Chapter 5: plasticity, recovery and neuropsychological rehabilitation

Question 1

Spontaneous recovery

Answer 1

Recovery form damage in the brain without active and targeted treatment in the first 12-14 weeks after the stroke.

Question 2

Reperfusion of the penumbra

Answer 2

Improvement in blood flow in the penumbra: the area adjecent to the side of the stroke. If there is enough blood going to the penumbra directly after the stroke, the regions can restore completely.

Question 3

The process after a brain injury

Answer 3

After the injury the brain starts forming new synaptic connections and starts the structural and functional recovery of the brain tissue in the prenumbra. In the penumbra there is reduced blood flow and potential damage to the neuron’s dedrites. Then reperfusion is set in motion via thrombolysis treatment (blood thinning medication).

Question 4

Function vs. functional recovery

Answer 4

• Function recovery: recovery of a function (like using a hand again).
• Functional recovery: being able to do something again (like using the hand for writing).

Question 5

2 mechanisms that enable recovery of neurons

Answer 5

1. Diffuse and redundant connectivity: some complex brain functions are distributed through the cortex, but are controlled by one side of the brain (contralateral). If there is damage in that brain area, the other side of the brain can take over that function (ipsilateral).
2. Remapping: the sensory and motor signals after damage in the brain run through a different cortical area than before.

Question 6

Rules in cognitive rehabilitation

Answer 6

1. Use it or lose it
2. Use it and prove it
3. Specificity
4. Repetition, repetition, repetition
5. Intensity (not too easy, not too hard)
6. Time (mostly in 3 months after the damage)
7. Salience (an experience must be relevant and important)

Question 7

ICF model: the international classification of functioning, disability and health model

Answer 7

This model looks at human functioning from 3 levels:
1. The perspective of the human organism, divides into ‘functions’ and ‘anatomical properties’
2. The perspective of the human actions of daily life
3. The perspective of a person as a participant in social life and society

Question 8

The restorative model

Answer 8

This model is based on the assumption that affected cognitive function can be repaired/restored via training. These trainings make use of repeated computer-assisted training (games), which can lead to:
- Near transfer: applying new learned skills to very similar sitautions. The tasks are closely related to the real world.
- Far transfer: the ability to apply new skills to very different situations.

Question 9

The compensatory model

Answer 9

Based on the learning of strategies to compensate for cognitive impairments. There are 3 types of compensation strategies:
1. Internal: learning techniques to support cognitive functions (like visualization).
2. External: learning to use a tool to support cognitive functions (like a calendar).
3. Metacognitive: learning to reflect on one’s own thinking or cognitive dysfunctioning, (like a g-schema).

Question 10

Function training

Answer 10

The repeated training of a task to attempt to restore cognitive functioning.

Question 11

Skills training

Answer 11

A repeated training of a relevant daily activity. This does not attempt to restore the cognitive function, but to teach sub-skills of a specific activity.

Question 11

Strategy training

Answer 11

A form a training where the cognitive impairments are compensated via strategies.

Question 12

Environmental adaptation

Answer 12

Is used when the patients learning ability is extremely impaired. It can include route markings or contrasting colors to keep things seperated in the mind.