Neuropsychological Rehabilitation Course - Brain & Cognition 2 2024 PDF

Neuropsychological rehabilitation Course: Brain and cognition 2 Dr. Dirk Bertens Clinical neuropsychologist Assistant professor [email protected]  Introduction: 1. Spontaneous recovery? 2. Experience-dependent recovery? 3. Cognitive rehabilitation? 4. Neuropsychological rehabilitation?...

Neuropsychological rehabilitation Course: Brain and cognition 2 Dr. Dirk Bertens Clinical neuropsychologist Assistant professor [email protected]  Introduction: 1. Spontaneous recovery? 2. Experience-dependent recovery? 3. Cognitive rehabilitation? 4. Neuropsychological rehabilitation? 2  Non-progressive brain injury  Traumatic brain injury  Stroke  Encephalitis  Anoxia  Epilepsy Progressive conditions  Dementia  Multiple Sclerosis  Parkinson’s disease  Huntington’s disease  Brain tumours 3  1. Spontaneous recovery 4   After the occurrence of a brain injury, a period of recovery follows, even if no treatment is offered = neuroplasticity Recovery in o motor skills o language (aphasia) o neglect (see next slides) 5  Neglect  A failure to report, respond, or orient to stimuli in the contralesional space after brain injury that is not explained by primary sensory or motor deficits (Heilman, 1979).  Especially after right hemisphere stroke  Acute phase: 30% of stroke survivors  Chronic phase: 3% 6   After the occurrence of a brain injury, a period of recovery follows, even if no treatment is offered = neuroplasticity  This 'spontaneous recovery' occurs mainly in the first 12 to 14 weeks 7  Spontaneous recovery = injury induced change 2009  diffuse and redundant connectivity  structural and functional networks formed through remapping (cortical reorganization) 8  Sem… Spontaneous recovery  Sem reported progress (without treatment) in several areas:  Motor function  Language (i.e. word-finding difficulties)  (Working) memory 9  2. Experience-dependent recovery 10  2. Experience-dependent recovery under the influence of stimulation and treatment  neuronal repair without training or treatment … only to a limited extent.  Another way to achieve functioning new connections between neurons is by promoting plasticity through learning (Kleim & Jones, 2008). ?  However, knowledge about recovery after brain injury has not yet led to forms of treatment that lead to recovery of cognitive functions.  Thus…. Cognitive rehabilitation? 11  Cognitive rehabilitation 12  Cognitive rehabilitation? “Cognitive rehabilitation interventions are applicable at all stages of post injury recovery… however…:”  Stage 1: Acute (+/- 0-1 month): hospital, lifesaving measures  Stage 2: Sub-acute (up to 6 months): recovery phase, clinical rehabilitation, often emphasis on sensorimotor rehabilitation  Stage 3: Chronic (after 6 months): outpatient rehabilitation, emphasis on cognitive, psychosocial and emotional problems 13  Cognitive rehabilitation? James Malec ‘it is really any intervention that addresses a cognitive problem’ https://www.youtube.com/watch?v=Jb_m9ghxQCk 14  Cognitive rehabilitation is a process whereby brain injured people work together with health professionals to remediate or alleviate cognitive deficits arising from neurological insult (Wilson, 1996) WFNR congress (Porto 2024) 15  ICF-model 17  Clinical neuropsychology discipline  Function training Neuropsychological  Skill training rehabilitation  Strategy training Cognitive rehabilitation Cognitive training 18 Fasotti (2005)  Function training Restorative model  Repeated practice approach  Evidence?  Brain training? 19 The ‘mental muscle approach’ 20  Flanker task (inhibition) 21  Transfer Near transfer? Far transfer? 22  Far transfer 23  Long term? 24  Function training in NPR: neglect ‘Prism adaptation’ 25 26  Brain training: hype or hope? 27 28  Clinical neuropsychology discipline  Function training Neuropsychological  Skill training rehabilitation  Strategy training Cognitive rehabilitation Cognitive training 29  Skill training (Re)training a skill/activity Also repeated practice … Task specific? Methods? 30  Skill training: errorless learning Preventing errors during learning Feedforward instructions Cues (cue cards) Modeling Gradually reducing assistance  Preventing errors  Practice step-by-step 31  Errorless learning in practice 32  Errorless learning Baddeley & Wilson (1994) ‘stem completion task’ 2 conditions: ** Geheugenprestatie Trial & error learning:  “five-letter word that starts with QU_ _ _ could you guess what it is?” Errorless learning: Young persons Older Persons Amnesic persons  “five-letter word that starts with AP_ _ _ Errorless and the word is APPLE.” 33  Implicit memory is responsible for Errorless learning! Barbara Wilson Errorless learning Alan Baddeley mechanism 1 34  Hmm… I am not sure.. (o.a.) Catherine Haslam 35  Residual explicit memory is responsible for Errorless learning (o.a.) Catherine Haslam Errorless learning mechanism 2 36  Skill training Long term Transfer 37  Could there be a third Let’s combine errorless Errorless learning learning Strategy training mechanism? Prof. Luciano Fasotti (on our way to a conference in Krakow) 38  Clinical neuropsychology discipline  Function training Neuropsychological  Skill training rehabilitation  Strategy training Cognitive rehabilitation Cognitive training 39  Strategy training Compensatory model  Learning an algorithm  A set of general steps (or questions) that have to be carried out  Time Pressure Management Information processing  Goal Management Training Executive functioning  Problem solving therapy Executive functioning  … 40  Goal Management Training (Ian Robertson) Problems with goal directed behaviour 42  Long term Transfer 43  Inclusion GMT-NPA GMT Sessions 1 & 2 Establish 2 treatment goals T0 Evaluation of treatment goals Randomization 30 patients 30 patients Errorless GMT Standard GMT Sessions 3 - 8 Sessions 3 - 8 Evaluation of T1 treatment goals 44 46  Outcomes 1. Video-scale Evaluation of each task stap: percentage score  Score 0: missing task step 0% 100%  Score 1: ineffective task step Worst Best  Score 2: correct task step performance performance 48  Results Taakuitvoering (%) Standard GMT Errorless GMT Change compared to baseline p