Idea Transcript
Neuropsychological Rehabilitation: Proposed Exercises Susana V. Silva1, Luís Simões da Cunha1, Rute F. Meneses1, & Joana Pais2 1
Faculdade de Ciências Humanas e Sociais – Universidade Fernando Pessoa , Porto;
Cognitive impairment is one of the major causes of disability
2
Laboratório de Neuropsicologia, Serviço de Neurologia, Hospital de São Sebastião, Santa Maria da Feira
4. Verbal Fluency Rehabilitation
2. Attention Rehabilitation
after brain damage. The ultimate goal of neuropsychological
The following activities, based on verbal fluency tests, were
rehabilitation is the reduction of that incapacity and the
In order to rehabilitate several dimensions of attention
promotion of the highest independence and quality of life of
(focused, divided and sustained), the following exercises
those with brain damage
were developed: (a) selection of an unique symbol - the
semantic fluency activities (e.g., the patient must say or write
patient must choose a certain figure (e.g., trefoil) among
words that belong to the following semantic categories: animals,
Cognitive rehabilitation involves a set of therapeutic activities
others; (b) selection of two distinct symbols - the patient
professions, sports, feminine or masculine names);
that are based on the evaluation and comprehension of the
must select a certain number with a line (e.g., 7) and
impairments resulting from brain damages; its fundamental
another number with a cross (e.g., 3); and (c) the patient
phonological fluency activities (e.g., the patient must say or
objective is to promote the best patient functioning in relevant
must write down in a note the position that certain figures
write words that began with the following phonemes: /m/, /R/,
areas of his/her daily life (Cicerone et al., 2000).
occupy on the table (adapted from Levitt & Johnstone,
/A/, /p/);
This type of intervention is usually implemented through series
presented (adapted from Simões, 2003):
2001).
alternated fluency tasks (e.g., the patient must say or write in
of exercises (Uzzell, 2000) developed to rehabilitate the
alternated form the name of a woman and the name of a man,
3. Executive Functions Rehabilitation
impairments of the following higher mental functions: attention
the name of an animal and the name of a profession, a word
and concentration, memory and learning, visual-spatial, visual-
started by an M and a word started by an “R”).
perceptive and visual-constructive abilities, language and
Stroop and Go-No-Go Paradigm
executive functions (Cicerone et al., 2000; Gouvier, O´Jile, & Ryan, 1998).
The following exercises were developed with the purpose of promoting the patient’s response-inhibition ability: (a) table divided in small rectangles in which there were sets
AIM
of numbers (cf. Figure 2) - the patient must say how many numbers are in each set and not the number in each
The aim of the present study was to develop a set of
rectangle; (b) contradictory commands (e.g., cf. Figure 3) -
rehabilitation exercises oriented to the rehabilitation of the
in this exercise the patient must memorize the instructions
following higher mental functions: memory, attention (focused,
previously given so that in face of a certain stimulus he
divided, sustained), executive functions, verbal fluency and
can inhibit the order of the card and follow the previously
constructive ability.
given instruction (adapted from Portellano, 2005). Reading
METHOD
and
colour
naming
exercises
were
5. Constructive Ability Rehabilitation In the complex geometric images reproduction task (adapted from Tárraga et al., 2003) (cf. Figure 4), the patient must copy the image, starting with the larger forms until he/she reaches the smaller details.
Figure 4. Complex geometric figure.
also
developed, based on the Portuguese Neuropsychological
PROCEDURE
Stroop (Castro, Martins, & Cunha, 2000).
PARTICIPANTS
The exercises were based on the literature, analysed by three independent experts, and tested in three adult patients.
The cognitive rehabilitation exercises developed were tested in three
adult
patients
undergoing
neuropsychological
444 44
6666 66 6
3 33 3
55 5 5
88 8 88
22 2
777 7 77
5 55 5
11 1 1
999 99 99
44 4 44
66 66 6
rehabilitation. These patients presented different kinds of brain damage, but similar mild impairments in terms of higher mental functions (memory and learning, attention, executive functions, verbal fluency and constructive ability).
They were administrated in a period of five months, once a week, in rehabilitation sessions of 40 minutes each.
PRELIMINARY RESULTS AND FUTURE DIRECTIONS Figure 2. Table divided into small rectangles.
