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The Brain Injury Rehabilitation of Disorganization

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

Last stop for Brain Injury Awareness Month – my favorite topic – organization!

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Yes, this is my drawer system to store pens, pencils, and markers. And if I find a pencil in the pen drawer look out! Perhaps being organized and knowing how to find what I need when I need it is one of the many ways I manage the demands of being a business owner and mother of four. But the reality is that we all have different levels of energy, tolerance and mental attention and these things can become depleted after a brain injury. So, if you were an energizer bunny with a DD battery before your injury, chances are your new batteries have 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 brain capacity and 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, keys, 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 and cognitive ability to manage these things, 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.

Helping clients with brain injury 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, it could completely derail your day.

After the day to day items have a place, then we can work to simplify other spaces that are identified barriers to function. Perhaps the kitchen has become too cluttered to allow for efficient meal preparation, or the bills are piling up because these are lost in a stack of papers. In the world of insurance I find that clients become overwhelmed by paperwork and this results in missed appointments, nonresponse to time sensitive material, or failure to submit for expense reimbursement. Slowly, over time and with suggestions and tools (filing cabinets, labels, folders, a pen drawer!) clients become able to more efficiently spend their units of energy on things that are more important, or more fun and ideally, learn to transfer these strategies into other life areas independently – like work, school or parenting.

 

 

To read more of our articles on brain injury check out our section on Brain Health.

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Put a Plug on Your Kid’s Summer Brain Drain

The report cards are done, the bell has rung, the kids are excited and summer vacation is upon us! Summer is a time for camps, vacations, trips, cottaging and so much more! But where do they fit in learning? Ahead lies two full months of vacation from traditional schooling; which for many kids is enough time for their young minds to unlearn much of what was taught. How do we as parents make sure our kids don’t suffer summer brain drain, while still ensuring they get the break and vacation they need? Check out the following from Family Education for great tips on how to easily and painlessly incorporate learning into your summer plans!

Family Education:  Stop the Summer Brain Drain!

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Use Fats to Feed Both a Growing and Aging Brain

The following from Dr. Sears discusses the importance of proper nutrition to fuel the body, and most importantly the brain. Dr. Sears states “…there are two windows of time in which the brain is especially sensitive to nutrition: the first two years of life for a growing baby and the last couple decades of life for a senior citizen.” The article discusses the best ways to provide this nutrition is through the incorporation DHA and Omega 3 fats. Read this great article here to get the facts on the fats you need for proper brain development and optimal brain function!

Ask Dr. Sears:  Omega-3 and DHA as Brain Food

 

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The World’s Most Popular Sport: Can “Heading” Cause Brain Damage?

Once every four years millions of people across the globe engage in World Cup enthusiasm. While known as the most popular game for years on other continents, the popularity of soccer in North America has grown significantly over the past decade. Soccer is a fantastic sport that teaches coordination and team work, provides an excellent source of exercise, and is an affordable and fun activity for people of all ages and abilities.

Recently there has been a growing concern of the effects that “heading” the ball may have on the brain. Due to repeat “knocks” to the head, many are concerned that heading the ball may be too dangerous and some are calling for this aspect of the game to be removed from youth soccer. For the time being, “heading” remains a part of the game so it’s important to ensure that players are doing this properly and safely. Check out the following from CBC to see some great ways to ensure safety on the soccer field.

CBC:  Soccer head injuries may be underappreciated

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Brain Injury and Executive Functions – When the CEO is on a Hiatus

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

Brain injury awareness month continues…this stop: Executive Functioning.

Simply defined, executive functions are the capacities we require to achieve a goal. These are commonly referred to as the “CEO” of the brain because they provide people with 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 that can be difficult. 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.

Really, 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. So now imagine that you have a brain injury and as a result 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 feel on a regular basis.

So, what can occupational therapy do to help? Well, the treatment for executive dysfunction is both broad and simple. It is broad because everyone experiences brain injury differently, and comes into it with varying levels of recoverability. It is simple because it merely involves taking a goal and breaking this down into component parts, manageable chunks, and smaller tasks within the whole.

Returning to the moving example, as an OT, assisting someone who has executive dysfunction with a pending move may involve making checklists with tasks and timeframes, 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 the 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 catalogue 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 far 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 transferrable to other events at later dates.

Often, the above strategies are also helpful for people with other forms of cognitive impairment – not just ABI, but could include stroke, dementia, or degenerative neurological conditions that impact how the brain organizes, processes and works through daily tasks. Ask an OT – we know stuff!

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Daily Dose of Inspiration

The following video created by Headway Brain Injury Services shows a collection of beautiful artwork created by survivors of brain injury. While the effects of brain injury can be devastating, these survivors decided create something beautiful to share with others and generate awareness about brain injury.

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Say “Bonjour” to a Healthier Mind

Bonjour… Hola…Konnichiwa…Say hello to a great way to boost brain power and help slow the process of aging for your brain. The following from New Scientist discusses recent findings which show that learning a second language may be one of the best ways to help keep your brain fit and strong, and bid adieu to memory loss in the latter years of life.

New Scientist: Learn a second language to slow ageing brain’s decline

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Food For Focus

Do you sometimes find it hard to focus? Whether at home, work, school or play, distractions are everywhere which can effect productivity and increase procrastination! The following from Men’s Health Magazine suggests 7 super foods to help you focus, improve memory and give you the boost you need to concentrate on your daily activities.

Men’s Health:  The Best Foods For Focus