Central Nervous System:

Psychological disturbances, assessment and

methods of intervention
MS. ALISHA ARORA
ASSISTANT PROFESSOR, DEPT. OF CLINICAL PSYCHOLOGY
The central nervous system CNS is responsible for integrating sensory
information and responding accordingly. It consists of two main components:

1. The spinal cord serves as a conduit for signals between the brain and the
rest of the body. It also controls simple musculoskeletal reflexes without input
from the brain.

2. The brain is responsible for integrating most sensory information and

coordinating body function, both consciously and unconsciously. Complex
functions such as thinking and feeling as well as regulation of homeostasis
are
attributable to different parts of the brain.
 The highest region of the brain is the cerebrum, which
includes both the cerebral cortex that is visible on the outside
of the brain as well as other internal structures.

 The cerebrum is responsible for conscious sensation and

voluntary movement, as well as advanced functions such as
thinking, learning and emotion.

 Any problems in parts or subparts of the

central nervous system can lead to
significant disturbances in the human
behavioural and cognitive functioning
among the human beings.
DISTURBANCES TO CNS/PNS

Destructive/Deficiency
Irritative
(e.g. infarction, tumour,
(e.g.: seizures, parsthesias)
trauma)

Release
Compensation
(e.g. Parkinson’s disease,
(e.g. broad gait in ataxia)
hyperemotionality)
Although there are many diseases and disorders related to the problems in central nervous
system, we will be discussing about

 Cerebrovascular (stroke),
 Developmental (cerebral palsy),
 Degenerative (Parkinson’s etc),
 Trauma (traumatic brain and spinal cord injury),
 Convulsive (epilepsy),
 Infectious (AIDS dementia)
CEREBROVASCULAR DISEASES
Assessment of the stroke and its consequent dysfunctions

o National Institutes of Health Stroke Scale (1989)

o Canadian Stroke Scale (1986)
o Glasgow Coma Scale (1974)
o Rankin Scale (1957), to assess the extent of disability after stroke
o Barthel Index (1965) to assess the daily functioning after stroke.
o Screening Instrument for Neuropsychological Impairments in Stroke (SINS)
o Clock drawing test

It is to be noted that before proceeding towards the neuropsychological testing of stroke

patients some of the necessary physical examinations must be concluded, these would give a
better picture for diagnosis and prognosis of the disease. Such test includes:
o History of previous episodes
o Physical examination
o Laboratory examination (urine analysis, blood analysis, electrocardiogram)
o Cerebral angiography
o Examination of cerebrospinal fluid
o EEG
Psychological Interventions/ Rehabilitation

 Psychoeducation
 Gait Training
 Constraint Induced Movement Therapy (CIMT)
 Virtual reality
 Mirror therapy
 Mental Imagery
 Speech therapy (for aphasia)
 Communication based therapies
 CEREBRAL PALSY

 Non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the
various areas of body movement.

 Scientific-consensus still holds that CP is neither genetic nor a disease, and it is also understood that the vast majority
of cases are congenital, coming at or about the time of birth, and/or are diagnosed at a very young age rather than
during adolescence or adulthood.

 It can be defined as a central motor dysfunction affecting muscle tone, posture and movement resulting from a
permanent, non-progressive defect or lesion of the immature brain.
ASSESSMENT TOOLS FOR DETECTING CEREBRAL PALSY

 Ages and Stages Questionnaire

 Child Development Inventories (such as the Denver II)
 Parents' Evaluations of Development Status (DST, VSMS)
 Modified Checklist for Autism in Toddlers (M-CHAT)
Psychological Interventions/ Rehabilitation

 Neurosurgical procedures
 Occupational therapy
 Physical therapy (aqua therapy, hippo therapy)
 Speech and language therapy
 Assistive technology/aids
 Management of seating/positioning/casting
 Traumatic Brain and Spinal Cord Injury

Traumatic brain injury (TBI) is leading cause of short term and long term
morbidity and mortality. Most patients of TBI have a protracted course of
rehabilitation. It is the neurobehavioral outcome, rather than the
neurological deficits which are really taxing to the patients and the family.

A spinal cord injury is complete if there is no somatic motor or sensory

function below the lever of injury. If the arms are spared the patient has
paraplegia. If they are involved he has tetraplegia. The level of injury is the
lowest intact spinal cord segment. If there is residual function several
segments below this, them the injury is incomplete and the patient has
either paraparesis or tetraparesis. Use of the terms quadriplegia and
quadriparesis should be avoided.
 The Glasgow Coma Scale (GCS) is at present the most widely used and accepted scale. It is
perhaps inadequate and insensitive for monitoring patients who are likely to deteriorate.

