BRAIN INJURY JOURNEY BULLETIN: EXECUTIVE FUNCTIONS — Critical and Vital to Organization, Prioritizing, and Behaviors

EXECUTIVE FUNCTIONS

Critical and Vital to Organization, Prioritizing, and Behaviors

June 2017

Edited by Lee E. Horton, L.C.A.S, C.C.S.

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What happens when a brain injury occurs?  How does the injury impact the executive functions?  There are many survivors who have provided us insight into the changes, consequences, and struggles.

Over the last few years I have had many gifts bestowed on me. Yes, some are the kind you can hold in your hand. Others however, are more cerebral and the kind you hold in your heart. Tonight I couldn’t find my keys and for an instant I could feel my stomach turn when I remembered last week having left them in the door for hours. It wasn’t that I was worried someone would walk away with them and use them later, it was that it was so reminiscent of that time in my life when I wouldn’t even have remembered putting them in the door in the first place.  This knowing that I could remember something so small as leaving my keys in the door last week was a gift, something I am so grateful to have and something I will never again take for granted.

Excerpt taken from “Why Is Survivor Recovery Not Just Another Headline? written by Bonnie Nish.

When the brain has been altered because of an injury, the small, sometimes insignificant tasks and activities can, and often do, become mountainous.  It is the relearning process that often can frustrate and stymie the survivor.  Because of this, it is critical to understand the roles of executive functions.  They form, define, control, and make a person who he or she is and will become post brain injury.  Children who have a parent with a brain injury experience additional challenges.

“Imagine being a single mom about to take your children on a family vacation. Suddenly, the van door swings shut and hits you in the head.” A few months after this happened to Meg S., she was sitting at her family’s Thanksgiving dinner table when she suddenly recalled signing papers to sell the home she shared with her two daughters and dog in order to move into a small two-bedroom condominium.”

Excerpt taken from Concussion and Mild Brain Injury: Not Just Another Headline, Bonnie Nish, MA, Editor

The capacity to reason through a decision and understand how it will impact immediate and extended family, as well as others within the survivor’s circle of influence, comes from the executive functions.  A brain injury also messes with even more intricate skills, like writing.  This skill becomes a challenge for adults and especially for students in middle and high school after a brain injury.  For those children in lower income families or students who are second language learners, the challenges are often compounded when it comes to communicating through writing after injury.

Excerpt taken from “Writing Challenges: Executive Functions of TBI Students in School” by Theresa Sacchi Armstrong, M.A.

To effectively assist and promote healing and to facilitate the recovery process, therapy designed for and focused on executive functions is essential.  It is the goal for all treatment/therapy to have the survivor regain autonomy.  The individual will need to be able to recognize dangerous, threatening moments, establish reasonable, achievable goals, and strive towards success.

Picture image obtained at: http://www.bing.com/images/search?q=executive+functions&id=B1333C29A2470158C0486FE232138E93F2E2B24C&FORM=IARRTH

The Brain works to promote safety, achieve goals and succeed

The brain, when it is functioning at optimum capacity, works in a unified way allowing us to take in information, process it, and act in a purposeful fashion. Purposeful behavior allows us to live safely in our environment, accomplish goals, and succeed to the best of our ability. Although the brain works in a unified way, the control mechanisms are complex systems.  One system is executive functions.  When they are compromised, there is a failure to organize and prioritize actions and behaviors.

The brain sustains an injury!  What happens?

The ability to do things like plan, organize, make decisions, focus attention, and manage emotions may no longer function as before the injury.  Opportunely, there are therapies and treatment programs to recover functions and work around unwanted, unusual behaviors that surface as a result of brain injury.

Excerpt taken from Cognitive Rehabiliation of Executive Functions by Lawrence Dilks, Ph.D., and Kimberly S. Hutchinson, Ph.D.

Children and adolescents who sustain a brain injury experience a disruption in executive functions and skills.  Because they are still developing and maturing, the latent effects of brain trauma often become more visible in adolescents, who experience increased cognitive challenges in school. Thankfully, workbooks and manuals for educators, therapists and psychologists that take a detailed approach to assessing executive skills and designing interventions for students with ADHD, learning disabilities and traumatic brain injury have been created and developed.

Excerpt taken from “Writing Challenges Executive Functions of TBI Students in School” by Theresa Sacchi Armstrong, M.A.

