Аннотация:Neuropsychological assessment necessarily precedes neurorehabilitation. Luria's approach to the assessment of patients with brain lesions consists of first describing the deficits in high-order cognitive functions, secondly determining the damaged brain areas responsible for these symptoms and finally defining a neuropsychological syndrome as a genuine constellation of these symptoms.
Two practical issues come up with the assessment. One is the need of defining the structure of the neuropsychological deficit that guides the development of the rehabilitation plan and evaluation of the progress.
Second is related to the localization of the lesion and more importantly to the detection of functionally affected brain regions that cannot be observed using structural imaging techniques.
Original syndrome analysis proposed by Luria was based on the description of syndromes that result from the well-defined local lesions. Diffuse brain lesions (e.g. TBI, MS) lead to multiple deficits that don't converge into a unit syndrome but could rather be described as a complex of syndromes associated with affected brain regions.
Global pathological conditions (stroke or epilepsy) secondary disturb the normal functioning of different brain regions functionally and morphologically connected to the prime lesion. These dysfunctions show up in the assessment in form of mild to severe syndromes. Combinations of these syndromes might reveal a stable pattern. A new concept of metasyndrome is introduced in order to describe these repetitive patterns that reflect both the effects of lesion and functionally impaired brain regions on cognition and behavior. It was further applied to the analysis of the focal epilepsy in adolescents.