Executive dysfunction is a term for the range of cognitive, emotional and behavioural difficulties which often occur after injury to the frontal lobes of the brain. Impairment of executive functions is common after acquired brain injury and has a profound effect on many aspects of everyday life. Executive functioning is an umbrella term for many abilities including:

• Planning and organisation

• Flexible thinking

• Monitoring performance

• Multi-tasking

• Solving unusual problems

• Self-awareness

• Learning rules

• Social behaviour

• Making decisions

• Motivation

• Initiating appropriate behaviour

• Inhibiting inappropriate behaviour

• Controlling emotions

• Concentrating and taking in information

Most people make an excellent physical recovery after a brain injury, which can mean there are few, or no, outwards signs that an injury has occurred. There are often physical problems present that are not always so apparent, but can have a real impact on daily life.

• Weakness or paralysis

• Ataxia

• Fatigue

• Sensory impairment

• Difficulties with speech

• Epilepsy

• Spasticity

Everyone who has had a brain injury can be left with some changes in emotional reaction. These are more difficult to see than the more obvious problems such as those which affect movement and speech, for example, but can be the most difficult for the individual concerned and their family to deal with.

It is important to be sensitive to extreme emotional changes after brain injury, as they may indicate a developing mental illness. Our Mental health and brain injury factsheet provides more information on this topic.

• Personality changes

• Mood swings or emotional lability

• Depression and sense of loss

• Anxiety

• Frustration and anger

• Post traumatic stress disorder (PTSD)

The cognitive effects of a brain injury affect the way a person thinks, learns and remembers. Different mental abilities are located in different parts of the brain, so a brain injury can damage some, but not necessarily all, skills such as speed of thought, memory, understanding, and concentration, solving problems and using language.

• Problems with memory

• Language loss (aphasia)

• Impairments in visual perceptual skills

• Reduced initiative and problems with motivation

• Reduced concentration span

• Reduced information processing ability

• Repetition or perseveration

• Impaired reasoning

• Impaired insight and empathy

Behavioural changes after brain injury are many and varied. Some appear to be an exaggeration of previous personality characteristics, while others may seem completely out of character for that person.

It is important to be sensitive to extreme behavioural changes after brain injury, as they may indicate a developing mental illness. Our Mental health and brain injury factsheet provides more information on this topic.

• Disinhibition

• Impulsiveness

• Obsessive behaviour

• Irritability and aggression

• Apathy and loss of initiative

• Egocentricity

Communication problems after brain injury are very common. Although most of us take it for granted, the ability to communicate requires extremely complex skills and many different parts of the brain are involved.

• Language impairment

• Speech difficulties

• Cognitive communication difficulties