Frontal Lobe Functioning: The Most Difficult to Accommodate

Frontal Lobe Functioning: Ian Part Seven

While all brain injury problems impact a survivor’s life, frontal lobe deficits are often the most difficult to accommodate for and the hardest to measure, particularly through neuropsychological testing. One of the principle goals of the TBI Voices project is to focus our interview on those deficits and his frontal lobe functioning, as it is a significant area where listening to the stories of dysfunction, can help illuminate the disability.

I have long believed that the best way to understand frontal lobe functioning interviews is to conduct an interview using a on a list of those issues. To a significant degree, my interview questions have the Iowa Collateral Head Injury Interview as there starting point. See N Varney Neuropsychology 5, 223 (1989).

Unlike the formal assessment and scoring involved in that frontal lobe functioning assessment tool, I use less structure and more conversation and instinct in my interviews. I try to get the interview subject talking, and let them tell me what is happening.

Ian was asked these questions:

Gordon Johnson: Do you find yourself to be absentminded with your problems with your frontal lobe functioning?

Ian: Some days.

Gordon Johnson: Any examples?

Ian: I –

Gordon Johnson: They were telling me earlier today that I shouldn’t ask for examples unless I’m going to warn people that I’m going to do that ahead of time though, so. What about trouble making decisions, do you have a hard time making decisions with your frontal lobe functions?

Ian: At times I’ll have a hard time deciding whether, you know, to figuratively put it, do you want red or do you want black, you know.

Gordon Johnson: Do you, do you go shopping?

Ian: I do some of the shopping at times.

Gordon Johnson: Do you have a hard time making choices as to what to buy because of your frontal lobe functioning problems?

Ian: Sometimes I do; sometimes I don’t.

Gordon Johnson: Any bad decisions that you’ve made that you remember?

Ian: Getting married.

Gordon Johnson: We’re talking about things after your accident and problems with your frontal lobe functioning.

Ian: No-no-no-no.

Gordon Johnson: Oh yeah.

Ian: I’m just, I’m just kidding. No, there have been not a lot of things; just like, oh you got the wrong kind of butter, or you got the – that ain’t the – or I should say – what’d I do.

Gordon Johnson: Do you go to the store for one thing and come home with something else (which can be attributed to problems with frontal lobe functioning)?

Ian: I’ve done that several times, but then again there’s a lot of people that have done that one. Oh, I’m just going there for buns. They come back and they’ve got buns and butter and milk and potatoes and peas and corn.

Gordon Johnson: Do you, are you pretty much independent in terms of you deciding what you’re going to do every day and no one else is like giving a plan and laying it out for you?

Ian: Pretty much.

Gordon Johnson: So what do you do on your normal day?

Ian: That’s the thing, I don’t have a normal day. Every day is different.

Gordon Johnson: Do you like it that way?

Ian: Sometimes I do; sometimes I don’t. Every – it varies. Like today, I got up. Go – went to the bio to donate plasma. Left there and went over to a friend’s house. I had to wait for a tow truck to show up to take his car, or his girlfriend’s car over to the transmission shop. Go over there and talk to the guys over there and, of course, the guy I wanted to talk to wasn’t in yet. And then went over – and then I went home. I had to pick up my second, my oldest son because he has half days at school. Oh, actually, my, my parents come over and picked us all up; dropped him off at school; and then we went over to a restaurant to get something to eat. And then of course we came here and then had to –

Gordon Johnson: And you were –

Ian: And we were early.

Gordon Johnson: And we were late; did that frustrate you that you had to wait?

Ian: Not really, because I had people to talk with and interact with. If I would have been by myself, it probably would have “burned my cookie” so to speak.

Gordon Johnson: Well we’re, we’re sorry that we had to keep you waiting, but the people that proceeded you had a lot to say.

Ian: Yeah. But this week is kind of a hectic week, because after this go home and make sure my sons have all their sports equipment that they need for tomorrow because we’ve got to go down to Menasha for 8:30 in the morning we have to be there. And they play one game at 9:00 and they play another game at 2:15. So some place in the middle we’ve got to go get lunch; go over to another friend of mine’s house. He owes me some money I’ve got to go pick up. So a lot of running around, of course, the Packers are in the Super Bowl.

Gordon Johnson: No, that doesn’t happen every week does it?

Ian: No.

Gordon Johnson: It’s going to be a little bit different routine on Sunday. (The interview was conducted the Saturday before the Green Bay Packers Super Bowl Victory in 2011.)

Ian: Yeah. Well, not really because I watch football all the time. It’s just that –

Gordon Johnson: It’s not that time of day.

Ian: – it’s our team instead of somebody else’s.

Next in Part Eight – Assessing Frontal Lobe Function