12 Effective neurorehabilitation activities to treat neurological diseases

We present 12 effective neurorehabilitation activities to treat neurological diseases.

What is neurorehabilitation?

Neurorehabilitation consists of a set of well-designed and planned activities and strategies aimed at recovering, compensating or slowing down the deterioration of certain affected functions following brain damage.

After any brain injury or alteration there are important transformations in life. Changes appear in cognitive functioning, emotions and also at the physical level, such as in muscle tone or movements.

However, neurorehabilitation or neuropsychological rehabilitation can be developed to improve different areas of the individual. The cognitive level (attention, memory, orientation…), physical aspects such as activities that work on fine hand movements and even the emotional world of the person are trained.

Let us not forget that the aim is both to restore functional capacities and to help the patient and his or her family to cope with the new situation.

What is the aim of neurorehabilitation?

The main objective of neurorehabilitation is to relearn skills that are at risk due to any type of brain injury or to develop the patient’s maximum potential, ensuring that he/she can lead a life of maximum independence and satisfaction.

Thus, tasks and exercises that are completely personalized are repeated. For this, we first carry out an exhaustive evaluation of the patient, discovering his strengths and the things that interest and motivate him, since we are going to use this to reduce his deficits.

This involves a great deal of work, since we have to know the patient well in order to design activities that really work on their difficulties and that correspond to their real environment: that make it easier for them to walk on their own again, to swim again or to do their gardening work.

What do we do when it is not possible to rehabilitate a function?

Through neurorehabilitation activities, not only the lost capacity is directly trained, but also the intact capacities are enhanced.

In other cases, the objective may be for the patient to learn to use external signals or devices to minimize his or her limitations. Here the use of new emerging technologies is very useful (Sanz Cortés and Olivares Crespo, 2013): applications that respond to various needs, that send reminders, alarms, voice-reading devices, etc.

Is brain training effective?

If it is designed by a professional based on scientific evidence and adapted to the real needs of the person, yes.

We know that neurorehabilitation is effective because it has been proven that our brain is plastic, i.e., when we carry out neurorehabilitation activities repeatedly, our neuronal connections are reorganized. Thus, multiple new synapses are created and strengthened over time.

For example, if you are learning something from this text and you remember it tomorrow or in a few days’ time, your brain has established new connections.

However, plasticity has certain limits and its magnitude depends on age or injury, but it is never lost.

12 neurorehabilitation activities

First of all, you should know that an activity usually works several capacities simultaneously. In fact, it is almost impossible to work attention, memory or executive functions in isolation.

Neurorehabilitation depends very much on the existing deficits and the person’s diagnosis. However, the most commonly used ones are included here, since attention and/or memory impairments are frequent.

You should know that there are many variants and that the same function can be trained in multiple ways and with different formats.

For example, NeuronUP has a wide variety of computerized activities that work on more than 40 cognitive processes.

If you want to get an idea of what neurorehabilitation activities are like, here are the best known, although the variations are endless:

1. Matching the Cards

An example is the NeuronUP card matching activity that works on attention, perception and short-term memory:

2. Mole invasion (or repeating a marked order)

Another activity that works on sustained attention and memory is “Mole Invasion”, where the patient has to first remember in which order the moles come out and then reproduce it, but in reverse.

3. Clicking on suddenly appearing objects

The patient must be concentrated on the screen, since sudden and unpredictable stimuli will appear and must click on them as soon as they are perceived.

It is an activity that works both processing speed and focused or sustained attention, which means maintaining attention for a prolonged time on the same task.

4. Giving a response when listening to the key stimulus

Something similar that also trains sustained attention would be to present a series of sounds by auditory means, the goal being to knock on the table when you hear the key number, word or sound.

5. Sorting Bugs

An example for working on sustained attention in NeuronUP is the activity “Sorting Bugs”, very useful for children with Attention Deficit Hyperactivity Disorder

The objective is to let the beetles pass to one side and keep the ladybugs on the other side. Thus, attention must be continuously focused on the movements of the insects as they approach the wall, to move the door up or down.

6. Hidden Letters

A widely used activity consists of a box filled with elements that can be different figures, numbers or letters. The objective is to point out or cross out a certain figure, number or letter. It serves to work on selective attention, which is the ability to focus on something specific while ignoring other stimuli.

