Back to work with a chronic dysexecutive syndrome? (A case report)

Abstract

We present the case of G.L., a 33-year-old medical doctor, who, nine years after traumatic brain injury, was admitted to our department after he had drifted through several jobs. According to his superiors he spent too much time on routine activities and seemed unable to adapt himself to open problems and the requirements of novel or changing situations. From a psychometric perspective we found G.L. rather unremarkable, with largely good attentional, memory, and problem-solving performance. Behavioural analysis, however, revealed that G.L.'s discrete but definite frontal-lobe damage had produced defects in “executive functions”. After 12 months of intensive training G.L.'s mental structure had been modified to incorporate new source schemata, which enabled him to carry out demanding routine thought operations. In creating and practising these higher-level schemata his handicap could be diminished to the point that he now has got a supported employment. His basic cognitive incompetence, however, remained unchanged. This remarkable case fits in with Norman and Shallice's model of cognitive control of action and thought operations.