Memory
Organizing Daily Life After Brain Injury
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Significant psychosocial and cognitive changes often occur as a result of brain injury. Consequently, changes in that person’s daily living activities and routines can be affected. Impairments in memory make it difficult for the person with brain injury to recall scheduled appointments and activities. Problem solving and reasoning decrements pose an obstacle for the person with brain injury to organize a routine and plan activities over the course of a typical week.
Use of memory aids and daily reminder systems are useful to begin the task of organizing activities. Memory capture methods such as a large calendar placed in a prominent place in the house will increase the frequency that a listing of daily events will be seen during the day. Although post-notes are sometimes useful for specific reminders (e.g., post-note on the door exiting the house), overuse of post-notes can be confusing. It’s important for those who live or work with the person with brain injury to establish regular times to view the daily schedule. Once in the morning and once prior to going to bed at night is a good starting place. Carrying a daily schedule during the day may also be helpful to keep track of activities while outside of the home. Use of a simple daily planner can augment the master schedule at home.
The person with brain injury may want to sit down with a friend or family member to brainstorm ideas of activities that could be done during the week, however the person may need structure in order to think of ideas. Assistance with categorizing tasks and pleasant events prior to brainstorming can help provide this. During this brainstorming phase it is important to think of as many activities as possible before eliminating specific items or giving them a lower priority. This approach encourages the greatest amount of creative thinking. Brainstorming can include the introduction of larger events such as visits with friends, neighbors and family members.
Breaking down activities between tasks versus pleasant events can be helpful. A good balance between work and pleasant activities should be also be maintained. Building in rewards such as going out for meal or watching a favorite video at home can be contingent upon completion of a certain percentage of a task. Larger tasks may need to be broken down into smaller parts, so that the task is less daunting. For example, cleaning out the clutter in a room may be needed to simplify the home environment for the person with brain injury. If the task seems overwhelming, it could be broken into two parts. Removing items for the trash could be step one. Straightening out what is left would be the second. These steps may need to be divided between two or three different days in order to accommodate a pleasant event for that day. Big projects will likely require assistance from a family member or friend.
Building in routines for activities is also desirable. Individuals with brain injury sometimes have trouble approaching activities in a new environment or context. For example, the person may do well cooking breakfast but struggle to prepare dinner. Several factors could account for this. The person may be fatigued at the end of the day, or distracted by television news on in the background or have difficulty fielding interruptions by telemarketers who tend to call during the dinner hour. In such a case, it might be better to build in fixing breakfast as the routine and not attempt to make the dinner meal preparation a daily activity.
Establishing a regular time and place (e.g., the family room; bedroom; basement recreation room) for things like exercise or home physical therapy may increase the likelihood of follow-through for important activities. Consistency also provides needed structure. Going to the grocery store may be built into a weekly routine. Going to the same store, and learning where items are can be helpful to allow the person with brain injury to be more independent in shopping for items.
In determining the set of activities that one plans for a day or for the week, two rules of planning can be helpful. First, a good balance between passive versus active events should be achieved. Passive tasks include watching the television and listening to music. Active tasks include reading, taking a walk, calling a friend on the telephone, or shopping for a gift. Both passive and active tasks are needed throughout the week. Secondly, stepping back from activity generation to allow opportunity to plan meaningful activities is important. We can think of activities that most of us may find interesting (e.g., reading a book; gardening; going out to eat), but each person may assign different levels of meaning to these activities. Meaningful activities to a person with brain injury may include activities that go beyond what one does in a typical day. This may include engaging in spiritual practices, looking through family albums and reminiscing with a family member, talking to friend that the person with brain injury has been out of touch with for years, and other such activities that do more than occupy time or serve a practical purpose.
Jay Uomoto, Ph.D. is a Professor in the Department of Graduate Psychology at Seattle Pacific University and teaches neuroscience, personality and rehabilitation psychology courses in the Ph.D. Clinical Psychology Program. His research emphasizes the neuropsychology and multicultural aspects of traumatic brain injury, long-term care patterns in older Japanese Americans, as well as studies in interpersonal changes after brain injury. Dr. Uomoto is certified in Health Care Ethics. He also has a private practice in neuropsychology and rehabilitation psychology.