Relationships between measured cognitive ability and reported psychosocial activity after bilateral frontal lobe injury: An 18‐year follow‐up

Abstract

This case study illustrates a well‐established paradox often seen after serious frontal injury. Some individuals have little or no neurological abnormality, perform well on cognitive tests, and display an apparently “normal” social appearance, yet have serious, if subtle, neurobehavioural disability that prevents reliable and efficient performance in a number of daily activities. In this case study, we report the psychosocial progress of a young man who suffered serious bilateral frontal injury in a road traffic accident at the age of 20 years. He made a good neurological recovery and relatively few cognitive deficits were recorded. His performance on a range of neuropsychological tests, including specialist tests of “frontal function”, was mainly in the above average or superior range. In contrast, observations of his functional activities revealed a number of dysexecutive problems that had an adverse impact on his life. Changes in his personality and social behaviour, reflecting a number of “frontal” characteristics, only marginally improved as a result of post‐acute neuropsychological rehabilitation. He did not receive long‐term professional support but, with the passage of time and continued support from his family, he has married and manages to maintain a basic level of social integration, but not one commensurate with his pre‐accident potential. Problems of planning, organisation, initiative, and self‐awareness that were not recognised early in his recovery, and are not evident from neuropsychological assessment, remain as major obstacles to full social independence.