NeuronUP has this task, among many others. As we can see in the photo, we have to select a key letter within a group of letters (in this case the letter “Q”):

Selective attention can also be trained by searching for words in word searches or locations on a map.

7. Hidden Letters (with target stimulus changing every so often)

If we transform the previous task, changing every 15 seconds (depending on the patient) the element to be selected, we would be working on alternating attention. This is the ability to change our focus of attention from one task to another.

8. Tapping

It consists of tapping successively with a finger on a surface while performing another task, such as reading a text.

This activity is perfect for training multitasking. For example, when we drive and talk at the same time, we consider that the attention is focused on a single task (talking), and driving is performed automatically. For example novice drivers do not talk, at most they alternate attention between driving and talking.

9. Questions about personal life, using photos or personal objects

It is very common in Alzheimer’s disease to ask patients questions such as “Where did you go to school?”, “What was your wedding day like?”, “Who are your siblings?”, etc. Or use old objects or photographs and ask them to express their memories.

It serves to improve autobiographical memory, which refers to personal events of the past. The activities will depend on the individual’s life and reliable information about the patient’s past is needed for training.

10. Ordering steps of activities

Non-declarative or procedural memory involves movements and actions that we have learned and do automatically. Such as writing, riding a bicycle, playing an instrument, cooking a certain dish, etc.

Procedural memory is something automatic, very difficult to explain if you want to make it conscious. We ride a bicycle without knowing how you do it. Procedural memory would be worked on by doing the action itself and making it automatic.

A previous task to achieve procedural memory can be to ask patients to tell you all the steps they would follow to make a recipe, take a shower or some domestic task.

Objects can also be used to practice old skills such as knitting, sewing on a button, screwing something, tying knots in a rope, playing a tambourine, etc. Or even with one’s own body: whistling, snapping fingers, making a certain gesture, imitating a sound….

At the same time some of these tasks can improve praxias and executive functions.

11. Making Words

As we see in the image, the patient must select each letter in the corresponding order to build the word.

It is useful for language and semantic memory, which stores general knowledge and concepts that we have learned during our life. It also works the working memory (you think about different combinations until you find the word).

You can also work with activities such as:

• Explaining what a word means.
• Presenting a series of sentences about definitions, having the person to say which one is true and which one is false.
• Describing what certain objects are used for.
• Naming things that we can find in a certain environment (such as a pharmacy).

Also useful are tasks involving synonyms and antonyms, questions about famous people or well-known places, remembering popular sayings, etc.

12. Straigten Up the Kitchen

NeuronUP has a daily life activity called “Straigten Up the Kitchen”, where the patient can train several cognitive areas with different degrees of difficulty. This exercise consists of placing the shopping items in their corresponding place.

Activities of daily living are those activities that increase a person’s independence and adaptation to the environment. For example, buttoning buttons, shopping, combing one’s hair, etc.

Neurorehabilitation can also focus on areas such as processing speed, visuospatial skills, social cognition, flexibility, etc. As we said, in this complex world of the mind, the possibilities are endless!

References

• New Zealand Guidelines Group (NZGG). (2006). Traumatic Brain Injury: Diagnosis, Acute Management and Rehabilitation. Evidence-based best practice guideline. Recuperadode: http://www.neuro-reha.com/wp-content/uploads/2013/01/guideline_tbi.pdf
• Cortés, Ana Sanz, and María Eugenia Olivares Crespo. (2013). REHABILITACIÓN NEUROPSICOLÓGICA EN PACIENTES CON TUMORES CEREBRALES (NEUROPSYCHOLOGICAL REHABILITATION IN PATIENTS WITH BRAIN TUMORS). Psicooncología 9, 2/3: 317-337.
• Estévez-González A., García-Sánchez C., Junqué C. (1997). La atención: una compleja función cerebral (Attention: a complex brain function). REV. NEUROL.; 25 (148): 1989-1997.
• García Sevilla, J. (2010). Estimulación cognitiva de la memoria (Cognitive stimulation of memory). Recuperado el 27 de Septiembre de 2016, de Universidad de Murcia: http://ocw.um.es/cc.-de-la-salud/estimulacion-cognitiva/material-de-clase-1/tema-6-texto.pdf