Lecture 3: neuropsychological interventions

Question 1

3 types of cerebrovasular accident (CVA) / stroke

Answer 1

1. Ischemic stroke (80%): blocked artery due to a blood clot.
2. Haemorrhagic stroke (20%): ruptured blood vessel in the brain that causes leakage and damage.
3. Subarachnoid haemorrhage (SAH): ruptured blood vessel in the tissue surrounding the brain.

Question 2

Traumatic brain injury (TBI)

Answer 2

1. Primary impact: injury in the place where the brain was hit.
2. Secondary impact: the brain is hit from the front and the force of the hit goes through the brain, which can cause shearing and tearing in other brain areas (but this isn’t visible on the CT scan). Or when the brain get’s bruised against the interior of the skull. Increased intracranial pressure can cause damage to the tissue which will result in swelling or edema. This causes expansion of the brain tissue where there is no room for this, and thus damage to brain areas.

Question 3

How is the severity of the brain injury determined?

Answer 3

By the length of the coma (how long have you been unconscious) and the length of the PTA (post traumatic amnesia).

Question 4

Consequences of traumatic brain injury

Answer 4

• Diaschisis: a sudden change of function in a portion of the brain connected to a distant, but damaged brain area.
• Synaptogenesis: creation of new synapses. If they rewire wrong this can evoke epilepsy.
• Reperfusion of the penumbra: some brain functions can restore fully if there is enough blood transferred to these brain areas directly after the injury (mostly the area’s surrounding the stroke).
• Spontaneous recovery: going back to normal functioning.

Question 5

Function vs. functional recovery

Answer 5

In function recovery someones function is back (like talking, walking etc.) and in functional recovery someone can use something again, either in the same or in a different way.

Question 6

Time scale / course of action following acquired brain injury

Answer 6

1. Acute phase: “will I live or not?”
2. Subacute phase: going to rehabilitation (only 20-30%). “Will I walk and talk again?”
3. Chronic phase: after 6 months there is less improvement. Focus on if and how they can go back to society again. “Will I work again?”

Question 7

Principles / rules of rehabilitation after brain injury (SUITORS)

Answer 7

1. Use it or lose it: if you don’t use certain brain areas, you will lose those functions.
2. Use it and improve it: doing tasks improves performance and can lead to plastic changes. (Cells that wire together fire together).
3. Specificity: specific training is better than global training.
4. Repetition
5. Intensity: must be sufficient enough to lead to plasticity.
6. Time: more recovery within the first 6 months.
7. Salience: it must be important and pleasant enough.

Question 8

Brain reserve

Answer 8

The actual differences in brain structure that might provide a reserve against the physical characteristics of the brain, such as the number of neurons, synaptic density and overall brain size.

Question 9

Cognitive reserve

Answer 9

The brains ability to improvise and find alternative ways of getting a job done in the face of brain damage. It involves the ability to optimise performance through differential recruitment of brain networks of cognitive strategies.

Factors that influence this:
- Education
- Occupation complexity
- Engaging in mentally stimulating activities
- Alchohol etc.

People with higher cognitive reserve can better tolerate brain damage such as TBI or before showing clinical symptoms in diseases like Alzheimer or other forms of dementia.

Question 10

Types of problems after acquired brain injury

Answer 10

• Cognitive: memory, attention etc.
• Emotional/ psychosocial/ behavioural: depression, anxiety, divorce etc.
• Sensorimotor: loss of strength, tinnitus etc.

Question 11

ICF-model

Answer 11

International classification of functioning, disability and health model. Looks at different aspects:
- Health condition / disease
- Body functions and structures
- Environmental factors
- Personal factors
- Participation
- Activities / limitation

Question 12

Cognitive pyramid

Answer 12

You need all these things (from the bottom to the top) to process certain stimuli. The most basal process is arousal –> sensory stimulus processing –> speed of information processing –> attention –> memory, language, perception –> executive functioning.

Question 13

Different types of cognitive rehabilitation training

Answer 13

• Restorative training (doing something more)
• Compensatory training (to compensate for damaged functions with intact abilities)
• Skill training (for relevant daily activities)
• Stimulus-response conditioning
• Environmental adaptation