Assessment of frontal lobe damage

In this study we examine the case of Mr. A, who had damaged his frontal lobe due to a harsh head injury. In order to examine the patient’s damage three different test were used. AVerbal Fluency Test, The Wisconsin Card Sorting Test and a Hand position Test. It was expected to observe lower scoring and difficulties in Mr. A performance regarding the tests.

The current study unfolds a variety of symptoms, difficulties and examination of frontal lobe injury. At the end some therapies are highlighted that may lead to treatment and in general a variety of ways that may produce cure to the damaged lobe.

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One of the most severe damage an individual can undertake is a frontal lobe injury. Unfortunately only lately we have focused in examining those kinds of injuries. Lack of information and examination from the previous years can be regarded as one drawback in the area (Thimble, 1990). Even though some cases have been examined with great detail and received attention, frontal lobes are rarely assessed efficiently (Jacobs, 2006). This, from one hand may be because some futures such as IQ and language are not affected by frontal lobe injury.

Generally, impairment in frontal lobe, is more likely to produce impairment regarding behaviour, goal setting, self awareness and self supervision, and implication in social life (Grace, Stout & Malloy, 1999). Additionally, it can produce emotional disturbances in the individual. Inability to speak properly, lack of proper judgement, lack of interest and inability to drive properly are but a few of emotional symptoms (Kant, Duffy & Pivovarnik, 1998).

Frontal lobe injury’s effect are more than meets the eye. Social disturbance is one of the most crucial aspect that is damaged. Poor social performance and the inability to produce reasoning for your supports or an alternative reasoning are some effects (Struss, Gallup & Alexander, 2001). Shammi & Stuss (1999) argue that frontal lobe takes part in the process and the ability to perceive humour. Furthermore, frontal lobe seems to play a vital role in the in social cognition (Struss, Gallup & Alexander, 2001).

The most significant aspect is the fact that frontal lobe injuries can have a severe impact in the individual’s behaviour and thus personality, memories and his awareness (Stuss, Gallup & Alexander, 2001; Jacobs, 2006; Thimble, 1990). Memory (either that is LTM or STM) is affected accordingly. Another observable fact is that patients seem to be goal neglecting whilst prior to the injury where goal achieving individuals (Duncan, Johnson, Swales & Freer, 1997).

Janowsky, Shimamura & Squire(1989), argue that damage to the frontal lobe affects greatly source memory. Individuals with frontal lobe injury had low performance in source memory tasks whilst compared to older control subjects. Janowsky, Shimamura & Squire (1989), argue that frontal lobe damage in combination with old age affect verbal abilities and organising tasks. Furthermore what comes with the aging is that neuron loss occurs that mainly are in frontal lobe.

Goel, Grafman, Tajik, Gana & Danto (1997), in a study with individuals with frontal lobe damage they found that subjects demonstrated reduced judgment about aspiration fulfilments (goals), and a complexity in time management and task perceiving. Also goals that were distant ones were more difficult to be perceived rather than goals that were set about the near future. Thus it was argues that in real life problems were likely to be arise dues to difficulties in the structure of a problem; all those because deadlines could not be achieved, answering a problem was quite illusive (meaning that they could not support their argument).

Studies like Dunbar & Sussan (1995) argue that the above difficulties are born by the insufficient attention and an unsuccessful way of preserving verbal information.

A variety of tasks has been used in order to assess frontal lobe damage and dysfunction (Goel, Grafman, Tajik, Gana & Danto, 1997; Stout, Ready, Grace, Malloy & Paulsen, 2003); some of them are the maze learning task, Wisconsin Card Sorting Task, block design task (WAIS). Additionally, some scales of measuring lob damage are the FLOPS (Frontal Personality Scale) (FLOPS; Grace, Stoud & Malloy, 1999) and the FrSBS (Frontal Systems Behaviour Scale) (FrSBe; Stout et al, 2003). The tests have been found reliable with internal consistency; Grace, Stout & Malloy (1999) argue that FLOPS is a successful way of identifying patients with frontal lobe damage from patients with injuries in other parts of their brain.

All in all, frontal lobe injury is hard to be assessed and treated. History of the patients as also as carful treatment, constant interviews with his family and in general the social environment of the patient is needed so that all the aspects of his personality could be considered. Also the family needs to be trained in order to be able to treat the patient in that way so that he could recover.



The current paper is a case study


The subject in the current study was Mr. A., 48 year-old man, who sustained a head injury in a white water rafting accident. This accident resulted in damage to the frontal lobe. Mr. A, an architect, of high intellectual ability was previously employed by a firm of architects were he was directly involved with the planning of large building complexes. His wife reported that after the accident he had become withdrawn, anxious, easily distracted and found great difficulty in holding a conversation and appeared ill at ease in social gatherings. His family described him as previously a sociable, cheerful and humorous person with a great enthusiasm for life. His greatest difficulties occurred with the supervisory and administrative aspects of his employment. He failed to organise and plan his work schedule and his previously good management skills were severely impaired.

