Executive dysfunction is a term for the range of cognitive, emotional and behavioural difficulties which often occur after injury to the frontal lobes of the brain.
It includes some of the most common effects of brain injury and makes up a big list, including difficulty planning and carrying out activities, rigidity in thoughts and actions, poor problem solving, impulsive behaviour, mood changes, difficulties in social situations and problems with memory and attention.
Are you or your loved one affected by one or more of these issues? If so, do you have any tips and strategies that help?
We know it's a big question but your answers will help us to put together an article on the subject to support all of those affected.
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(PS: If you need to find out more about executive dysfunction you can see our existing information on our website: headway.org.uk/about-brain-...
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I've almost completed a full recovery from mTBI which had all the above mentioned and much more. At almost 2 years post injury I was diagnosed as unrecoverable. I learned and developed over time a strategy to regain many cognitive functions. Although the functions work and are in the final higher integration phase, the former person is nowhere to be found.
This strategy was based on the simple premise that repetitive action develops neural pathways, if this is coupled with the understanding that micro damage throughout the brain can be reconnected through repetitive actions, or that neural bypasses can be built, it should be possible in theory to repair and regain brain functions including executive function.
This was done in conjunction with mindfulness practices which are vehicles for neuro-plasticity. Currently theses are, clinically, in the form of Mindfulness-based stress reduction (MBSR) or Mindfulness-based cognitive therapy (MBCT). These may help some people with stress and depression however they are of no clinical use for cognitive functional reconstruction. I can show this in finite detail. I am developing a new variation specifically for functional cognitive reconstruction based on experience.
I am currently researching the steps I took and verifying them through the Buddhist psychology model and modern neuroscience at the Centre for Mindfulness Practice and Research (CMRP), Bangor University, Wales. I will be qualitatively showing the process in my final thesis next year.
I sent an email to the main headway email address describing what I was doing and asking if there was any interest in further developing this at a later stage. Simply if it worked for me and if I can show it scientifically, it will have validity and others may benefit from it. It's worth pursuing.
As yet, I have had no response from Headway to the email.
I could have walked away from a brain injury into the big blue yonder; but I was so surprised by how rapidly I progressed once I got started I felt a responsibility to help others. I've been through the same inhuman processes that most people go through. I was just lucky, have a background in science and could understand the basic principles and concepts required to rebuild my cognitive functions. I focused my whole being on rehabilitation and it worked.
I can develop this process into a workable format and share it for the greater good.
Hi pinkvision, thank you very much for your reply - it's really interesting to hear the approach you've taken and the benefit you've had from it. Sorry we haven't replied to your email, would you like to send it through to me on website@headway.org.uk and I can take a look?
Thank you for sharing this and persisting with your own recovery and developing a process. Are you able to say what the initial steps were that got you onto that rapid progression? I also wonder whether they have any impact on fatigue?
I found that fatigue was mostly from sensory overload, especially vision, I got that corrected over a period of time. A percentage of the fatigue was due to loss of automatic functions, ie simple things like trying to work out how to make a cup of tea or work out how to put socks and shoes on in the correct order. Brain capacity was at full stretch doing this. What I realised was that if the sensory stress was lifted it was easier to work out how to to the simple things. Then by repetitively training simple things they became automatic again and needed less cognitive energy. The trick is to recognise and accept the issues to reduce your stress levels, then set about building up heirarchical levels of cognitive functions. This process includes the body also, balance etc.
It's important to get the process in the right order. Sensory, perceptual and short term memory, these feed the cognitive processes. Then you can work out which cognitive processes are really affected rather than being masked by the senory/perceptual issues.
This is common sense scientifically. It's called a bottom up approach. Medical science currently use a top down approach and think that everything can be solved cognitively. The reality is that both need to work in tandem, both affect each other. Many of the sensory and perceptual treatment options are missing from the health service programs. They seem to categorise these issues as 'psychological.'
This paper and the ensuing argument surrounding what is termed 'The miserable Minority' highlights the point in the confusion between cognition and other persistent 'chronic' conditions. researchgate.net/publicatio...
This is within the mainstream paradigm. There is another paradigm for treating brain injuries and it via treatment for sensory perceptual issues called the 'functional brain injury model.' It is based on visuo/auditory/vestibular/body shape and regulation. This is mostly private and DIY through shared information across brain injury forums. Much of it is based on experiences from people like Clark Elliott who wrote the book 'The Ghost in My Brain.' It alerted people to the possibility of another way. A flexible fusion of methods is the sensible approach.
This is basically what I did, worked out what was happening, in what order it was happening and worked through solving the issues at each stage in a progressive manner.
It's doable. I've tried to share this information but the hurdle is that the response is 'you're not an expert' etc, so I'm scientifically writing it up for viability.
