Executive Dysfunction After Brain Injury: Causes, Symptoms, and Rehabilitation

When the frontal lobe is damaged after a traumatic brain injury, survivors may experience what is known as executive dysfunction. Executive dysfunction is an umbrella term for many of the cognitive, emotional, and behavioral impairments survivors may experience.

Symptoms of executive dysfunction after brain injury may be hard to identify such as lack of motivation or impulsivity. This can make it challenging for survivors to be aware of their symptoms or explain the difficulties they are experiencing to others.

In this article we’ll discuss some of the most common signs and symptoms of executive dysfunction after brain injury. While there are many, we’ll further discuss cognitive training and helpful mechanisms a survivor can use to cope with executive dysfunction.

What Causes Executive Dysfunction After Brain Injury?

To understand executive dysfunction it helps to know what executive functions consist of and how we use them in our everyday lives.

Executive functions are skills that allow us to learn new things and manage daily life activities. This can include activities like planning, organizing, and multitasking. It also includes high-level skills such as self-awareness, making decisions with good judgment, and understanding social cues.

Executive function is made possible by the frontal lobe and prefrontal cortex. These areas of the brain play a role in planning, decision making, and other cognitive functions that help us manage our daily activities.

When the frontal lobe becomes damaged after a brain injury, it can impair the survivor’s ability to execute these skills. 

The frontal lobe is a large area of the brain, and because of this, a frontal lobe brain injury can affect many different areas. Every brain injury is different and survivors with executive dysfunction can exhibit many different symptoms. 

Common Symptoms of Executive Dysfunction

Some symptoms of executive dysfunction after brain injury may not be as evident as others. It’s important to determine what the issue is to find the best solution.

Here are possible symptoms of executive dysfunction after brain injury:

Lack of motivation or initiation

In some cases, survivors with executive dysfunction may struggle with performing basic self-care tasks such as taking medication or a shower. This lack of motivation or initiation is medically known as adynamia. This can occur after damage to the frontal lobe and symptoms may include low activity, social isolation, and difficulty starting or completing a task.

Loss of planning/organizational skills

Another symptom of executive dysfunction may be the loss of organizational or planning skills. This can cause survivors to exhibit poor organizational skills, such as being easily distracted, poor time management, attention problems, procrastination, or difficulty multitasking. Poor organizational skills may also be a result of cognitive fatigue after brain injury.

Impaired memory

Memory is a brain-wide process that involves recalling information, among many other cognitive processes. After brain injury, executive functioning can be limited because of losses in memory capacity. Both short term and long term memory failings can impact executive functioning.

Loss of cognitive flexibility

Survivors may also experience loss of cognitive flexibility. Inflexible thoughts can make it difficult to form an opinion or execute a plan. Many of these symptoms can be hard for the survivor to explain, which can increase frustration and result in aggressive behavior. If you notice this tendency, it’s important to consult a neuropsychologist or therapist for a thorough assessment and for help to create a recovery plan.

Impulsivity

Another symptom of executive dysfunction after brain injury is impulsivity. This is more likely to occur when an injury impacts the area of the frontal lobe that contributes to self-control.

A clinical term used to describe impulsivity is disinhibition, which is limited abilities to control inappropriate behaviors. This can cause survivors to partake in risky behaviors or disregard social subtleties. Disinhibition can also cause survivors to experience aggressive or overly friendly behavior. Impulsivity or disinhibition can present a safety concern for some individuals.

Attention Problems

Attention is the ability to focus on a task at hand without regard to other stimuli in the environment. This is a complex ability that requires many executive functions; and skills such as selective attention and divided attention (multitasking) require even more executive skills. As a result, many survivors with executive dysfunction struggle with attention problems after brain injury.

Fortunately, many of the effects of executive dysfunction can be improved through cognitive rehabilitation.

Cognitive Training

While there are many different symptoms of executive dysfunction, there is hope for recovery. The brain has the ability to rewire itself and improve certain functions through the process of neuroplasticity.

Neuroplasticity is activated by “massed practice,” or high repetition of a specific task. This means we can potentially improve executive functions by practicing them and sparking neuroplasticity. This is what cognitive rehabilitation is all about.

There are many cognitive rehabilitation exercises you can try to help with inflexible thinking, concentration, or other executive functions affected by a traumatic brain injury. When a specific cognitive skill is practiced over and over, it helps the brain rewire itself and improve that specific function.

The best way to get started with cognitive rehabilitation is to work with an expert such as a Speech-Language Pathologist (SLP) or an Occupational Therapist. Both professionals have training in ways to maximize your neuroplasticity to improve executive functioning.

They make detailed assessments of your cognitive functioning and then create a plan for you towards improvement in specific measurable areas such as attention, memory, or processing speed. But, if your insurance will not cover the high cost of personalized OT or Speech Therapy, there is a new app that you can try from your own home.

Two SLPs created an app called the CT Speech & Cognitive Therapy App that contains over 100,000 cognitive exercises you can practice at home. It assesses your current ability level and then assigns relevant exercises for your needs.

Ideally, survivors can work with a Speech-Language Pathologist as often as they can and also stay engaged in therapy by using the app between sessions.

Coping Mechanisms

In addition to brain training activities like those in the CT Speech and Cognitive Therapy App, there ways you can modify how you get things done in your daily routine to increase your success even with cognitive changes. Therapists call these ways you modify your activities of daily living, compensatory strategies.

These compensation techniques provide short-cuts to cope with executive dysfunction. While they do not address the root cause of executive dysfunction directly (cognitive rehabilitation does that) these strategies can increase your capacity to complete your essential daily tasks in the meantime.

Here are some tips for coping with executive dysfunction:

Break down activities into smaller steps

A family member may be able to help you create a step-by-step plan for a specific activity you like to do but that becomes overwhelming at times. This way the task becomes more manageable and you can achieve components of the complete task before meeting your final goal.

To stay on track, write steps down and cross off each step as you complete it. It is also helpful to keep checklists around the house. For example, keep a list in the kitchen which reminds you of the right sequence to prepare your favorite meal.

Create signals

For impulsive behavior, work with your loved ones to create a special “stop and think” signal that they can flash at you when you are doing something inappropriate or dangerous. This can help you retrain yourself to not make impulsive or unwanted decisions that you may later regret.

Find external motivation

Executive dysfunction may limit your capacity for internal motivation or initiation to do what you needs to be done. Therefore find external forms of motivation to compensate. For example, ask a loved one or friend to take you to your therapy appointments so that you don’t have to rely on your own motivation to get going.

Sometimes auditory or visual cues can stimulate you to be more active or engaged if you struggle with low initiation. Playing music might help you to keep working on a task for example.

While these tips can be a great way to cope with executive dysfunction after brain injury, be sure to talk to a professional such as a Speech-Language Pathologist or an Occupational Therapist to obtain more personalized techniques. 

Coping with Executive Dysfunction After Brain Injury

Executive dysfunction is a common symptom of frontal lobe damage. Survivors can experience a variety of symptoms such as impulsivity, lack of motivation, or loss of planning skills, just to name a few.

Fortunately, there is hope for recovery through cognitive rehabilitation. By practicing cognitive skills on a consistent basis, survivors can spark neuroplasticity and rewire the brain. 

An initial assessment with an SLP can be helpful in identifying the symptoms and finding the most suitable cognitive exercises and coping mechanisms.