One of the most frequent consequences of brain damage or brain injury are the problem solving deficits. In neuropsychology they are referred to as 'executive functions'. They are the most complex and specialized functions the brain has. Usually, our forebrain, frontal lobes are the seat of these problem solving functions. They are also the most interesting kind of functions we have, but also the least understood or recognized. Here I'll try to explain what they are.
Part of the problem solving functions are taking initiatives to solve problems. Planning is a fundamental concept, just like forming hypotheses (ideas) about a problem, flexibly switching between them and checking these ideas. Then trying to solve a problem by executing some kind of action, and monitoring your own actions and mistakes. When a mistake is made, you'll have to self-correct it. So, initiative, planning, self-monitoring and self-correction are the fundamental parts of the executive system. Recently, in scientific literature, even attention is considered a part of the executive functional system.
Perhaps, an example can clarify this executive system. Tomorrow I want to cycle to my work which takes about 20 minutes (8 km). This doesn't seem much of a 'problem' but 'problem' is defined by the brain as 'anything that has to be executed in a special efficient way'. So, I can for example take a very long route to my work, cycling for about 2 hours. But of course, I don't just do that because I want to be there on time. My executive brain actually plans my actions...I have to have some breakfast, then I have to get my bike at a specific time to get there in time, I have to use one efficient route to arrive at my work on time. So, in this relatively simple example, I have to take some initiative to gather my working stuff (notes, briefcase), make some breakfast, get my bike), plan to do all these things in a certain order or sequence (I mean, first getting my bike, cycling for about 10 minutes and only then making my breakfast would be inadequate, wouldn't it?), execute the actions in a correct way, checking all things to take to my work and then go.
Our brain is constantly solving problems, every minute. But usually it goes on doing this automatically so we do not realize it is really problem solving. The reason it does all this automatically, is that most action sequences are already familiar routines for us. I mean, getting up in the morning, making some breakfast, gathering some things to take to your work or school, then getting in your car of on your bike, all those things are being done almost without thinking. Because we train it, do it every day. For this kind of routine our brain has already the right action sequences or scripts, it just have to execute them in a right sequence. But, for the brain it is problem solving, albeit an almost overlearned and therefore automatized routine.
Usually, in science and in daily life, we see problem solving as some things we do when we are confronted with problems new or unknown to us. That's when our brain really is challenged to solve a problem. That's when our executive functions are really called upon and we can test whether they function correctly or not.
What I'd like to point out here is a much heard misconception about 'executive function': it is only there when we have to solve a new or unknown problem. This is absolutely NOT true at all! Our brain uses problem solving skills EVERY time. Every time we have to take initiatives, every time we have to plan our action sequences, every time we have to watch what we are doing, every time we have to correct our actions whenever they do not lead to our desired goals.
This major fault in thinking (also in neuropsychologists), is due to a lot of scientific literature in which very clearly executive functions are researched in problems that are very new to someone. So one does get the mistaken idea that problem solving skills are only active when we are confronted with unknown problems. True, only then our executive functions are challenged the most. So they can be seen most clearly. But even when doing your daily routines, like washing yourself, making breakfast, getting your bike, taking your familiar route onto work, during all these actions your action guide in your brain, your executive system is active. However, not thát much as when you are confronted with really new problems in which the solution is unknown to you.
How can we see as neuropsychologists that the executive system is damaged after brain injury? Well, one fundamental aspect of solving problems is taking an initiative. An initiative which shows you are trying to solve the problem. In frontal lobe damage (at the front of your brain), it can be that a patient does not get up to wash himself, or even to get something to drink or eat. The urge to eat or drink something can really be absent. Such serious damage can be life-threatening because such a patient won't eat by himself, even not when they are hungry. Only when food is in their sight, they can react to that by eating something. Less serious low initiative is whenever someone faces a problem but no serious attempts are made to think about it and to try to solve it. Usually, such a patient can really initiate an action sequence (doing A and B) but when confronted with a problem where his actions do not lead to solutions, it may well be that he doesn't bother much and stops the action sequence. For example, when trying to dress himself, it may well be that not succeeding in putting his T-shirt on in the right way, he just leaves it at that. Ending up with a T-shirt which is really inside-out or the front is the back. But the patient can not correct this and then just leaves it, without any feeling of worry. Taking any initiative is usually related to emotions, to motivation, to a certain drive to do things orderly, perfectly. Here we see that the information processing system is heavily related to our basic emotional system.
Another fundamental but often overlooked part of the executive system is Planning. When talking about planning everybody seems to think that it involves heavy planning such as planning a vacation or a trip or organizing a party. Of course, those activities require planning indeed. But again, planning is constantly being done by our brain. Our brain calculates a lot of action sequences every second, minute we are awake (even in our sleep). But most of them are executed in a relatively routine way, more or less automatically. Like when we come home, take our coats off and lay down our car and house key. Such kind of planning is so automatically done that we do not really remember where we left our keys when we came home. Especially, when our keys are not at the expected normal place (the place where we always put them), we are not really able to remember where we left them. That is entirely due to our automatic planning routines which we carried out automatically. And sometimes in this automatic processing we do things slightly differently such as going to the toilet with our keys in our hands and putting them down in the toilet room, continuing to do our toilet (planning) routine...and then just forgetting our keys there. This 'toilet' example just shows that we plan all day, carrying out our action routines almost automatically. It also shows the pitfalls of depending on such routines: when slightly doing something else, we easily can not remember this diversion anymore, heavily depending on what we 'normally' do. This is the same reason why we normally do not remember what we have seen during taking our daily route from work back to home. We sort of plunged into our 'driving the car' routine, freeing our mind of concentrating much on the driving itself, thereby thinking of other things, and voilà we easily can not remember anything of what was on the road.
