Executive Dysfunction After Traumatic Brain Injury

Abstract

Traumatic Brain Injury (TBI) is defined as an alteration in brain function, produced after focal or diffuse brain damage caused by external biomechanical forces. TBI severity is classified on a continuum, ranging from mild to moderate to severe, and about 80% of TBIs are mild. They are one of the leading causes of mortality in the world, constituting a major health and socioeconomic problem. TBIs affect individuals of all ages, with epidemiological research identifying gender (i.e., being a man) and age (i.e., children 0–4, older adolescents 15–19, and older adults ≥65 years old) as the demographic variables associated with higher risk of TBI. The neural, cognitive, behavioral, and social outcomes of TBI have been well studied. One of the most debilitating outcomes regards the presentation of executive dysfunctions post-injury, as adequate executive functioning is associated with independent living, return to work or school, and other activities including accessing and progressing through rehabilitation. This chapter reviews the research on the effects of TBI, particularly mild TBI, on executive functioning and across the lifespan, with an emphasis on four vulnerable groups: children and adolescents (pediatric TBI), and in adults (occupational TBI, sports-related concussions, and military TBI). Despite the potential multitude of impairments associated with executive functioning following TBI, there are interventions that have shown to be effective for restitution of function. We address these areas toward the end of the chapter, focusing on interventions aimed at regaining self-awareness, and remediating attention, problem-solving, and metacognition.