Posts Tagged cognitive

[WEB SITE] 7 signs of executive dysfunction after brain injury

7 signs of executive dysfunction after brain injury Main Image

 ‘Executive dysfunction‘ is not, perhaps, a particularly well known term, but the effects of brain injury that it covers are very common indeed. It is used to collectively describe impairment in the ‘executive functions’ – the key cognitiveemotional and behavioural skills that are used to navigate through life, especially when undertaking activities and interacting with others.

Although executive dysfunction is a common problem among many brain injury survivors, it is most commonly experienced following an injury to the frontal lobe.

The importance of executive functions is shown by the difficulties caused when they don’t work properly and someone has problems with executive dysfunction. Since the executive functions are involved in even the most routine activities, frontal injuries leading to executive dysfunction can lead to problems in many aspects of life.

Here we list the most common effects of executive dysfunction, with some examples of common issues that brain injury survivors can face:

Difficulties with motivation and organisation

  • Loss of ‘get up and go’, which can be mistaken for laziness
  • Problems with thinking ahead and carrying out the sequence of steps needed to complete a task

Rigid thinking

  • Difficulty in evaluating the result of actions and reduced ability to change behaviour or switch between tasks if needed

Poor problem solving

  • Finding it hard to anticipate consequences
  • Decreased ability to make accurate judgements or find solutions if things are going wrong

Impulsivity

  • Acting too quickly and impulsively without fully thinking through the consequences, for example, spending more money than can be afforded

Mood disturbances

  • Difficulty in controlling emotions which may lead to outbursts of emotion such as anger or crying
  • Rapid mood changes may occur, for example, switching from happiness to sadness for no apparent reason

Difficulties in social situations

  • Reduced ability to engage in social interactions
  • Finding it hard to initiate, participate in, or pay attention to conversations
  • Poor judgement in social situations, which may lead to saying or doing inappropriate things

Memory/attention problems

  • Finding it harder to concentrate
  • Difficulty with learning new information
  • Decreased memory for past or current events, which may lead to disorientation

Find out more

If you or someone you care for is affected by executive dysfunction, it is important to seek support. Speak to your doctor about your symptoms, and ask about referral to specialist services such as counselling, neuropsychology and rehabilitation.

You can find out more and get tips and strategies to help manage your condition on our executive dysfunction after brain injury page.

Headway groups and branches can offer support in your area, and you can contact our helpline if you would like to talk things through.

via 7 signs of executive dysfunction after brain injury | Headway

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[WEB SITE] Executive dysfunction after brain injury

Executive dysfunction after brain injury

Executive dysfunction is a term for the range of cognitiveemotional and behavioural difficulties which often occur after injury to the frontal lobes of the brain. Impairment of executive functions is common after acquired brain injury and has a profound effect on many aspects of everyday life.

This page explains what executive functions are, why they are so important and which part of the brain is responsible for controlling them. It then provides an overview of the causes, effects, assessment and rehabilitation of executive dysfunction. Some general coping strategies are also suggested to help brain injury survivors to compensate for impairments.

What are executive functions?

Executive functioning is an umbrella term for many abilities including:

  • Planning and organisation
  • Flexible thinking
  • Monitoring performance
  • Multi-tasking
  • Solving unusual problems
  • Self-awareness
  • Learning rules
  • Social behaviour
  • Making decisions
  • Motivation
  • Initiating appropriate behaviour
  • Inhibiting inappropriate behaviour
  • Controlling emotions
  • Concentrating and taking in information

Most of us take these abilities for granted and we effortlessly perform extremely complex tasks all the time in our everyday lives. Let us consider, for example, the role of some executive functions in a ‘simple’ activity like cooking a meal:

Motivation – Wanting to make a nice meal and making the decision to start doing it.

Planning and organisation – Getting all the ingredients and thinking about the right times to start them cooking so they will be ready at the same time.

Monitoring performance – Checking the food is cooking properly and the water isn’t boiling over.

Flexible thinking – Lowering the heat if the food is cooking too quickly or leaving it longer if it is not cooked.

Multi-tasking – Washing the laundry and putting it out to dry, while still remembering to attend to the food at the right times.

These complex skills require advanced brain functions. The brain areas involved are described in the next section.

Which part of the brain controls executive functions?

