Sunday, April 5, 2009

Brain Injuries: Perseveration and Rigidity of Thinking

Perseveration and rigidity of thinking are two of the deficits of frontal lobe injury. The frontal lobe is the largest part of the brain and is, therefore, most often the area of injury. As with most deficits, it will be important to find solutions that will work and to make adjustments in both your life and your injured family member's life. But, it will probably be necessary for the majority of adjustments to be made by the 'healthy' partner.

Perseveration is a repetitive and continuous behavior where a person is locked into a specific activity; persisting or persevering with repeated behavior; being narrowly focused or having tunnel vision; or having an inappropriate cognitive-behavioral response in spite of a changing task requirement. The brain injured person is unable to change his process of thinking because of difficulties in abstract reasoning.

Dealing with perseveration is like watching a dog with his bone. He only has one thought in his mind and very little will remove his focus from that bone. And if you try to remove that bone from the dog, you had better be prepared to accept the consequences of such an action.

In my injured partner's case, his 'dog with a bone' behavior showed up especially in his determination to smoke in the ensuite when smoking had never previously been done in the house before. At the same time, he first denied vehemently that he was smoking at all and secondly that he was smoking in the ensuite. In spite of the year of discussions we had over this issue, his perseveration continued. I've since decided that in order to avoid further stressing myself, I will give up mentioning the smoking issue to him. Some things are just not worth the hassle. ** (See note below)

A possible solution for perseveration is cognitive-behavioral training. However, this option is not always available.

Mental rigidity is another deficit of frontal lobe injuries. It can show itself with difficulties in experiencing emotions or the ability to move from one emotion to another at appropriate times; difficulty in accepting changes and difficulties when they are out of their regular routine. My partner, although now in his third year post injury, still has difficulties when he is out of his regular routine. By 'regular routine', in our case I mean the difference between whether or not I'm here. One example is if I am not at home, he usually does not remember to take his medications.

Some possible solutions for this deficit are that family members can help the injured person by discussing upcoming changes and assure them that not all routines will be changed. The injured member of the family can also do their part as well by learning to be accepting of changes since not all changes can be prevented; and by doing self-talk strategies. i.e.: 'I don't like changes but this will be okay.'

The most important thing you can do for your loved one who has had a brain injury is to be supportive and encouraging.

When dealing with brain injuries, the following quote is a thought to remember for those who have considered giving up or for those who have thought there was no problem to consider:

'No head injury is too severe to despair of, nor too trivial to ignore.' - Hippocrates

** Note: Smoking severely inhibits the healing process of a brain injury. It restricts the vessels and the blood flow to the brain and thereby slows the healing.

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