WHAT IS NEUROPSYCHOLOGICAL REHABILITATION?

Neuropsychological rehabilitation is one that focuses on the treatment of disorders that affect any cognitive domain: attention, memory, perceptual-motor processes, executive functions (planning, inhibition, working memory, etc.), emotion and behavior. Cognitive functioning can be altered by different causes, one of these being Acquired Brain Damage (DCA). When we talk about DCA, we are referring to a sudden brain injury that has had normal development so far. This can be due to different causes: strokes or strokes, traumatic brain injuries, brain tumors, infections, anoxia, etc. Whatever the cause, the DCA has as its main consequence the loss of previously developed functions. These losses can be physical, cognitive and emotional, causing, in most cases, a loss of functional independence.

Neuropsychological rehabilitation, as mentioned above, is the one that focuses on the improvement of cognitive, behavioral and emotional functions. Cognitive deficits can range from mild to severe, where, for example, the person only notices a little difficulty when performing tasks, such as absent-mindedness, slowness or slight forgetfulness; or, in more serious cases, where the person is unable to remember what they did that morning, follow the thread of a conversation or prepare breakfast. It can also happen that the family perceives that the person has changed, that he is no longer the same as before; and that the patient does not realize their difficulties.

It is important to carry out a complete neuropsychological evaluation to be able to determine the damaged or altered functions, as well as those that are preserved, since the latter will be the basis of the rehabilitation process. You must also take into account how the person was before, his tastes and hobbies, so that the process is as motivating as possible and with significant objectives for him or her. The purpose of all this is to ensure that the person is as functional as possible in their day to day. This is done both with the patient and with the family, giving them information about the relative’s difficulties, orientation, guidelines and emotional support; among many others.

Finally, it should be noted that throughout the rehabilitation process it is necessary to work in an interdisciplinary way since, as mentioned at the beginning, the alterations that persist after a DCA are of a different nature, requiring the joint and coordinated participation of a team from different professionals.

Gilma Acosta Llopart
Neuropsychologist


			

IT HURTS!

Quite a few patients have consulted me by phone during the confinement since they have suffered some episode of pain. A pain that in many cases had no apparent cause or justification, hence its anguish and bewilderment.

We often associate pain with injury, but is there always a correlation?

In other words, whenever there is an injury do we feel pain? And vice versa, whenever there is pain does it mean that we have been injured? The answer is no.

Furthermore, when faced with consummate damage, the intensity of the pain we feel does not always coincide with the actual damage to the tissues, for example, when we cut the fingertip with a sheet of paper (Has this never happened to you? It hurts!!!).

Let’s start at the beginning … what is pain?

Pain is a perception of alert linked to the defense system that, as defined by the IASP (International Association of Study of Pain), “… notifies us of the existence of current or potential tissue damage or that it is experienced as such damage “

Therefore, tissue damage is not necessary for its appearance, it is enough that it is interpreted that there may be.

And who makes such an interpretation? The boss, our central nervous system (or in other words, the brain).

A perception (in the case at hand, pain) is a brain hypothesis of what is happening outside our body, through information that comes from the environment to the central nervous system through information from the senses . And our brain faces the challenge of building a story as rational as possible.

Specifically, the Nociceptive System (I will discuss it in more detail in the next publication) is in charge of detecting a state of current or potential tissue damage and informing the central nervous system so that the latter produces a modulation of the response.

All perception has its function and pain tries to protect us (yes, in fact, on many occasions we have to be very grateful to it) and promote healing. Pain has been evolutionarily promoted and selected to modulate our behavior in periods of adversity: discomfort, exploratory inhibition and apathy (little desire to move and do new things), and the lowering of the pain threshold (we feel pain more ease) are preservation behaviors that appear with such behavioral modulation.

The curious thing is that consummate damage is not necessary for such modulation of behavior to be activated, since the simple expectation of damage is sufficient to activate such behaviors.

The brain is always responsible for making the final decision about whether something (however small and insignificant it is) is dangerous to the tissues and integrity of the individual, and whether action is required (project pain into consciousness to stop of using a body part or deciding not to take a potentially dangerous action).

