Initiation, Planning, Organization, and Brain Injury

The University of Washington TBI Model System and the University of Washington Medical Center
Initiation, Planning, Organization, and Brain Injury

What is initiation?

“Initiation” is the ability to start doing something. It requires seeing what needs to be done, making a plan about how to start doing it, and putting the plan into action. For example, if a person wants to get dressed they must first recognize the need to get dressed, plan what they will wear, and begin gathering clothing.

What is planning?

“Planning” is the ability to choose how to do a task, and to list all the steps of the task. Planning also requires the person to decide what they will need to do the task and estimate how long it will take them to complete it. For example, if a person wants to cook a meal they must decide what they will cook, what ingredients they will need, where they can get the ingredients, what time to start cooking, and how much to cook.

What is organization?

“Organization” is the ability to put all the steps of a task (or many tasks) in the correct order. It also includes changing the order of the steps, as needed, so the task can be completed. Organization is also the ability to create logical places to store items and information so that you can find them later.

Why does a brain injury affect the ability to initiate, plan, and organize?

Initiation, planning, and organization are thought of as “higher level thinking processes” because they require a lot of brain power. To initiate, plan, and organize, a person needs to be able to think ahead, concentrate, remember things, gather and sort information, and set priorities. If you have damage to the front of your brain, you are more likely to have problems with initiation, planning, or organization. This is because the front of the brain is the part most involved in planning, organizing, and problem solving.

What happens with initiation, planning, and organization problems?

When you have problems with initiation, planning, or organization, other people may think you are unmotivated or lazy. You may also:

  • Have a hard time starting or finishing things you try to do.
  • Have a hard time with tasks that used to be easy, such as getting dressed or finishing a work assignment.
  • Stop doing favorite activities.
  • Have a hard time trying new ways of doing things.
  • Only be able to do one thing at a time, where before your injury you may have been able to do many things at once.

What makes initiation, planning, and organization worse?

  • Fatigue and lack of sleep.
  • Stress or illness.
  • Too much information to sort through.
  • Trying to do too many things at one time.
  • A distracting environment.
  • Doing something unfamiliar that is not already well organized or clear.

When should I ask for help with initiation, planning, or organization?

Talk with your health care provider if:

  • Your problems with initiation, planning, or organization are interfering with your ability to care for yourself or your family.
  • You feel like you are having a harder time than usual initiating things, planning, or organizing.

What can I do to help myself initiate, plan, and organize?

Minimize distractions:

  • Focus on one thing at a time. For example, if you are cooking, do not listen to music at the same time.
  • Put things away when you are done with them.
  • When you are doing a task, bring out only the things you are going to use. Put away everything else in your work space.
  • Get rid of things you don’t need, want, or use.

Follow a routine:

  • Set a specific time each day to focus on planning and organizing for the next day.
  • Look at your schedule often during the day, so you don’t forget to do things.
  • Set a specific day for each of your household chores. For example, do the laundry on Mondays, go grocery shopping on Tuesdays, and clean the bathroom on Wednesdays.
  • Set a timer or alarm to remind you of important things to do in the day, such as starting to cook a meal.
  • Do things that require the most initiation, planning, or organization early in the morning, when you are the least tired.
  • Set a reasonable number of goals for yourself.
  • Take breaks during the day.

Use organizers:

  • Put all important information in ONE book or an electronic organizer. Include:
    • A monthly planner, where you write down appointments, events, and your daily schedule.
    • A short “to-do” list of 3 to 5 items. Check off items as you complete them.
    • Shopping lists.
    • A list of your medicines, including how much you take of each medicine, and when to take each one.
    • Phone numbers and addresses of medical providers, friends, and family.
    • Goals you are working on.
  • Make a place for everything in your home, and label the location so you know where everything goes.
  • Break down complex tasks into small steps.
  • Have other people verbally remind you to start tasks.

Where can I learn more about initiation, planning, and organization?

Ask a professional:

  • Your doctor or health care provider.
  • Your psychologist.
  • A speech and language pathologist or occupational therapist.

Check out these resources:

Brain Injury Association of America
8201 Greensboro Drive, Suite 611, McLean, VA 22102
Brain Injury Information Hotline: 800-444-6443

Brain Injury Association of Washington
3516 S. 47th Street, Suite 100, Tacoma, WA 98409
Helpline: 800-523-5438

Multiple Sclerosis Association of America
706 Haddonfield Road, Cherry Hill, NJ 08002

National Brain Tumor Foundation
22 Battery Street, Suite 612, San Francisco, CA 94111
Patient Line: 800-934-2873

National Multiple Sclerosis Society
Greater Washington Chapter
192 Nickerson St., Suite 100
Seattle, WA 98109

National Stroke Association
9707 E. Easter Lane, Englewood, CO 80112
800-STROKES (800-787-6537)

Alzheimer’s Association
225 N. Michigan Ave., Fl. 17, Chicago, IL 60601
Helpline: 800-272-3900

National Parkinson Foundation
1501 N.W. 9th Avenue, Miami, FL 33136-1494


Call 206-598-4295. Your questions are important. Call your doctor or health care provider if you have questions or concerns. UWMC clinic staff are also available to help at any time.

