Today, a look at what can happen when the work of the frontal lobe is interrupted or damaged.
This builds on my attempt last week to simply explain what the frontal lobe does.
How Does Frontal Lobe Damage Happen?
Last week I mentioned a book I had found useful THE EXECUTIVE BRAIN: Frontal Lobes And The Civilized Mind by Dr Elkhonon Goldberg.
In a Chapter entitled “When the Leader is Wounded” (yes your frontal lobe is the boss of the brain), he uses a military picture to describe how frontal lobe damage can happen.
I will try and summarise what Dr Goldberg describes:
If the leader is damaged, the soldiers (read ‘soldiers’ as ‘other lobes of the brain’) are without an organiser. The soldiers can’t sort out what needs to be done because they don’t know what each other is doing, no-one is taking charge, and they can’t do their job properly.
If the links between the leader and the field are damaged (inside, or outside the frontal lobe) the soldiers will be cut off from their leader, and soldiers in the field lack information to act as a team.
The frontal lobe appears to be very sensitive to damage. It can be damaged from a wide range of causes including dementia, stroke, disease, and trauma.
Dr Goldberg explains that the frontal lobes can be affected even if damage is not directly to the frontal lobe. For example studies of tumours elsewhere in the brain, showed that blood flow was disrupted around the tumour, and also in the frontal lobe.
Why would that be?
The conclusion is that the frontal lobe is very susceptible to what is going on in the rest of the brain. More sensitive than most other parts of the brain. This is most likely, because it has far more connections to other parts of the brain.
What does all this mean?
- Interruption to the work of the frontal lobe is common in brain injury of any type.
- Damage can occur whether the damage is to the front lobe directly, or to another lobe in the brain.
- Frontal lobe damage can cause a wide range of difficulties because it controls much of what the brain does.
What Can Happen With Frontal Lobe Damage?
Before listing what can happen with frontal lobe damage it is worth remembering 4 things:
- Every person with brain injury will be different, UNIQUE.
- Not all of these difficulties will occur in every person.
- The degree of difficulty will vary from person to person.
- It is not always negative. People do find new strengths, skills and talents. Imagine a politician who as a result of disinhibition, who could not help but tell the truth!
Cognitive Outcomes after Frontal Lobe Damage
In the list below I have underlined the terms you might hear, or read about, along with an explanation of what might happen if a person had this outcome. The list is not exhaustive, it is a range of the difficulties you might see.
Please ask questions in the comments below or contact me if anything does not make sense, or if you have additional information and resources to offer.
- Lack of initiation and motivation – Lack of drive, not able to start up – you might sit, or lie in bed, gazing blankly and not do anything without significant prompting and assistance. In more mild damage you may be less enthusiastic, less interested in what is going on around you.
- Memory Loss – Changes in working memory. Memory loss following frontal lobe damage is thought to be more because of its job organising memory for other parts of the brain. Damage to other functions of the frontal lobe might also affect your ability to remember such as difficulty concentrating and paying attention.
- Sequencing difficulties – Not able to follow the proper order of steps, tasks, or movements to do a task. This might happen even if it’s a very familiar task such as making a cup of coffee or performing a work task previously done many many times.
- Distractibility – Not being able to filter out what is unnecessary for the task being carried out. Difficulty staying on track. Following everything going on whether important or not.
- Difficulty with planning organizing and problem solving – Inability to plan and to work out what the consequences of your actions might be.
- Behaviour changes – there are likely to be MANY future discussions about the challenges around behaviour. Listed here because it is a common outcome of frontal lobe damage. Many changes can occur from mild impulsive acts to physical aggression.
- Broca’s Aphasia – also called Expressive Aphasia. Not being able to express language. This can include word and gesture. You might be able to understand what is said, but not respond.
- Perseveration – Lack of ability to stop a word, thought or action – repeating over and over again. There may also be difficulty stopping a behavior or action once started (this can be related to the lack of initiation and motivation in the point above).
- Echolalia or Echopraxia – The term “echo” gives a clue. It is when words or actions are copied rather than giving an answer, or independent response. When asked “What do you want for dinner?” the person replies “What do you want for dinner?” or the person might mimic what another person is doing. Repetition may also be doing something automatically because there is a familiar prompt – picking up and sipping from a glass even if it is empty. This is commonly seen in dementia.
- Rigidity and Concrete thinking – not able to be flexible in thinking. Difficulty changing from one thought or task to another. Not able to follow morethan one path of thinking or action. Maybe you are not able to change course even if it looks like the wrong path. You might stay on track no matter what. Loss of the ability to think about, and imagine something.
- Anogognosia – you might not often see this term but you are likely to see the difficulty. What it means is you appear to not be aware of your difficulties, and what things are really like. There might also be a lack of insight that can sometimes be overcome with time. This may be more related to the overwhelming changes. Way too much to be able to face everything at once.
- Reduced attention and concentration – Inability to remain focussed. See HERE for more information.
- Disinhibition – the filter on words and action is reduced or missing. You are no longer able to stop, or modify the behaviour, actions, or comments that are not OK. You find yourself doing and saying what first comes into our mind, without thinking.
- Lability – Unpredicatable, sudden mood changes. Laughing one minute, crying the next, or not being able to control emotions as well.
- Changes in personality – All these potential changes that can happen with frontal lobe damage can appear to change your personality. It might become a more extreme version, or it might change completely e.g someone quiet and thoughtful, becomes very talkative and appears brash. This can often be linked back to the various changes that have been listed above.
Many of these difficulties along with strategies, will be discussed in individual posts in the future. For now this was a summary of just some aspects of frontal lobe damage. At the risk of repeating myself too often I want to add (again) that the outcomes will be different for each person.
What Can You Do?
One small step
Think about the idea the frontal lobe is the boss. If the frontal lobe is the leader, the boss, the CEO, think about what leaders, bosses, CEO’s need? They usually have a good assistant (Chief of Staff, Personal Assistants (PA), Secretary).
Whatever the title, they need a person who helps with planning and organizing schedules and projects. A person who works alongside to achieve the goals, monitors what the boss is asked to do and say, does the tasks the boss is not able to do, modifies the task or schedule when necessary, and steps in whenever needed.
And if you ask any PA… a whole lot more!
The important part of the role is to make the boss look good, and efficient, while quietly working away in the background. As a supporter we can learn from this role.
What I Found this Week
As always, an exciting week of prowling around the internet and finding lovely surprises. Here are two you might like, both using a more creative approach to all things brain:
The first is a delightful and informative blog I discovered while looking for an image to compliment this post. Click on the image below to visit Die Hard Brain. A blog by Jill Andrews who describes herself as an artist and a writer:
The second is a perspective of frontal lobe damage by Anne Ricketts, presented in a creative and personal way
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