Early Rehabilitation Important in Neurological Diseases

Clinical Neuropsychologist at Üsküdar University NPİSTANBUL Hospital İnci Birincioğlu discussed early rehabilitation in neurological diseases. Clinical Neuropsychologist İnci Birincioğlu, who noted that clinical neuropsychology as a new field offers entirely different rehabilitation experiences for patients, shared her experience on the subject as follows: "After understanding the patient's mental processes and determining what approach they will receive treatment with, you need to be creative. Take a patient who will recover, a stroke patient. After measuring where they struggle most in daily life, we organize various tasks. Family members also participate in the sessions. You're essentially training co-therapists. Whether it's going shopping, withdrawing cash, calling friends and organizing an activity, or using the internet and social media—whatever tasks remained before the stroke—we arrange a structured return starting at the correct levels in the correct order, restoring their functionality."

Facilitating patients' lives is not a favour to them

Clinical Neuropsychologist İnci Birincioğlu, who also provided information about her work with patients who have age-related dementia or are predisposed to dementia, stated: "We must allow people to think, speak and make requests for some things. As their relatives, in fact we're not actually having those people do anything to make their lives easier. No responsibility is given, we don't want them to do anything and sometimes we don't even allow them to speak, saying 'I understood you, you actually want this.' When the situation is like this, perhaps these people withdraw. They give up. They think anyway someone will do everything for them." she explained. [caption id="attachment_158953" align="aligncenter"] Clinical Neuropsychologist İnci Birincioğlu[/caption]

Two types of conditions lead people to neurology or psychiatry

Clinical Neuropsychologist İnci Birincioğlu, emphasizing the importance of customizing treatment for each patient, stated: "People consult neurology or psychiatry for 2 types of conditions: vascular or brain disease. In acute cases; a person either experiences a traffic accident or encephalitis (brain inflammation). That is, brain tissue or brain cells become infected or a stroke occurs. There can be a blockage or bleeding in one of the blood vessels that feed the brain tissue. A dysfunction emerges related to the brain tissue it damages. A person either cannot speak or has difficulty moving. It can be unilateral, affecting the visual field and attention area or memory. They remember short-term memory but cannot remember long-term memory. Or vice versa."

Alzheimer's eats away at the brain

Clinical Neuropsychologist İnci Birincioğlu, drawing attention to the process in Alzheimer's patients, stated: "Swallowing is actually a reflex and a movement performed by cells through muscle memory. When cells that preserve muscle memory die, swallowing cannot occur. This leads to lung problems. Alzheimer's and dementia patients actually die from pneumonia. At the endpoint reached, patients don't die because of Alzheimer's, but Alzheimer's eats away the brain and because certain vital functions can no longer be performed, the person passes away."

There are many chronically progressive neurological diseases

Clinical Neuropsychologist İnci Birincioğlu, noting that there are many chronically progressive neurological diseases, continued: "It varies depending on which one it is. For example, primary progressive aphasia is a progressive language disorder that starts in the left anterior brain. This is also a dementia. Here the person is aware of the oddity and decline in their own speech ability, they have insight. You even encounter a scene like this; while saying 'I'm speaking more slowly now,' they struggle when counting days. Since the awareness area is not affected, the person is aware of their own inability to speak. This is cognitive. The psychological aspect is added on top of this. As the person sees they cannot do what they want to do, they fall into depression. What's happening to me, will it always be like this, it's getting worse and worse, and this time anxiety disorders are added." she said.

In late-onset Alzheimer's, the person does not accept there is something odd about them

Clinical Neuropsychologist İnci Birincioğlu, noting that in late-onset Alzheimer's the person does not even accept there is something odd about them, stated: "They can have delusions such as (they'll hospitalize me and divide my inheritance). There are also frontal dementias. They start directly with psychological behavioral disorders. Excessive mockery, social maladjustment, previously non-existent obsessions, spending money, changes in sleeping and eating behaviors and even sexual orientation. A previously highly respected lawyer can start using profanity, engage in sexually inappropriate behavior toward others. These continue with progressively more serious social maladjustment problems leading to more severe issues. Until speech, urinary incontinence and dressing preferences and other neurological problems emerge, the family may view it as psychological." she said. Clinical Neuropsychologist İnci Birincioğlu also discussed mild cognitive impairment and Alzheimer's, stating: "This type has a precursory condition. According to one study; only 12 percent of patients diagnosed with mild cognitive impairment develop Alzheimer's. Rehabilitation may have the potential to prevent that transformation." she said.

The brain has a healing window and we must not miss it

Clinical Neuropsychologist İnci Birincioğlu, while saying that for some diseases the brain has a healing window that must not be missed, continued as follows:

"Saying it heals on its own is the biggest mistake. It's true, there are patients who completely recover after stroke with correct, appropriate and timely treatments and the number is not insignificant. What determines this recovery is where the stroke is in the brain, how quickly intervention is provided, age, education and many other factors. You can calculate a patient's recovery ratio. Therefore, the idea that neurological diseases are conditions of elderly patients is entirely wrong. Especially in the last 2 years, young patients are coming and if we can convey the message of immediate intervention, we can enable them to recover without becoming a disabled person who will live in a rehabilitation center for life or they can be at a level of functionality where they can manage independently. Recovery takes approximately 1.5 to 2 years. Recovery can be achieved within the first 2 years with medical, physiotherapy, speech and language, occupational therapy and neurorehabilitation."