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?
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.