Executive functions are controlled by the frontal lobes of the brain. The frontal lobes are connected with many other brain areas and co-ordinate the activities of these other regions. They can be thought of as the conductor of the brain’s orchestra. Injury to the frontal lobes is the most common cause of executive dysfunction. Occasionally, damage to other brain areas which are connected to the frontal lobes can also impair executive functions.

The frontal lobes cover a large part of the front of the brain, directly behind the forehead. The diagram below shows their location:

The frontal lobes can be damaged by any form of acquired brain injury, such as stroketumourencephalitis  and meningitis They are particularly vulnerable to traumatic brain injury, due to their location at the front of the brain and their large size. Even a blow to the back of the head can cause frontal lobe injury because the brain is knocked back and forth in the skull and the frontal lobes bang against bony ridges above the eyes.

What is executive dysfunction?

The importance of executive functions is shown by the difficulties caused when they don’t work properly. Since the executive functions are involved in even the most routine activities, frontal lobe injuries can lead to deficits in cognitive (thinking) skills, personality and social behaviour.

The most common effects of executive dysfunction are summarised below:

Difficulties with initiating, organising and carrying out activities

  • Loss of ‘get up and go’.
  • Problems with thinking ahead and carrying out the sequence of steps needed to complete a task.

This can often be mistaken for ‘laziness’ or a lack of motivation and energy.

Rigidity in thoughts and actions

  • Difficulty in evaluating the result of actions and reduced ability to change behaviour or switch between tasks if needed.

Poor problem solving

  • Finding it hard to anticipate consequences.
  • Decreased ability to make accurate judgements or find solutions if things are going wrong.

Impulsivity

  • Acting too quickly and impulsively without fully thinking through the consequences. For example, spending more money than can be afforded.

Mood disturbances

  • Difficulty in controlling emotions which may lead to outbursts of emotion such as anger or crying.
  • Rapid mood changes may occur. For example, switching from happiness to sadness for no apparent reason.

Difficulties in social situations

  • Reduced ability to engage in social interactions.
  • Finding it hard to initiate, participate in, or pay attention to conversations.
  • Poor judgement in social situations, which may lead to saying or doing inappropriate things.

Difficulties with memory and attention

  • Finding it harder to concentrate.
  • Difficulty with learning new information.
  • Decreased memory for past or current events, which may lead to disorientation.

You may hear different names for these symptoms. They are commonly referred to as executive dysfunction but many people use the term ‘dysexecutive syndrome’ or simply ‘frontal lobe problems’. They are sometimes referred to as a syndrome because several of the symptoms usually occur together.

It is important to remember that not everyone with executive dysfunction experiences all of these problems. The symptoms can range from subtle effects, which only close friends and family members may notice, to extreme and problematic behaviour.

The effects of executive dysfunction on day-to-day life

It is often hard for people with frontal lobe injuries to explain the difficulties they are experiencing, often because they may be unaware that their behaviour is inappropriate. Their behaviour may appear to be very anti-social and can be misunderstood as depression, lack of motivation, selfishness, or aggression. Relationships with others may be negatively affected as a result.

Executive functioning problems may also have a significant emotional impact and can lead to feelings of frustration, exhaustion, embarrassment and isolation. It can also be very difficult to return to work due to problems with multi-tasking, organisation and motivation. An inability to prioritise and complete tasks also makes working life difficult.

It is important to be aware of the fact that these behaviours occur as a result of brain injury and are not intentional. Specialised input from rehabilitation specialists, such as neuropsychologists and occupational therapists, can help to compensate for the problems.

The following sections provide an overview of assessment and rehabilitation, before providing some practical coping strategies.

Assessing executive dysfunction

The initial assessment of executive functioning after brain injury will usually be carried out by a clinical neuropsychologist. The assessment provides detailed information about an individual’s cognitive, emotional and behavioural deficits. The results can then assist in planning rehabilitation strategies to manage the problems.

During an assessment, the neuropsychologist will consider the following questions:

  • What are the main problems for the individual and their family?
  • How do the problems affect functioning in everyday life?
  • What are the person’s goals and can they go back to work/college/school?
  • To what extent are the executive deficits related to other problems in areas such as language, memory and perception?
  • How do the person’s abilities compare with others of the same age, background, gender and with injury to a similar area of the brain?
  • How are the person with brain injury and their family coping?
  • What kind of rehabilitation should be offered?

