Executive Functioning Deficits After TBI

By Attorney Gordon Johnson
Call me at 800-992-9447

Perhaps too much of the focus on frontal lobe deficits is upon executive functioning deficits. Damage to this part of the brain can impact almost all things that make humans unique within the animal kingdom. It is in frontal development that man is most different than all other mammals, even the great apes. Yet, to understand the breadth of frontal lobe dysfunction, it is appropriate to begin executive dysfunction.

My long time colleague and mentor, Nils Varney, Ph.D. had this to say: “Executive functions are the neurocognitive operations that enable purposeful behavior as it unfolds in time.”

“Executive” decision making involves managing the brain’s resources. To help understand executive functioning, we will begin with these three primary areas of management of the brain: goals, organization of time and flexibility.

• 1. Goals. A person or organization must be able to set goals;
  
• 2. Time Management. Likewise, in order to achieve those goals, a person or organization must organize how time and effort are allocated to a plan; and
• 3.  Flexibility. A person or an organization must have sufficient flexibility to shift the methods of enacting the plan, when change or miscalculations require it.

Think of the brain as the quarterback of an American football team.  The team has the larger mission of winning the game, going to the playoffs, winning the Super Bowl.  The quarterback has smaller missions on each play, each drive.  Prior to the game, the coaches will create a game plan to achieve those goals. Each player is assigned his tasks to carry out the game plan.  Such goals must be carried out in the proper temporal sequence. Yet, the success or failure of the short term and long term goals, will depend upon the ability of the executive on the field, the quarterback, to implement the plan. 

Even if all other parts of the team are operating as expected, if the on-field executive is unable to coordinate all of the various activities of the other players – in time sequence and with flexibility to make changes –  the team will fail.
Without a plan (Goals), the team will fail. Without the quarterback to coordinate the time sequence of his teammates (Time Management), the play will fail. If signal caller can’t change the signal (Flexibility), at critical junctures, the play will also fail.

Underlying much of executive dysfunction is a disruption in the premorbid sense of self and the surrounding world. Self-awareness impacts the above three primary areas, but also has social ramifications which compromise insight and empathy.

 

Contact Attorney Gordon Johnson: 1-800-992-9447

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