NEUROPLASTICITY AND COGNITIVE NEUROREHABILITATION

1. NEUROPLASTICITY AND COGNITIVE NEUROREHABILITATION MONIKA MAKCLINIC OF PSYCHIATRY PAM

2. NEUROPLASTICITY • Neurons in brain, as proven, have modification ability called neuroplasticity. On account of neuroplasticity, injured brain is able to partial recovery or impaired functions improvement. Pharmacological treatment and environmental stimuli can influence neuroplasticity.

3. Recent researches tendencies are aiming at creating an interdisciplinary schema of treatment for patients with different cognitive disorders etiology. The schema should integrate theoretical and practical knowledge of genetics, neurophisiology, neuroanatomy, neuropsychology, pharmacology, psychiatry and psychotherapy. A comprehensive treatment should show results in increased quality of patient’s life.

4. COGNITIVE DYSFUNCTIONS IN SCHIZOPHRENIA • According to scientific researches, schizophrenic patients examined neuropsychologically present cognitive dysfunctions, as far as working memory and executive functions (connected with prefrontal cortex) are concerned. Cognitive dysfunctions are currently regarded to be one of endophenotypical markers predisposing to schizophrenia. Working memory is also connected with neurotransmission in brain, especially with dopamine activity. This indicates neurostructural changes underlying schizophrenia, what can be treaten as neurodegenerative and neurodeveloping disease.

5. THE CONCEPT • Computerized training programs are meant to transform the client's cognitive capacities in a positive way.RehaCom is not just a product, but also an overall concept, that fulfils the necessary requirements for positive change in the client. These are: • Modularity • Individualization and adaptation to difficulty • Continuity and measurement of the course • Performance feedback • Efficiency and economy

6. RehaCom

7. WHY REHACOM? RehaCom is a software package, with which you can focus on the different cognitive areas you want to train.You can work on your attention, memory, logical thinking, visual motor skills and reactive capacity in a motivating and efficient way. An ergonomically designed input panel and training programs, which adapt to the respondent's success progress result in a varied and encouraging administration.

8. INPUT DEVICES • RehaCom can be used with a special input panel, the computer keyboard, the mouse or a touchscreen.The computer keyboard is not always suitable as an input device for computerized therapeutic trainings. This is why we have developed a special input panel with a very simple keyboard. It reduces the control elements to a minimum and has: • 6 big keys • 2 special keys • One joystick The generous and very robust design of the reaction keys enables also clients with severely impaired or unpractised hand motor skills to use them safely.

9. AttentionAttention & Concentration (AUFM)Divided Attention (GEAU)Vigilance (VIGI) MemoryTopological Memory (MEMO)Memory for Words (WORT)Figural Memory (BILD)Verbal Memory (VERB)Physiognomic Memory (GESI) Field of visionSaccadic Training (SAKA)Exploration (EXPL) Logical thinkingLogical Reasoning (LODE) Spatial operationsSpatial Operations (RAUM)Two-dimensional Operations (VRO1) Problem solvingPlan a Day (PLAN) Shopping (EINK) Reactive behaviourAcoustic reactivity (AKRE)Reaction Behaviour (REVE) Visual-motor/constructive abilitiesVisuomotor Coordination (WISO) Visuoconstructive Abilities (KONS) TRAINING PROGRAMS18 training programs are available which are categorized as follows:

10. Attention & Concentration Functionally and organically caused attention disturbances represent the most widespread neuropsychological performance deficits after an acquired brain damage. They can be found in 80 % of the patients after a stroke, a brain trauma, diffuse organic brain damages (e.g. caused by chronic alcohol abuse or intoxication), as well as with other diseases of the central nervous system. This training is suitable for adult patients and for children with attention and concentration disturbances from 11 years on.

11. Divided Attention Problems in focusing attention simultaneously on several different objects occur with almost all diffuse brain damages (e.g. intoxication or alcohol abuse) as well as with local damages of the right hemisphere, especially of the parietal parts of the brain. This means it is difficult for the patient to focus his/her attention on different objects at the same time. Because of the animated presentation, this training is very motivating and also suitable for children over 11 years

12. Vigilance The training is indicated for all disorders or restricted sustained attention of different etiology and genesis.

13. Topological Memory This training is indicated for all memory disorders or impairments regarding verbal and non-verbal contents. These amnestic syndromes can be observed for all diffuse cerebro-organic diseases (dementia, intoxication, chronic alcohol abuse, etc.) as well as for all left-sided or bilateral lesions of the medial or basolateral limbic lemniscus. Moreover vascular diseases, brain traumata, or brain tumors in prefrontal, temporal up to parietal cortical areas can lead to memory deficits.

14. Memory for Words This training is especially suitable for patients with an impairment of the word span or with a reduced recognition capability - especially for patients with first signs of amnestic syndrome. This syndrome occurs in patients with diffuse cerebro-organic damage and left hemispheric or bilateral lesion (especially of the limbic lemniscus with damaged parts of the thalamus). The training is also suitable for patients with functionally caused impairments and for children from 11 years on.