As human beings we have the capabilities to plan an event, to quickly learn from an experience and to use logic to predict the future (the brain is predictive, not reactive). Therefore, we can identify a situation / context / scenario as potentially dangerous long before the information reaches our tissues.

In short, although painful stimuli have nothing to do with tissues, if our brain considers them dangerous, they may be enough to evoke pain.

With the current situation that we have had to live, we have been locked up at home for many hours, thinking and watching the news, and receiving an informative bombardment of constant alarm. Our nervous system has been in a constant nociceptive alert situation, focusing our attention towards the body and towards an expectation of symptoms in order to act as quickly as possible at the slightest sign of danger (in this case, the symptoms of Covid-19 ), and therefore our sensitivity has increased to raise alarms at the slightest suspicion.

As a consequence, stimuli or bodily states that prior to confinement were asymptomatic or silent, have now become conscious and perceived.

Our nervous system has increased its sensitivity and effectiveness to protect us better, but as in any great computer program, there is always a mistake. I explain myself better with a very illustrative example:

Imagine that you are the owners of an industrial warehouse, and you have the bad luck that one night thieves enter to steal. Obviously, your work is very important to you and you do not want this to happen again, and you decide that you are going to invest in the best infrared security system so that thieves never enter without alarms and you can catch them with your hands. in the mass.

Perfect! Now your business is protected and you can rest easy.

At midnight they call you on the phone, it is the company in charge of the security system, the alarms have gone off! How can it be?

You get up running and go straight to your computer to check the security cameras to see if you see what has happened, and what is your surprise when you see a couple of very cute little mice hanging around your company!!!

Infrared rays are sure to detect thieves, but they are so highly sensitive that they set off alarms with something that is harmless to your company… little mice!”

We have a wonderful organism, which is capable of remembering events that we ourselves do not know are stored in some corner of our memory, and if it detects that there is an alarm signal similar to the stored memory and that it could be dangerous for our physical integrity, it sets in motion all the machinery necessary to protect us, and if we have to feel pain with it, it will make sure we feel it.

Author of the entry: Anna Canet. Physiotherapist specializing in the musculoskeletal system

Bibliography:

  • Butler D, Moseley G. Explicando el dolor. Adelaide: Noigroup; 2016.

  • Goicoechea A. Depresión y dolor. Enero 2020.

THE IMPORTANCE OF MUSCLE WORK TO TREAT MUSCLE ATROPHY

 

   

Muscular atrophy is a disorder that involves the wasting, loss or decrease of skeletal muscle. It is produced by an imbalance between protein synthesis and its degradation. Nerve cells of the skeletal muscles are affected, generating partial or total paralysis. This disorder causes loss of muscle strength. It is a progressive process gradually affecting the functionality of everyday movements.This process of atrophy can occur due to different circumstances. One of them would be the lack of muscular activity due to disuse (decrease in physical activity in our daily life due to a change in routine, due to immobility due to alterations in the locomotor system or sedative states …) another cause may be aging in which the capacity for muscular contraction decreases and the muscular capacities (elasticity, contractility, excitability, flexibility) are diminished. And another cause may be due to damage to the central nervous system (brain, brain stem, cerebellum, spinal cord) such as stroke, traumatic brain injury, spinal cord injury, or the peripheral nervous system (motor nerves).

At the Neurorehabilitation Clinic we focus our physiotherapy and occupational therapy treatments on the recovery of functional movement that requires tone and muscle strength. Muscle tone is necessary for maintaining posture, joint stability, giving proprioceptive information to the nervous system, stimulating the movement of lymphatic and blood vessels, etc …To work muscle atrophy, we carry out active and assisted exercises with certain repetitions to increase the nervous stimulus that activates muscle fibers, necessary to reverse muscle atrophy.It is very important to stop the atrophy and regain muscle strength that the affected person remains active both in the sessions and in their daily life. For this reason, therapists always give guidelines for exercises and functional activities that stimulate and motivate the person to move and use their body to achieve their functional objectives.

 

Reopening

We open the Neurorehabilitation Clinic next Monday, May 11.

