Monday, November 10, 2008

Frontal Lobe Injury

Frontal Lobe Injury

Consequences of Frontal Lobe Injury

The major role of the frontal lobes is the regulation of behavior. They coordinate attention, memory, language, perception, motor functions, and social behavior as we go about our daily living and vocational activities. In short, they put the human machine to work. When function is impaired, all of the other cognitive systems are affected even though they remain individually intact. The frontal lobes have been likened to the pilot of a Boeing 747, without whom millions of dollars worth of highly complex technology would sit idle at the airport. Recognition and appreciation of these deficits is critical to rehabilitation efforts with the closed head injured population. These deficits can be classed generally and include:

* Problems of Starting--This may manifest as decreased spontaneity and initiation. Such individuals seem to lack motivation and may sit silently without apparent interest in or curiosity about surroundings until they are directed to do something.
* Difficulties in Making Mental or Behavioral Shifts--This includes rigidity or perseveration on a single idea or a single action. Individuals with these problems may be able to successfully verbalize solutions to problems, including plans necessary to meet goals successfully, yet be unable to put any plan into effective action.
* Difficulties with Attention--Individuals with frontal lobe deficits are often captured by extraneous aspects of a task. As a result, they may demonstrate behaviors which seem irrelevant, even bizarre, to the observer. Because they may be highly distractible, they often seem to shift focus continually, never arriving at a point which seems purposeful.
* Problems in Stopping--This may manifest as a more general deficit in self monitoring. It may present as impulsivity or a quickness to anger, speaking too loudly, or carrying a joke or sexual innuendo too far.
* Problems with Social Awareness--This category would include deficits in the ability to appreciate the impact one makes on others, sometimes resulting in rude or insensitive behavior or with a general lack of apparent concern about social conventions.
* Deficient Self-Awareness--Defective self-criticism may be associated with a tendency to be self-satisfied, to experience little or no anxiety, and to fail to appreciate the existence and practical implications of deficits (limited insight).
* A Concrete Attitude--Some patients with frontal lobe lesions retain high-level conceptual abilities but demonstrate a day-to-day literal-mindedness and loss of perspective.

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