From Belfast to Dublin: a busy week for neuropsychological rehabilitation

by Dr Sara da Silva Ramos, Senior Research Fellow

 

Those who follow key events in neuropsychology and neurorehabilitation know that July is a busy month. So much so, that we’ve kept extra-busy ever since!

Within the space of a week, members of the Brainkind team attended two important international meetings: the NR-SIG-WFNR conference (Neuropsychological Rehabilitation Special Interest Group of the World Federation for Neurorehabilitation) in Belfast, followed almost immediately by the International Neuropsychological Society (INS) Mid-Year Meeting in Dublin.

Two conferences, two cities and rather a lot of new findings and innovations in neuropsychology and rehabilitation. Inevitably, there was much more to hear and think about than we could possibly cover here. But a few themes stood out.

Cognitive enhancement in rehabilitation: does it work?

This sounds like a surprisingly basic question for a neurorehabilitation conference. But Professor Caroline van Heugten’s opening keynote in Belfast, “Cognitive enhancement in rehabilitation: hype or hope?”, provided a useful reminder that rehabilitation is ultimately about enabling people to function better in their everyday lives – not simply improving scores on tests.

The mechanisms underpinning recovery are complex. Neuroplasticity, recovery and compensation all have a part to play, and rehabilitation may involve restoring function, learning different ways of doing things, or changing the environment around a person to provide scaffolding and support. The question then becomes “what works, for whom, and in what circumstances”. Prof van Heugten’s talk gave a comprehensive and enthralling overview of the evidence base for cognitive enhancers in neurorehabilitation, but the hard truth is that it is still quite limited. This means that there is more work to do, but also we need to approach the wide range of cognitive enhancement options with caution, and be aware that some might not help at all!

Measuring what matters

Another recurring theme in both conferences was whether our usual ways of assessing people, particularly anxiety and depression, always tell us what we really need to know.

Dr Alexandra Rose presented a formulation-based model for assessing mood following severe brain injury. Rather than relying solely on standardised measures, the model considers multiple sources of information and individual circumstances. While Dr Laura Calabrese’s presentation, exploring the addition of brief qualitative interviews to multidisciplinary follow-up after cardiac arrest, provided some insight into the counter-intuitive results of our own study “Is ignorance bliss?”, exploring the interaction between self-awareness and self- versus clinician-reported mood. We found no evidence for this catchy saying, as the levels of depression reported by those with lower self-awareness were very consistent to the assessments by clinicians. Dr Calabrese’s study highlighted that the information that people with depression and professionals think about to provide ratings in a questionnaire may be quite different. All three studies prompted the same thought: standardised questionnaires are extremely useful, but sometimes the numbers they derive cannot tell us the whole story.

Neuropsychologists famously like measurement. But good measurement still requires us to understand the person behind the score.

Rehabilitation beyond cognition

Both conferences also prompted reflection on how much the field has expanded beyond a narrow understanding of cognitive rehabilitation.

We heard about studies focusing on relationships, identity, emotional adjustment, communication, peer support, social cognition and the needs of families. There was also considerable interest in how rehabilitation can be delivered differently – from telehealth and online interventions to smart devices and other forms of assistive technology.

This matters because a person’s rehabilitation does not happen independently of their environment. Recovery takes place within families, communities, relationships, workplaces and services.

That message was even stronger a few days later in Dublin.

Professor Shari Wade’s work on paediatric brain injury has long emphasised the influence of family and social environments on children’s outcomes, alongside the possibilities offered by technology-supported interventions. Her plenary talk “Reimagining pediatric neurorehabilitation: where we are and where we must go”, returned attention to the long-term consequences of childhood brain injury and how best to support both children and their families.

One particularly memorable message was that rehabilitation cannot end with the child. Parents, siblings, school and the wider social environment are all part of the picture. There were many parallels with adult rehabilitation, which must also consider the whole individual and the relationships and environment that surround them.

From evidence to practice

If Belfast generated questions about what rehabilitation is, or should be, trying to achieve, Dublin provided an opportunity to consider what holistic rehabilitation looks like in 2026.

It was a great privilege to chair a symposium on this theme, entitled “Revisiting holistic neurorehabilitation in 2026: evidence, challenges and solutions”. Our Director of Research, Professor Rudi Coetzer, Dr Christian Salas and Dr Anne Norup, and I were surprised to have a reasonably sized audience, but very honoured to see them first thing in the morning on the last day of the conference, with lots of ideas and energy left in the tank to engage in a lively conversation.

This brought us back to a familiar challenge. Neuropsychological rehabilitation has accumulated an increasingly sophisticated evidence base, but translating evidence into routine clinical practice can remain challenging, with many factors to be balanced, including, of course, a good balance between benefits and costs.

Brainkind research on the international stage

Brainkind was also represented by our Clinical Director, Dr Pieter Du Toit, Dr Annmarie Burns, and Dr Natasha Anderson. This provided an excellent opportunity to network with colleagues, and develop ideas for improvement.

Dr Burns and Dr Anderson presented work concerned with equitable access to brain health and neuropsychological care. In Belfast, this focused on a study exploring the prevalence and consequences of co-occurring neurodevelopmental conditions among people accessing brain injury support within the criminal justice system. In Dublin, Dr Burns presented on Brainkind Adapt, our new tool to support people with lived experience of domestic abuse presenting with brain injury symptoms, and further evidence of the positive impact that our Brain Injury Linkworker service is having for people with brain injury within the criminal justice system.

Disseminating Brainkind’s research at international meetings is important, as it helps extend our reach beyond our services. But being able to bring back new evidence, questions, and ideas emerging from conversations with colleagues working on similar problems around the world is also extremely valuable.

What did we bring home?

The most striking observation following a whole week of symposiums, plenary talks, and poster sessions was that despite all the advancements in the science of neuropsychology and neurorehabilitation there is still a lot more to uncover. This is perhaps not surprising, given that underlying it all is the brain – arguably our most complex organ – but also everything else that emerges and surrounds it, that makes us human, continuously curious and motivated to do more and better.