Neuropsychological assessments involve a range of different standardised tests, which are designed to measure different aspects of cognitive functioning. Some of these tests are in a questionnaire, puzzle or game format, while others take place in a real-world environment. It is very important that the tests are completed without prior knowledge or preparation in order for them to accurately reflect an individual’s abilities. For that reason, no details of specific tests are included here.

It is important to remember that there are no passes or failures in the assessments. They simply provide an indication of areas that need help and rehabilitation, so there is no need for people to worry about their performance but simply to complete the tasks as best they can.

Rehabilitation of executive dysfunction

Rehabilitation of executive dysfunction can be challenging and requires an individualised approach to treatment. The rehabilitation programme for each patient will depend on their goals, the nature of their difficulties, selfawareness, readiness to engage in treatment, level of social support and presence of other issues such as mood disturbances.

An important part of the rehabilitation process is educating the person about the effects of their injury. This can help increase the person’s insight and understanding of what has happened. For that reason, reading this factsheet or other Headway information materials may be helpful for both survivors and their family members.

If you feel that you or someone you know would benefit from rehabilitation then the first step is to ask a GP if a referral is available, preferably to a neuropsychologist initially. If there are no NHS referrals available then it may be possible to visit someone in private practice.

For more information on this subject see the Headway booklet Rehabilitation after brain injury, or visit the ‘Rehabilitation after brain injury‘ section using the link on the right. Also, the Headway helpline can talk you through the referral process and signpost you to organisations that can help.

Coping strategies for brain injury survivors

Because executive functions are such a vital part of our everyday lives, it is important to find ‘survival strategies’ when problems arise. Here are a few suggestions of strategies that may help if you have difficulties yourself:

Planning

Allow yourself plenty of time to plan activities and record your plans, using as many aids as you find helpful (such as calendars, diaries, electronic timing devices, mobile phones and pagers).

  • When planning your day, week, or a particular activity use a step-bystep approach, dividing the activity into manageable ‘chunks’.
  • Use checklists and tick off each part of the activity that you have accomplished. This will help you to stay on track.
  • Mentally rehearse your plans.
  • Discuss your plans for the day with others. They can help you to write down a step-by-step checklist of the different actions for that day.
  • Similar strategies can be used for longer term planning, such as appointments you need to make. Discussing your plans with others will make you more likely to remember and the other person can remind you of things if necessary.
  • Step-by-step checklists can be placed in key locations in the house in order to remind you of the different sequences to go through to do a task, such as preparing a meal.
  • Prepare a weekly routine for tasks like shopping, washing and tidying the house. Knowing that, for example, Monday is shopping day, will make you more motivated to get the task done.
  • Try to develop back up plans in advance, rather than when problems arise.

Many strategies for overcoming memory problems can also be helpful for difficulties with planning. See the Headway factsheet Coping with memory problems – practical strategies for more information.

Mood

  • If you feel unable to manage your emotions, it may help to talk to your doctor about this. They may be able to refer you to a form of therapy that will work for you, such as cognitive behavioural therapy (CBT).
  • It may be helpful for others to make allowances for the difficulties you may experience in controlling your mood. When you feel very upset, it may be better for the other person to try to calm the situation in the short term and discuss it with you later.
  • Others may need to make allowances for changes in your behaviour and personality. It is important for them to remember that the changes are a result of the injury and not because you are being lazy, self-centred or difficult.

Social difficulties

  • Trusted friends or family members could help you by reminding you of what may be the most appropriate thing to do or say if you are struggling in social situations.
  • It may help to mentally prepare for social situations and to think about any difficult situations that have occurred before in similar environments.

Executive dysfunction from a carer’s point of view

Caring for a person with executive deficits can be a full-time job and living with personality and behaviour changes in a relative or friend can be very distressing.

Problems that carers may experience include:

  • Stress, anxiety or depression
  • Increased responsibility
  • Strained relationships
  • Reduced communication with partner
  • Restricted leisure/social life
  • Reduced sexual and emotional intimacy with a partner
  • Feeling tired and frustrated

It is important for family members, carers and friends to access support for their practical and emotional needs. Input from the rehabilitation team can help and some people find peer support groups for carers useful. Headway’s Groups and Branches offer valuable support for both survivors and family members. It is also important to see a GP, who will be able to refer to local counselling and therapy services where they are available.

