1. Callie Chatterton

2. Facts Located directly behind the forehead Most frequently injured
Largest portion of the brain
1/3 of cortical area of cerebral hemisphere
Connected to many other portions of the brain

3. Frontal Lobe

4. Functions Frontal lobe is critical in executive roles
Goal-setting
Completion of purposeful activities
Planning
Also plays important role in social behavior
Inhibition
Judgment/insight
Attention

5. Phineas Gage Foreman of a track construction gang Frontal lobe damage
Responsible and well-liked by his crew
Building a railroad through Vermont’s Green Mts.
Frontal lobe damage
13.25 lb, 3.5 ft. tamping iron penetrates brain
Passes from behind the left eye through the top of the head carrying away a substantial part of the frontal lobe

6. Phineas Gage

7. Phineas Gage No immediate problems after incident
Phineas Gage supposedly never lost consciousness and was up and discussing the accident soon after it happened
Did eventually develop a wound infection but recovered quickly and was soon deemed physically able to return to work
“Gage is no longer Gage”
Before the accident he was responsible, caring, and well-behaved in a social setting.
After the accident he became erratic, profane, and impatient

8. Causes of Injury Trauma Diseases
Blows from the front, back, or side of the head can result in frontal lobe injury
Even injuries not involving the head can cause bruising of the brain (whiplash)
Diseases
Strokes, lesions, meningitis, tumors

9. Causes of Injury

10. Consequences of Injury
Three Frontal Lobe syndromes
Orbitofrontal syndrome (lacks inhibition)
Frontal Convexity syndrome (apathetic)
Medial Frontal syndrome (akinetic)
Answer lab assessments correctly but make poor choices in real situations
Tests of perception, construction, language, and spatial attention are unharmed

11. Three Syndromes Orbitalfrontal syndrome
Commonly caused by closed-head injury
Characterized by disinhibited, impulsive behavior, difficulty in controlling their emotions, lacking in judgment and are easily distracted
Many patients are incorrectly diagnosed with a personality disorder
Possible link between violent offenders and traumatic brain injury

12. Three syndromes Frontal Convexity syndrome
Characterized by disinterest, slowing of the motor functions and apathy
Inability to regulate behavior according to personal goals
Inability to plan ahead, lack of motivation and concern
Generally not caring about the world around them

13. Three Syndromes Medial Frontal syndrome
Characterized by occasional mutism, inability to control sexual appetite and akinesia
Loss of sensation in lower extremities as well as weakness also occur
Many patients experience symptoms from each syndrome

14. Detection
Unless noticeable damage occurs (car accident trauma, etc.) tests are not usually performed
Normal neurological and psychological tests rarely detect any abnormalities
Requires careful observation of previous and current behavior

15. Tests Wisconsin Card Sorting Test Stroop Test Rhythm Tapping Test
Patient sorts cards into one of four piles based on clues from instructor
Stroop Test
Patients must say the color that the word is written in rather than reading the word itself
Rhythm Tapping Test
Patient essentially imitates rhythm that has been tapped to them (easy to difficult)

16. Rehabilitation Goal Neglect Drug Therapy
Based on the idea that human behavior is controlled by internal demands in response to the environment
Selection of new actions when previously selected actions fail to achieve the goal
Brief auditory stimuli also used
Drug Therapy
Alter the action of the working memory link and dopaminergic system dysfunction

17. Rehabilitation Reinforcement Organizing the executive system
Simple reinforcement and reward techniques
Organizing the executive system
Targeted to specific areas in which the patient has problems

18. Conclusion Rehabilitation is difficult
While there are many similar behaviors, each brain injury is different
Individuals without brain damage
Patients with frontal lobe lesions show similar signs to people without any brain damage (irresponsible, immoral, and flippant)

19. Resources
Burgess, P.W. & I. H. Robertson (2002). Principles of the rehabilitation of frontal lobe function. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp ). Oxford, NY: Oxford University Press.
Mesulam, M.-Marsel (2002). The human frontal lobes: Transcending the default mode through contingent encoding. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 8-28). Oxford, NY: Oxford University Press.
Tranel, D. (2002). Emotion, decision making, and the ventromedial prefrontal cortex. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp ). Oxford, NY: Oxford University Press.
Burgess, P.W. & I. H. Robertson (2002). Principles of the rehabilitation of frontal lobe function. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp ). Oxford, NY: Oxford University Press.
Mesulam, M.-Marsel (2002). The human frontal lobes: Transcending the default mode through contingent encoding. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp. 8-28). Oxford, NY: Oxford University Press.
Tranel, D. (2002). Emotion, decision making, and the ventromedial prefrontal cortex. In D.T. Stuss & R.T. Knight Principles of Frontal Lobe Function (pp ). Oxford, NY: Oxford University Press.