15. Figural Memory This training is indicated for all memory disturbances (especially of the working memory) for verbal and non-verbal contents. The program can also be used on patients with an - organically or functionally caused - impaired ability to name objects and difficulties in conceptual pairing. Figural Memory can be used for children over eleven years when they have average vocabulary.

16. Verbal Memory The training is especially suitable for patients with an impairment of the short-term and mid-term memory span. This syndrome occurs in patients with diffuse cerebro-organic damage (dementia, abuse of alcohol etc.) as well as left hemispheric or bilateral lesions.

17. PhysiognomicMemory People with prosopagnosia have a restricted ability to recognize faces and establish meaningful associations or have lost this ability completely. The problem can also be related to memory components that are responsible for remembering faces. This disorder is caused by a lesion of the temporal lobe (usually situated in the left hemisphere). This training is therefore intended for all patients with right-sided or bilateral temporal lobe damage of different pathogenesis, when the above mentioned impairments have been observed.

18. Saccadic Training The program was designed for patients with contra-lateral visual neglect phenomena of one side of the body. Impairments in the visual exploration for one half of the visual field appear often together with neglect or extensive cerebral infarcts (stroke) in the supply area of the arteria cerebra media or posterior. Also other cerebro-organic diseases may cause these dysfunctions.

19. Exploration The training is recommended for patients witha homonymous restriction in their visual field, with problems of visual exploration due to dysfunction of the visual field or of neglect, a combination of several of these disorders resulting from brain damage. The training can also be used to help patients who suffer from linguistic restrictions and restrictions in their ability to understand words, by including non-verbal material.

20. Spatial Operations This program is designed to provide training of the basic functions of spatial perception. Using non-verbal material minimizes the demands on verbal comprehension and enables the application to patients with speech disorders.

21. Two-dimensional Operations A decline in the performance in visual-constructive tasks, items of the position-in-space-exploration, as well as of spatial orientation have been observed in patients with right hemispheric temporal and parietal lesions and damages of the frontal lobe. The training is indicated for patients with lesions of the above mentioned and with diffuse brain damage, or mental defects.

22. Logical Reasoning Most authors associate the frontal lobes above all with abstract reasoning. However, isolated lesions of the frontal lobe appear seldom alone. For that reason experts disagree about which cortical parts are also responsible for the solution of reasoning tasks with non-verbal material. This training is indicated for patients with acquired cerebro-organic (frontal lobe) damage, when an impairment in logical thinking can be observed. Those dysfunctions occur quite frequently, for example, as a result of chronic alcohol abuse, dementia, seizures, and schizophrenia.

23. Plan a Day This training is indicated for adult patients with restrictions in the executive functions and the coordination of activities. These abilities are among the most complex human abilities. These can be impaired by brain damage of any origin and aetiology, especially in the case of damaged frontal structures or diffuse cerebral damages. PLAN can also be used within the context of memory training, but is not advisable in the case of severe amnesic disorders.

24. Shopping This procedure is recommended for patients with deficits in working memory, concept attainment, or planning an action sequence. Furthermore it is possible to administer this program to children aged 11 years and older ,and to people of advanced age to maintain their mental abilities.

25. Acoustic reactivity The application of this procedure is recommended for adult patients diagnosed with deficiencies in reaction speed and decisiveness as well as with acoustic discrimination disorders. Moreover, the training requires high mental flexibility and focussed attention. Patients with interference inclination should be prevented from being overstrained. In order to carry out trainings with children over eight years, instructions appropriate for children have also been elaborated.

26. Reaction Behaviour The training is indicated for all patients with reduced reactive speed due to dysfunctions of the CNS. Such a reduction in reactive speed occurs almost always in patients with a diffuse brain damage as well as with frontal and prefrontal lesions (e.g. dementia, brain trauma, seizures, tumors, ischemia, etc.).

27. Visuomotor Coordination Damages of the motor cortex (frontal lobe) lead to deficits in the control of the fine motor skills, which can be observed most clearly in disorders to coordinate hand and fingers. In many cerebro-organic diseases and damages, like cerebral stroke, haemorrhage, extensive tumors, brain trauma, etc., visuo motor functions are affected as well. The training is indicated for all disorders of the fine motor skills.

28. Visuoconstructive Abilities Specialist literature reports that parietallesions cause constructional apraxia. The abilities necessary to manage the tasks of this training are reconstruction as well as both memory and attention. The training is recommended for patients with a slight or medium decline in the capacity of the visuo-constructive field or in other general functional disorders. The latter can be frequently observed in patients with diffuse brain damage e.g. due to intoxication, alcohol abuse, etc. As only pictorial material is used, the training is also suitable for children (aged 8 years and over).