Neuropsychological rehabilitation after a stroke. How can it help?
Aleksandra Mielnik
Therapy results
What patients say about us
When we talk about the effects of a stroke, we most often mean physical limitations — that is, muscle weakness (paresis) — and speech difficulties. For these problems there is relatively broad access in Poland to various forms of therapy, such as speech rehabilitation after a stroke, rehabilitation stays and one-to-one work with a physiotherapist.
Far less attention is paid to cognitive impairments. They are less visible than motor deficits, but they can significantly limit the everyday functioning of a person after a stroke. In such situations, neuropsychological rehabilitation becomes an important part of the recovery process.
Cognitive processes include, among others, visual and auditory perception, attention, memory, thinking, language functions, executive functions and cognitive control. All of these areas are needed for normal, everyday functioning and are involved even in very simple activities.
As a result of a stroke, one or more of these processes may be weakened. Identifying what has been impaired, to what extent and how the return of lost functions can be supported is the work of a psychologist — and in particular a neuropsychologist.
The type and severity of deficits after a stroke
The type and severity of the deficits that arise as a result of a stroke depend on many factors, including the location of the stroke, the number of previous strokes and the patient’s age. The most commonly observed cognitive impairments include:
- Impaired attention — reduced ability to divide attention, a shortened or excessively prolonged span of concentration, and greater susceptibility to distraction.
- Impaired memory function, including difficulty remembering new information, retrieving previously known material or learning new tasks. We write in more detail about what memory loss after a stroke involves in a separate article.
- Perceptual impairments — difficulty recognising familiar objects by sight, sound or touch despite no damage to the sensory organ itself.
- Impaired language functions, most often aphasic after damage to the left hemisphere, but also possible after right-sided strokes — for example, difficulty understanding metaphor and humour.
- Impaired self-control.
This does not cover all the possible changes. Cognitive impairments may also be accompanied by changes in personality and behaviour, as well as mood swings — both towards excessive lowering and excessive elevation — up to and including depression after a stroke.
What can a patient expect from a neuropsychologist?
A person who has had a stroke and comes to see a neuropsychologist can expect a thorough assessment of their cognitive functioning. Such an assessment makes it possible to identify the patient’s strengths, pinpoint the impaired areas and establish their severity.
On the basis of a well-conducted assessment, the further course of therapeutic care can be planned — that is, a course of neuropsychological rehabilitation tailored to the individual patient.
What is neuropsychological rehabilitation?
Neuropsychological rehabilitation involves measures designed to help a person after a stroke regain as much independence as possible and return to everyday activities, including work. It draws on the brain’s natural plasticity, appropriately stimulating the processes responsible for restoring lost functions.
At the same time, the patient learns strategies for compensating for lasting deficits by making better use of the processes that have not been weakened. One example is relying more on auditory information when visual perception is impaired.
During rehabilitation, materials are used that are matched to the patient’s needs and abilities, and their complexity is gradually increased. The aim is to improve quality of life and to enable the best possible adaptation to everyday, as independent as possible, functioning.
Neuropsychological rehabilitation is often an essential part of recovery after a stroke, and it is best when it forms part of broader neurological rehabilitation programmes, because impairments of attention, memory or comprehension can also hinder physical rehabilitation. The patient may have difficulty remembering instructions, learning how to perform exercises or understanding longer messages. That is why cognitive exercises are sometimes necessary in order for the patient to make full use of physical therapy as well.
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Aphasia after a stroke is the loss of the ability to understand and produce speech. We explain the types of aphasia, the role of the speech therapist and the directions rehabilitation can take.
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Memory loss after a stroke. What it involves and what can help.
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The next step
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