Presentation and Discussion by Speech-Language Pathologists Herb Hein, MMSc, CCC-SLP and Joanne G. Hein, MS, CCC-SLP
I. THE REHABILITATION PROCESS FROM A SPEECH-LANGUAGE PATHOLOGIST’S PERSPECTIVE
The process of recovering from a brain injury involves three different things:
Building back skills that were lost with the injury (wherever possible).
Learning strategies to compensate for skills that are harder to re-build (by learning new ways to work around challenges).
Making changes in the environment (to help you work around deficits).
Then, it takes a lot of practice until the new way of doing the activity becomes automatic.
In order to help someone with their organization skills, Speech-Language Pathologists help with the following cognitive (thinking) skills, which are often impaired in some way following a brain injury:
ATTENTION – General ability to focus on one task.
CONCENTRATION – Ability to tune into the details of a task with finely-tuned attention.
MEMORY – Storing information in the brain and pulling it back out when needed.
ORGANIZATION - Ability to have all of the things needed to do a job, and to do the job in the right order.
REASONING SKILLS & PROBLEM SOLVING – Ability to be realistic, logical and flexible when doing a job.
EXECUTIVE FUNCTIONS of the frontal lobes, including:
Planning – Deciding what you intend to do.
Initiating - Actually starting to take action on each step.
Self- Monitoring - Being able to see if you said or did what you intended.
Following-Through - Persisting in order to complete a task.
II . THE “OLD ME” vs. THE “NEW ME”. You will want to know that the way you used to do things might not work as consistently for you anymore. After a brain injury, as difficult as it may be, it is important to get to know the “new you”. You will want to learn how to do things in new ways, that still allow you to be successful.
“THE OLD ME” (HOW I WAS BEFORE THE INJURY)
I can REMEMBER anything (without any notes).
I do multiple things at once (MULTI-TASKING).
I am a FAST thinker and a FAST talker.
“THE NEW ME” (HOW I AM SINCE THE INJURY)
I can’t remember (and have no idea where I put my notes!).
I have to do one thing at a time.
I have to do everything SLOWLY!
THINK ABOUT THIS:
STICKING WITH THE OLD ME DOES NOT WORK ANYMORE
1. I never used to write things down. 2. So, I try to remember information in my head like I used to do. 3. This feels good, because it feels like I am the Old Me….sort of . 4. Oops! But, I forget the information. 5. So, I really was not successful. 6. This feels bad!
I NEED TO BE DOING THINGS THE NEW WAY FOR THE SUCCESSFUL NEW ME
1. I cannot remember things without notes anymore . 2. So, I write info down for myself. 3. I feel badly because I hate having to do things differently, because it reminds me that I am no longer the OLD ME. 4. But, my new ways help me to REMEMBER the information! 5. So, I am SUCCESSFUL! 6. This feels GOOD! ☺
III. AUTOMATIC vs. DELIBERATE
Doing things on “Automatic” means going through an activity without thinking much about it.
Doing things “Deliberately” means thinking carefully about each step, so you make very few mistakes.
After a brain injury, pieces get missed when you do things on “Automatic.”
Now, your brain has to be very deliberate about everything you do.
Even though it takes a lot of energy to think through every little step to accomplish a task, this is the way to be successful more of the time.
Work on becoming Super Deliberate in all that you do!!!
If you are super-deliberate, you lay down new brain pathways.
Then it gets more automatic. Really!!
But these improvements do not happen overnight! Repetition is needed.
How to get started being More Deliberate:
Pick one thing you want to get better at doing, then:
Stop and think about the activity so you are paying more deliberate attention to it.
Set out a plan, including a list of steps to follow.
Try the plan for one week. Slowly! Do it the same way each day!
Evaluate the results. What worked? What did not work?
Change the plan if the first one had parts that did not work.
SELF-CHECK OF ORGANIZATION SKILLS AND STRATEGIES
How organized am I? What do I do to help myself? Fill out this questionnaire to do a self-check of your own organization skills and use of strategies.
