Posted on September 26, 2011 · Posted in TBI Voices
This entry is part 20 of 24 in the series Nancy

Time Management After Severe Pediatric Brain Injury: Nancy Part Twenty

As there are many deficits caused by brain injury, we will talk about Nancy’s issue with time management after severe pediatric brain injury along with other issues.

Too much reliance in brain injury diagnosis is put on MRI and neuropsychological test results. In no area is this more true than in assessing deficits in frontal lobe function.  Neuropsychological testing simply cannot provide significant enlightenment on frontal lobe function because testing laboratory does not simulate in any appreciable way, the interaction with people and the environment where frontal lobe deficits become apparent.  The most complex things a human mind is required to do is interact with other people.  As we age, those interactions become more nuanced and the intricate lessons that we learn about those nuances are encoded onto our frontal lobes. If in an adult, the frontal lobes are damaged, much of that encoding may be erased.  If in a child, the frontal lobes are damaged, there may no efficient storage mechanism available to the developing adolescent upon which to lay those rules and manners of behavior.

Much of my motivation for undertaking TBI Voices was to provide a greater understanding of those real world frontal lobe and behavior changes.

What is so significant about Nancy’s story, is the stark contrast between her relatively normal cognitive function and her childlike personality.  Her Mom explains:

She came out of the injury angelic because that’s the way she went in.  We noticed the girls who were teenagers that were in at the same time she was for other brain injuries or injuries were very emotional – would cry in the middle of the night.  It was very difficult for me to listen to that – thinking is that what she’s going to do three years from now or four years.  Is she going to turn into that age level and is she going to be that emotional?  That never occurred thank goodness.

Let’s talk about some of the frontal lobe and emotional issues.  As I said off camera if we had an infinite amount of time we could go down the long list of frontal lobe deficits and I’m sure you could give me a 15 minutes explanation of how she is in general. So please tell me what it is you see about her that shows frontal lobe dysfunction or executive functioning problems.

The executive functioning problems she has is processing.  The reason why she needs help in the math area is because there’s a process to math.  There’s a way you put the numbers on the page.  There’s a way you write the numbers.  There’s how you line them up.  How the line goes if it’s addition, subtraction.  Everything has its own process.

Same thing with writing.  You start on the left side of the page and a T has a downward stroke and a cross stroke but then you have to make the word the.  So it’s every process she has to think about and I think that’s why the handwriting is so difficult for her.

Verbal tests, if she gets to give a verbal test or does a verbal assignment or uses Dragon Speaks, no problem.  And she’s very intelligent.  She can put her, her thoughts in order most of the time.

Getting ready and monitoring her on daily activities is difficult. I’ll go tell Nancy to go get dressed and, okay, and she’ll go in there.  Even if her clothes are laid out, but it will take an infinite amount of time.  It could take all day if I don’t interrupt her.

But if you tell her what to put on it’s a quick process with her time management after severe pediatric brain injury issue?

It’s not so much what to put on it’s, okay let’s get ready.  Are you ready yet?  You know just reminding her what she’s doing.  And it’s not because she’s forgotten.  It’s because her attention has been taken away to, oh, look at, you know –  I forgot about that magazine and let’s sit down and read this magazine.  It’s, there’s no flow.

No concept of time causes her time management after severe pediatric brain injury problem?

Right.  Time is, time is toast I tell her.

What about other people’s time?


Does she have any sort of sense that people outside of herself are important?  That other person’s needs, matter? 

She’s very sweet to other people.  She’s very nice and she’s courteous and she’s polite but as far as knowing that, say her brother has to get to school for a baseball game.  So this means we have to get ready or we have to leave the house by this time, or that this is important to him.

I also asked her father (who is the subject of our next story Otto) about her time time management after severe pediatric brain injury issues.

What did you guys do today to get her to come to this program concerning her time management after severe pediatric brain injury issues? (The Brain Injury Association of Wisconsin Convention.)

I got her up at, ah – I think it was about 6 o’clock and my wife helped get her ready and, usually you – we have a, a list for her to do, a checklist, wash, get ready.

If you don’t give her the checklist she doesn’t do those things?

Oh no.  Well, the – even if the checklist is there she has a hard time.  You have to be right with her to coach her along.

Next in Part Twenty One – Mood After Severe Pediatric Brain Injury

By Attorney Gordon Johnson


About the Author

Attorney Gordon S. Johnson, Jr.
Past Chair Traumatic Brain Injury Litigation Group, American Association of Justice :: 800-992-9447