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How to Avoid a Charlie Foxtrot After a Traumatic Brain Injury – Part 1

Air Traffic Control

Just as an air traffic controller must pay attention to multiple planes at the same time and make decisions to avoid collisions and delays, executive functioning involves managing multiple cognitive processes simultaneously.

These skills are intertwined like three strands of a rope: you cannot have one without the others. In turn, they form the foundation for learning and how we navigate the unpredictable challenges we face throughout our life.

Collectively, this set of cognitive abilities involves higher-order thinking related to:

• Working memory
• Attention and focus
• Planning and organizing thoughts and actions
• Cognitive flexibility and decision making
• Keeping track of time
• Initiating activities
• Self-monitoring of thoughts, actions, and emotions

Executive Functioning in Brain Injury

Executive dysfunction is among the most common and disabling aspects of cognitive impairment following a traumatic brain injury. This is largely due to the location of the prefrontal cortex (frontal lobe), which is an area of the brain located at the front of the skull that also sits atop many bony ridges making it even more susceptible to injury.

As you might expect, an injury affecting one or more areas of the brain responsible for executive functioning impacts an individuals’ ability to be successful in all aspects of life. More importantly, learning and skill acquisition are both impacted because of difficulties with working memory, mental flexibility, and self-control.

Common Mistakes

Following a severe frontal lobe injury, deficits are often obvious. Alternatively, individuals who have suffered a mild brain injury frequently present well in a controlled, clinical setting, but their deficits can be more subtle and nuanced. Consequently, it is common to see family, 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).

Avoid the Charlie Foxtrot (Chaos)

Obtain formal AND functional assessments to understand strengths and deficits.

• Complete functional assessments in familiar environments to get a first-hand view of the unique challenges and demands of the real world.
• Use the formal assessment data to supplement the functional findings.

What’s Next?

Part two of this series will highlight the distinction between implicit and explicit learning and how this translates into aligning expectations and building effective treatment programs. Stay tuned!