Context sensitivity - Why meaning matters

by | Feb 16, 2021 | Neurorehabilitation

Bild Apfel Kontextsensitivität

Alexander Romanowitsch Lurija and the experiment with apples

In 1963 Alexander Romanovich Luriya treats patients with neurological diseases. Luriya is a psychologist at Moscow University. He studies human behavior and how our brain is involved in producing that behavior. Among other things, he wondered what happens when parts of the human brain are damaged. Here, Lurija encounters a wide variety of people and also a lot of different diseases. 

One particular approach to treatment remained particularly memorable to Lurija. Together with patients suffering from a paralyzed arm, also called "arm paresis," after a stroke, he performed various exercises. Among other things, the patients were to repeatedly lift the paralyzed arm as high as possible. This was to gradually improve the movement of the arm. Another task was to lift the paralyzed arm to the height of a shelf hanging high on the wall and perform a reaching movement. The third task now involved grabbing an apple from this same shelf. Each of the three tasks was very challenging for the patients. Lifting the arm was difficult for many patients. Lifting the arm to the shelf was at least as difficult. 

Because of this, the result of the third task was surprising: If an apple was placed on the shelf, almost all patients suddenly managed to lift their arm higher than before. Actually, nothing had changed - the paralyzed arm was not miraculously healed by the apple on the shelf. And yet, one crucial thing was different: The keyword is "context sensitivity".


Why is context sensitivity important?

To understand what is meant by context sensitivity and its importance, we need to go back a few decades. The traditional approach to guiding patients with neurological disorders through rehabilitation at that time focused on treating the major symptoms of the condition. That means, if one suffers from difficulty with concentration, one receives training with specific exercises. These exercises then exclusively train concentration. In the case of speech disorders, one begins to relearn individual words step by step in order to find one's way back to speaking. 

Until the 1990s, this approach was the standard, especially for cognitive disorders (difficulties in thinking and behavior). The exercises became more difficult step by step until a certain level of performance was achieved. Over time, however, it was found that only repeating these training tasks led to a mess: Patients got better at performing the tasks, but still couldn't remember a conversation or follow lessons any better. This is because mental abilities cannot be divided into completely separable components. Memory, for example, is very closely related to attention. Attention, in turn, is important for us to be able to concentrate. Especially in everyday life, several components of our mind are often engaged at the same time. 

That's why special educator Lester Mann emphasized back in 1979 that neurorehabilitation should always focus on helping patients where they need it most. Young patients today may benefit more from relearning how to use a smartphone. For older patients, gardening with a shovel and rake may be of greater value. Even if in the end it becomes clear that both are learning similar patterns of movement and thinking with different tasks, the main thing is that rehabilitants clearly see where what they are learning is being used.

Context sensitivity is particularly interesting from the perspective of how our brain learns. When we learn something, a link to it is created in the brain. These links become stronger the more often we refer back to them. How this works in real life can be seen in learning a language: If we learned French or Latin as children in the past, we might actually be able to speak or at least understand it quite well when we went to school (author's note: Latin was usually more of a pain). At that time, every time a new vocabulary or grammatical rule was learned, a new link was created in the brain and the already existing ones were consolidated. If we then even have a good reason to use the language, for example because our latest sweetheart speaks French, we will most likely find it easier to learn and use the language. However, the longer this does not happen, the more difficult it becomes to store or recall what we have learned. The links do not become stronger or weaker. The vocabulary and rules lose their context. And thus their meaning. 

In the example of Luriya, simply moving the paralyzed arm upward had little meaning for the patients. However, when they were asked to reach for an apple, there was suddenly a context and the task became easier. What do we conclude from this? If therapy is embedded in a context, chances for a functional rehabilitation may be higher.


Context sensitivity in therapy

However, implementing this is often a greater challenge in everyday therapeutic practice. Neither inpatient nor outpatient neurorehabilitation can do justice to every special feature of a patient's life. It is therefore all the more important to find out together, i.e. with the patients, relatives, therapists and doctors, where a therapy can start. In this way, it is possible to find out together how abilities can be trained in the best possible way. The patient's own needs should therefore be at the forefront when deciding which abilities to re-learn. In doing so, it is important to consider which abilities were important for one's own life before the illness and which could be so in the future. If therapy is geared toward a return to everyday life and if it is directly recognizable to the patient what he or she is receiving a particular treatment for and how he or she can use the acquired skills in everyday life, the probability of therapy success is higher (Frommelt & Lösslein, 2010).

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