For further information see the Headway booklet Caring for someone with a brain injury, which can be obtained free-of-charge from the Headway helpline, or visit the ‘Caring‘ section for more information. The helpline can also provide support and refer to local Groups and Branches.

Conclusion

The frontal lobes are commonly affected by acquired brain injury. Damage to the frontal lobes is likely to cause symptoms which are collectively termed executive dysfunction.

The diverse ways executive difficulties present themselves mean that assessment and rehabilitation are not straightforward. However, with appropriate rehabilitation and the use of coping strategies, many people can make good recoveries and learn to manage their difficulties.

via Executive dysfunction | Headway

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[WEB SITE] Rutgers VR spinoff moves to NJEDA incubator

New Jersey Economic Development Authority
The New Jersey Economic Development Authority’s Commercialization Center for Innovative Technologies in North Brunswick.

Virtual reality is mostly known as a platform for gamers — allowing its users to escape from the real world by commanding the Enterprise, rescuing their child from a post-apocalyptic wasteland or being transported smack-dab into the middle of a murder mystery.

However, there’s another angle at play.

It can also help alleviate symptoms and improve the health of people who’ve suffered illnesses and injuries.

Patients who have suffered stroke, dementia and traumatic brain injuries are using virtual reality as part of their rehabilitation therapy, thanks to technology developed by Bright Cloud International Corp.

BCI, a Rutgers University spinoff, announced earlier this month it moved its operations into the New Jersey Economic Development Authority’s Commercialization Center for Innovative Technologies in North Brunswick. The move will expand the CCIT’s footprint in New Jersey as a life sciences incubator.

“Having spent the past 30 years here, I know the intrinsic value that New Jersey offers entrepreneurs, including its strong academic institutions and its dynamic life sciences community. I also wanted to maintain strong ties with Rutgers and to offer jobs for students and graduates. In return for the decades of support I have received from the university, I wanted to strengthen BCI while also benefitting Rutgers,” said Grigore “Greg” Burdea, BCI founder and president.

The rehabilitation system, known as BrightBrainer, is a self-contained and mobile rehabilitation medical device that has custom virtual reality therapy games.

The system, which is available for lease or purchase, targets motor skills such as motor control, speed of movement, endurance, hand-eye coordination and task sequencing. It also targets cognitive abilities, including attention, short-term visual and auditory memory, working memory, reading comprehension and dual tasking.

The virtual reality system, according to BCI, is useful in a variety of health care settings, including outpatient clinics, skilled nursing facilities and medical adult day programs.

“Our biggest success to date is the BrightBrainer rehabilitation system. I am proud that it reduces care costs, increases access to care and improves therapy outcomes,” Burdea said.

A team of researchers, engineers, physicians, therapists and game developers created the games, which adapt to each individual patient.

According to BCI, BrightBrainer has been found to benefit a patient’s motor and cognitive skills, as well as a patient’s emotional state, leading to an increased quality of life.

“We know that the brain can rewire itself to bypass non-working neurons, so our technology helps patients build that bypass to regain use of their bodies,” Burdea said. “It also puts a new and interactive spin on the monotony of occupational therapy, bringing an age-old industry into the 21st century.”

Burdea said he moved the incubator to CCIT because of its environment, access to networking and investors, and opportunities for increased visibility.

“Understanding and responding to the needs of the market is imperative to the state’s ability to retain and attract innovative companies and top talent,” EDA CEO Tim Sullivan said. “Nurturing early-stage companies is just one facet of Gov. (Phil) Murphy’s vision of a more robust and equitable economy, and CCIT offers a model of what can be achieved through collaboration between the private, public and academic sectors.”

via Rutgers VR spinoff moves to NJEDA incubator – ROI-NJ

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[BLOG] Who Am I Now? Loss of Self after TBI – Brain Injury Blog With Free TBI Information

Loss of self is one of the biggest hurdles that TBI Survivors face

March, 2018

By Bill Herrin

When a loved one dies, friends and family bear the brunt of the loss. There are rituals for their grief and mourning. As they go on with their lives, they hope and often expect that the pain will fade with time. They are often told, “Give yourself time” or “Don’t make any major decisions now” and “It will get easier.” They are expected to feel sad, upset, and even angry after a death. But they are also expected to move on with their lives, no matter how difficult or painful it is.