I sure hope you are able to take this further , Pink. I more or less feel I have to find my way on my own - I ahve no issues with hard work, just need direction.
Hi Pink Vision, what head injuries did you have after your accident? I think what you have written is so true and if I had that support would have recovered far better than I did. Trying to work and carry on as nothing had happened was a joke 5 days a week falling asleep at my desk as I was so tired then anger, emotional wreck by the end which made everything far worse. Referred to go to the doctor for pills which was my treatment. A few appointments which came to nothing.
Hmmmm, I tried to do a few work related things but found it impossible. I thought the best option was to concentrate fully of rehabilitation. I lived the process, there was realistically no other option. I lived off credit cards for 2 years until the CAB sorted out my financial position and also with the help from my MP, got UC and PIP which provided a window to reduce stress levels and crack on with recovering.
I decided after reading many horror stories of people trying to go back to work to retrain higher function skills ie communication, spoken and written to a good standard. My thinking after reading other's peoples trials at working and so often failing was that there was a difference between feeling ok at home and thinking you are recovered. Then going to work and realising that the skills required for this are different from those needed to be at home. All the work related skills would also have to be retrained and that would take a long time.
So the strategy was to expose myself to levels of activity around the house and in the viscinity where I lived and keep doing these until I could cope functionally with them. Then increase the activities by adding an extra task. Basically it's doing the simpler things then increasing the range over time until they cause no problems, become automatic processes.
My injury was a contra-coup with twist. So the main damage was to the rear left side and the secondary frontal to the front right. I'm left handed so it affected visual and perceptual processing of objects, body regulation mainly from the rear hit and prefrontal and motor at the effect from the front hit. Many functions in the left arm 'died', my speach was affected with aphasia and attention and concentration control via the prefrontal damage. The other effect was tearing or shearing to the corpus callossum which affected hemisphere dominance. My right brain became more dominant but with visual distortions. Very trippy internally and externally.
As to support there is none realistically. The main health service programs are to contain the patient rather than rehabilitate. This is why the recent ABI/BILL is important because this process needs to shift emphasis from containment to rehabilitation. All the methods are available they just need bringing together into a usable format.
Your understanding of all this is amazing I really hope you can make a difference to the current service. Would you say you are the same as before the accident mentality and physically? Sorry for the questions but I think I’m better now physically due to training difficult for me to say mentally as how would I know I have had tests at my appointments 1 year after the accident and when I have been recently. I will ask on the 20th if or how they differ not sure if I did the same tests or if they we’re going to be compared? I don’t think my memory is all that good but maybe it’s no different to pre accident. Another few months and it will be 20 years ago.
There's three distinctions there, physical, brain function and identity. I'm at the wrong age to guess my physical ability, late 50's is when people lose their 'strength and agility' and it does not come back easy, if at all, I was incredibly strong before my accident, I'm not anymore and tend to focus on cardio vascular exercises and stretching with yoga moves. Brain functions are all working and I'm in the final stage of integrating and tuning up. Identity is a different matter, it's odd, there's a knowing of the person before the BI but any actions now are due to the repetitive training for rehabilitation.
Many people talk about the loss of the former self, there's memory or a felt sense, but identifying with the new person is difficult to explain. You should look up the 'Sperry' experiments where the corpus collossum was cut between the brain hemispheres of some people. It turned out that we all have 2 minds that are independent of each other. Normally these two communicate to give the illusion that there is one mind. So if a region of one hemisphere is damaged in a BI the other hemisphere takes over in dominance leaving the former balance between the minds altered. Hence the loss and gain. It's a lot more complicated than that but you get the drift.
Yes I think I get that and will take a look it sounds really interesting. I was thinking tests, memory, physical strength, mental ability but then emotion, love, empathy, feelings. The first could be all relearned but the later I’m not sure or how we are thinking is that creating the emotions we feel?
That sounds amazing Pinkvision! Really interesting and I look forward to hearing how your practices can be made into a workable format. We need more people like you 👏👍 well done
Hi, for a long time my executive function was skewed. My stroke damaged mainly the low deep region of the brain involving the hypothalamus. This was like knocking out the quad core processor.
At first it was like a sat nav of thoughts had shorted out, thousands of thoughts flying round and not knowing where to go, rest, stop, or be filed for reference.
The most simple of choice became impossible to process, at the same time the emotional regulators went on strike. When an emotion was triggered, it felt like every emotion vide for supremacy, resulting in a gibbering wreck.
The lack of ability to regulate emotions and thoughts ran 24/7 for months. They didn't allow sleep, but were exhausting. I attended a sleep clinic, neuro-psychologist and neuro-psychiatrist.
The sleep clinic fairly quickly decided that my problems were out of their remit. The neuro-psychologist helped to know what was not working, and the neuro- psychiatrist helped with emotional regulation.
