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 is 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.
Dr. Celeste Campbell is a neuropsychologist in the Polytrauma Program at the Washington, DC Veterans Administration Medical Center. She has a long history of providing cognitive psychotherapy and developing residential behavioral management programs for children and adults.