How to Avoid a Charlie Foxtrot After a Traumatic Brain Injury – Part 2
April 14, 2023 by Steve Kerschke, PT
One Size Doesn’t Fit All
Previously, we discussed the higher order cognitive functions associated with the frontal lobe and what deficits are present when a traumatic brain injury occurs in this area of the brain. Following formal AND functional assessments, we should have a clear picture of strengths and deficits.
How do we help someone acquire the skills necessary to be successful despite difficulties with working memory, mental flexibility, and self-control? Beyond understanding the location and mechanism of the injury, we must understand the distinction between implicit and explicit learning and how this translates into building effective treatment programs.
Explicit learning is an intentional and conscious method of acquiring knowledge and skills, where the learner is actively involved in the process. It involves interpretation of instructions and immediate feedback as well as memory and problem-solving capabilities. Think: memorizing ingredients to a recipe or attending a workshop to learn a new skill.
Implicit learning, on the other hand, is more automatic and involves absorbing information through observation and experience. It results in memories that are difficult to recall but can influence decisions and behaviors. Unlike explicit learning which relies heavily on verbal instruction and practice-based reinforcement, implicit learning involves completing a task without instruction(s) on how to do it. Consequently, implicit learning has been found to be incredibly efficient at generating a detailed understanding of complex systems that are difficult to explain in words alone. Think: learning to ride a bike or recognizing chords and melodies based on repeated exposure to music.
Learning After a Brain Injury
As we know, explicit learning is frequently impacted and in some cases, impossible after a traumatic injury. While both types of learning lead to acquiring and mastering simple and complex skills, deficits related to attention, memory, and reasoning impact skill acquisition.
Family members, friends, and even the most skilled clinicians overestimate a person’s ability to make sound decisions and connect past experiences with present actions (i.e., learn from consequences) after a brain injury. As a result, having unrealistic expectations and implementing misguided treatment programs that focus primarily on explicit learning leads to frustration and poor outcomes.
Avoid the Charlie Foxtrot (Chaos)
Align the treatment plan and expectations to the person’s capabilities
• Confirm attention, memory, and reasoning are sufficient explicit learning.
• Promote explicit learning as appropriate.
• Incorporate strategies focused on implicit learning when deficits are present.
Part three of this series will highlight the keys to facilitating implicit learning and how this translates into learning in the presence of mild to severe frontal lobe injuries. Stay tuned!