According to the methodology followed, the exercises were
MATERIAL
considered adequate to the aims underlying their development. 1. Memory and Learning Rehabilitation With this work we have tried to give our contribution to reduce Restoring, one of the memory rehabilitation strategies, involves
the lack of instruments available in the field of cognitive
the practice of certain tasks, such as learning strings of
rehabilitation.
numbers or lists of words, using rehearsal and learning The exercises presented here may serve as a starting point in
strategies that allow memory recall of items, grouping them into
Say “Blue”
different categories (Skell & Edwards, 2001). Based on these
Say “Yellow”
the preparation of cognitive rehabilitation programs, but the idiosyncratic aspects of the person must always be taken into
strategies, different exercises were developed:
account in the formulation of a successful therapy. An exercise, based on the California Verbal Learning Test (Baeta, 2002; Delis et al., 1987/2000, as cited in Lezak,
KITCHEN
BEDROOM
REFERENCES
Howieson, & Loring, 2004), on which the patient has to Baeta, E. (2002). Bateria para avaliação neuropsicológica de adultos com epilepsia. Psicologia, 16(1), 79-96.
memorize a list of words, “chunking” them into categories. To avoid learning effects, the stimulus in the proposed exercises differ from the ones in the original instrument. The words were
“Place
where we sleep”
“Place where we eat”
Cicerone, K. D., Dahlberg, C., Kalmar, K., Langenbahn, D. M., Malec, J. F., Bergquist, T. F., et al. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Archives of Physical Medicine and Rehabilitation , 81, 1596-1615.
selected taking into account their frequency. Figure 3. Contradictory commands.
In another exercise, a restaurant menu (adapted from Skell & Edwards, 2001; Tárraga et al., 2003) (cf. Figure 1) is presented in the beginning of the session and the patient is
Trail Making Test Paradigm
questioned about the information on the menu.
Chocolate Cake
Figure 1. Restaurant menu.
Levitt, T., & Johnstone, B. (2001). The assessment and rehabilitation of attention disorders. In B. Johnstone, & H. H. Stonnington (Eds.), Rehabilitation of neuropsychological disorders: Practical guide for rehabilitation professionals (pp.27-52). Hove: Psychology Press.
Portellano, J. A. (2005). Introducción a la neuropsicología. Madrid: McGraw-Hill.
In the developed exercise, there were two geometric forms
Carrot Cream Mixed Grill
Gouvier, W. D., O´Jile, J. R., & Ryan, L. M. (1998). Neuropsychological assessment for planning cognitive interventions. In G. Goldstein, & S. R. Beers (Eds.), Rehabilitation (pp. 181- 200). New York: Plenum Press.
Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychology assessment (4th ed.). Oxford: Oxford University Press.
invited to memorize it. Along the session, the patient is
Saturday
Castro, S. L., Martins, L., & Cunha, L. S. (2000). Stroop Neuropsicológico Português. Porto: Centro de Psicologia da Universidade do Porto [Unpublished material].
(square and triangle) and two colours (red and blue). The task consisted in connecting the different geometric forms in the following alternate sequence: red square, blue square, blue triangle, red square and so on (adapted from Portellano, 2005).
1st International Symposium on Neuropsychology and Rehabilitation CRPG – 26th-28th October, 2006
Simões, M. R. (2003). Os testes de fluência verbal na avaliação neuropsicológica: Pressupostos, funções examinadas e estruturas anatómicas envolvidas. Psychologica, 32, 25-48. Skeel, R., & Edwards, S. (2001). The assessment and rehabilitation of memory impairments. In B. Johnstone, & H. H., Stonnington (Eds.), Rehabilitation of neuropsychological disorders: Practical guide for rehabilitation professionals (pp. ??-??). Hove: Psychology Press. Tárraga, L., Boada, M., Morera, A., Guitart, M., Domènech, S., & Llorente, A. (2003). Cuaderno de repaso: Ejercicios prácticos de estimulación cognitiva para enfermos de Alzheimer en fase moderada. Barcelona: Glosa. Uzzell, B. P. (2000). Neuropsychological rehabilitation. In A. Christensen, & B. P. Uzzell (Eds.), International Handbook of neuropsychological rehabilitation (pp. 353- 369). New York: Plenum Publishers.