The Frontal Lobe

“Every clinical assessment of behavior requires a careful review of frontal lobe functions.  Nonetheless, several challenges face behavioral neurologists and neuropsychologists in their clinical attempts to assess the frontal lobes.  Whereas an assessment of sensorimotor systems is guided by a relatively well understood pattern of brain-behavior relationships, the frontal lobes are incredibly complex, and because of their extensive interconnections with other neural structures, they control or influence a broad range of behaviors.  Injury to the frontal lobes can affect initiation of complex motor behavior, attention, executive functioning, working memory, episodic memory, language, emotions, and behavior.”~ from the chapter “Bedside Frontal Lobe Testing,” of The Human Frontal Lobes.

The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms. The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium, proximity to the sphenoid wing and their large size. MRI studies have shown that the frontal area is the most common region of injury following mild to moderate traumatic brain injury.

There are important asymmetrical differences in the frontal lobes. The left frontal lobe is involved in controlling language related movement, whereas the right frontal lobe plays a role in non-verbal abilities. Some researchers emphasize that this rule is not absolute and that with many people, both lobes are involved in nearly all behavior.

Another area often associated with frontal damage is that of “behavioral sponteneity.” individual with frontal damage displayed fewer spontaneous facial movements, spoke fewer words (left frontal lesions) or excessively (right frontal lesions).

One of the most common characteristics of frontal lobe damage is difficulty in interpreting feedback from the environment. Perseverating on a response, risk taking, and non-compliance with rules, and impaired associated learning (using external cues to help guide behavior) are a few examples of this type of deficit.The frontal lobes are also thought to play a part in our spatial orientation, including our body’s orientation in space.

One of the most common effects of frontal damage can be a dramatic change in social behavior. A person’s personality can undergo significant changes after an injury to the frontal lobes, especially when both lobes are involved. There are some differences in the left versus right frontal lobes in this area. Left frontal damage usually manifests as pseudodepression and right frontal damage as psuedopsychopathic.

When traumatic brain injury occurs to the frontal area, it is impacting the brain’s largest lobe. Located at the front of each cerebral hemisphere, this lobe is responsible for conscious thought, voluntary movement, and individual personality characteristics. When you are searching for just the right word to say, it is this section of the brain upon which you rely. Damage to this vital lobe can cause impairments in judgment, attention span and organizational ability, as well as a loss of motivation. In addition, the frontal lobes are charged with the task of regulating mood and emotions. Consequently, when they are compromised, a patient may become impulsive, act rashly, and adopt risky behaviors such as substance abuse.

Sexual behavior can also be effected by frontal lesions. Orbital frontal damage can introduce abnormal sexual behavior, while dorolateral lesions may reduce sexual interest.

As is the case with other traumatic brain injuries, damage to the frontal lobe most often occurs as a result of vehicle crashes, falls, and firearms. There are over 6 million car accidents in the USA every year, resulting in 3 million injuries, 2 million of which are permanent.

In the case of frontal lobe damage, particular attention will be focused on helping the patient to learn strategies for curbing impulsive behaviors and regulating emotions. Since many of the symptoms of frontal lobe damage are similar to those of attention deficit disorder, researchers are conducting preliminary studies to see if these traumatic brain injury victims respond to Ritalin and other ADHD medications.

Patience and perseverance will be absolutely essential for all involved. Since frontal lobe damage causes marked deficits in mood, personality and behavior, a patient might have to thoroughly overhaul many of his or her most basic coping and human relations strategies.

Okay, so are you ready for the layman’s terms???

I’ll do my best here to summarize in shorter length what this all means.

The frontal lobe of the brain is usually the part of the that receives the most damage when a person is involved in a vehicle accident. This part of the brain controls the cognitive motor skills that drive us every day. It also controls the part of the brain that deals with emotions. When a fronal lobe injury occurs, then a lot of usual function becomes impaired.

What is fascinating to know is that people who have these kind of brain injuries actually go through a lack of compassion, care, and otherwise loving emotions towards another human being. A spouse for example will have an extremely decreased sex drive. The thought of having sex with their partner after having a frontal lobe injury just no longer interests them. Yet on the other hand, if sexual contact is something that they desire, they are not considerate of their partner’s feelings and they drive for what they want and disregard their partner.

Which is sad because I think that a lot of the times in this particular situation the relationships crumble and fall apart and then totally dissolves. And the person who has suffered the injury begins to think “it’s me, it’s all me… I am no good. I am nothing but a bother to people. I am sorry.”- and so on.

Not only that, their relationships with family, friends, and other people become extremely diminished as well. They seek only what they want without the thought of other people. If it is attention that they want, then they seek it- anytime, anywhere, by any means possible.

Some people with a lesser injury will actually appear to become concerned for the feelings of others but the injury doesn’t allow them to fully understand that what they are really doing is looking for the acceptance from other people that what they are doing, “is okay” with them. And if so, they continue on in this behavior.

They fear that people will run away from them because of their injury. And sometimes that is actually the case. They will come across so frustrating that it breaks the point of the other person and they put an end to it because they are no longer able to handle the situation.

My sister was in a serious vehicle accident and she suffered the same injuries. Luckily she was not injured any more than she was or even killed, just because some asshole decided to leave his house after drinking and get out on the wet roads in the middle of winter where there was actual snowfall in Texas after the sun was gone and the temperatures at night were dipping below freezing.

Yet because I had known about what happens with the frontal lobes when they become damaged, I thought to myself that “this was going to get interesting, or miserable”. I was living with her and her family at the time. And indeed, it became interesting. She got into more arguments with her husband and was frustrated a lot with her son, and with me. The best I could do was try to see where she was coming from and NOT take everything extremely personal because I knew that she has this injury to her brain.

For those of us who know someone with a frontal lobe injury: Taking things personally all of the time is not really the best resort in dealing with the person. Yet it is extremely difficult not to. Patience is the key. Also you should make clear of your boundaries so you are not being taken advantage of all of the time. You shouldn’t fear to tell a person with a brain injury “no”, or “stop”. Set your boundaries and explain them that as much as you still care for them, just because you are telling them “no” does not mean you have stopped caring.

For those who have suffered a frontal lobe injury: Clearly this is not the end of the world. It just means that your world is going to be different than what it was before. I am not a medical professional, so I cannot say if this is possible or not but working on your social behavior could save you a lot of anguish in the long run. Finding a way that is non-intrusive upon your family and friends could greatly benefit you. After all, before the injury, you knew that it was not the right thing to do to be a constant bother towards others. Finding a solid outlet (such as therapy) could definitely help. Yet the entire “woe is me, I’ve got a brain injury” is only going to get you so far before people DO start walking away. And it is not because you have that injury it is because of your impaired behavior. The injury itself has nothing to do with it.

Like I said, I am no professional. So I do not even know if “thinking before you act” is even possible because of the damage sustained. Yet using the injury as a crutch is only going to turn people off, and then eventually turn them away.

Understand your injury and what you can do about it. Once the brain is damaged, there is no cure. A broken arm can heal, but a “broken brain” cannot. So that is why I would suggest to a person that they seek the professional help of a therapist to begin some kind of mental rehabilitation.

It is not an impossibility to have human relations with a person with a frontal lobe injury. But it is safe to say that it is extremely complicated and difficult.