Traumatic brain injury (TBI) to the left frontal lobe, whether from a closed-head injury, lesion, stroke, disease, tumour, or other misfortune of health, can have devastating effects on adaptive functioning and behaviour. The frontal lobe is considered to be the centre of personality and emotional functioning. It controls motor behaviour, language, motivation, attention, judgment, decision making, problem solving, social and sexual behaviour, and impulse control. Both frontal lobes are involved in all kinds of behaviours, but for most people, the left frontal lobe is more involved in language functions, while the right frontal lobe is more involved in non-verbal abilities.
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Identify the nature and extent of damage. Traumatic brain injury to the left frontal lobe will have varying effects on different people depending on their level of functioning prior to the trauma, the location, nature, and extent of damage to the frontal lobe, idiosyncrasies of their brain structure, and collateral damage to the prefrontal cortex and surrounding regions of the brain.
The nature of damage to behavioural and cognitive functioning is best determined through a comprehensive neuropsychological evaluation. This evaluation should assess all aspects of behaviour that are potentially affected by the brain injury. Testing should assess motor function, problem solving, memory, language, language-related movement, judgment, impulse control, spontaneity, and social behaviour. Problems such as difficulty controlling facial expressions, fine movements and strength of arms, hands and fingers, complex chains of motor movements, and difficulty in speaking are all associated with frontal injury.
Develop an individualised rehabilitation program based upon the nature and extent of functional disability and the TBI survivor's strengths and capacities. An interdisciplinary team of specialists from physiotherapy, occupational therapy, speech/language therapy, rehabilitation medicine, psychology and psychiatry should work together to address specific deficits and issues that were identified during the neuropsychological evaluation. Additionally, dietary and nutritional programs designed to enhance nutritional healing should be initiated and continued throughout the recovery.
Often, admission to a good brain trauma recovery unit with a quality staff will be the best way to affect maximum recovery. It is critical that the individually tailored treatment is implemented as quickly after the trauma as possible. These interventions work to alter cell efficiency, reorganise neural communication and brain organisation, alter brain chemistry, and "reassign" brain functions to adjacent or even more distant areas of the brain. Rehabilitation helps people relearn cognitive skills and compensate for deficits. There is a specific window of opportunity of about 6 months following the trauma during which these brain recovery processes are most active.
Implement the rehabilitation program. Each member of the treatment team needs to work with the TBI survivor to enhance recovery. Several factors can promote or interfere with rehabilitation.
The TBI survivor can take medications that affect neurotransmitters involved in the frontal and prefrontal cortex to facilitate recovery. Ritalin and other medications used to treat attention deficit hyperactivity disorder can enhance recovery of concentration, attention, impulse control and decision making. Immune system suppression drugs can reduce the oedema (excessive body fluid accumulation) in the brain and reduce damage to surviving tissues.
A good deal of social support can be provided. Motivation to do the work of therapy is important to recovery. The TBI survivor is overwhelmed, fearful and anxious about the future, and depressed over his injury, interruption to his life routine, and loss of function. Emotional factors influence recovery, so psychotherapy and supportive therapy should be an integral part of the recovery program.
The TBI survivor should engage in activities that work his ailing "mental muscles." Mental tasks, reading exercises, problem solving, verbalisation and training exercises designed to target specific speech and language problems can all enhance long-term outcomes. Often, pre-trauma levels of functioning will predict the level of recovery of language and speech functions, presumably because of the pre-morbid "fitness" of the frontal lobes.
Identify Damage, Develop and Implement Program
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