But this left me in a twilight zone for about six years. In this time it left me open to emotional, financial, and to a lesser degree physical abuse. This culminated when I moved and attended a new GP practice. They felt that the cocktail of medication was not good, and attempted to adjust it, resulting in a complete crash. I was referred to a new neuro team.
After a number of weeks of assess, the crash came to ahead, the neuro-psychiatrist prescribed additional antidepressants, on top of instructing the GP to stop any further adjustments. This was like the sun had come out. I regained emotional control, and some ability to resume thoughts and choice. It also allowed me to recognise the abuse that had been ongoing, and put a stop to it.
That was probably five years ago now as I approach eleven years post hiccup.
For the last year, decision making has been noted as declining, but has possibly been longer. Covid, and lockdowns has possibly delayed this being discovered. At this point I am eight months into this decline being investigated.
I don't think I have any tips or strategies as such. I would say that following any form of brain injury there needs to be ongoing neuro collaboration with GP services as many of the ongoing health concerns are as a direct result of the injury to the brain, and the most minimal changes need prompt access and investigation.
Hi guys I haven't been here for ages, the word wxecutive disfunction was used as another cover all cop-out by my specialist in order that he could put me on the back burner and "discharge" me following my behavioural difficulties or anger and frustration with being passed across to someone else..... a great excuse for discharging a patient and not being willing to engage with me or see me regularly..... and this Headway was treatment or the absence of care by the Mawdesley hospital
All of the above and at the end of the day embrace it….. Meeting up with extended family for a family get together…said to my cousins….” Well you remember before Johns accident he was extrovert,loud, said what he thought and sometimes entertaining, sometimes a pain in the bum?”Yes, they said apprehensively……… we remember…..
“Well since his TBI he’s all of that only more so”! I apologise now but he is what is…”
They laughed with relief , said no problem and we all had a great afternoon, noisy, happy , eating and drinking and John did his thing.
Sometimes you have to be honest with people and hope for the best.
All those for me. Neuropsychology tests confirmed problems with executive memory. It's still an issue three and a half years on. Private rehab in London, graded exercise based on John Leddy's Buffalo treadmill protocol, oculomotor and vestibular exercises from a concussion specialist sports physio who also lectures here ( Theo Farley) input from a neuropsychiatrist and a neuropsychologist, Duloxetine for a couple of years, and an MBSR course have provided me with useful strategies, and a marked improvement at the time of all the input ( had to stop when my firm let me go, and the insurance ended, could only self fund for a limited time after that). I think a useful thing to raise is that insurance companies are allowed to class brain injury as psychological and put a cap on funding, which they don't apply to 'physical' injuries. Many medical insurance policies simply exclude treatment for any psychological problems. This is clearly wrong and should be addressed politically.
Strategies that help me-
Extensive use of a calendar, a large week at a view diary, reminder alarms on my phone and on Alexa, the combination of the week and month at a view helps to keep me orientated. All appointments, social or otherwise, are on my phone calendar with a system of reminders between a week to an hour on advance to stop me forgetting. Planning out a week can take me a whole morning. Changes in plans can throw me completely. When I get in a state I sit down and write out on a separate large notepad what actions I need to take that day in minute detail, and just follow it. I also need a late night curfew on shopping online because I do more impulse shopping than I can truly afford - find I'm over influenced by marketing emails - so am unsubscribing.
If I can't make a decision I describe what I'm trying to do to a friend and they guide me through it.
Trying to deal with emotional disregulation is difficult and can lead me into bad feeling with family. Try various techniques including mindfulness to divert myself from the extreme feelings. Sometimes works. Sometimes doesn't. But deciding not to act on strong feelings of anger or sadness is important, and trying to wait till they blow over.
In social situations I focus on my listening skills as am not as fluent in conversation as I was previously, and have to pause to collect my thoughts. I think my strategy is not to let myself worry if I get in a conversational knot - people are okay with waiting.
When I'm tired, everything gets harder to handle so good breaks are really important.. if I can I listen to a body scan recording from the MBSR course I did twice a day, it's essentially 25 mins of nidra yoga. The day goes better if I can do that.
Writing on here is really hard, but I have improved my tolerance with practice.
I haven't been able to return to work, my previous job was pretty intense, and am actually struggling to do a couple of hours of voluntary very basic office admin work a week now.
Executive dysfunction and fatigue are my biggest problems neurologically. Tips for dealing with it are basically to rest and pray I dont fo anything too stupid when executive dysfunction is more prominent. things I wish I could do are; have a better routine, have problem solving techniques that I can follow long term, deal with my anxiety around domestic paperwork, learn to meditate and have a healthier diet long term. All things I thing would help mitigate for prominent periods of executive dysfunction. I am just coming out of a period of high executive dysfunction and I think I really need to try to have a diary to help me work through problems of exec dysfunction mainly dwelling on social problems and isolating myself in these periods etc... any tips on exec dysfunction would be greatly appreciated.