Rehabilitation Medicine:

University of Washington
Traumatic Brain Injury
Model System:

Production of this patient information brochure was funded in part by the National Institute for Disability and Rehabilitation Research, Grant #H133A070032.

Posted on BrainLine June 19, 2009. Reviewed July 27, 2018.

From the University of Washington TBI Model System and the University of Washington Medical Center. Used with permission.

Comments (13)

Professional Organizers help clients with these challenges. Some specialize. They can do the planning and the initial setup for folks to be successful ongoing.

What if your organizing skills are diminished and you really don't know when this took place? I did hit the front of my head hard a few years ago, buy I never made the connection. What do you recommend in this situation? Thanks for sharing your thoughts.

If you are brain injured this is not enough. It takes an uninjured brain to put everything in one notebook and not get confused.'

Me in a nutshell! It's been 3 years and this is my first attempt at a Thanksgiving dinner. I'm considering writing a book entitled "The Misadventures of Cooking With A Brain Injury: Thanksgiving Edition". Ive struggled, I've cried and I've prayed and I might just survive. I'll laugh later but right now I'm very sad and showing myself no grace. I still struggle with finances to the point of ruining our almost perfect credit. People don't get it when I say it's confusing and hard. I might look normal and I may have come so very far compared to where I was but my brain just isn't recovered.

I sustained my latest TBI in April 2015. Lately I have been experiencing fatigue, short fuse and lack of initation - thank you for the article I will try the tips. 

Thank you for the organizational article, its been 3 years for me with non diagnosed CTE as consequence of what was initially thought had been a pretty minor work place accident and then learned of its cumulative effect with prior injuries. Its turned into an un-believable night mare with little or no brain injury help (medical or otherwise) or even recognition apart from support by my amazing family MD. When I read this article it made so much sense explaining why every matter once simple is 3 years counting now extremely difficult. Don't know where this is all headed, barely coping on own and things pile up. When barely managing you find a plate with only so many apples on it, cant add one more with out  sacrificing another and if your not paying attention you loose the entire plate, taking months attempting to regain back to place you once were. With no insurance, no diagnosis and few Canadian resources I am so grateful for your help. Thank you, I Shared your article today with my MD and she was impressed too and can now share with others. BD Alberta Canada

Thank u so much. After being hypoxic bc my Dr didnt recognize septic pneumonia, ICU, a heart attack, renal failure all during a week long coma, you've finally labelled what I experience. Its taken 4 years bc no one wanted to admit their mistakes. Now I have a plan and I know what I'm experiencing is real. Such a relief. Maybe w planning and practice I'll be able to finish my Masters. Yay!

Thank You for this article. I was hit by a bus as a passenger in a vehicle and subsequently suffered a 16 day coma. It is important that everyone knows that although it is difficult, we can, by the Grace of God, overcome it. jc

Thank you for compiling this easy to read, understand and absorb summary/definition of frontal lobe tbi symptoms associated with initiation and task completion. I have been struggling for 4 + years and although I have the insight and education to understand I have not been able to put what I have been struggling with into words. I have even been working with a brain injury home rehab company for 9 months and they have not provided as much information as I have read in this short document. This was clear, concise, organized and descriptive. I have recogized many of the adaptive techniques on my own, but still find it difficult to implement as it requires an understanding of others around me (including "cognitive therapist"). Others need to be organized around me when assisting me or creates more confusion and frustration.

These are all issues I have although my stroke and brain surgery was in my cerebellum, which I was told by one doc, coordinates EVERTHING, from Speech to swallowing - coordination of thinking, are there any links to articles that relate these problems to issues in cerebellum too? 

My son does not have a brain injury. He has a mixed receptive-expressive language disorder. He scores most poorly on the organization of things. He knows how to read and write, he just can't seem to coordinate all of the things in his brain that he needs to do school work. I will be using these tips. Thank you so much.
Thank you for this article I am a victim of abuse and had a head injury. I felt all these symptoms and i have become introverted from being a jolly person. i will visit my doctor
This article was very helpful. It addressed the major points of concern I have experienced after my brain injury. It also gave easy to understand steps to assist myself in dealing with these problems.