Material & Apparatus

Hand Positioning test, Wisconsin Card Sorting Task and a test of Verbal fluency were used in order to assess Mr. A.

Hand Positioning test, tests individuals’ capacity for different sequencing. The Hand Positioning test was given to the subject as standardised instructions said so. The individual needs to place his palm (facing down) in a flat surface, then place it on the edge on one side and then make his hand a fist. The above movements are measured in reaction time and intervals (Luria, 1973; cited in Jacobs, 2006). Jacobs (2006), argue that additive errors occur in patients with frontal lobe injury.

Wisconsin Card Sorting Task, are a variety of cards that depict different symbols (e.g. star, cross) numbers (e.g. 1, 2, 3) and colours (e.g. yellow, red). Four cards (divided into this attributes) are given to the individual and he has to try and sort a total number of 128 cards based in the above attributes chosen randomly by the examiner. The individual cannot learn his answer but he is given feedback either if his choice was correct or wrong. Patients with frontal lobe damage score fewer categories than the control group and have complications into adjusting in the rules change.

Regarding Verbal Fluency Test (Benton & Hamsher, 1978; cited in Duncan et al., 1997), the individual has to generate under a limit time of 1 minute as many words as he can that begin with a particular letter. Three examinations are run one with a different starting letter. No nouns are allowed (Jacobs, 2006). Scores vary from 8-15 words. The sum is produced by adding all the words from all the three trials.


The above tests were selected in order to assess the individual’s frontal lobe damage. Those tests are used by a variety of researchers in order to make a distinction between frontal lobe injuries and other brain areas (Thimble, 1990; Dunbar & Sussman, 1995; Duncan et al, 1997; Jacobs, 2006).


It is expected to observe dysfunction on all three tests. Regarding hand position test, errors are expected to occur as patient’s are unsuccessful to follow the sequence of hand movements but rather they are prone to redo a particular movement over and over again (Luria, 1973; cited in Jabobs, 2006) because an injury in behaviour and planning actions occurred.

As regards the Wisconsin Card Sorting Test, individuals with frontal lobe injury are expected to score lower (significantly lower), than the control subjects. Also it is expected to find impairment in shifting in-between categories regarding the particular task. In a study conducted by Janowsky (1989), it was argued that individuals with frontal lobe damage achieved 2.1 categories from the total of 6 were the control group scores were on average M=4. In a different study though, conducted by Duncan et al. (1997), argue that their subjects achieved a M=3.7 categories (of the possible 6). Additionally Janowsky (1989), found that the patients had a scoring of 41.6 errors in relation to the control group which was 20.2 errors on average.

In the Verbal Fluency Test individuals with frontal lobe damage score significantly less than the control groups. An individual is expected to produce approximately 8 to 15 words (Jacobs, 2006). Janowsky et al. (1989) argue that healthy individual with individuals that have suffered frontal lobe damage don’t have a significant difference between them. Individuals with frontal lobe damaged scored on average 29.5 words whilst control group scored 37.5. If we examine the phenomenon in more depth though, we can see from the finding that individuals with left or bilateral injury scored significantly lower (m=21.5 words) whilst individuals with right frontal lobe injury demonstrated alike the control group (m=40.7).


Take the above are valid we can infer that Mr. A is most likely to have a variety of problems in his daily life; accordingly it is not suggested to be left alone because he may not be able to cope with problems and task (of medium difficulty) that may arise. Additionally, his behaviours may lead other people to feel uncomfortable because of their unfamiliarity of the problem. Thimble (1900), argues that individuals who have suffered frontal lobe injury may be regarded from the social environment as individuals who are egocentricall and moody. As thus, it is of paramount importance to inform the patients family and friends in order to explain them that some behaviours are not normal, and that some people who have suffered frontal lobe injury are not able to control their behaviour or take blame for their actions (Grace, Stout & Malloy, 1999). It is important to interview family and friends in order to understand how the individuals behaviours have changed because the above tests are not the one that assess behavioural problem and social functioning. Additionally it is debatable how those test can validate that an individual may have a problem in his daily life. Rather, some individuals who have suffered frontal lobe damage may score high or normal to the above scored but they are nonetheless unable to pilot their lives (Damasio, Tranel & Damasio, 1990).

Therapeutically ways however, remain but a few. The treatment (if the individual is given permition to go home) is a combination of family members, friends and doctors. That is why such an emphasis in training the family or at least give them the appropriate knowledge is required. On the drawback of the frontal lobe injury is that (regarding brain damage) as each individual is unique the injury also may have different effects upon him (even though some standardised phenomena exist).

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