AIM

METHOD

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; 2 Laboratório de Neuropsicologia, Serviço de Neurologia, Hospital de São Sebastião, Santa Maria da Feira

PARTICIPANTS

The cognitive rehabilitation exercises developed were tested in

three adult patients undergoing neuropsychological

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).

MATERIAL

Restoring, one of the memory rehabilitation strategies, involves

the practice of certain tasks, such as learning strings of

numbers or lists of words, using rehearsal and learning

strategies that allow memory recall of items, grouping them into

different categories (Skell & Edwards, 2001). Based on these

strategies, different exercises were developed:

An exercise, based on the California Verbal Learning Test

(Baeta, 2002; Delis et al., 1987/2000, as cited in Lezak,

Howieson, & Loring, 2004), on which the patient has to

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

selected taking into account their frequency.

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

invited to memorize it. Along the session, the patient is

questioned about the information on the menu.

Cognitive impairment is one of the major causes of disability

after brain damage. The ultimate goal of neuropsychological

rehabilitation is the reduction of that incapacity and the

promotion of the highest independence and quality of life of

those with brain damage

Cognitive rehabilitation involves a set of therapeutic activities

that are based on the evaluation and comprehension of the

impairments resulting from brain damages; its fundamental

objective is to promote the best patient functioning in relevant

areas of his/her daily life (Cicerone et al., 2000).

This type of intervention is usually implemented through series

of exercises (Uzzell, 2000) developed to rehabilitate the

impairments of the following higher mental functions: attention

and concentration, memory and learning, visual-spatial, visual-

perceptive and visual-constructive abilities, language and

executive functions (Cicerone et al., 2000; Gouvier, O´Jile, &

Ryan, 1998).

REFERENCES

The aim of the present study was to develop a set of

rehabilitation exercises oriented to the rehabilitation of the

following higher mental functions: memory, attention (focused,

divided, sustained), executive functions, verbal fluency and

constructive ability.

Saturday

Carrot CreamMixed GrillChocolate Cake

Figure 1. Restaurant menu.

In order to rehabilitate several dimensions of attention

(focused, divided and sustained), the following exercises

were developed: (a) selection of an unique symbol - the

patient must choose a certain figure (e.g., trefoil) among

others; (b) selection of two distinct symbols - the patient

must select a certain number with a line (e.g., 7) and

another number with a cross (e.g., 3); and (c) the patient

must write down in a note the position that certain figures

occupy on the table (adapted from Levitt & Johnstone,

2001).

Stroop and Go-No-Go Paradigm

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

of numbers (cf. Figure 2) - the patient must say how many

numbers are in each set and not the number in each

rectangle; (b) contradictory commands (e.g., cf. Figure 3) -

in this exercise the patient must memorize the instructions

previously given so that in face of a certain stimulus he

can inhibit the order of the card and follow the previously

given instruction (adapted from Portellano, 2005).

Reading and colour naming exercises were also

developed, based on the Portuguese Neuropsychological

Stroop (Castro, Martins, & Cunha, 2000).

Trail Making Test Paradigm

Figure 4. Complex geometric figure.

According to the methodology followed, the exercises were

considered adequate to the aims underlying their development.

With this work we have tried to give our contribution to reduce

the lack of instruments available in the field of cognitive

rehabilitation.

The exercises presented here may serve as a starting point in

the preparation of cognitive rehabilitation programs, but the

idiosyncratic aspects of the person must always be taken into

account in the formulation of a successful therapy.

PROCEDURE

The exercises were based on the literature, analysed by three

independent experts, and tested in three adult patients.

They were administrated in a period of five months, once a

week, in rehabilitation sessions of 40 minutes each.

6 66 66

4 44

4 4

9 9 99 99 9

1 111

5 5 5 5

7 7 77

7 7

2 22

8 88

8 8

5 555

3333

6 6 6 6 6 66

4 4 44 4

Figure 2. Table divided into small rectangles.

KITCHEN BEDROOM

“Place where we sleep” “Place where we eat”

Figure 3. Contradictory commands.

2. Attention Rehabilitation2. Attention Rehabilitation

3. Executive Functions Rehabilitation3. Executive Functions 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.

The following activities, based on verbal fluency tests, were

presented (adapted from Simões, 2003):

semantic fluency activities (e.g., the patient must say or write

words that belong to the following semantic categories: animals,

professions, sports, feminine or masculine names);

phonological fluency activities (e.g., the patient must say or

write words that began with the following phonemes: /m/, /R/,

/A/, /p/);

alternated fluency tasks (e.g., the patient must say or write in

alternated form the name of a woman and the name of a man,

the name of an animal and the name of a profession, a word

started by an M and a word started by an “R”).

Say “Blue” Say “Yellow”

In the developed exercise, there were two geometric forms

(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).

Baeta, E. (2002). Bateria para avaliação neuropsicológica de adultos com epilepsia.Psicologia, 16(1), 79-96.

Castro, S. L., Martins, L., & Cunha, L. S. (2000). Stroop Neuropsicológico Português. Porto: Centro de Psicologia da Universidade do Porto [Unpublished material].

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.

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.

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: PsychologyPress.

Lezak, M. D., Howieson, D. B., & Loring, D. W. (2004). Neuropsychology assessment (4th

ed.). Oxford: Oxford University Press.

Portellano, J. A. (2005). Introducción a la neuropsicología. Madrid: McGraw-Hill.

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: PsychologyPress.

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.

4. Verbal Fluency Rehabilitation4. Verbal Fluency Rehabilitation

PRELIMINARY RESULTS AND FUTURE DIRECTIONS

1. Memory and Learning Rehabilitation1. Memory and Learning Rehabilitation

5. Constructive Ability Rehabilitation5. Constructive Ability Rehabilitation

1st International Symposium on Neuropsychology and Rehabilitation

CRPG – 26th-28th October, 2006