Executive Deficits – Flexibility

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

The third element of out tri-partite elements of executive functioning is Flexibility. The problem with Flexibility after brain injury is that it is hard to predict when you need to be flexible. Routine can be very important to survivors of severe brain injury. It may be that relearning day-to-day tasks requires so much of the available reserves, that any diversion from the routine, demands too much.

Paradoxically, while frontal dysfunction can contribute to problems with being on time, it also makes survivors extremely intolerant of someone else who isn’t.

Take the case of TJ, a survivor of a severe TBI with a 7 week coma and during which he had a persisting GCS score of 4. Considering that there was serious debate about removing life support during his coma, his recovery has been satisfactory. He now is co-chair of a TBI support group with his step-mother, Michelle. He rides his bike independently and comes across more reserved than impaired. But the frontal lobe issues and neurobehavioral concerns still persist. Michelle in our interview talked about TJ’s problems with flexibility:

Well, TJ cannot multitask.  So the fact of giving your interview today, he was dressed and ready for you at 7:00 a.m.  He did not do anything.   There was no go for his bike ride and his bike ride is just down the other street. There is another gentleman that has traumatic brain injury and they sit and play cards for as long as four hours. But he couldn’t do that today because you were coming and you were coming at 12:00.  There was lots of things you could get done between. He sat and he waited for you to come.  He knew the minute you pulled in the driveway and was at the front door waiting.

I’m glad I was on time. 

Yeah, oh he would have had a fit if you weren’t.  He cannot, you don’t change.  If you say you’re going to do something, you better do it. Just for instance: Red Lobster for dinner and all of a sudden you decide, well, I’m really in the mood for Chili’s.  That, you cannot do that in this household.

For the beginning of the TJ story, click here.

Michael, another severe survivor who has had a longer and more satisfactory recovery, gave us a more nuanced view.

In a job, you are expected to come in every day and follow the same routine.   Were you capable of doing that daily?

No, because every time I went into the places I was working things would switch.  And since I worked in the human service area of where I worked that was very hard to deal with. 

How important is routine to you? 

I like routine with some things. For example, when I need routine is when it comes with my kids.  If, when I have to take them to school and pick them up and then, there are certain routines that we do - homework, other stuff.   But say for, like, around the house, I have a hard time following routines here specifically.

Do you have problems when something changes the routine? 

Very much. Example: I just took the kids to school, came back home and I need to go pick them up because they're sick at school.  That throws my routine off for the day, even though I don't have too much of a routine.  But now they're coming home.  I have to watch them, I have to take care of them.

Now we're on spring break right now.  And so that's off your routine? 

Yes very much.

Today's Good Friday. 

Yes.

They're back to school on Monday? 

Oh I'm so happy.

For the beginning of the Michael story, click here.

In football, the more flexible the quarterback in terms of changing the play at the line of scrimmage, the more successful the team will be. The quarterback’s flexibility will increase as he acquires more knowledge of his team and the opposing team’s defense. The sports cliché is that as the quarterback gets more experienced, the “game slows down” for him. Translated, that means that the information is not coming in to fast for the quarterback to process it, with flexibility, under the time pressure it takes to be successful.

Frontal lobe injury has the opposite effect. What happens is that life “speeds up.” Information comes in at a pace that the brain no longer can process it fully, in real time. Allow more time under optimal conditions, the processing may be completed. But add time pressure to any function, and the deficits will multiply.

 

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

This site is brought to you by the advocates of the Brain Injury Law Group, a community of plaintiff's trial lawyers across the United States united by a common interest in serving the rights of persons with traumatic brain injuries and a common commitment to fully understanding the anatomic, medical and psychological aspects of TBI.