Executive (dys) function revisited

Getting out of bed, starting the daily routine, making plans for the day, returning to the routine if interrupted or distracted, moving onto the next item, striving to conclusion, and recognizing when a task is complete; these are some of the "executive functions" of the brain. Recognizing when efforts are going well or seeing problems ahead and then problem solving or changing plans on the fly; all are tasks for the brain's frontal lobes (the seat of executive functioning). The frontal lobes enable us to persist in the face of difficulties or discomfort and to tolerate frustration. When we remember to pick up the dry-cleaning on the way home and to make plans for a birthday next week, when we notice a friend's new haircut and then remark on it, when we go on to express empathy for that friend's sick relative then pick up social cues that it's time for the conversation to move on; that's also all executive functioning. Your well-working frontal lobes allow you usually to think before you act and enable you to use self-talk to control behavior and direct future actions. When you've finished the day pleased with what you've done but ruefully vowing to go back and work on the items you put off, thank your frontal lobes for serving so faithfully.



Mark has largely lost all of this. But I know, and researchers agree, that with effort and activity, persons with brain injuries can regain functions. Mark has goals. He wants to improve physically, to be a better husband and father, to cook, and more. He just can't get there from here without God's divine power and grace and, I think, without friends who will share their lives and share his.

New Year brings new accomplishments

What a difference a year (or more) makes! When Mark first came home, he was unable to figure out why the toaster wasn't working when the unplugged-in cord was laying on the counter. Six months later, he might work on something requiring persistence for five minutes, only if I were in the room, and only if not distracted. Last week, these arm cycles arrived (one for my dad, who's had a stroke, and one for Mark). Without help and without my even being in the house, Mark spent a half-hour assembling his. This morning, he put together the one for my dad.

After the huge blow in nearly losing Mark, losing both our incomes, and truly losing him in his roles as husband and father, this fall brought even more loss. My dad, who used to spend weeks at a time here helping us, suffered a major stroke, leaving him nearly speechless in a wheelchair. Mark's mother, another pillar of support for us, had major surgery requiring months of recovery. And at least four other families and individuals important to me and the kids, providing daily acts of service for us, all moved out of state. Three of the four moved out of the country. I felt the blows raining down while the ground was cut out from under my feet. I've tried to trust God and am truly grateful, but I felt more and more alone.

Resilience and faith wins out, though, helped with a resolve to look forward rather than behind (as much as I can). Mark's mother has recovered to the point that, even at nearly 87, she could entertain Mark for two weeks. With this break and the advent of the new year, I've thought intensely (and should have prayed even more) about my goals for Mark this year. I've decided on three: to help Mark regain self-determination, to help Mark relearn or reimplement how to connect with people in a meaningful way, and to help him develop or maintain his physical status to the point he can do what he wants to do. For me, the most important goal I have is to get help for me and our children.

I've decided, or realized, or have had revealed, that I must move from being taskmaster for Mark to facilitator, companion, and friend.

Here we are working on movement together preparatory to working on all the goals noted above.

So far as motor skills are concerned, Mark has the greatest difficulty with his left side (meaning the right side of the brain). See below and compare to the video right below this one.

Mark finds it easier to move his right side, though his poor balance and spasticity in his hips and thighs affects his use of his entire body.

Control of impulses and attention remain a great challenge for Mark. Here he's distracted by our dog.

Blessings all and have a wonderful 2009!