Archive for category: Brain Health


The Goal is Improved Executive Functioning

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

As a caring professional, I refuse to believe that my clients are not motivated.  All of my clients have goals or I would not be treating them.  However, their ability to achieve their goals independently remains the reason that they require active therapy.  Previously, I wrote about executive functioning, and used the example of moving to highlight how people with executive dysfunction may feel on a regular basis when completing relatively simple tasks.

Treatment for executive dysfunction is as broad as it is specific.  It is broad because everyone experiences brain injury differently, and comes into that type of trauma with varying levels of ability to start with.  However, treating problems with executive function is really as simple as taking a goal and breaking this down into component parts, manageable chunks, and smaller goals within the whole.

So, returning to the moving example, assisting someone with executive dysfunction with a pending move will involve making checklists, with time frames, and checking on progress frequently.  Personally, I like to take a project approach:  calling the goal “Operation Move” and mapping out – start to finish – the metrics for success.  Perhaps in month one an “apartment hunting worksheet” is created to help a client summarize all the places they are looking at, the pros / cons, address, and list of questions that need to be answered (price, utilities included, length of lease etc.).  Often I encourage my clients to use a smartphone to take photos of the options then we cross reference these and catalog them to keep things organized.  From there, the process continues with checklists for calls to make, addresses to change, ways to organize packing and management of belongings.  Ensuring the client is responsible for follow-up via “homework” between sessions and holding them accountable for completion of this aids to developing independence.  Really, the therapeutic goal is more than just ensuring the client is able to move successfully.  Rather, it is demonstrating a model and method that can be used for any future transitions, goals or tasks.  This ensures success that is transferable to other events at later dates. 


"You Only Get One Brain; Treat it Well!"

Concussions are a hot topic in sport.  Yet the management of these continues to vary.  It is now felt that if someone sustains a head injury during sports, they should not return to the game and should be checked by a professional.  Take a look at this article about concussions and the changing guidelines for treatment.  In the article, an expert, Dr. Jeffrey Kutcher, states:  “If in doubt, sit it out,” and points out the important fact that “you only get one brain; treat it well!”

CBC News Health: “If in Doubt, Sit it Out”


June is Brain Injury Awareness Month: How Is Your Executive Functioning?

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Last month, I spoke at a conference with my colleague Tamara Forbes ( on the topic of executive dysfunction.  Executive dysfunction is a common problem following brain injury.  Simply defined, executive functions are the capacities we require to achieve a goal.  They are commonly referred to as the “CEO” of the brain because they provide the higher order processes that allow us to plan, organize, initiate and complete tasks successfully.

Practically, think about the last time you moved.  Moving, as an example, is a simple goal of just wanting to relocate from one place to another. The goal is not the problem: it is the processes and thinking required to manage the transition effectively.  Several months before moving you are searching for a suitable place, weighing the pros and cons of each location, checking your budget.  Then you make the decision of where to move and you need to deal with your existing location.  When do you need to notify your landlord, or when should you list your house?  Then, months and weeks before you move there are calls to make to utility companies, mail to redirect, insurance to organize, movers to book and packing to do.  What belongings are you moving?  What should be sold, donated, discarded?  The day of the move is chaotic, stressful, and exhausting.  Then for months after you continue to unpack, move things around, find ways to arrange and store your stuff.

Your level of executive functioning, or your ability to delegate and enlist support for your areas of weakness, will determine the outcome of your move.  Now imagine, with brain injury, that you feel the same sense of stress, fatigue and frustration with more simple daily tasks, such as planning a meal, sorting your mail, or scheduling your time.  This is often how people with brain injury will feel on a regular basis.   The goal then of occupational therapy will be to simplify daily tasks and help a client break activities down into smaller and more manageable chunks.  More on this to come…


What Behaviors Do You Want to Modify?

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

One of the best courses I took in university was Behavior Modification.  Our main project was to modify one of our own behaviors over a four month period.  Personally, I had a dog and wanted to develop a better walking routine.  So, over the four months I mapped out several walking routes that increased my time spent walking on a weekly basis.  By the end of the four months, I was walking my dog two hours and twelve kilometers a day.  Research indicates that it takes four months to develop a new habit, so by the end of the course my new walking routine became standard practice and something I did religiously with my dog (and then dogs) until I had my family and needed to develop a new routine.

Often, when our regular routines are interrupted by disability bad habits develop.  While not immediate, over time days can become more and more unproductive until soon very little is getting accomplished.  This has a drastic impact on mental health and impacts all areas of physical, cognitive and emotional functioning, let alone the impact on those that we live with.

The best way I have been able to help clients to break such routines is to simply have them track how they spend their time.  Once this is documented, people can quickly identify the problems areas and then together we discuss how to fix them.  For example, through tracking for a week, one client discovered that she does not shower, one found that he watches ten hours of TV per day, and another learned that she does not eat during the day, but consumes junk food all evening.  In every case, people discovered something about their routine that drove them into action for change.

