Reduced Initiative after Severe TBI Another TBI Issue

Reduced Initiative after Severe TBI: Quinn Part Twenty-Nine

Quinn and I discussed some of the issues he was having with reduced initiative after severe TBI and some examples of this:

Do you have difficulty completing a task? 

Sometimes yes.

Examples of Reduced Initiative after Severe TBI

Can you give me an example? 

Cleaning the house.  If it’s, let’s say it’s taking care of the cat litter and vacuuming and doing the windows.  When I first came home, doing three of those things would never have happened.  Doing one partially might have, you know, whereas now I can at least do those functions, but I’ll sometimes, you know, I’ll do, start one of those tasks, get distracted and then remember oh yeah, I got to finish what I started.

Is the distraction where you run into the most difficulties with your reduced initiative after severe TBI? 

I don’t know.  I’m not sure, but like let’s say I’m in the middle of doing the cat litter; I may get a phone call, you know, and, and then get off the phone and be hungry and remember, oh yeah, I haven’t had breakfast.  It’s 2:00, I’ve got to eat, and then oh yeah, I’ve got to finish the litter, and then well I need to eat breakfast before 2:00 in the afternoon.

Quinn damages his olfactory nerve (technically the olfactory bulb), established by his loss of smell. The part of the brain immediately adjacent to the olfactory bulb is the part of the brain responsible for initiating and coordinating activities, the orbital frontal lobe and may be responsible for reduced initiative after severe TBI.  One neuropsychological colleague of mine likes to refer to this part of the brain as the conductor of the symphony.  He often makes the point that if you lose the conductor, regardless of how much is left of the symphony, it can’t make music. In other words reduced initiative after severe TBI.

Do you have difficulty actually deciding to go forward with activity, actually starting something. 

Sometimes, yes.

Examples? 

Figuring out which to do first; the groceries, the bank, gas in the car, taking a nap.

What role does your wife play in making sure that you do something? 

She’s there for me unbelievably.  I mean, she’s there for me every day.

Now she’s working at home today, how often does she do that? 

She works from home.  She sees patients on the road so she sets up her schedule, takes care of her note taking here, and then she goes and she sees patients on the road and then she comes home.

How much harder would it be for you if she wasn’t home all the time because of your reduced initiative after severe TBI?

Probably extremely.  I mean it drives me nuts if she does leave the house, and that’s an issue that I’ve had to work through too, just scared the b’jesus out of me that, you know. And it’s not, it’s not a wrong fear but it’s something, I’m scared she’s going to be kidnapped or in an accident and never come home.  It’s not, a false fear, but it’s just an issue I’ve had to work through.

You were describing an incident where someone leaped into your car because of an interchange that happened and stuff, as you look back on that is there anything in your behavior that would explain his over response? 

I laughed at him, looked away.  Didn’t say anything to him.  When I looked back at him, he decided it was my day that he was going to jump into my car and beat me up, kill me, whatever, you know.  Looking back on it, hopefully I’ve learned a lesson that maybe close the windows, so that that person couldn’t dive into my car.

People with head injuries do get punched much more often than average.  Did you think about that? 

No.

Next in Part Thirty – Fatigue and Sleep Contribute to All TBI Deficits

By Attorney Gordon Johnson

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