AULA 1 | ASPECTOS HISTÓRICOS DA NEUROPSICOLOGIA

Hi, peoples. This is the first video lesson and we will talk about the historical aspects of neuropsychology. I wanted you not to stick to the dates, because the importance of this class is related to the ability to identify how each character and how each discovery was essential for the formation of neuropsychology as a modern evidence-based discipline.

So, think of this historical process as a construction process, you don't need to decorate the dates, you just need to know how each period contributes, in its own way, to neuropsychology as it is seen today. So to begin with, the first reports on medical practices date back to something between seven thousand and twenty thousand years ago, where the knowledge based on mysticism affirmed that the illnesses were the result of evil spirits housed in the skullcap and from that came the trepanation, which it is a practice that consisted of opening a hole in the skull of individuals so that the evil spirits could leave. The evidences on this practice goes back to the archaeological findings of skulls with these perforations, such as examples of a skull that was excavated in a tomb in Jericho, Israel in 1958, think that this practice could be both ritualistic and therapeutic.

A curiosity about it is that as you can see here there was a process of calcification, that is, there were individuals who survived these practices even in those remote times, without modern medical devices and without sedatives, this is quite impressive. However, the oldest account we have of the nervous system is found in Edwin Smith's papyrus , written about 1700 years ago BC, possibly by the Egyptian physician Imhotep. This papyrus contains discussions about clinical cases, treatments and prognosis, as well as inserting the term "brain".

In general, the reports found in these papyri are outside the standard of the time, which were much more related to medical-philosophical conceptions based on the supernatural and mysticism as we discussed in trepanation, for example. In ancient Greece the focus was on establishing the center of cognition and behavior. On the one hand, we had the cerebral hypothesis, defended by some thinkers like Hippocrates, who argued that the brain was the center of mental functions.

On the other side we had thinkers like Aristotle, who defended the cardiac hypothesis, saying that the heart was the center of this cognition and behavior. Over time, the cerebral hypothesis became more popular and had been perpetuated by famous thinkers, such as Roman physician Galen, who during the pre-medieval period studied the anatomy of the brain, describing it. Galen's studies influenced the entire middle age, despite the decay process suffered by medical knowledge after his death.

During the Mediavel period, the Catholic Church took Galen's anatomical knowledge and assimilated its own ideas. For example, Galen described the cerebral ventricles, as you see in the image. The Catholic Church took this knowledge and added it to theological knowledge, as for example these three compartments that you can see here, they (the Catholic Church) said that they represented the most holy trinity then father, son and holy spirit.

For them, only a clear place, such as the ventricles where you have your cerebrospinal fluid - or cerebrospinal fluid - was pure to store the human soul, which for them was what made us have behaviors and cognition. Then the brain would be mundane and dirty, so just a place as clean as those ventricles could be is worthy of housing our soul, which would later become confused with our mind. From the second half of the 17th century, the mind-brain problem increased the discussions of the time.

René Descartes affirmed that the soul was a free and immaterial entity, while the body is a mechanical part, endowed with movement and totally controlled by that mind that we could neither see nor touch, therefore intangible and immaterial. The center of encounter between this intangible mind and this mechanical body was the pineal gland. Why?

Because the pineal gland was a region that did not correspond to brain asymmetry when divided in the middle, it was a unique region in the middle of the brain, so there was a whole symbolism in relation to this gland, in addition to other functions related to sleep, which also influenced Descartes choosing it as that center between the immaterial and the material. With the advent of the so-called "natural sciences" the mystical character of issues related to the human being lost strength, which caused new ways of perceiving the human being to appear. Franz Gall believed that the brain is actually a set of separate organs, each of which controlled a separate faculty or aptitude.

In this case, for him, starting from this assumption that each region corresponds to a function, the more that region was used, the more it would develop, creating hypertrophies in the skull. So, the more I used a region that, for example, corresponded to my intelligence, the more that region of my brain would develop, so the development of an aptitude would correspond to the development, on a physical level, in that region. In contrast, if I used one of these skills little, then depressions in my skull would occur, that is, flattening of my skullcap.

Despite the pseudoscientific and very doubtful nature of phrenology, it was responsible for the birth of what we know today as experimental neuroscience, because Gall's claims about where the subjects' aptitudes were located led to a large number of experiments, where part of the brain of animals they were damaged so that the symptoms could be observed. From this, a localization period began, inaugurated by phenology and with the birth of experimental neuroscience, which made possible the emergence of studies such as those by Broca and Wernicke, who through studies with aphasic patients managed to establish anatomical and clinical correlations between damage in specific brain regions and clinical symptoms. Broca, for example, studied patients with language expression difficulties and in the postmortem he was able to verify that those patients who were unable to express themselves properly had structural and functional damage in a region of the left frontal lobe, which is known today as the Broca's area.

On the same principle as Broca, Wernicke also studied aphasic patients. The difference here is that he studied patients with language comprehension difficulties. Wernicke found that these patients had damage in a region of the left hemisphere of the parietal lobe , known as the wernicke area today.

As you can see here in the image where the wernicke's area is located, but it starts from the same principle as Broca, that there is a specific region for language processing, in this case, for language understanding. From that he also managed to develop a model of linguistic processing, this model was later updated by Geschwind it is already a little outdated and has been replaced by more current models about how language processed in our brain, both comprehension and expression. From the 20th century onwards, the great name of neuropsychology was Alexander Luria, who during the second world war, in his work at the army hospital, made his greatest discoveries and contributions to modern neuropsychology.

He studied the case of soldiers with brain injuries and cognitive deficits, he also studied methods of neurological rehabilitation, making immeasurable contributions to modern neuropsychology. Luria also described a model of brain functioning based on dynamism. The Lurian brain is made up of 3 basic functional units, the function of which is necessary for any type of mental activity.

The first unit, as you can see, regulates the state of the cerebral cortex, changing and maintaining the waking state through the reticular formation. The second unit has the function of receiving, analyzing and storing information, which includes visual, auditory and sensory regions of the cerebral cortex . The third unit is related to the development of behavioral programs, which are responsible for their realization and participate in the controls of their execution.

This unit includes structures located in the anterior frontal or prefrontal regions of the cerebral hemispheres. According to Luria: "All human mental activity is a complex functional system carried out through a combination of brain structures functioning in concert, each of which makes its own particular contribution to the functional system as a whole". From the second half of the 20th century onwards, neuroscientists, in general, started to count on countless instruments and techniques for observing brain activity, in addition to the advent of new and increasingly sophisticated technologies, it is also necessary to highlight the growth of methods neuropsychological evaluation and rehabilitation , such as neurofeedback and transcranial direct current stimulation.