Assessing Frontal Lobe Function After Severe Brain Injury

Assessing Frontal Lobe Function: Ian Part Eight

One principal theory for assessing frontal lobe function is that the diagnostician cannot make those determinations based upon the word of the survivor, that “collateral witnesses” are necessary. While I don’t subscribe to that theory in totality, it is one of the reasons we have made an effort to include third party interviews in this project. With Ian, we were fortunate to not only have his parents as interview subjects, but his close friend.

Here are some of the questions of his parents that relate to assessing frontal lobe function issues:

Gordon Johnson: While assessing frontal lobe function, does he have problems with impulsivity?

Mom: Do things impulsively you mean?

Gordon Johnson: Yeah. Act first, think later.

Mom: Yeah. He does. Because I had something I say why’d you do that. And then later on he’ll say I wish I wouldn’t have done that. Well did you think about it first? No just went ahead and did it. It’s not anything tangible sometimes. It’s just he gets up and walks away and you’re going okay.

Gordon Johnson: Does he seem in some ways like he’s gone back to being a teenager?

Mom: I don’t know if I’d –

Dad: Say it over again a little louder.

Gordon Johnson: Does he in some ways seem like he’s gone back to being a teenager? I mean some of those child, things, problems that you have with kids?

Dad: No I wouldn’t think so. No.

Mom: I don’t know if I would describe it that way. He’s just – I sometimes wonder if he – I know he loves his kids but, but he would prefer if he was alone. You know? That he didn’t have that responsibility. Not just to the kids but maybe with his wife he gets frustrated. It’s hard to really pinpoint. It just a different kind of personality then he had when he was growing up and it depends on what you say to him what triggers him to get angry.

The full Iowa Collateral Head Injury Interview is reproduced in the outstanding book, Varney and Roberts, “The Evaluation and Treatment of Mild Traumatic Brain Injury” Erlbaum, 1999. It has 21 question subjects for assessing frontal lobe function, which include:

• Absentmindedness,
• Indeciveness,
• Apparent low motivation,
• Disorganization,
• Inflexibility,
• Poor planning and follow through,
• Failure to learn from experience,
• Poor judgment,
• Neutral attitude towards others,
• Risk seeking behavior,
• Disinhibition,
• Immaturity,
• Poor insight,
• Poor Empathy, and
• Self Centeredness.

We highly recommend this text to all who either work in the field of TBI or who are impacted by brain injury. While our interviews do not strictly follow the structure of this inventory, we do try to illuminate these frontal deficits with each story.

Coming Tomorrow in Part Nine – Mood and Anger Issues