 Also the use of X-rays, Computerized tomography CT scans and MRI scans are important in the
assessment processes of the TBI and SCI conditions.

CLASSIFICATION OF PATIENT WITH TBI/SCI

· Grade 1- Transient loss of consciousness (<5 min), now alert,
oriented without neurological deficit. GCS 14-15

 Grade 2- Previous loss of consciousness but able to follow at least

a simple command, other neurological deficit. GCS 9-13

· Grade 3- Previously unresponsive (<5min) and now not following

even a simple command. Pupil’s unequal, inappropriate words.
GCS <9.

 No evidence of brain function (brain death).

COMPLICATIONS

1. Post traumatic epilepsy

2. Post-concussion syndrome
3. Cognitive impairments
4. Memory impairments such as- retrograde amnesia, post-traumatic amnesia.
5. Behavioural changes including changes in personality changes and changes in interpersonal communication
changes, emotional changes.
Psychological Interventions/ Rehabilitation

 Pain management (relaxation, biofeedback, breathing, hypnosis)

 Direct attention training
 External memory aids
 Behavior management
 Learning new skills
 Awareness and metacognitive skills
 Speech-swallowing rehabilitation
 Epilepsy

Epilepsy is "an occasional, an excessive and a disorderly

discharge of nervous tissue“ induced by any process involving
the cerebral cortex that pathologically increases the likelihood
of depolarization and synchronized firing of groups of neurons
(John Hughlings Jackson, 1889).
 There are many potential underlying causes such as metabolic disorders of nerve cells or virtually any disorder that
damages cortical tissue including trauma, haemorrhage, ischemia, anoxia, infection, hyperthermia, or the presence of scar
tissue relating to prior injury.

 There are several types of seizures. Broadly, they can be divided into primary generalized seizures and focal onset
(localization-related) seizures.

 In primary generalized seizures, the seizure involves all of the cerebral cortex simultaneously. In focal onset seizures, it
involves a localized cluster of neurons having epileptiform activity.

 While most seizures present with motor correlates, some can present with mainly inhibitory phenomena.

 Seizures are not only recognized by the activity during the main portion of the seizure but also by phenomena that lead up
to the clinical seizure (often termed an "aura"), and the condition of the patient after the event (the "post-ictal" state).
ASSESSMENTS USED FOR EPILEPSY

 Electrocardiograph
 Blood testing
 Positron emission tomography
 Spinal Tap
 Bender Visuo Motor Gestalt test
 Luria Nebraska Neuropsychological Battery
 Serum prolactin levels
Psychological Interventions/ Rehabilitation

 Family counselling
 Educational interventions
 Behavior modifications
 Lifestyle modifications
 CBT
 Biofeedback
 Neurodegenerative/Infectious Disorders of Central
Nervous System

 Infection of the nervous system can involve the meninges (meningitis) or the brain substance
itself (encephalitis), or both (meningoencephalitis).

 Additionally, infections can be acute or chronic. The organisms that are involved in infection
are bacterial, parasitic or viral. Additionally, prions represent an unusual class of infectious
agent that can damage the brain.
Some of the commonly studied neurodegenerative and infectious disorders are:

 Alzheimer disease
 Parkinson’s disease
 Spinocerebellar ataxia
 Pick’s disease
 Muscular dystrophy
 AIDS dementia complex
Cognitive impairment
 Executive functioning
 Information processing speed
 Attention
 Memory
 Language
 Visuospatial/visuoperceptual functioning
 General intellectual functioning

Mood disorders
 Depression and
· Various anxiety disorders

Psychosis
Psychosis is one of the most disabling and distressing symptoms
.
Sleep disorders
Specific sleep disorders include insomnia, hypersomnia, parasomnia, and rapid eye
movement (REM) sleep behaviour disorder

Fatigue
Fatigue is one of the most common, distressing and disabling non-motor symptoms.

Neuro-behavioural disorders
Neuro-behavioural problems such as hyper-sexuality, preoccupation with complex motor acts
such as disassembling electrical equipment, hypomania and mania, aggression and
heightened irritability, an urge to walk considerable distances without purpose, pathological
gambling and shopping, and food cravings.
Common symptoms
Psychological Interventions/ Rehabilitation

 Cognitive rehabilitation
 Remedial training
 Compensatory approach
 Physical exercise and gait training
 Occupational therapy
 Educational intervention
 Behavior Modification
 Supportive therapy
 Group therapy (patient and caregivers)