Callie Chatterton

Facts Located directly behind the forehead Most frequently injured Largest portion of the brain 1/3 of cortical area of cerebral hemisphere Connected to many other portions of the brain

Frontal Lobe

Functions Frontal lobe is critical in executive roles Goal-setting Completion of purposeful activities Planning Also plays important role in social behavior Inhibition Judgment/insight Attention

Phineas Gage Foreman of a track construction gang Frontal lobe damage Responsible and well-liked by his crew Building a railroad through Vermont’s Green Mts. Frontal lobe damage 13.25 lb, 3.5 ft. tamping iron penetrates brain Passes from behind the left eye through the top of the head carrying away a substantial part of the frontal lobe

Phineas Gage

Phineas Gage No immediate problems after incident Phineas Gage supposedly never lost consciousness and was up and discussing the accident soon after it happened Did eventually develop a wound infection but recovered quickly and was soon deemed physically able to return to work “Gage is no longer Gage” Before the accident he was responsible, caring, and well-behaved in a social setting. After the accident he became erratic, profane, and impatient

Causes of Injury Trauma Diseases Blows from the front, back, or side of the head can result in frontal lobe injury Even injuries not involving the head can cause bruising of the brain (whiplash) Diseases Strokes, lesions, meningitis, tumors

Causes of Injury

Consequences of Injury Three Frontal Lobe syndromes Orbitofrontal syndrome (lacks inhibition) Frontal Convexity syndrome (apathetic) Medial Frontal syndrome (akinetic) Answer lab assessments correctly but make poor choices in real situations Tests of perception, construction, language, and spatial attention are unharmed

Three Syndromes Orbitalfrontal syndrome Commonly caused by closed-head injury Characterized by disinhibited, impulsive behavior, difficulty in controlling their emotions, lacking in judgment and are easily distracted Many patients are incorrectly diagnosed with a personality disorder Possible link between violent offenders and traumatic brain injury

Three syndromes Frontal Convexity syndrome Characterized by disinterest, slowing of the motor functions and apathy Inability to regulate behavior according to personal goals Inability to plan ahead, lack of motivation and concern Generally not caring about the world around them

Three Syndromes Medial Frontal syndrome Characterized by occasional mutism, inability to control sexual appetite and akinesia Loss of sensation in lower extremities as well as weakness also occur Many patients experience symptoms from each syndrome

Detection Unless noticeable damage occurs (car accident trauma, etc.) tests are not usually performed Normal neurological and psychological tests rarely detect any abnormalities Requires careful observation of previous and current behavior

Tests Wisconsin Card Sorting Test Stroop Test Rhythm Tapping Test Patient sorts cards into one of four piles based on clues from instructor Stroop Test Patients must say the color that the word is written in rather than reading the word itself Rhythm Tapping Test Patient essentially imitates rhythm that has been tapped to them (easy to difficult)

Rehabilitation Goal Neglect Drug Therapy Based on the idea that human behavior is controlled by internal demands in response to the environment Selection of new actions when previously selected actions fail to achieve the goal Brief auditory stimuli also used Drug Therapy Alter the action of the working memory link and dopaminergic system dysfunction

Rehabilitation Reinforcement Organizing the executive system Simple reinforcement and reward techniques Organizing the executive system Targeted to specific areas in which the patient has problems

Conclusion Rehabilitation is difficult While there are many similar behaviors, each brain injury is different Individuals without brain damage Patients with frontal lobe lesions show similar signs to people without any brain damage (irresponsible, immoral, and flippant)

Resources Burgess, P.W. & I. H. Robertson (2002). Principles of the rehabilitation of frontal lobe function. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 557-570). Oxford, NY: Oxford University Press. Mesulam, M.-Marsel (2002). The human frontal lobes: Transcending the default mode through contingent encoding. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 8-28). Oxford, NY: Oxford University Press. Tranel, D. (2002). Emotion, decision making, and the ventromedial prefrontal cortex. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 338-353). Oxford, NY: Oxford University Press. Burgess, P.W. & I. H. Robertson (2002). Principles of the rehabilitation of frontal lobe function. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 557-570). Oxford, NY: Oxford University Press. Mesulam, M.-Marsel (2002). The human frontal lobes: Transcending the default mode through contingent encoding. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 8-28). Oxford, NY: Oxford University Press. Tranel, D. (2002). Emotion, decision making, and the ventromedial prefrontal cortex. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 338-353). Oxford, NY: Oxford University Press.