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Brain Damage

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Brain damage

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Maastricht University (UM)

In this document you will find all the necessary answers to the learning goals in order to pass your exams. Moreover, pictures accompanying the theory are added.

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Geupload op 11 november 2022
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Geschreven in 2021/2022
Type College aantekeningen
Docent(en) Sonja kotz
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Exam:
2 case reports and be neuropsycholoog
2 article questions (recovery)

Stroke + TBI and for each a case and most important is to understand the concept and
related

30/08/2021 HC 01: Basics in Neuropsychology

Introduction
● Spanning from 30/08/2021 - 12/10/2021
● Goals:
a. Introduction to theory and practice of neuropsychology
b. Central themes: brain damage and lesion models
c. Integration of brain structure and function (constraints (neurobiology) and
functional capacity (models of brain function))
d. Build on and enrich undergraduate knowledge
● Mandatory literature is NOT marked in yellow and additional literature help in
discussions and is yellow > Luria is highly relevant
● Lecture slides will be uploaded
● Rotation Excel sheet of who will come to campus and shared google doc with
learning goals
● 19th of October 13:00-16:00 exam with nine questions or less and covers all course
materials (tasks, book chapters and papers in e-reader, highlights from lectures) >
diagnosis + treatment. Keep course goals/learning goals in mind

Introduction in Neuropsychology
Broad evolution of the evolution of neuropsychology > one of the youngest disciplines. Head
is responsible for our behavior + process and reacts to information. It is not the head, but it is
the brain that is responsible for our behaviour > neuropsychology.
- Francois Lachal explained the relation between left frontal damage and speech >
begin of classical neuropsychology
- Wernicke explained our whole language system, how we receive language and what
is needed to understand and together with Broca it became clear how speech is
processed
- Jackson for neuronal networks is a key thing for processing information. Symptoms
arise from brain damage and are because of interruption of networks and not a
specific location
- Alexander Luria explains how the brain makes sure that energetic levels stay at the
level needed for processing + how the brain receives info needed + how do we make
meaning/react to the info (frontal brain). First idea how the brain works > he was right
in ancient times of neuropsychology and confirmed by modern techniques
Traditional domains are related to neurons, neuronal networks and in the end you hope it
explains behavior and also sometimes predicts it. Modern neuropsychology also looks at
society (take care of patients and how do you do that), Also genetics that come into play for
example Huntington’s disease > touches on ethical topics (diagnose with the disease AD,
because of the genes that are there).

Biopsychosocial approach:

,Exam:
2 case reports and be neuropsycholoog
2 article questions (recovery)

Stroke + TBI and for each a case and most important is to understand the concept and
related

Brain lives in the head of a person and the person lives in the world > the same damage to
different brains/heads/persons/places in the world has different consequences. When I lose
a finger, it would not interfere a lot in my life, because I can go on with my life as a
neuropsychologist, but as a piano player it has a bigger consequence.
- Biology (physical/health, genetics, drug effects)
- Social (peers, family circumstances etc.)
- Psychological (how you can cope/social help)
You can measure with neuropsychological assessments the damage to the patient.

Models for understanding behaviour after injury are very complex > picture do not
remember. There are pre-injury factors > damaged brain > damaged brain lives in a world.
The cognitive possibilities + emotional processes change = behavioural changes and there
is also the change of physical changes (motor). Challenge clinical > come up with a good
description.

When regulation fails:
- Difficult to integrate perception, behavior and emotion in relation to time and place,
because info first enters our brain
- Difficult to make a good match between behaviour and environmental challenges
- Developmental course turns toward increasing risk for maladaptive strategies
Example: genetic vulnerability for psychosis > expression of psychotic experiences >
persistence of psychosis > psychotic limitation. A man has dopamine production that
becomes higher and at a certain point in time it is too much and can happen that you have
mild psychotic symptoms > what happens afterwards > how the individual/environment
reacts and what is the stress that the environment extra delivers.

Neuropsychology = study of brain and behaviour + developing, exploring and learning +
brain diseases + protecting, enhancing and cognitive training.
Covid-19 has cognitive consequences > very small brain infarcts, but is under debate, is this
a general effect of an infection or consequences of cortical damage due to infarctions.

