What exactly is “initiation deficit” and are there coaches or specialists who can help with this problem after a brain injury?
Initiation deficit refers to difficulty getting started in doing something. This appears to be a frontal lobe function and is not uncommon following a traumatic brain injury. The individual may have every intention of doing something, and may even have a plan, but just does not seem to be able to get started. This may be particularly difficult with tasks that have a vague starting or ending point such as “sometime next week I need to call the bank.” It may also affect immediate actions like “I need to go upstairs and get my glasses” as the individual just sits there. It as if somebody needs to push the “go” button.
Fortunately, there are strategies — and specialists — to help with this problem. A cognitive rehabilitation specialist (a neuropsychologist, speech-language therapist, or even an occupational therapist) will be able to teach these strategies and provide proper supports for implementation. Some of the strategies include different cuing techniques, scheduling specific times to get things done, auditory alarms, visual cues, and specific routines.
The strategies used will vary from person to person — depending on things like learning style, temperament, environment, interpersonal supports, and cognitive strengths and weaknesses — and will often take some trial-and-error and practice to perfect. Some of these techniques certainly can be used at home, and a cognitive rehabilitation specialist can help streamline and focus the process. As always, be sure the specialists you choose have expertise in brain injury.
Celeste Campbell, PsyD,
Dr. Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center.
She completed a postdoctoral fellowship in Rehabilitation Neuropsychology at National Rehabilitation Hospital and has served as adjunct faculty for the George Washington University Graduate Certificate Program in Special Education and Traumatic Brain Injury.
Dr. Campbell has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults with a variety of cognitive deficits, including learning disability, developmental disability and traumatic brain injury.
She has served as adjunct faculty for the George Washington University Graduate Certificate Program in Special Education and Traumatic Brain Injury. In addition she has been a frequent presenter and workshop facilitator, addressing psychological, neuropsychological and cognitive issues following brain injury to survivors and their families and friends, rehabilitation and vocational specialists, special education teachers, and case managers.
She has appeared on The Donahue Show, Taking the ‘Dis’ out of Disability, and PBS’ Exploring the Brain with Garrick Utley.
The contents of Brainline (the “Web Site”), such as text, graphics, images, information obtained from the Web Site’s licensors and/or consultants, and other material contained on the Web Site (collectively, the “Content”) are for informational purposes only. The Content is not intended to be a substitute for medical, legal, or other professional advice, diagnosis, or treatment.
Specifically, with regards to medical issues, always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Web Site. If you think you may have a medical emergency, call your doctor or 911 immediately. The Web Site does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Web Site. Reliance on any information provided by the Web Site or by employees, volunteers or contractors or others associated with the Web Site and/or other visitors to the Web Site is solely at your own risk.
Hello Dr. Campbell, Wonderful article. Too bad, however, few windows are opened for the frontal/diffuse injury sufferers. I did it! I'm doing it! Small victories are most often the best. Take good care Paul Scott
Dec 17th, 2010 8:53am