Appointments will be given 15 minutes apart to ensure proper compliance with disinfection protocols for all surfaces used by patients.

We ask patients to be punctual.

We will carry out disinfection of the footwear and supervision of hand washing (with soap and water or with hydroalcoholic gel) of the patients, who must also wear a surgical mask during the sessions.

In order to guarantee the distance of 2 meters between people, the waiting room is disabled, the companions must wait in the garden.

Companions cannot access the treatment room.

We ask patients and companions that if they have had contact with patients with Covid-19 in the last weeks, or have had a cough, fever, feeling of suffocation or any other symptom susceptible to Coronavirus in the last week, cancel the treatment session and do not go to the Neurorehabilitation Clinic

The staff and therapists have been informed of the protocol developed by the Neurorehabilitation Clinic and have trained in the correct use of Personal Protective Equipment.

Neurorehabilitation service: preventive measures

Knowing how important the process of rehabilitation of neurological patients is, the Neurorehabilitation Clinic reopens its doors fully respecting the health recommendations.

Neurological patients affected by diseases such as a stroke, Parkinson’s disease, traumatic brain injury, etc., must continue their rehabilitative process to restore mobility, increase functionality, prevent deterioration, among others. In some cases, physiotherapy, speech therapy or psychology treatment is essential to improve participation in daily activities, including domestic activities, which are so important in these last days of confinement.

The treatment sessions will develop naturally with the necessary protections such as the 15-minute separation between appointments for disinfection, ventilation and change of protective material for the therapists. On the other hand, we have also reduced the maximum capacity of the facilities to 30% and the time adjustment for the most vulnerable patients.

The new measures for both patients, therapists and adaptation of the facilities have been individually disclosed and can be consulted on our social networks. We are also available by phone and e-mail for more detailed explanations and clarification of doubts that may arise among users.

Apart from the inexcusable and more urgent treatments of patients affected by a neurological disease, we also carry out virtual sessions by video call to non-urgent cases or in case of displacement viability.

Neurological patient and coronavirus (COVID-19)

We are currently affected by the coronavirus pandemic (COVID 19). Apart from the very evident affectations of the respiratory system and the main problem of patients with COVID-19 that can lead to death, it has been observed that patients severely affected by this disease can also present neurological symptoms.

Scientific research concludes that neurological disorders can be found in about 35% of severely affected patients with COVID19, the most frequent symptom being loss of smell. Other known symptoms related to the central nervous system may be headaches, dizziness, changes in level of consciousness, ataxia, epilepsy and stroke. Relative to the peripheral nervous system, the best known symptoms are hyposmia and neuralgia. And finally, muscle weakness and muscle pain are the most common musculoskeletal disorders.

It is also known that the previous situation of the patient with COVID-19 must be taken into account, especially in cases of neurological disease. Patients with Parkinson’s Disease, Stroke, Multiple Sclerosis among others should have special attention. Even if they do not suffer from COVID19, these patients are indirectly affected by confinement since they do not follow their routine and rehabilitation care.

Faced with the large number of cases of COVID 19 in our country, the Spanish Neurology Society has addressed the issue and has transmitted a message of reassurance to neurological patients, since up to now it has not been proven that they are a more vulnerable group than the others (except in cases of depression of the immune system such as Multiple Sclerosis).

Many health centers have had to take urgent measures to be able to monitor patients, especially in cases of possible deterioration and degeneration. These measures are supported by the Spanish Neurology Society, which recommends that “In no case, neurological patients should abandon their treatment, as this could have serious consequences on their health.” The most frequent measures have been telephone consultations, consultations by video calls, publication of videos of therapeutic advice and use of softwares and app of rehabilitation guidelines.

The Neurorehabilitation Clinic has not been left behind and has maintained contact with its patients via telematics (phone calls, whatsapp, video call by Skype and zoom), has published video tips suitable for patients with neurological disorders and has carried out free classes of focused therapeutic exercises to the base alterations of neurological patients.

Thanks to all the Neurorehabilitation Clinic team for actively collaborating in all initiatives.