About Brain Injury

Executive Functions

The executive functions of the brain include such things as multitasking, analyzing, reasoning, decision making, problem solving and planning. Of all the things the brain does, these tasks require the highest level of cognitive ability.

The executive functions of the brain can be compared to the executive functions of the big boss of a company. In a company, each supervisor brings information about their department to the big boss, who then makes decisions and plans for the whole company. In the brain, each part sends information to the frontal lobe, which then makes decisions and plans about what should be done.

In order to perform executive functions, the frontal lobe needs to see the “big picture”. It needs to hold onto many pieces of information at the same time, juggle them around, compare them, come up with possible solutions, look at lessons from the past, predict possible results in the future, identify possible pitfalls, and make logical plans. That’s a lot of mental work. It requires all of the skills we have discussed so far – concentration, memory, processing, sequencing, organizing, understanding, mental flexibility and communicating. This can be a very difficult task for many people after injury.

Examples:

• You are trying to resume your normal life. You coach soccer, serve as treasurer for the swim team, take painting classes, and have several projects on the go at home. You are getting more and more behind, you are arriving at meetings unprepared or late, and people are getting frustrated with you.
• Your wife has asked you what you would like for dinner – spaghetti or roast beef. You are able to picture spaghetti and you are able to picture roast beef, but not at the same time. As a result you are unable to compare them to decide which you’d rather have.
• Your spouse is upset with your lack of good judgment….again. You thought it was perfectly reasonable to give $100 to that nice young woman at your door. She needed money to fix her car so she could visit her dying mother in hospital.
• Last week you had decided to move closer to your family so you would have more support. Yesterday you realized this was a stupid idea, because you would have fewer job options there. Today you are thinking you should move because you are really tired of the city you live in. Your thoughts keep jumping around and never settle on a plan.
• You decide to start a woodworking project. You have not planned ahead so you do not have the materials you need. You go to the store and buy the wood and nails, but then you discover you also needed glue. So you head off to the store a second time.
• You and your wife are discussing a problem with your son. You jump at the first suggestion your wife makes, because it is too overwhelming to look at all the options, pros and cons etc.

 

Strategies for Executive Function Difficulties:

Stop and Think

When faced with any new situation, take time to think things through before you act. Use the acronym STOP

• Stop – stop what you are doing
• Think – think about the situation and what your options are
• Observe – look at the situation. Look for any problems right now and potential problems in the near future.
• Plan – make a plan about what you are going to do

Follow a Problem Solving Process

• Use pen and paper to help you see things more clearly.
  • Write out everything you know about the problem.
  • Write out all possible solutions. Don't settle on the first idea that comes to mind
  • Write out the pros and cons of each solution.
  • Pick the best solution.
  • Write up your plan. List all the necessary steps in the correct order.
  • Set a deadline for your plan, so you do not put it off.
• Write out everything you know about the problem.
• Write out all possible solutions. Don't settle on the first idea that comes to mind
• Write out the pros and cons of each solution.
• Pick the best solution.
• Write up your plan. List all the necessary steps in the correct order.
• Set a deadline for your plan, so you do not put it off.
• Talk to yourself out loud while problem solving, to help you stay on track.
• Check and double-check your thinking process. Make sure you have not missed anything.
• Sleep on your thoughts or plans for one night. Review your plan before you act on it.
• Tackle only one problem at a time.
• See strategies for specific cognitive deficits, such as concentration and organization.
• See also the section on “Problem Solving – How to Develop Your Own Coping Strategies” for an outline of a simple problem solving process.

Get help from someone you trust

• Watch others using their decision making and problem solving skills. Learn from them.
• Ask for their ideas or suggestions.
• Ask for feedback about your ideas.
• Ask them to help you work through the problem solving process to make sure you do not miss anything.