So, if you are concerned that your routine is lacking in productivity, self-care or leisure, or there are activities you would like to resume or goals to achieve, just keep a log of how you spend your time.  After a week, reflect on your log and make a list of the problem areas.  Commit to making small changes (start with the easiest changes first) and over time, you will see huge improvements in how you feel about yourself and your routines.  Or, for a more structured approach, consider hiring a professional to assess your suitability for the Progressive Goal Attainment Program.  This program involves using time tracking over 10 weeks to completely revamp routines to reduce psychosocial barriers to recovery, improve mental health and reduce disability caused by chronic pain.


The Rehabilitation of Organization

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Previously on our blog I outlined the importance of organization in helping people with limited energy reserves to make sure their energy is spent on enjoyable or purposeful tasks and is not wasted looking for things that should be easy to find.

Helping clients to become more organized can take many forms, depending on the client, the nature of their problems, and how they previously organized their stuff and their time.  What I tend to witness is the time lost and sheer frustration that clients experience looking for cell phones, wallets and keys.  Often, cell phones become used as a “second brain” assisting people to maintain a schedule and make appointments (calendar), remember things (task lists), have access to support systems (contacts, calls, text, email), and negotiate their environment (maps and GPS).  If this gadget is so important, it is even more important that people know where it is.  Having a catch tray by the front door, in their room, or a standard docking station can be helpful.  Wallets and keys should also be left in a consistent location.  I am sure we can all relate to that feeling of looking for our keys in their usual spot to find they are missing.  But if you lack the ability to efficiently look for these, or the energy, it could completely derail your plans.

After the day to day items have a place, then as a therapist we can work with our clients to simplify other spaces that are barriers to function.  Perhaps the kitchen has become too cluttered to allow for efficient meal preparation, or the bills are piling up because these become forgotten in a stack of papers.  In the world of insurance I find that clients become overwhelmed by the paperwork and this results in them missing appointments, not responding to time sensitive material, or failing to submit for expense reimbursement.

Slowly, over time and with suggestions and tools (filing cabinets, labels, folders) clients will be able to more efficiently spend their units of energy on things that are more important, or more fun.



You Can’t Afford to be Disorganized

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

We all have different levels of energy, tolerance and mental attention.  If suffering from chronic pain, brain injury, or another chronic condition, chances are the DD battery that you used to have has been replaced with some AAA’s.  This means that daily activities will take more time, more energy, and you will need to recharge sooner.  So, considering this, do you really want to spend your valuable energy looking for stuff? 

Consider that you have 10 units of energy when you wake in the morning.  Every activity you have on your “to do” list takes one unit.  Going for a walk, preparing supper, managing the laundry, responding to emails, attending an appointment, completing personal care, and having coffee with a friend all drain your battery.  Some of these activities are necessary, some can be put off, and others are enjoyable.  So what if you spend one unit of energy looking for your phone, that bill that needs to be paid, your agenda, or those new runners you bought yesterday?  What activity will come off your list when you have spent your energy to find something that with some organization would have taken you no time at all?  Maybe you will call your friend to cancel, or order supper in again.  Maybe the laundry will wait to tomorrow, or those emails will just keep accumulating. But this is unnecessary because you had the energy, it just became misdirected.

Often the focus of occupational therapy becomes helping people to organize their activities, their stuff or their time.  Schedules and consistency are keys to helping people to understand the size of their battery and the amount of units each activity takes.  This can be difficult when working with clients who did not need to be organized before an injury or illness, but the necessity of this following cannot be ignored.   Even small steps to help people to be more organized can have a huge impact.



The Five Whys as a Practical Tool for Problem Solving

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Being fully aware of a situation requires reflection and inquiry.  Yet, often what we see and feel on the surface is not necessarily what is truly going on.  Think of those times where you have become upset at your spouse, child, or parent to later realize that what you thought were upset about was really grounded in something else.  I know personally, I use long walks with my dog and music to try and understand any sources of discontent.  I find my walks enlightening and always try to ensure that I don’t speak too soon about a problem until I have taken that time to reflect.

At a recent seminar, we discussed the value of using the Five Whys to develop awareness.  This technique is grounded in the manufacturing industry to find the root cause of a problem.  For example, a conversation might go something like this:















Why did a screw get missed on that tire?



That was missed by John.






Why did John miss that?



The line is moving too fast and he is missing every 15th tire.






Why is the line moving too fast?



We have deadlines that we are not sure we will make.






Why can’t we meet the deadlines?



We have three staff off right now.






Why are they off?



They are injured and have not been replaced.



By the fifth why, the relationship between the current problem and the root problem is determined.  Now, consider the use of that in daily life.  Why am I angry?  Because the kitchen is a mess.  Why is the kitchen a mess?  Because the kids ate and didn’t clean up.  Why didn’t they clean up?  Because they were going to be late for practice.  Why were they going to be late for practice?  Because they forgot about the practice.  Why?  Because it was not written on the calendar.  So, we can get angry at our kids for not cleaning the kitchen, or realize the root cause was our fault when we failed to use the strategy (the calendar) that helps them to manage their time.

Try using the Five Whys in practice when trying to solve a problem.  See if that helps you to truly succeed in understanding situations, getting to the root cause, and being able to make change to prevent the problem from reoccurring.