Question:

Dear Kathy M.,

I have a problem getting things done. I don't understand why getting conked on the head would make it so difficult to do things like clean the house or pay my bills. I don't have to work so I have all the time in the world to do things. I know what needs to be done and I give myself enough time, but it doesn't seem to matter. I've gotten to the point where I don't have more than one or two things on my TO DO list each day, but every day I just seem to get more and more behind. This is very frustrating and depressing. It's true I'm tired a lot, but I haven't been able to get the house cleaned all week. My bills are late and we're out of food. Do you know of strategies for this kind of problem? I don't know where to start.

Thank you.
Caroline

Kathy's Response:

Dear Caroline,

There could be many reasons for the kind of problem you describe. Let me mention a couple of possibilities, and let's see if one or more may be a factor:

• Not knowing where to start
• Starting a project, but getting distracted and starting something else
• Running out of steam (energy)
• Knowing where to start, but not being able to do the first step
• Taking the first step but then forgetting what comes next
• Starting a project and then realizing something else is more important, so you quit it to switch gears
• Starting a project, but worry something else should be done, and you shut down (ending up doing nothing)

Difficulties With Initiation

This is a common issue following a brain injury. Some of us can feel completely paralyzed when facing a project. I remember feeling so overwhelmed with the idea of shopping for groceries that I simply would not go. A therapist suggested that I write out the steps and then only focus on the first one - giving myself permission to stop anywhere along the way. I distinctly recall writing down, "Put grocery list in planner," "Get in car," "Drive to the store," "Park the car," "Get out of the car," Walk into the store," and "Buy items on list." The first few times, I got as far as the car and turned around. Pretty soon, I could park the car in the lot and get to the front door of the store. Finally, I actually made it all the way inside, but only bought two or three items.

One would think a trip to the store would be fairly easy. It wasn't for me and it isn't for lots of those us with brain injury. I learned later that I had other problems with initiation. Quite simply, I would not know where to start, so I shut down and did not do anything (unpacking boxes after moving was one situation I distinctly recall; I had to call a friend to help me get started).
Writing down the steps, giving yourself permission to only do one or two of them, calling a friend - all these can help with "initiation" problems.

Difficulty With Distractions

This is another big issue with many of us. Combined with initiation problems, and it's a wonder we get anything done. I used something I call a "FOCUS" card to help me stay focused. It's a big card I put on a stand (or a big gold clip on my desk). If the phone rings or someone comes to the door, I always know I can go back to my "FOCUS" card to remind me what I need or want to do.

Cognitive And Physical Fatigue

Many of us get more fatigued than we used to. Ordinary tasks of living require so much more energy than they used to, little wonder. If we "bite off more than we can chew" for a project, we can simply become to tired to finish. For example, I learned a long time ago that "cleaning the house" was out of the question for me. At least not in one day. I have the stamina to clean one or two rooms, and that's it. If "CLEAN THE HOUSE" should ever appear on a TO DO list for me, I can guarantee you it won't get done. Of course, I know better now, and would never try to do such a task on a single day. For me, the key to not becoming fatigued is to do big tasks in small pieces and schedule time for resting or napping in between.

Difficulty Sequencing Parts Of A Complex Task

This is another problem for many of us with brain injury. Prior to our injuries, we were probably not aware of all the steps (and mini-steps) that were involved in a simply task of daily living. Heck, brushing one's teeth has more than a few steps. So does "paying the bills." Even though some tasks of daily living are known to us (meaning, we have not lost memory for them after our injury), sequencing the steps could well be an issue afterward. To be on the safe side, you might want to list out all the steps for a project (yes, even simple projects) and mark the parts off as "done" as you go (I use an orange highlighter as my code for "DONE," with yellow being reserved for "IMPORTANT"). Doing things in steps can make all the difference between wanting to do a project and actually getting it done!

Short-Term Memory Problems

Depending on the severity of your injury, short-term memory problems may interfere with getting tasks and projects done too. If so, writing things in steps - also scheduling things to do at specific times, on specific days - can help.

Difficulty Prioritizing And Planning

When we do not plan and prioritize well, we run the risk of always having to stop mid-stream to do something else that may be more important. Planning and prioritizing is an art, and it can be learned. I don't want to go into all the details here, but if you are on one of the support group lists, you can learn a lot from others with brain injury who have mastered the art of post brain-injury planning and prioritizing.

Feeling Overwhelmed And Shutting Down

Last, but not least, "shut down" happens if we get overwhelmed with too much to do - or even too many "intruder thoughts" and distractions. If you feel "shut down" coming on, it is best to take a break, recoup and focus on one priority.

It should be clear by now that any ONE of these factors could be a deal-breaker when it comes to getting a task or project done. Chances are, you are dealing with more than one factor, as well. Little wonder, things are taking so long.

Let me know if this helps at all, but if not, feel free to e-mail me privately and we can problem-solve a particular situation together. Know that you are not alone, as many of us need to tackle tasks and projects very differently now. The good news is that awareness of the issues and knowledge about strategies can be curative.

Kathy M.