Of the hundreds of billions of neurons and the lobes of the brain they make up, arguably the most important ones compose the frontal lobes. These lobes are where the majority of higher-level thought and decision making takes place. However, when this part of the brain sustains injury, a number of other functions can be affected.
Frontal Lobe Functions
- Emotional response
- Expressive language
- Word associations
- Motor memory
While survivors of a brain injury (BI) may not display signs of problems in the above-listed areas, these are problems which exist for the most part only when there is damage to the frontal lobes. Like planning complex movements, theability to plan a sequence of complex movements needed to complete multi-stepped tasks, such as making coffee (Sequencing), and loss of spontaneity in interacting with others including loss of flexibility in thinking. Additionally, the tendency to perseverate, or keep the same thought rolling over in your head is substantial.
I was talking to a doctor today, and she said, "Did you realize that you are not really flexible in your thinking?" Well, yeah, I told her, I'm bad about perseverating, too. She agreed with me, we laughed and she said " Really, you have a problem being flexible." I asked her to clarify what she mean, and she said that once I get going with a thought, even though I think I should not say XYZ, that I just get going and can not keep myself from "going there."
She was right. Sometimes it's like I get going down a hill, and just can not stop myself. It's like the brakes do not work in my car going down Monteagle Mountain. Just like there are different areas which are affected with each BI, there are dozens-if not hundreds-of ways the survivor can be affected.
Impaired justice is a major problem for many survivors of TBI: knowing what to say and what not to say. It can even translate into other areas of survivors' lives like behaviors.
Consciousness is another area in which problems can occur when someone injures the frontal lobes. I do not just mean remaining conscious, but rather being aware of their surroundings. Often survivors do not know where they are if they go to the store, and many have difficulty remembering what day it is. These are all due to a problem with consciousness.
The third area which can become problematic for BI survivors is initiation . When there is an issue with this, the survivor may have difficulty doing even the simplest things, like making lunch or deciding on a book to read. I'm not saying that we all do not have days like that, but for the BI survivor with a problem in this area, signals and symptoms are more prevalent.
The next area of concern is emotional response . How the survivor deals with disappointment, pleasure, or even being told something as unexciting as what time it is, is displayed when there is a problem with emotional response. The survivor may laugh at inappropriat times or cry when a compliment is given.
The next problem which TBI can cause is with expressive language . Although being dead-pan can be appropriate and even funny at times, for a survivor with this affliction, life is no laughing matter. The survivor has difficulty knowing how to include inclection into his voice, so that "The house is on fire" sounds the same as "I'm bored." When I was early on in my recovery, the nurses in my neuro-rehab unit teased me by saying things like "I just won a million dollars" with little or no intonation while they would use gredat inflection when relishing something mundane.
When the survivor has difficulty with word associations , often he uses the wrong word for everyday objects. Like saying door for window or calling a trashcan an umbrella. The problem lies in the ability to recall words with the appropriate meaning attached to them.
Finally, BI survivors have difficulty with motor memory . This means that their muscles do not function in quite the same ways as they did before the injury. For example, my left foot acts as though it does not know where it's going as I lift it to step forward. Not my whole leg, but just my foot tends to "flop" and make a curve while in the air. Another example is swallowing. For those survivors with problems with motor memory, the act of swallowing – having the epiglottis close while liquids move into the esophagus – can prove to be most challenging.
The above listed areas are signs and symptoms of having some sort of frontal lobe damage. For the most part, when a BI survivor has difficulty in one of these areas, there are difficulties in other areas as well.