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So what about initiative? Well Initiative is a very critical problem for people with
brain injury and it may actually relate to a very specific local focal injury of the
brain in the area above our nose. We have often see a loss of our smell of the cranium
nerve I. Which is unfortunately rarely tested by your favorite specialist neuroendocrinologist.
But people who have damage right where the olfactory nerve comes into the brain, its
also the part of the brain that really tells the brain to start an activity. A friend of
mine calls it the conductor of a symphony.You can have ninty-nine instruments playing perfectly
but the conductor is asleep they don't make any music.If the conductor is not paying attention
they don't make any music. If the conductor is off beat then the music is pretty bad so
the part of the brain initiates activity goes from doing nothing to doing something can
be damaged. Of course fatigue and stress and all the other things combined, that part of
the brain is more symptomatic. There are very few jobs that you can maintain with a five
percent error rate and many of the errors are errors of omission. We as lawyers think
about we can make a mistake, active mistake do something negligent actively where we fail
to do something and then the process of so many brain injury people is that they just
fail to do things when they should. Does that mean they won't do what they are told. No
they are very often very good at doing what they are told as long as it doesn't irritate
them or set off the behavioral problem.But its when no one tells them what to do and
you don't want to have to hire someone that you have to supervise ever minute. It's like
the energy equation where it takes more energy into it than the energy you get out. No employer
wants to have to tell their employee what to do every minute of the day. It isn't so
bad as to say that they will wind to a stop for a minute but they may wind to stop after
every task and that is a very serious problem with keeping people employed and its one that
is never tested by a neuropsychological test because the neuropsychologist is always initiating
the activity.So if the employee is not showing up for work, is tired all of the time, and
only does what he is told to as long as he is told to, how do you extinguish that at
trial other than just being lazy? Well there is a pattern to it. People who are lazy will
probably avoid the task they are being given. But no brain injury symptom standing by itself
will necessarily say a diagnosis of brain injury. Headache can be explained by other
things. Cognitive lapses can be explained by other things. Depression, you can go down
the list. They all are what we would say are non-specific. But what is specific is when
you get those patterns in the same person and their triggered the symptoms get worse
under the same stimuli. They get tired quickly. They get irritable. They fail to initiate
and all of those things wind up with them not getting to work when they are suppose
to be and not being reliable and ultimately that is the biggest problem the employee,
really really talented people is that the employer needs to rely on a person to do their
job. And its the reliability part that is the biggest fault.