Acquired Brain Injury from a Neuropsychological Perspective

Acquired brain injury (ABI) is brain damage caused on a brain after birth. It can be caused by many things, such as a traumatic brain injury that resulted from a car accident, a brain tumor, and a stroke, among others.

The main consequence of an acquired brain injury is the loss of previously developed brain functions. These functions involve the motor and sensory system, cognitive functioning, communication skills, and the ability to regulate behavior and emotions.

That being said, a frequent characteristic of patients affected by an ABI is the loss of functional independence that results in a disability. This overloads their immediate environment with responsibilities and stress.

Neuropsychology and acquired brain injury

Neuropsychological rehabilitation employs three basic tools or strategies in patients affected by ABI:

• Restitution or restoration: Through the stimulation or exercise of the affected function.
• Compensation: Through the use of other preserved cognitive functions in order to execute the task that was originally performed by the altered function.
• Substitution: Refers to the use of aids or external mechanisms for the effective development of the task.

The main goal of these three classic strategies is to get the subject to resume their daily activities in the most productive and satisfactory way possible.

What cognitive functions can be affected after an acquired brain injury?

Higher brain functions such as reasoning, memory, or attention are essential for people to be able to live independent lives. We use our cognitive functions constantly every day. Our brain uses different cognitive abilities to cook food, drive, or go to meetings by activating different parts of the hemispheres to a greater or lesser extent.

Here are the basic cognitive functions:

• Orientation: It allows us to be aware of ourselves and the context in which we find ourselves at a specific moment. It’s important to keep in mind that there are three parameters that assess orientation: personal, spatial, and temporal.
• Attention: It’s the state of observation and alertness that allows us to become aware of what happens in our environment. It’s important to note the five different processes within this function: selective attention, sustained attention, divided attention, processing speed, and hemispatial neglect.
• Executive functions: These are complex mental activities used to plan, organize, guide, review, and evaluate the behavior we need to have so we can adapt to our environment and achieve our goals. Within the executive functions, we find working memory, planning, and flexibility, among others.
• Language: There are different language processes that an acquired brain injury can deeply affect, such as vocabulary, expression, and understanding, among others.
• Memory: This is our ability to encode, store, and retrieve already learned information or an experienced event. We can distinguish between episodic memory, semantic memory, and procedural memory.

Behavior modification and psychotherapy are also important in acquired brain injury

In the process of neuropsychological rehabilitation, there are clinical psychology techniques that specialists commonly use:

• Behavioral therapy or behavioral modification: This includes classical conditioning, operant conditioning, and vicarious learning. Their goal is to analyze and manipulate stimuli and responses to consequently increase appropriate behaviors and eliminate those that are maladaptive. Psychologists apply them to be able to intervene in behavior alterations such as aggressiveness, irritability, disinhibition, and other undesirable behaviors.
• Cognitive behavioral therapy: It’s based on the idea that the way in which the individual perceives and interprets different experiences is actually what determines their behavior and emotions. Therefore, cognitive restructuring tries to modify those cognitions to change the individual’s behavior and emotions.
• Psychotherapy: This includes interpersonal interventions focused on the psychological aspects reactive to brain injury, emotional and personality alterations, or self-consciousness alterations.

These procedures have proven to be effective in different patients affected by acquired brain injury.

In conclusion, specialists consider neuropsychological rehabilitation a useful tool for the improvement of basic cognitive functions in ABI patients.