Lack of overview and structure
People with brain injuries generally need structure, overview and rest.
The clearer the life, the day and the week are organized, the better a person can function. Is is recommended to use action lists or the modern variant of apps that alert to ensure that something is not forgotten.
Unfortunately, many people with brain injuries cannot create the necessary structure and overview themselves. It also happens that it takes a lot of effort, therefore consumes a lot the scarce energy that is available.
Therefore, many people with brain injury are partly and sometimes completely dependent on others, for example individual (outpatient) counselors or caregivers.
Several areas of the brain must work together to provide an overview. This means that damaged areas, which work with a delay or with difficulty, are also required for this. An injured brain is quickly overburdened. Getting an overview is difficult due to delayed information processing. In combination with stress it often becomes really impossible.. The executive functions can be disrupted.
The problems become greater due to aphasia, word-finding problems, memory problems, severe fatigue, over-stimulation, under-stimulation or concentration disorders, reduced flexibility or apraxia.
(Pay attention! It differs per injury and per person and per location of the injury in the brain. The list below does not apply to everyone. One problem may apply to a person and others may not.)
There is (often) a lack of ability to:
- Put things in order yourself,
- Monitor the overview yourself,
- Get all the facts or thoughts at a glance,
- Summarize the main points,
- Get 'to the point' quickly, therefore a tendancy to be verbose,
- Limit yourself to one topic or task,
- Obtain an overview of a complex task,
- Divide tasks into small logical steps,
- Be concrete and practical,
- Purposefully complete tasks,
- Start the day without an agenda,
- Get an overview of how to organize wardrobes,
- Unexpectedly and without preparation have imposed a task (note that this also applies to unexpected phone calls where someone is suddenly asked to do something or to answer a question),
- Get an overview of how to organize the day or week or holiday, including the necessary breaks,
- Implement the plans,
- Make plans for shopping lists, menu plans including coming up with the necessary ingredients. On this website you may find an app to help you.
Possible solutions for caregiver or professional
- Help organize complex tasks,
- Help to divide an action into small steps,
- Give lists of tasks if a person is not able to organize the day and write it down in the agenda,
- If something unexpected happens, delete tasks. Rest is the most important thing in such a moment,
- Use short checklists bedause that gives a better feeling than a long 'to do' list
- Maintain regularity and rest times,
- Stick to this structure,
- Make a week list with what you are going to eat, write down the ingredients and then make a shopping list,
- Be specific in the conversation, don't expand,
- Use clear language that cannot be understood in two ways
- Discuss one topic at a time
- Give time, don't hurry,
- Use a whiteboard and keep it well-arranged and low on stimuli,
- Keep a written step-by-step plan b and c (emergency plans),
- Give children a large worksheet - that is visually low in stimuli,
- Put a list of important telephone numbers with the telephone,
- Summarize a conversation and sum up the main points or write down the catchwords,
- Ask whether something that has just been discussed has been understood
- Encourage the use of helping apps, calendars or other tools
- Use reminder notes, sticky notes ('don't forget the laundry!')
There are trainings both at rehabilitation clinics and at individual occupational therapy practices that aim to teach the affected person how to handle rest and regularity and structure. Nevertheless, support from ambulatory counselors or caregivers will remain desirable, even after such training.