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Executive Functioning following Brain Injury (planning and initiating tasks)

 
 
 
See our TBI Home Page for a full list of information about Brain Injury, and links to information and strategies relating to memory, attention, social skills, executive functioning, and improving communication.
 
Executive functions refer to those skills and abilities that enable us to accomplish goal-directed activities. These are that activities that we do everyday, often without thinking. Executive functioning following brain injury can be seriously compromised.

 

Executive Functioning and completing a task

There are several steps to completing a task:

  • Planning – knowing and / or planning the steps for an activity
  • Initiation – starting an activity
  • Doing the task – carrying out your plans and at the same time, self monitoring and self regulating
  • Evaluating – looking at the results of your work
  • Changing and improving – looking at ways of making the task easier next time and avoiding any mistakes

 

We use these executive functions for all sorts of everyday tasks such as cooking, doing our laundry and shopping (as well as many more complex tasks). To accomplish a task we must initiate each step, organise and follow through, and while this is going on, we monitor and adjust our actions as necessary. Most of us do these things without much thought or planning. For a person with a brain injury however, it is more difficult. A person with a brain injury may not be able to initiate a task. They may not think about doing the washing or going food shopping, even if they are faced with a pile of dirty laundry or an empty fridge, these cues may not set into action the thought process that makes them initiate a plan of action.
 
Individuals with an acquired brain injury may initiate an activity, but not have planned it properly, so they make mistakes. A simple example would be going shopping, but not bringing your wallet or shopping list. Although this could happen to anyone, it happens more regularly if you have a brain injury. Individuals with traumatic brain injury may not learn from their mistakes and continue to make the same mistake each time they try to accomplish a task. A person with brain injury might also lack the insight into their own abilities to perform tasks, even when other people make suggestions or question their actions.

 

Rehabilitation and treatment often involves implementing strategies and systems to help brain injured individuals with executive functioning difficulties. These might include:

  • Daily planners and organisers
  • Home information centre – noticeboards, calendars etc
  • Set aside time each day for planning
  • Use timers and a Dictaphone, and mobile phone alarms and calendars for reminders
  • Use step by step checklists

 

Executive functions and regulating thinking and behaviour

Executive functions also have another purpose, they help us control our behaviour, and act and respond appropriately. Difficulties with self regulation can lead to impulsive behaviour or spoken words which can present in several ways:

 

  • Making inappropriate remarks or statements
  • Being rude
  • Dominating the conversation
  • Continually talking about a certain subject
  • Not being able to stay on topic
  • Inappropriate physical actions

 

With the help of a suitably qualified speech and language therapist/ pathologist, some individuals with brain injury can be taught to pick up on a listener’s reactions or facial expressions to know when they are making communication mistakes. Recovery from brain injury may mean re-learning social conventions and what facial expressions represent. e.g. if I say something and my communication partner looks shocked, I may have said the wrong thing.

 

 
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources, or for specific fact-sheets about TBI and information and strategies for improving communication, memory and attention skills go to the Downloads

Section.

 

Recommended Reading

 

 

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