Finding Strategies That Work After Brain Injury

Ask the Expert: Finding Strategies That Work After Brain Injury

My brother had a brain injury six years ago and has been through several periods of rehabilitation to where he now jokes he could be a therapist! He can list all the strategies he is supposed to use to get somewhere on time — like his job — he just doesn’t do them or says they don’t help. Can you give me some insight here?


To begin, one has to consider whether being on time to work is meaningful to your brother. If he enjoys his job and recognizes the implications of being late, then chances of helping him figure out how to get there on time are much better.

Assuming this is the case, your brother’s dilemma is not uncommon after a brain injury. Many everyday activities, such as being somewhere on time, actually involve a number of different skills. It’s important to first figure out what skills are involved so you can choose strategies that are likely to work.

Let’s take your example of getting to work on time and list just some of the cognitive skills and steps that play a part and could be causing his problems:


  • Attention: What time is it, anyway? Am I on time or running late? Am I doing what I am supposed to be doing right now (or getting distracted by a TV show)?
  • Memory: What time do I have to be at work today? What needs to be done before I leave the house?
  • Initiation: Do I get started on each step of my routine in a timely manner?
  • Planning: Do I have enough time to get ready? Are my clothes ready? Have I planned enough time for transportation?
  • Problem-solving: What do I do if I’m running late? What if my transportation falls through? What are my other options? Do I have enough time to go back if I forgot something like my ID badge, lunch, or newspaper?


Breaking down an activity into more specific component skills can often help tease apart where the true difficulty lies. Then a strategy that promotes success (generally, one that builds on his strengths) can be developed by the person with brain injury and if needed, a significant other. If this proves too difficult, some consultation with a cognitive rehabilitation specialist may be useful as well. And remember, any new strategy often requires a lot of practice to make it a habit, especially after brain injury.

Finally, if your brother does not seem motivated, the discussion needs to be about what is important to him. If getting to work on time is not one of his priorities, what is it that he wants to accomplish?


Posted on BrainLine January 22, 2010.

About the author: Elaine Sherard

Elaine Sherard practiced as a speech-language pathologist and had various roles in the neurorehabilitation field for 25 years, including management and serving as President of the Board of Directors of the Brain Injury Association of South Carolina. She continues as a consultant in the brain injury rehabilitation field as well as advocacy endeavors.

Elaine Phillips

Comments (5)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

When we have lost executive functioning, its not about whether we know something, it is about whether the link is there between what we know and what we are able to execute. Even if we know about a strategy, it still has to be remembered, noticed, sequenced, applied, and so on. therefore when these things are damaged we have to do things differently and (probably with help) learn a lot of habits, slowly, by rote. It can take a long time, but it really does help.

Tiredness is a major issue. I know that I struggle in the morning even if I am motivated, and often end up late due to that horrible, dreaded "brain fog". All I can suggest here is longer nights sleep and a less stressful day ahead.

Since my brain injury, I have found that 'strategies' as I used to use them, do not work. I make decisions that I am going to use them and then they do not happen. the only thing that has worked over the years is forming concrete, specific habits. They only came into being by learning one small step of the habit over and over and then building the next step on that, taking years. I really want to emphasize that the fact that we do not do something does not necessarily mean at all that we do not want to do it. It was confusing for me as well as anyone else. I did not know how to get around it and none of the 'advice' given really seemed to work. i think it was too abstract. breaking things down into the concrete habits needed and getting them so overlearned it was automatic was what was needed.  Good luck.

And maybe the work is overtiring in itself. He might not be fit enough to work? And maybe the employer doesn't understand (as most don't) our 'invisible' disability? Sounds to me like work isn't great for him or it's the wrong job for him?

If your brother wants to be on time, it might also be that having all those strategies are jamming his system and he needs to just try one at a time instead of thinking of all of them. This is a cognitive problem even for uninjured folks - having more choices makes it harder to choose any one of them. It can be hard to decide what is best to do, hard to know that it's time to employ the strategy - or depressing and demotivating to accept that he has to use a strategy at all when he did not need to before.