This question is quite common when the family member of a person with brain damage comes for a consultation. -Hey, but is it worth it? -What exactly does neuropsychological rehabilitation do?
Despite the fact that more and more professionals in gerontology, neurology, and rehabilitation medicine believe it is a growing and advancing field, there are still professionals who argue that there is no consistent scientific evidence to show that neuropsychological rehabilitation has any effect on brain function or even on the brain and question its “usefulness.
Solving this question is very relevant because of the high amount of personal, emotional and economic resources that Rehabilitation Centers and families of those affected by brain damage (of whatever origin) invest. We will analyze some reasons that complicate the study of the effectiveness of neuropsychological rehabilitation programs.
When we consider the effectiveness of a method, we must compare. And what do we compare to prove the effectiveness of a rehabilitation program? We can compare some people with others, the person with him or herself or the rehabilitation method with others.
Compare the person with others in the same population group. As we have commented in a previous post (Funambulists), two brains are far from being the same. There are many factors that alter the configuration of a brain. From learning, which modifies the neuronal networks, or the type of damage that each person suffers, which disconnects the different areas of the brain, drug use or simply the environment.
Let’s think about dementia. In these cases, we say that there is a factor that makes it possible to delay cognitive decline: cognitive reserve. To draw a parallel, the cognitive reserve is like the reserve of a tank of gas in a car. The more capacity this reserve has, the longer the car will run and the more routes we can take. In the case of the brain, we all have a different reserve, because we have done different things; therefore, the impact of rehabilitation programs is different in each person.
The type of dementia is another factor that complicates the evaluation of rehabilitation programs. To continue the simile, an oil leak is not the same as a broken exhaust pipe, even though both affect performance. The age at which the dementia is detected (especially if it is high) and the time of development that has passed until that time impact on the evaluation of the effect of cognitive stimulation and rehabilitation programs. Cognitive reserve is a double-edged sword: it allows the maintenance of cognitive functions to be prolonged, but also causes the symptoms of dementia to be detected later.
Compare the person with him or herself.
Compare their functions, their brain and their ability to do things that were not there before rehabilitation. In this case, the main problem is that we cannot look out a window to see what would happen to that person in the future without rehabilitation.
Some professionals argue that there is a natural and spontaneous recovery. They refer to the already proven ability of the brain to reorganize itself. It is also true that neural connections can, in many cases, be reconfigured. If you cover one eye for a year, you won’t lose your vision, but the information load on the other eye will cause the neurons to strengthen their connections, while on the other side they are lost.
Based on these capabilities, isn’t it better to have that learning guided by a professional through a structured and personalized program?
Compare the method of neuropsychological rehabilitation with others.
Not all programs rehabilitate the same thing or use the same strategies. What if some subjects respond better to some rehabilitation strategies than others?
We find professionals who prioritize “physical” outcomes over cognitive ones. Personally, I don’t see the dissociation between physical and cognitive. It is important to understand that everything goes together and in brain injury rehabilitation each area of intervention is equally important since they are all interrelated.
In fact, exercise has been shown to promote the activity of neuroplasticity factors and this – we all agree, I hope – is a potential factor for learning.
At this point we ask ourselves again: is it worth it? Despite these problems…
Let the therapist who has not been able to improve the quality of life of a patient raise his hand!