Relationships with other people may be altered due to problems managing emotions following a brain injury.  Common situations that can increase emotional reactions or lead to emotional outbursts include: poor diet, not enough rest, negative criticism, worry, or anger. Re‑learning emotional control is possible.  The survivor and caregivers are exposed to and taught new strategies, such as:

  • Learn to recognize triggers
  • Use distraction or redirection before the situation gets out of control
  • Practice responses and have a plan for how and when to leave social events
  • Be sensitive to situations that may have too much stimulation and may be overwhelming
  • Work on developing patience and empathy

Excerpt taken from Cognitive Rehabiliation of Executive Functions by Lawrence Dilks, Ph.D., and Kimberly S. Hutchinson, Ph.D.

Picture image obtained at: http://www.bing.com/images/search?q=executive+functions&id=B1333C29A2470158C0486FE232138E93F2E2B24C&FORM=IARRTH

Directing Your Thoughts and Behavior

Awareness, Attention and Concentration

Awareness: the level of consciousness regarding the world around you.  It is the first step (of many) in cognition. In fact, more complex activities are based upon it.  There are degrees of cognition, ranging from: unconsciousness, semi‑awareness, full awareness, responsiveness. Cognition is the foundation that attention and concentration build upon.

Attention: the ability to focus on an event while filtering out or ignoring other things.

Concentration: the ability to maintain attention for a period of time, often while there are distractions.

Picture Image obtained at:  http://www.bing.com/images/search?q=executive+functions+pictures&id=2FE863691D214A61FB8996C199ECC819E59EB894&FORM=IQFRBA

Many are in need of ways to address, change, alter, and improve the executive functions, particularly awareness, attention, and concentration.  Listed below are some suggestions.

Tips to improve awareness, attention and concentration…

  • Organize a task before you start. Make a list.
  • Do one thing at a time.
  • Stay calm and cool. Keep anxiety low.
  • Break difficult tasks into smaller simpler tasks.
  • Take notes and recopy them.
  • Hunt down and eliminate self‑defeating thoughts.
  • visualize and use mental imagery.

In addition to these suggestions, it would also be of value to address any issues associated with reasoning and judgment.

Tips to improve reasoning and judgment…

  • Check your ego, you’re not omnipotent.
  • Brainstorm ideas.
  • Always consider the cost.
  • Plan ahead.
  • Control impulses.
  • Be willing to change.
  • Have a back‑up plan.

Categorization abilities, related to the process of establishing goals and remaining focused on goal directed activities will improve when attention is focused on specific actions.

Tips to improve categorization abilities…

  • Establish the goal.
  • Compare similarities and differences.
  • Establish key properties.
  • Look at function or activities for each object.
  • Describe each object/activity by its physical features.

One other function that often provides stability and tracks accomplishments is planning activities of daily living.

Tips to improve planning ability…

  • Set time aside every day to plan activities.
  • Prioritize goals and set sub‑goals.
  • Establish an alternative plan, the infamous “Plan B”.
  • Consider the sequence of events that might occur. Consider the effect on others.

Excerpt taken from Cognitive Rehabiliation of Executive Functions by Lawrence Dilks, Ph.D., and Kimberly S. Hutchinson, Ph.D.

A Personal Insight and Testimony

“TRC THERAPY – for Cognition” by William C. Jarvis, Ed.D.

THOUGHT/REFLECTING/COMMENT (TRC) Therapy comes from personal experience in having a brain injury for seventeen years. Over this period of time, I have made a remarkable recovery of necessary skills for daily living. All skills practiced require cognitive abilities (executive functions). Of course, cognition is often compromised as a result of a brain injury.  Therefore, what can be done to help the healing process that creates clear thinking of the mind?  The answer to this for me was and is TRC Therapy.

Simply: it is having a “thought,” “reflecting” on it, and making a “comment” on that thought. The fundamental idea is to repeat an active process of deliberate reflection of a thought and then verbally commenting on it to someone else.  By doing this, the brain injured person makes gains in the healing process.  I have found that healing was and is reinforced each time I practice this activity. The process is slow, but cognitive gains will be visible (there is improvement).

The more often TRC is repeated, the better. My vocation as a teacher seemed to benefit from this therapy activity and approach to healing. I taught a Sunday school at church for three years after my injury. Consequently, I did TRC therapy in this part of my life. I remember when my cognition was fuzzy. This was followed by being aware of many opportunities to follow this path for healing. Many people who only periodically saw me would comment on my general language improvement. I believe this approach clearly had its impact on the healing process.  

Of course every brain injury is different and some may not fit into this approach. But for those who think this may help them, start today and let me know in five months if you are able to tell a difference!!  Sincerely, Bill Jarvis. (William C. Jarvis, wljarvis57@hotmail.com)

Review & Summary

Executive Functions control activities such as managing emotions, attention, concentration, categorization, planning, sequencing, problem solving, impulse control, reasoning, and judgment. Changes in executive functions often occur after brain injury. Many variety of strategies can be found in many publications.  Most will be helpful in the recovery process for the injured individual and the caregivers.

