A lot of people complain that following a head injury they have difficulty getting organized. I commonly hear, "I've got 50 projects going, but I've completed none of them," or "I start on something, but I just can't seem to finish it." These problems involve organization.
Why do people have a problem with organization? The front part of the brain is called the frontal lobe. We have a left frontal lobe and a right frontal lobe. Each is involved in planning activities, getting things in the right sequence, and evaluating possible errors. There are two types of processes that occur in the front of the brain: language and visual analysis. The left frontal lobe helps us with language. This is important because the majority of things that we do in our day-to-day life is language-related. The right frontal lobe generally involves visual organization. For example, if you're going to take a lawnmower apart, you've got to make sure all the parts go back together in the right order. Having a few "extra parts" after putting a lawnmower together is not a good thing. This problem happens very frequently in head injury.
Can you get a frontal lobe injury from hitting the back of your head? Yes. If you've ever watched the seat belt commercials on cars, you'll notice that in a head-on collision, the people are thrown forward in the car, then go flying backward. In a car that's been rear-ended, the brain is thrown backward, then bounces forward. The medical term for this is contra-coup injury. That's a French word meaning "other side". In this type of injury, the brain essentially rattles back and forth.
Many of my patients complain that they used to be able to handle 10 things at one time but now can only handle one or two. Secretaries, for example, often have to do multiple activities. They have to type, answer phones, talk with customers, and do filing, all at the same time. In your home, you cook dinner, watch television, and maybe have a load of laundry going at the same time. But if you have problems organizing and sequencing, you may lose track of one or more tasks. You may be watching TV or doing the laundry only to realize that you're also burning the food.
SO WHAT CAN I DO?
Getting help in a head injury program is very important. These programs have a number of activities aimed at improving various skills. At Neuro-Recovery, we will give people two tasks, then throw in something to distract them. For example, we may have some noise going on in the room while the other tasks are being completed. The brain has to process many things at once. This is a gradual process, requiring a working knowledge of what the head-injured person can handle at one time.
If you're not involved in a head injury program, what can you do for yourself? Start simple--do one thing at a time. This may sound easy, but it's hard to do in the real world. For example, if you're home cooking a meal, family members can't be in the kitchen bugging you. You should not be doing other tasks at the same time (like the laundry or watching TV). Limit yourself to one activity at a time until you've mastered that task. Once you feel confident, start adding a second task. Be patient--this process can take many months.
One of the most important things to help with organization is writing things down. Get a daily planner and write things down in the order you're going to do them. Let's look at a common problem. Someone with a head injury may go into town because they need to get groceries. Afterwards, they realize that they needed to go to the post office; and now a second trip into town is needed. That's extra work and very frustrating if it happens to you enough. Sit down at the beginning of every day or the night before (actually, you should do both) and look at your schedule. Plan what you are going to do. I know that people have very busy schedules, but taking that extra 10 minutes to organize is going to save you a lot of time and frustration.
Let's look at another common problem. Planning a meal each day is difficult even if you don't have a head injury; it can become a nightmare if you do have one. One solution is to sit down on Saturday or Sunday and plan out meals for the entire week. Just plan one main meal for each day. Once you have the main meal, go back and add dishes. Make a list of what you need and do your shopping in one visit. This will save both time and the daily frustration of making a decision. I know this sounds like a lot of work, but it will help stop the "brain lock" problem of not being able to make a decision.
Secondly, use a "Modified To-Do List" (This is also discussed in the Memory section of this book). Get a dry marker board (2x3 feet) and put it up somewhere in your house. Write on it the things that you have to do and then erase them as you complete them. Sometimes people will list 50 projects and none of them will get done. If you have this problem, create a list of 5 projects that you want to do and write them on the dry marker board. Dont add another project to the list until you completed one of the 5 items. As you add one, you have to subtract one. You may want to limit it to only 3 projects on the board; sometimes looking at even 5 things can be overwhelming.
Practice organization skills early in the day. Remember, fatigue will make your ability to organize worse. Do it when you are fresh.
By Dr. Glen Johnson, Clinical Neuropsychologist
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