Everything Has Changed

But when a person has a traumatic brain injury, their family faces new and different challenges. They have lost many of the things that they knew and loved about the Survivor. Their relationship with the Survivor has changed and so have their expectations and dreams for the future. While the physical, cognitive, behavioral, social and  even financial changes may be most evident, there’s something else that’s harder to define.  That’s the loss of self that the Survivor of a TBI faces. “Who am I now?” is the critical question. “What gives meaning to my life now?” Then there is the uncertainty of whether it’s even possible to reclaim your old life when so much has changed? While most everyone tries to overcome loss of self, some succeed…some cannot.

Necessity is the Mother of Reinvention

Hilary Zayed, who survived her brain injury, knows how difficult finding your new self can be. Her story is one of a huge transition described in her book, Reinventing Oneself After Loss.  Her artwork became a vehicle as she explored who she had become since her injury and how she rebuilt her identity, mourning her loss of self, and slowly regaining her new sense of self. Everyone will have different goals and different results. It’s not necessarily finding what makes you happy (though it helps), but more importantly, it’s finding what gives your life meaning now. This is the first step toward such a huge change. Finding a catalyst that drives you forward toward your reinvention can be incredibly motivating. Think about what makes you feel fulfilled, satisfied and meaningful and consider how that could become a part of your life after TBI.

There is no set timetable or deadlines for reinventing your self. Survivor Garry Prowe’s tips on Living a Full Life after Brain Injury, admits that the initial steps to finding your new life may sound obvious – dealing with a roller coaster of emotions, feeling overwhelmed, angry, and depressed along with financial stress, unemployment, social isolation, and life style changes. But the greatest stress may be the uncertainty of the future as the path and extent of recovery is unpredictable. However, the road to reinvention has to start somewhere. It can take months and even years until you feel ready to work on reinventing your sense of self. Once you’ve been able to self-assess your strengths and capabilities, you’ll have a much better idea of your new direction as you begin the process of rebuilding. Prowe’s tip card is an inexpensive resource ($1) that outlines the many steps of recovery with contacts/resources/ideas for you. (You can sign up to receive a free catalog and tip card from Lash & Associates – and choose his tip card “Living a Full Life after Brain Injury at this link).

Different Paths for Different People

As life goes on, be encouraged by the many who have been in your shoes and traveled your journey. Jeff Sebell, also a survivor,  worked on “getting his power back” after his brain injury by focusing on regaining his self confidence, re-learning how to make decisions, and taking action steps toward living the life he wanted. Sounds simple, right? Of course it’s not at all, but Jeff shares an incredibly insightful peek into his “Modus Operandi” in this blog post, and also in his book “Learning to Live with Yourself after Brain Injury.” Jeff’s take on having a better life is based on how you choose to interpret the things that happen on a daily basis. This can make the difference between having a good day or a bad one. Just using this as a starting point can move your life in a more positive direction! We don’t have control over what happens to us, but we can interpret and judge its impact on us – and try to see the big picture. Jeff reminds us that TBI, and loss of self, doesn’t have to leave you powerless. Rather you can regain control over your life by working on positivity and determination. The results will follow. Your loss of self will soon become transforming…you’ll find that you’ve discovered your “new normal.”

There are no set rules for this rediscovery. We all have very different paths after a brain injury. Some of these paths may criss-cross and you may share common experiences and feelings with other survivors. However, navigating through the maze of traumatic brain injury requires self-determination, finding your strengths, setting some incremental goals for your life, and making the commitment to start working toward them.

Lash and Associates’ award winning blog site (on our website) offers hundreds of absolutely free blog articles by TBI experts and clinicians, TBI survivors, and family members that share insights as well. A well-rounded offering of insights from every possible angle – including more on the subject of today’s bulletin – loss of self. Lash & Associates is also a leading publisher of books, cognitive software, and more – all for the brain injury community. Just click the two award icons, or CLICK HERE to see our entire blog article collection!

via Who Am I Now? Loss of Self after TBI – Brain Injury Blog With Free TBI Information

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[TED] 3 Clues to undertand your Brain – TED Talks

Vilayanur Ramachandran tells us what brain damage can reveal about the connection between celebral tissue and the mind, using three startling delusions as examples.

Neurologist V.S. Ramachandran looks deep into the brain’s most basic mechanisms. By working with those who have very specific mental disabilities caused by brain injury or stroke, he can map functions of the mind to physical structures of the brain.

 

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