Today neuroscience can no longer deal with the brain considering only the perspective of neurobiology that is interested in more structural levels of the nervous system (cellular and molecular level); with the entry, in the mid-twentieth century, of cognitive sciences in the panorama of sciences it is considered that the nervous system should be studied in relation to mind and behavior. Thus, disciplines such as psychology, neuropsychology, linguistics, philosophy, physics, artificial intelligence,… They can provide valuable information about the functioning and organization of the brain-mind. And what would be the consequences of this change? Currently it will not be enough to talk about neuroscience but we should talk about cognitive neuroscience understood as the study of the nervous system from a multidisciplinary point of view.
That means giving answers to questions such as how do we move?, how do we perceive?, how do we think?, how do we imagine?, how do we speak?… In short, how we interact with the world to give it meaning. Returning to history, the rehabilitation of the early twentieth century, according to the behaviorist paradigm that prioritizes environmental stimulus excluding the investigation of any intermediate process between it and the response, considered movement as a reflex response to a stimulus and interpreted pathology as an alteration of reflex activity.
In a multidisciplinary field, from psychology to linguistics, the second half of the twentieth century offers a different panorama. On the one hand in the USSR, Alexander Romanovich Luria, like other scientists of the time, begins to deal with higher cortical processes.
While in the Soviet Union there is talk of functional systems (Anokhin, Luria), in parallel in Europe “The General Theory of Systems” by the Austrian Ludwig van Bettanffly is published and, a few decades later, towards the 80s, the scientific world speaks of self-organization of living beings. Biologists Humberto Maturana and Francisco Varela dedicate their efforts to establishing the difference between living beings and those that are not and conclude that living beings are characterized by the ability to know.
The CNS and the behavior of man are interpreted in the light of this new knowledge and all those processes that behaviorism and the physiology of reflexes excluded, can now and should be investigated. Therefore, those processes not directly observable, such as mental activity, begin to gain importance and from here we can date the birth of cognitive science (50s twentieth century).
In the last three decades, adapting to the scientific knowledge of the time, the Italian neurologist Carlo Perfetti has been especially interested in these processes relating them to the recovery of sensorimotor deficit in hemiplegic patients (1970, Italy) and progressively developing a new vision in rehabilitation called neurocognitive theory.
This takes into consideration the contribution of cognitive neuroscience to the study of the processes that lead to knowledge understood as the ability to make sense of the world through the fragmentation of the body. Fragmentation is understood as the ability to direct different segments of the body in different directions through the joints. Cognitive processes such as memory, attention, perception, language, image… They are considered important for the physical recovery of the patient.
Neurocognitive theory holds that the entity and quality of recovery depend on the type of cognitive processes activated and the mode of activation. The hypothesis that bases the neurocognitive theory is that by activating these processes, basic to allow man a significant interaction with the world, modifications are achieved in the CNS and in the patient’s behavior.
Movement is no longer considered a reflex response to a stimulus but a means to know; rehabilitation is conceived as learning in a pathological condition and the body is seen as a receiving surface capable of fragmentation.
These are the three basic principles of neurocognitive theory and in turn, have important consequences for the rehabilitation of the neurological patient; Exercises and all therapeutic conduct should be consistent with these principles. For example, it is considered that to recover movement we should not ask the hemiplegic patient to move but to think, to recognize, to perceive, to imagine. How is it achieved? We must create, with the exercises, programmed situations of recognition in which the patient activates those cortical processes that spontaneously could not activate because of the injury. That is, in the case of a kinesthetic exercise, the patient is proposed, with his eyes closed, to discriminate in which position, among several possible, the therapist has positioned his arm.
The attempt of recognition will force a new organization of the human system that can be objectively verified through the observation of motor behavior (modification of the pathology in case of injury). According to Perfetti, movement (for example, of the arm) is a way of knowing (allowing him to discriminate position), of interacting with the environment through the fragmentation of the body. Exercise is considered a problem whose attempt to solve it forces a change in nerve processing, an activation of new areas of the brain and finally the control of the pathological elements characteristic of the pathology.
Thinking, projecting, feeling… It should not be exclusive to the patient but the therapist himself must always be modifying and attentive to what he observes and what the patient explains, not being valid standardized treatment protocols. In fact, neurocognitive theory has been adapted in recent decades to knowledge in cognitive neuroscience allowing a more precise definition of pathology (specific motor and profile), individualizing peculiar work instruments (problem, perceptual hypothesis, motor image, control) and generating exercises consistent with the theory.