Enactive Approach and Dual-Tasks for the Treatment of Severe Behavioral and Cognitive Impairment in a Person with Acquired Brain Injury: A Case Study

Abstract

One of the most important sequela in persons who suffer from acquired brain injury is a behavioral disorder. To date, the primary approaches for the rehabilitation of this sequela are Applied Behavior Analysis, Cognitive-Behavior Therapy, and Comprehensive-Holistic Rehabilitation Programs. Despite this theoretical plurality, none of these approaches focuses on rehabilitating behavioral disorders considering the relation between affordance and environmental adaptation. To introduce this therapeutic view to neurorehabilitation, we apply the theoretical tenets of the enactive paradigm to the rehabilitation of a woman with severe behavioral and cognitive impairment. Over seventeen sessions, her behavioral and cognitive performance was assessed in relation to two seated affordances (seated on a chair and seated on a ball 65 cm in diameter) and the environmental adaptation while she was working on various cognitive tasks. These two seated affordances allowed to incorporate the theoretical assumptions of the enactive approach and to know how the behavior and the cognition were modified based on these two postural settings and the environmental adaptation. The findings indicate that the subject exhibited better behavioral (physical and verbal) and cognitive (matching success and complex task) performances when the woman worked on the therapeutic ball than when the woman was on the chair. The enactive paradigm applied in neurorehabilitation introduces a level of treatment that precedes behavior and cognition. This theoretical consideration allowed the discovery of a better relation between a seated affordance and the environmental adaptation for the improvement behavioral and cognitive performance in our case study.

Phenomenological Research Needs to be Renewed: Time to Integrate Enactivism as a Flexible Resource

“…Many authors have expanded on the work of Varela et al (1991) and applied enactive theory in many ways to various areas, such as: mathematics education (Reid, 1996), architecture (Jelic et al, 2016), brain injury (Martínez-Pernía et al, 2016), schizophrenia (Kyselo, 2016), cerebral palsy (Martiny, 2016), correctional (criminal) rehabilitation (Dent et al, 2020), (Engel, 2010, p. 220-222).…”

Experiential Neurorehabilitation: A Neurological Therapy Based on the Enactive Paradigm

“…Although many authors across various fields of knowledge lament the lack of attention given the body following the emergence of cognition, rarely has it been discussed, nor indeed analyzed, for its impact on clinical application (Martínez-Pernía et al, 2016). Since many interventions require the stimulation of the body for the stimulation of cognitive function, perhaps the assertion that the body has little relevance in cognition and, therefore, in behavior, may be seen with skepticism among neurorehabilitation researchers and therapists.…”

“…To wit: the gold standard of these disciplines is to perform therapeutic sessions with the patient seated in a chair (Martínez-Pernía et al, 2016). This is not to suggest that bodily or environmental stimulation produced by the therapist during the session -and transferred to the brain as a sensory signal -does not improve neurological damage suffered by the person.…”

“…The enactive paradigm has been widely applied in various fields of knowledge such as neuroscience, philosophy, education, psychology and artificial intelligence, among others (Damasio et al, 1991;Varela et al, 1993;Brooks, 2003;Gallagher, 2005;Shapiro, 2011;McGann et al, 2013). However, in the field of neurorehabilitation few studies have been developed from this perspective (Martínez-Pernía and Ceric, 2011;Øberg et al, 2015;Hay et al, 2016;Martínez-Pernía et al, 2016;Repetto et al, 2016;Cardona, 2017).…”

“…By incorporating a new theoretical framework in neurorehabilitation, not only will the understandings of the therapeutic process be broadened to living systems and their environmental interactions as a whole, so too will the possibility of generating and creating new therapeutic strategies based on its theoretical precepts. Thus, for example, the study developed by Martínez-Pernía et al (2016) investigated differences in behavioral and cognitive performance under two different postural settings (sitting on a chair vs. sitting on a ball). That exploration of patient dynamics in structural coupling between the body and the environment in rehabilitative learning showed that neuropsychological therapy sitting on a ball achieves better cognitive performance and greater behavioral self-regulation than sitting on a chair (traditional therapeutic setting).…”