What's Initiation Deficit?

What's Initiation Deficit?

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.


Posted on BrainLine July 7, 2010.

Comments (9)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Hello. My 20-year-old son, diagnosed with dyslexia at 8 years of age, has difficulty with initiation and completion of college work. He has had a mild head injury that we never had evaluated. I am wondering if this is a result of the past HI or dyslexia or both. Would a neuropsych be able to help?

Need resources on brain injury d's services . advocacy for mentally incapacitated 32 yr old male adult in guardian for now . as to whether he is eligble for mental health court. And services for victom of doc crimes. And neglect. Abuse from livingston county deputy pulling sons hair while handcuffed and not responding with cit officer causing great harm and threat to life of son. Need help resources for macon county missouri

First accept its a problem for artist anyway: See "The Blank Canvas" by Anna Held Audette.  Whether you got a brain injury or not its typical fro artists, it's like stage fright.  In my case I found I was imagining somebody looking at my picture whilst I was doing it and criticising it. But I found if I obeyed that criticizm my art turned out dead, lifeless, depressing. So when i was angry I tried painting with my left hand instead, mentally attacking the inner critic, and found my painting became dynamic, alive. much better work.

Initiation deficit may be one of the most misunderstood challenges of TBI recovery. People just don't get it.

The only partial remedy which I have found which regularly helps me a little with my subtle initiation deficit is coffee/caffeine compounds (including alertness aids like Tirend, NoDoz, etc.). Concepts: personal initiative vs initiation deficit. Charles Thomas Wild - Thank you.
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

This is totally me. Smashed in the head in a car accident a few years ago. Most health professionals think of memory only with concussion. Unable to think fast enough and imitate things we are unable to advocate for ourselves. I've lost my house, boat. All my savings trying to survive and no one would help.
Only after 2 and a half years after ending up on the street was I admitted into a brain injury unit . And get help to understand what has gone on

Look into HBOT.com for treatments that actually help the brain to heal. I've had some initiation problems but mine now seem to be in combination with neurofatigue issues or I do start things but get distracted by something else to do and often forget what I had already been doing. This has definitely improved after the HBOT treatments I've had though. I just need more healing with more HBOT as every time I've gone through a block of about 40 HBOT dives I've had improvements. And I've had six brain injuries with secondary complication effects.