Experimental Treatment for Frontal Lobe Injuries

A frontal lobe is frequently involved in a traumatic brain injury (TBI). When the front of the head is struck, the frontal lobes will hit the inside of the skull. The impact can result in injury because the brain is soft (about the consistency of toothpaste). And even when the back of the head is struck, the brain may bounce off the back of the skull, ricochet forward and strike the front of the skull, injuring both the back and front of the brain.

The frontal lobes are responsible for “higher” brain functions, such as planning, decision making, and judgment (which are called “executive functions”). When the frontal lobes are injured, an individual may be indecisive or apathetic and have trouble initiating activity. The frontal lobes are also responsible for regulating, checking, and inhibiting emotions and actions. As a result, some TBI survivors with frontal lobe damage are impulsive, moody, agitated, easily irritable, explosive, or make poor decisions. These survivors are quite vulnerable to becoming substance abusers.

People with Attention Deficit and Hyperactivity Disorder (ADHD) experience symptoms similar to symptoms experienced by some TBI survivors with frontal lobe damage – difficulty focusing and concentrating, impulsiveness, and poor decision making. One form of treatment for ADHD is a class of medications that includes Ritalin. These drugs stimulate the brain. While giving a stimulant to someone who is hyperactive and impulsive might seem like pouring gasoline on a fire, it is believed that the drugs stimulate the frontal lobes and increase their ability to regulate and control impulsive and inappropriate behavior while enhancing the person’s planning and decision making.

Because some of the characteristics of ADHD are similar to the symptoms of some TBI survivors with frontal lobe damage, studies have been performed to determine if medications used to treat ADHD can be helpful in the treatment of TBI. These studies have produced some evidence that Ritalin is helpful with some TBI survivors in improving concentration and reducing impulsivity. A study is currently underway at the University of Washington, one of the model centers in the U.S. for treatment of traumatic brain injuries, to determine if Ritalin improves short term memory (also called working memory) in survivors who have memory impairment.

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