Back to work with a chronic dysexecutive syndrome? (A case report)

Abstract We present the case of G.L., a 33-year-old medical doctor, who, nine years after traumatic brain injury, was admitted to our department after he had drifted through several jobs. According to his superiors he spent too much time on routine activities and seemed unable to adapt himself to open problems and the requirements of novel or changing situations. From a psychometric perspective we found G.L. rather unremarkable, with largely good attentional, memory, and problem-solving performance. Behavioural analysis, however, revealed that G.L.'s discrete but definite frontal-lobe damage had produced defects in “executive functions”. After 12 months of intensive training G.L.'s mental structure had been modified to incorporate new source schemata, which enabled him to carry out demanding routine thought operations. In creating and practising these higher-level schemata his handicap could be diminished to the point that he now has got a supported employment. His basic cognitive incompetence, however, r...

[1]  Scherzer Bp.  Rehabilitation following severe head trauma: results of a three-year program. , 1986 .

[2]  E. Renzi,et al.  The Influence of Aphasia and of the Hemispheric Side of the Cerebral Lesion on Abstract Thinking , 1966 .

[3]  D. Norman.  Categorization of action slips. , 1981 .

[4]  Tim Shallice,et al.  The Involvement of the Frontal Lobes in Cognitive Estimation , 1978, Cortex.

[5]  J. W. Getzels,et al.  Creativity and Intelligence , 1962 .

[6]  G. Prigatano,et al.  Neuropsychological Rehabilitation After Brain Injury , 1985 .

[7]  A. Damasio,et al.  Severe disturbance of higher cognition after bilateral frontal lobe ablation , 1985, Neurology.

[8]  K. Walsh.  Neuropsychology: A Clinical Approach , 1978 .

[9]  M. W. Montgomery,et al.  The Quantitative Description of Action Disorganisation after Brain Damage: A Case Study , 1991 .

[10]  Y. Ben-Yishay,et al.  Neuropsychologic Rehabilitation: Quest for a Holistic Approach , 1985 .

[11]  R. Sternberg.  Beyond IQ: A Triarchic Theory of Human Intelligence , 1984 .

[12]  The Retraining of Frontal Lobe Dysfunction , 1982 .

[13]  D. Meichenbaum,et al.  Training impulsive children to talk to themselves: a means of developing self-control. , 1971, Journal of abnormal psychology.

[14]  D. Gronwall,et al.  Delayed recovery of intellectual function after minor head injury. , 1974, Lancet.

[15]  D. Norman,et al.  Attention to Action: Willed and Automatic Control of Behavior Technical Report No. 8006. , 1980 .

[16]  E. Weigl,et al.  On the psychology of so-called processes of abstraction. , 1941 .

[17]  H. Goodglass,et al.  Disorders in executive control functions among aphasic and other brain-damaged patients. , 1990, Journal of clinical and experimental neuropsychology.

[18]  D. Stuss,et al.  The Frontal Lobes , 1986 .

[19]  H. Nelson.  A Modified Card Sorting Test Sensitive to Frontal Lobe Defects , 1976, Cortex.

[20]  D. Stuss.  Disturbance of self-awareness after frontal system damage. , 1991 .

[21]  G. Bäumler,et al.  Farbe-Wort-Interferenztest (FWIT) nach J. R. Stroop , 1985 .

[22]  H. Simon,et al.  The functional equivalence of problem solving skills , 1975, Cognitive Psychology.

[23]  A. Baddeley.  Working Memory: The Interface between Memory and Cognition , 1992, Journal of Cognitive Neuroscience.

[24]  Teresa C. Brobeck,et al.  Training awareness and compensation in postacute head injury rehabilitation. , 1989 .

[25]  M. Goldfried,et al.  Problem solving and behavior modification. , 1971, Journal of abnormal psychology.

[26]  D. Meichenbaum.  Self-instructional strategy training: a cognitive prothesis for the aged. , 1974, Human development.

[27]  C. Reynolds,et al.  Wechsler memory scale-revised , 1988 .

[28]  D. Stuss,et al.  Verbal Regulation in the Control of Motor Impersistence: A Proposed Rehabilitation Procedure , 1987 .

[29]  H. Simon,et al.  Why are some problems hard? Evidence from Tower of Hanoi , 1985, Cognitive Psychology.

[30]  J. Duncan.  Disorganisation of behaviour after frontal lobe damage , 1986 .

[31]  Michael W. Montgomery,et al.  Cognitive theory and the study of everyday action disorders after brain damage , 1993 .

[32]  Norbert Mai,et al.  Problem-solving deficits in brain-injured patients: A therapeutic approach , 1991 .

[33]  McKay Moore Sohlberg,et al.  Contemporary approaches to the management of executive control dysfunction , 1993 .

[34]  Gabi Matthes-von Cramon,et al.  Reflections on the treatment of brain-injured patients suffering from problem-solving disorders , 1992 .

[35]  A. Nezu,et al.  Effects of problem definition and formulation on decision making in the social problem-solving process , 1981 .

[36]  T. Shallice.  Specific impairments of planning. , 1982, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[37]  D. Meichenbaum,et al.  Training schizophrenics to talk to themselves: A means of developing attentional controls , 1973 .

[38]  A. Luria,et al.  The programming of constructive activity in local brain injuries , 1964 .

[39]  G. Prigatano,et al.  Neuropsychological rehabilitation after closed head injury in young adults. , 1984, Journal of neurology, neurosurgery, and psychiatry.

[40]  J. Mandler.  Stories, Scripts, and Scenes: Aspects of Schema Theory , 1984 .

[41]  T. Shallice,et al.  Deficits in strategy application following frontal lobe damage in man. , 1991, Brain : a journal of neurology.

[42]  A. Luria.  Higher Cortical Functions in Man , 1980, Springer US.

[43]  J. Giacino,et al.  Remediation of Executive Function Deficits After Traumatic Brain Injury , 1992 .

[44]  Patrick C. Kyllonen,et al.  Reasoning ability is (little more than) working-memory capacity?! , 1990 .