Every brain has a cognitive reserve (protected against trivial types of brain injury), but these
benign injuries > at what point in time are you confronted with definite changes of brian
damage.

Imaging is not enough, we need cognitive measurements to explain the ultimate changes to
the brain. Axon bundles that connect two brain areas of a TBI patient > how much can we
lose before the cognitive changes become visible/memory/attentional complaints.
Visualisation is not enough > always need proper and good cognitive measurements to
explain this.
CT scan > no idea what you are looking at (tumor/infection etc.). As a psychologist it is in the
memory area and controlling of behaviour and when you look at the man itself with his
lifestyle it does not look good and the person already changed a lot.

,Exam:
2 case reports and be neuropsycholoog
2 article questions (recovery)

Stroke + TBI and for each a case and most important is to understand the concept and
related

Cognitive tests for behaviour:
- Classic visual scanning test > has to find all the bells in the sheet, have an idea of
the visual scanning > right frontal patients neglect a part of the world, so very efficient
way of measuring and explaining the consequences of the injury to patient and family
- Cognitive test with clock > right frontal hemisphere difficulty (parietal) > left side
neglected, patients do not recognize that the clock is wrong
- Visual difficulties + information processing > kissing rocks in Thailand, men saw only
snippets of this picture after the stroke
- Visual information processing (complex Ray figure) > copy attempt of the figure and
has severe difficulty in organizing information, could be visual problem or structuring
information

Neuropsychological treatment:
- Dealing with cognitive changes (compensate/cope) > cognitive rehabilitation
- Grief/depression and anxiety, sexuality, intolerance etc.
- Environment
- Psychotherapeutic techniques

ICF model for neuropsychological treatment for stroke:
1. Brain training, pharmacotherapy, brain stimulation result in activities loss see below
2. Skills training.strategy training will change participation in live see below
3. Vocational rehab/holistic rehab
System therapy > surrounds patient (people that surround them)
Coping skills training > individual characteristics patient

MS:
- Most often fatigue as frequent symptom
- Damage of the myelin > signal from one cell to the other is interfered and leads to
cognitive changes
- Measure using MRI techniques > white dot is an infection due to the disease and
information processing is interfered. A lot of places in the brain.
- Different subtypes:
a. Progressive
b. Secondary progressive
c. Relapse and remitting (benign, most often) > after an infection, the brain can
repair itself and is the question if that is possible.
A are control and B are patients > patient group needs to recruit more brain
areas to do the same task as healthy people. More activation for the same
task > could explain the fatigue, but is an academic model to explain to
patients how they can understand the fatigue

Neuropsychological assessment

, Exam:
2 case reports and be neuropsycholoog
2 article questions (recovery)

Stroke + TBI and for each a case and most important is to understand the concept and
related

- Infection origin in MS leads to cognitive, emotional and social changes
- Relapse and remitting is most common
a. Mental slowness
b. Impaired speed of information
c. Secondary working memory problems
d. Mental fatigue
e. Depressed mood
f. Anxiety
g. Role changes
h. Loss of work/hobbies
i. Dependency
- Primary progressive:
a. Executive dysfunction (organization/planning.initiation/adapting behaviour to
environmental changes)
b. Irritation.anger
c. Flat affect
d. Social cognitive problems recognition
e. Irritability/impulsivity/loss of control
f. Loss of interest/apathy/motivational problems
g. Lack of concern

31/08/2021 PBL 01: A matter of approach

2 options for exam:
- Diagnosis + intervention plan of a patient > combines knowledge about symptoms
etc. Decide if we do it this way for the exam.
- 2-3 weeks before the exam > new articles (new angle on a scientific article and need
to discuss critically yourself). You can provide your own opinion.

3 little problems:
Some notes:
- Used to be phrenology > based on formalities of the skull base someone’s
characteristics.
- Lesions in every cortical zone can result in different problems. Luria proposed this
idea of networks that can be disturbed and lead to several forms of lesions.
- Shifts in the image that are still present in nowadays neuropsychology.
1. Defining concepts:
- Luria = groundbreaking for not thinking about local lesions, but more towards
networks
2. Problem statement
- How different discoveries and theories have led to neuropsychology nowadays/how
they have evolved.

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