different activities related to daily life exercises and the versatility of activities it offers, allows us to create sessions to work different cognitive domains and focused on their daily life in order to offer solutions to the problems of daily life of the affected person.

1. Accurate Payments

For example, as shown in the photograph, we have used the Exact Payments task to work on cognitive functions such as attention and working memory.

2. Moving Cubes

Other activities that we have used and that have been very well received by the patients are the tasks that work on visuospatial skills, such as the cube movement task. After the completion of the task, with the feedback offered by the program, we complement the task with psychoeducation and evaluation of our performance, taking into account our difficulties and assessing strategies and skills to be able to perform the task better.