ATTENTION / CONCENTRATION 1. I GET DISTRACTED BY THINGS IN MY ENVIRONMENT (USUALLY, SOMETIMES, RARELY) 2. I get distracted by my own thoughts (USUALLY, SOMETIMES, RARELY) 3. I TELL MYSELF TO FOCUS (USUALLY, SOMETIMES, RARELY) 4. I ASK TO MOVE TO A DIFFERENT LOCATION IN ORDER TO CONCENTRATE BETTER (USUALLY, SOMETIMES, RARELY)
MEMORY/RETENTION 5. i REMEMBER TO DO ALL THE THINGS I NEED TO DO EACH DAY. (USUALLY, SOMETIMES, RARELY) 6. i write things on calendars. (USUALLY, SOMETIMES, RARELY) 7. i write a list of things to do each day. (USUALLY, SOMETIMES, RARELY) 8. i write out a daIly schedule. (USUALLY, SOMETIMES, RARELY) 9. i (USUALLY, SOMETIMES, RARELY) MAKE CHECKLISTS TO REMEMBER ALL THE STEPS I NEED TO DO and to do things in the right order. 10. i USE MY LISTS AND DAILY SCHEDULES. (USUALLY, SOMETIMES, RARELY)
ORGANIZATION 11. i have the things i need to do my daily tasks and jobs. (USUALLY, SOMETIMES, RARELY) 12. I KEEP THINGS IN THE SAME PLACE TO FIND THEM EASILY. (USUALLY, SOMETIMES, RARELY) 13. I MISS STEPS OR DO THINGS IN THE WRONG ORDER WHEN DOING A JOB. (USUALLY, SOMETIMES, RARELY)
EXECUTIVE FUNCTIONING 14. I AM ABLE TO DETERMINE (PRIORITIZE) THE MOST IMPORTANT THINGS TO DO EACH DAY. (USUALLY, SOMETIMES, RARELY) 15. I am realistic about what I can accomplish in any situation. (USUALLY, SOMETIMES, RARELY) 16. I am able to INITIATE/start doing the things that I need to do to get a job done. (USUALLY, SOMETIMES, RARELY) 17. I (USUALLY, SOMETIMES, RARELY) am able to realize when I am not doing a task well, and am able to figure out what to do about it. (USUALLY, SOMETIMES, RARELY) 18. I ask for help from others when I need it. (USUALLY, SOMETIMES, RARELY) _____________________________________________________________________________STRATEGIES TO IMPROVE ORGANIZATION
ATTENTION / CONCENTRATION
Tell yourself what you are supposed to be paying attention to and challenge yourself to focus for increasingly longer periods of time.
Keep track of where you started to lose your concentration so you can return to that point later.
Take a break until you think you are able to focus again.
Decide if you can pay attention longer if the task is simpler or if you have fewer distractions. Change up the task to match your level of attention.
Write down appointments, classes, work schedules and social events on a monthly calendar. Look at the calendar every time you are writing up your daily schedule.
Write up a daily schedule so you know what you want to accomplish each day. Write down when you want to do each thing. Be realistic with how long each activity will take.
Make checklists to remember all of the things you need and all of the steps that are needed to do multi-step tasks. Check off after you finish each step to help you remember that you did it.
Before you go out to appointments, write down what you want to say and/or what you want to accomplish, so you can have these notes with you as you are meeting with and talking with other people. Write down what the other people say in response so you can remember it when you get back home.
Write down a list of doctors and therapists that you are currently seeing and use this list to help remind you of appointments that need to be made or appointments that need to be kept.
Keep a section of your binder to keep track of what each professional says and what you need to do in each area.
Work very hard to keep things in the same place so you and the other people who live with you know where you can find them again. (Keys, wallet, bills, tools, medicine, notes, etc.)
As needed, write labels on the places where things go so nothing else can be put there. This is true for cabinets in the kitchen, drawers in desks, shelves in the garage, sections in binders, etc. Take the time to put things back in these designated locations.
Put papers related to different categories in well-labeled file folder. Keep an index of file folders. Keep these file folders in an accordion file or a file cabinet. Write down on your schedule if you need to get a specific file folder to bring with you to an appointment or to have with you when completing a task.
Strive to do things in the same way so they become routines. Use checklists to do things thoroughly and in the best order. Each time you start a new step of a task, take the time to make sure it is the right step and that you have everything you need to finish that step. Be deliberate with each action by consciously telling yourself what you are doing, or what you are focusing on as you work through the task.
Make a list of all of the “Categories of Your Life” so you can always have this available when you are thinking of what you need to accomplish each day.
Then in each category, “brainstorm” all of the things that need to be done.
After you brainstorm this list of everything that needs to be done in every category, mark the ones that need to be on your “A” list. (These are the things to be scheduled to be done this week! They are your priority activities.)
Then get a weekly schedule and write what day and time each of the things on your “A” list should be done.
Refer to this weekly schedule to actually do all of the things you need to do. (You may also write out a daily schedule and use it to do your priority things at the time you think they could or should be done. Check off when you do each thing!)
Schedule a time in the evening to make your daily schedule for the next day. (Don’t forget to include the things that are on your calendar.)
Schedule a time on the weekend to again review all of the things on your “Categories of Your Life” list so you can make a revised priority “A” list and then write out a schedule for the next week with these appointments and things to do.
You might get a watch with an alarm that goes off every 15 or 30 minutes to help remind you to check your schedule and initiate what needs to be done.
Reward yourself for finishing tasks by crossing them off with your favorite color highlighter when you are done with each thing.
If you find you cannot accomplish what you thought you could, use this information the next time you are writing up your daily schedule.
Maybe you need to expect yourself to do less.
Maybe you need to give yourself more time to get something done.
Maybe you need some help to get the task done.
Maybe you need to use different materials next time.
Maybe you need to do things in a different order.
BE PATIENT. It often takes months of small changes to make your systems work for you. But then after that, you will have a system that will work for a lifetime.
Learn to PACE YOURSELF, so you do not use too much energy at one time and drain yourself down to nothing.
Write out the date that you are working on your categories because your list will probably by changing as your life continues to evolve. The categories may change and the details within each category will definitely change.
Make the categories your own. Your initial list does not need to be absolutely complete. You can always add to the list as you start to do some of the activities.
CATEGORIES OF MY LIFE as of (date): _________________________