Planning is very much a subconscious aka automatic process. Just like walking the stairs. Our brain really plans ahead our steps, without having to think consciously about taking the stairs. That's the main reason we can rush off the stairs very quickly: our motor planning has these 'taking stairs' routine and executes it efficiently. But, whenever there is something new, this whole routine comes to a sudden stop. Ever had the experience that your taking the stairs routine really thought that you already were at the end of the stairs? Well, then you'll know that the last step is quite hazardous and a shocking surprise. You might even fall. Relying too much on our automatic planning routines can be dangerous. But normally, automatic planning routines save us a lot of conscious thinking/processing. It is quick, efficient and usually very effective.
It becomes effortfull whenever the automatic planning does not reach an adequate solution. Then our more conscious planning system kicks in. Then we have to be able to form ideas, being creative and flexible. This kind of planning we, as neuropsychologists, test in neuropsychological assessment. Because we are normally interested in how someone behaves when things do not work out the way they are supposed to be.
Self-monitoring and Self-correction The last two fundamental parts of the problem solving system are intertwined. Self-monitoring refers to our ability to see our actions and our errors. We have to see and check them in order to direct our actions in the right (desired) way. An error can only be seen whenever we have a basic plan that is constantly compared to our real actions. Whenever our actions deviate from the pre-thought plan, a sort of 'error feeling' in the brain (probably the anterior cingulate gyrus) is formed. That is the reason we become conscious of this deviation and our attention is drawn to it so we can redirect our actions. Whenever we do not have a plan, or whenever we do not see our actions correctly, there can not be a mismatch between plan and action. So no error message pops up, so no correction is made and we go on to making mistakes. In brain injury, this very process of error monitoring (seeing our errors) can be disturbed or even destroyed all together, leading to serious action mistakes. Especially, in problem solving tasks like the Tower of London test (see my pages on Problem solving tests), the outcome usually is negative when not seeing your errors.
Brain injury usually leads to damage in the error-monitoring system. The very broad but much used term 'awareness' has a lot to do with this part of the executive or problem solving system. Brain injured patients are almost famous in their not seeing their mistakes or shortcomings. In my opinion this has a lot to do with their damaged planning system and their damaged error-monitoring system. First of all, when such a patient really thinks that his action sequence is the correct way of doing things (he sticks to his own erroneous plan), then of course he will not interpret errors as being errors but as irritating feedback. The normal way of responding is: "I don't understand why this is wrong. There must be something wrong with this test or computer, because I am doing the right thing"). Even when having a correct action sequence or plan, it is necessary to look closely to what you are doing. Every single deviation (fault) has to be corrected immediately to arrive at a correct solution. When errors are not really concrete or can be seen clearly, then a brain injured patient can not correct them of course.
Problem solving skills are needed every second of our lives but the intensity varies greatly over time. Depending on normal daily routines, not much energy or attention is needed in this kind of problem solving. However, being in a hectic environment where things change rapidly and problems can show up at any time, then our problem solving skills are challenged a lot.
When driving to our work, taking our routine route, an accident on this route can make us change our planning routine. People who start to panic then, usually are not able to flexibly plan a new course of action. Their planning ability is below average. We see it in autistic or autistiform people: deviating from their daily routines can cause a lot of distress and panic. This is due to a sudden challenge to their damaged executive system in which they are less or even not able to initiate other courses of action or new action plans.
When shopping and looking for our daily products like bread or milk, a change in the shop can force us to plan actively. Usually, searching for our products in a changed shop, takes a lot more energy and attention, but we can manage to find every thing we need. A brain injured patient can start to panic in such a situation or end up with less products then he planned to.
Organizing your working day can be very difficult after a brain injury because of planning deficits. Planning involves not only a specific action sequence, but the actions have to be tied to a specific point in time. When keeping time and estimating time is damaged, planning usually is hindered as well. Activities can be planned on top of each other so that there may be no time to do them all, or do them all correctly. Such a person seems chaotic and turns out to be not really productive, due to serious organization difficulties.
Even preparing a meal requires a lot of problem solving. Especially when a meal is new, not really practiced, then executive function deficits can show up. Usually, cooking then takes much longer, the risk of burning your food is higher, and it is possible that some ingredients may be forgotten.
In driving a car, planning is required as well. When taking a left turn (one of the most difficult things in driving), it is essential to do it efficiently. Especially, when traffic is dense and there is a lot of time pressure, an efficient plan where to position your car is needed. A lot of people just drive on, more or less slowly, waiting for the oncoming traffic to pass. However, there is only a short time to drive on and doing this leads to a build up of time pressure. It is much more safe and efficient to just drive your car up to the middle of the road and stop, and look around. Whenever you can take the left turn, you can then do it. Such a simple plan is safe but also reduces any stress or time pressure.
A very much overlooked planning sequence is in talking. A lot of folks just talk and there is really no plan in their talking. Because, planning is required in the talking process. You have to plan your sentences, the kind of words you will use, where you will like to go to in your conversation. Especially, when you are tired, this kind of planning in talking is reduced. That is the reason a lot of people have no real coherent story when they talk a lot. Just producing words is not really difficult...
Even writing this website takes a lot of planning. I have to have a plan to communicate with you in a clear and hopefully entertaining way.