Patience and practice using any of these strategies will help with emotional management, reducing behaviors that interfere with progress, regaining skills, and working around limitations due to brain injury. Working on improving executive functions does improve daily functioning and quality of life.

References

Goverover, Y. (2003). Categorization, Deductive reasoning, and Self‑Awareness: Association to everyday competence in persons with brain injury. Archives of Physical Medicine and Rehabilitation, 84(10), E2. doi: 10.1016/j.apmr.2003.08.008

Hutchinson, K., & Dilks, L. (2015). Practical Guide to Cognitive Rehabilitation: Overcoming Cognitive Neurological Impairments. Youngsville, NC: Lash & Associates Publishing/Training, Inc.

Rabinowitz, A. R., & Levin, H. S. (2014). Cognitive sequelae of traumatic brain injury. The Psychiatric Clinics of North America, 37(1), 1‑11. doi:10.1016/j.psc.2013.11.004

Resources

Executive Functions After Brain Injury (Tip Card)

Lawrence S. Dilks, Ph.D. Kimberly S. Hutchinson, PhD

www.lapublishing.com/tbi-executive-function-dilks/.

Executive Functions control activities such as managing emotions, attention, concentration, categorization, planning, sequencing, problem solving, impulse control, reasoning, and judgment. Changes in executive functions often occur after brain injury.  Strategies found in this Tip Card can be helpful in the recovery process for the injured individual and the caregivers.

 Cognitive Rehabiliation of Executive Functions for Clinicians

CREF

This is a two-volume set by Lawrence Dilks, Ph.D., and Kimberly S. Hutchinson, Ph.D. www.lapublishing.com/cognitive-rehabilitation-executive-functions/.  This set of two workbooks by Lawrence S. Dilks, Ph.D., and Kimberly Hutchinson, Ph.D. developed for clinicians, features practical intervention exercises involving the reconstruction of executive functions of the brain. Using functional approaches, the authors address: attention, concentration, processing speed, categorization, sequencing, awareness, neglect, working memory, reasoning, judgment, humor, language, planning ability, impulse control, and stress/anger management.

Items that come with the two-volume set include: One (1) CD or  One (1) USB Drive (containing all exercises in PDF format from Workbooks), and One (1) Stopwatch

Cognitive Rehabilitation Triple Play

Lawrence S. Dilks, Ph.D. and Kimberly S. Hutchinson, Ph.D.,

www.lapublishing.com/cognitive-rehab-executive-function-therapist-clinician/

This is a 3-volume set by Lawrence S. Dilks, Ph.D., and Kimberly Hutchinson, Ph.D., that has been developed for clinicians. The set features exercises and activities that can be timed (stopwatch included), print-ready on a flashdrive, that address: attention, concentration, processing speed, categorization, sequencing, awareness, neglect, working memory, reasoning, judgment, humor, language, planning ability, impulse control, and stress/anger management. The contents are designed to assist persons with neurological impairments in the recovery process in areas of: orientation, attention and concentration, processing speed, memory, executive functions, language redevelopment, visual perception, anxiety and depression.

Items that come with the three-volume set include: One (1) CD or One (1) USB Drive (containing all exercises in PDF format from Workbooks), and One (1) Stopwatch

Concussion and Mild Brain Injury: Not Just Another Headline,

Bonnie Nish, MA, Editor

www.lapublishing.com/concussion-mild-brain-injury-survivors/

Bonnie has compiled the personal recovery experiences written and told by survivors of mild traumatic brain injury.  Each story gives clear insight into how the life of the person suffering from concussion and mild brain injury (MBI) was impacted.  The individual stories of injury, recovery and discovery document the effect of the survivor’s MBI on immediate and extended family members, and social and work communities.  Some stories will bring tears, others laughter and all of them will increase the reader’s understanding.  Through the stories, assurance arises that the ongoing challenges faced by the survivors in all walks of life can and will improve.

2 responses to “BRAIN INJURY JOURNEY BULLETIN: EXECUTIVE FUNCTIONS — Critical and Vital to Organization, Prioritizing, and Behaviors”

  1. Dear Lash & Associates Publishing,

    This is another well-planned and easy to understand bulletin. I like how you list bulleted points. You make it so easy to gather information quickly.

    Donna O’Donnell Figurski
    survivingtraumaticbraininjury.com
    donnaodonnellfigurski.com

  2. Majella Connolly says:

    Great newsletter, very informative. Well done.

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