Frequently Asked Questions
Question:
What are executive functions?
Answer:
The term executive function (EF) is an “umbrella term” which encompasses a range of cognitive, emotional and behavioural difficulties which often occur after injury to the frontal lobes of the brain. Impairment of executive functions is common after brain injury and has a profound effect on many aspects of everyday life. Planning, problem-solving, self-monitoring, organization, divided attention, shifting or mental flexibility, and initiation of behaviors are often included under the term executive functions.
Attention and working memory are also sometimes listed as executive functions. The development of executive functions (EFs) is considered to be important because they are necessary for purposeful, planned, organized behaviors such as goal-setting and attainment. Most of us take these abilities for granted and we effortlessly perform extremely complex tasks all the time in our everyday lives. Brain injury, Brain damage or active autoimmune encephalitis are all reasons that an individual may have difficulty with executive functions.
Let’s look at an example of the role of some executive functions play in an everyday activity like cooking a meal:
Motivation – Wanting to make a nice meal and making the decision to start doing it.
Planning and organization – Getting all the ingredients and thinking about the right times to start them cooking so they will be ready at the same time.
Monitoring performance – Checking the food is cooking properly, that the stove or oven is on and nothing is burning or boiling over.
Flexible thinking – Lowering the heat if the food is cooking too quickly or leaving it longer if it is not cooked.
Multi-tasking – Washing dishes and cleaning up after yourself or adding to your grocery list if you have used the last of an ingredient you need to replenish while still remembering to attend to the food cooking and timing of the meal.
Which Parts of the Brain Controls Executive Function?
Executive functions are controlled by the frontal lobes of the brain. The frontal lobes are connected with many other brain areas and co-ordinate the activities of these other regions. They can be thought of as the conductor of the brain’s orchestra. Injury to the frontal lobes is the most common cause of executive dysfunction. Occasionally, damage to other brain areas which are connected to the frontal lobes can also impair executive functions. The frontal lobes cover a large part of the front of the brain, directly behind the forehead.
Rehabilitation
It is often hard for people with frontal lobe injuries to explain the difficulties they are experiencing, often because they may be unaware that their behavior is inappropriate. Their behavior may appear to be anti-social and can be misunderstood as depression, lack of motivation, selfishness, or aggression. Relationships with others may be negatively affected as a result. Executive functioning problems may also have a significant emotional impact and can lead to feelings of frustration, exhaustion, embarrassment and isolation. It can also be very difficult to return to work due to problems with multi-tasking, organisation and motivation. An inability to prioritise and complete tasks also makes working life difficult. It is important to be aware of the fact that these behaviours occur as a result of brain injury and are not intentional.
Rehabilitation of executive dysfunction can be challenging and requires an individualised approach to treatment. The rehabilitation program for each patient will depend on their goals, the nature of their difficulties, self-awareness, readiness to engage in treatment, level of social support and presence of other issues such as mood disturbances. An important part of the rehabilitation process is educating the person about the effects of their injury. This can help increase the person’s insight and understanding of what has happened.
Impairments in executive functions can cut across many areas and affect academic performance, social interactions, and vocational performance. A neurologist will refer an AE patient for a neuropsych evaluation to see what areas of the brain are not functioning properly and how that is impacting the patient’s daily living. The results are then used to create rehabilitation goals to re-learn and re-train the brain.