MEN'S HEALTH MATTERS:More than 10,000 people suffer an acquired brain injury in the State each year, with the frontal lobes being the most common area affected, writes THOMAS LYNCH.
Q My 21-year-old son was involved in an accident almost a year ago when he was knocked from his bicycle. He wasn’t wearing a helmet and suffered a fractured skull and the doctors told us that he had an injury to his brain.
For a while after coming home he seemed to have made a full recovery. However, more recently we have noticed that he seems to have had a change in his character.
Before the accident he was a very motivated young man, but now he has no interest in anything, his concentration is not good, he can be inappropriate in his conversation when we have friends over to the house, and when he goes into his bedroom to get changed, we often find he has got into bed as if it were bedtime.
Our doctor said it is because he has damage to his frontal lobes. What does this mean and will it improve?
AIt has been estimated that in excess of 10,000 people suffer an acquired brain injury in the State each year. For the high numbers of people who sustain their brain injury as a result of an accident on our roads, the frontal lobes are a common site of their injury.
The frontal lobes are situated, as the name implies, towards the front of the head, behind the forehead. Because of this position and the fact that they are the largest lobes of the brain they tend to receive the brunt of injury to the brain in road traffic accidents, assaults, or trips and falls.
Generally speaking, the frontal lobes work much like the chief executive of an organisation. As such they act in a supervisory or executive capacity in the overall hierarchy of the work of the brain.
This executive function allows us to understand and organise our environment, respond in an appropriate way to that environment (such as recognising that we can say things in one environment that we should not say in another), and it allows us to flexibly change or inhibit automatic behaviour (for example, if we go into our bedroom to get changed, we do not automatically get into bed).
The executive function of the frontal lobes also helps us to anticipate future goals, and consider the consequences of behaving in a particular way.
People, like your son, who have an executive problem arising from brain injury can show difficulties in any number of these functions, which may become more apparent when the person is placed in a novel or new situation in which they cannot rely upon over-learned routines.
There is no quick answer to improving your son’s executive functioning, and change can be frustratingly slow for all concerned; but change may be possible.
It sounds like one of the more challenging aspects of your son’s behaviour concerns his difficulty with inhibiting those kinds of automatic responses which stop him from staying focused on what he aims to do (such as automatically getting into bed when in his bedroom).
A specific kind of clinical rehabilitation training programme could help as it involves training the person to manage their approach to their goals through a sequence of fairly straightforward techniques.
Firstly, it would aim to help him to develop awareness of his lapses in his executive control. Secondly, it would aim to help him to increase the opportunity for greater focus on the task in hand by interrupting his automatic behaviours that happen during lapses in his attention, such as getting into bed when he goes into his bedroom to get changed. Thirdly, it would help him to divide the task into more manageable steps. And finally to train him so that he continues to check his progress towards that particular goal.
It is important to also bear in mind that people who have sustained a brain injury often show behaviour which is not necessarily due to the brain injury on its own.
There are also likely to be psychological issues relating to mood, adjustment and loss which may dovetail with the acquired brain injury, and which may also need addressing by a competent clinical professional.
Your GP can help you to access appropriate services.
- This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James's Hospital, Dublin with a contribution from Dr Dónal Fortune, senior clinical neuropsychologist with the Peter Bradley Foundation, Acquired Brain Injury Services Ireland