The Carlo Perfetti Neurocognitive Rehabilitation

The Neurocognitive Theory (TNC), conceived by Prof. Dr. Carlo Cesare Perfetti (1940 – 2020) in the 1970s, studies the recovery of motor organization for subjects suffering from neurological pathologies of central or peripheral origin, pain syndromes, degenerative and musculoskeletal pathologies.

This theory considers that in order to reach advanced movement that brings the patient back to optimal performance, adopting modalities that engage the body and mind in a unitary and integrated way is a necessity.

The fundamental premise of Neurocognitive Rehabilitation (RNC) is that the processes of knowledge changes the biological structure of people and their actions, possibly affecting the subject as a whole. The pathology in general (and the neurological one in particular) disrupts the mind-body unit severely. Among the consequences, the subject loses the ability to perceive themselves in their own body, no longer recognizing indispensable self-attributes in interacting with the world.

The original hypothesis of the TNC pertains to the quality of recovery, both spontaneous and guided by the therapist, relying on the activation of cognitive processes and manner of initiation.

The Neurocognitive Theory's principles

1. The body is a receptor surface capable of providing for a meaningful world by processing various information: tactile, kinesthetic, visual, acoustic, friction, weight, pressure, etc. In human actions, the norm is the integration of differing information.

Each action is an act of knowledge, and as such, involves the construction of information and its integration. The information is not present in either the acting subject nor object. It is the interaction between the subject and the object that allows the construction of one piece of information rather than another one, selected based on the subject’s intentions.

2. Action is a means of knowledge.

The body can fragment to recognize itself, and this fragmentation is linked to intent and information needed by the subject. Muscle contraction represents the last link in a complex process (action), implemented by an intentional system that interacts with environment, according to needs, and provides meaning to this interaction physically and relationally.

3. Recovery is a learning process in pathological conditions.

Through the learning process (the activation with certain modalities of cognitive processes such as perception, attention, memory, motor image and problem resolution), the biological plasticity at the nervous system occurs. If we consider healthy subjects, we use the term ‘learning’. If we consider subjects with pathology, we refer to it as ‘recovery’.

Recovery and learning share the same mechanisms. Thus, the Neurocognitive Rehabilitation can be defined as a process of learning in pathological conditions for the recovery of skills lost after injuries.

The patient must be educated, instructed and trained on body perception, and through this perception, the processing of emotional and physical experiences, in addition to building and integrating information useful for knowledge. They will learn, with the help of a therapist and through cognitive exercises, to put in place adequate cognitive and organizational choices for behavioral change. To this end, the therapist has at their disposal neurocognitive tools, which are cognitive processes – through a Cognitive Problem, a Perceptive Hypothesis, a Verification of these hypothesis, a Representation of Action and a Comparison of Actions – that lead the patient to re-learn better actions from the point of view of motor organization. The preferred means of introducing and modulating all neurocognitive tools within the exercise is through language (from the patient and from the therapist).