When I read this I asked myself how do I cope with executive dysfunction? How do you answer such a profound question…I need time and space in my life and do not cope with busy/stressful situations anymore!
Old me’ was a busy working(staff nurse) mum ‘New me’ is ill health retired from a 20 yr career, stay home mum as I have limited mobility and don’t cope well outside of the ‘safety’ of my home and without the support of my long suffering family!
My coping mechanisms:
Time and Space(physically and mentally)
White Boards and Note or Brain pads as I call them!
Alexa and reminder apps
Wheelchair and several walking frames in prominent places
Careful pre planning of all trips outside the home
2 toilets and walk in sit bath/shower
Supportive family to do shopping/cooking assist with day to day household chores.
The list is far longer than I thought/like when I began it so really don’t know what I would do without my unpaid carers my husband and daughter must give them both a hug😀Hope this helps…
It is now 22 years since my accident and I imagine an accident which took seconds to actually occur took approximately 10 years of recovery to get me where I am today. I initially suffered with the inability to read and write which kind of took precedence over a wide range of problems, all of which fit into executive dysfunction, although at the time I was unaware of this term.
Out of all the areas you have highlighted in your message I have continuously suffered in social situations and despite massive improvements I still have specific memory problems. To combat this problem, I write down the names of who is coming to a party before hand, not to carry around but somehow writing names down first helps me to remember them. I also kind of rehearse scripts in my mind regarding what are normal kinds of questions to ask and anything I know about the person which can act as a conversation topic. This generally breaks the ice and involves me more in the social situation than I would have been had I not prepared. Also keep conversations to a minimum of participants, 2 being the maximum this is due to the fact that as soon as I surround myself with people I become uncomfortable and lose track of what is being said. Even now though, social interaction does not come naturally to me I am afraid and I find myself retreating from social engagements far too often. It kind of moves in phases where I have to give myself a slap in the face to get a grip on myself to enter the social world once again. The slap in the face is necessary because if you consistently refuse offers of going out with colleagues or whoever, they eventually stop asking. Socially it might be an idea to tell the people about your brain injury, briefly, but in my experience this has far too often resulted in a less than positive result so nowadays I avoid it at all costs. I still work and have never told an employer about it either.
On the subject of work, I use my mobile phone planner for everything, appointments with customers, times of meetings and forward planning times. In addition to this I also use it for my home life ie. what time to collect the kids, what time to turn off the gas etc etc etc. I also use Samsung notes to remind me of names of customers and friends with a brief description of who they are in my own words, this is not shared with anybody as they are written quickly and may appear a little blunt to the outsider.
With regards to mood changes I find whereever possible that exercise helps to relieve the stress I think my brain injury puts on me. I have to escape from the world sometimes, there is no other way of putting it. I find escape into the quietest places helps the most and where I am surrounding by nothing. I do not want to exist on this isolation permanently but sometimes it is exactly what I need. Exercising in isolation is even better and when I do I find that exerting myself physically, often by cycling and pushing myself relentlessly helps to return me to normal; whatever normality is supposed to be these days. I have no idea why I have to push myself so hard physically but after I have done so I feel so much more in control of my mood.
I haven't really looked into rigidity of thought much but I imagine that is an area which I need to visit in more detail. I probably am fixitated on certain ideals and probably harp on about them too much but constant self analysis can in itself become a problem too.
This problem, the way I see it, is that when I look at the list of possible symptoms of brain injuries on the Headway site I find I suffer from nearly all of them on a daily basis and dealing with all of them on a continuous basis would remove all my time and make it impossible to enjoy my life at all. And on this note I would add that everybody needs a break sometimes, so please do not spend all your time trying to recover, I have been there years and years ago and it does not lead to a successful conclusion in my opinion. I find life much more difficult and have to prepare far too much to do things I did not need to prepare for before my accident but I do not sit looking in a mirror and writing down long lists of things I need to improve anymore. Not because I am now perfect, far from it, but simply put because sometimes enough is enough - and I need to get on with life. Don't spend too long trying to be normal like I did because who the hell really is anyway?
Hi everyone, we just wanted to say a huge thank you to all of you for taking time to answer this question in such detail. It's hugely appreciated and will really help with our feature, due to be released in the spring.
It's clear that this is a consequence of brain injury that has such a huge impact on people's lives so I hope we can create something that will be of use to everyone.
In the meantime if you need to find out more or get support:
You can also contact our helpline on 0808 800 2244 or helpline@headway.org.uk if you'd like to talk things through and get guidance that's tailored to your experience.
And of course we're always hugely grateful to all of you for providing such a welcoming and supportive place on this forum, so do post any issues or questions you might have.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
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