Tips to Support Challenges With Time Management After Traumatic Brain Injury
Often people who have experienced a Traumatic Brain Injury (TBI) experience challenges with time management. This can be a challenging impairment to address in occupational therapy but it is vital to support occupational performance.
Time management skills allow an individual to set and achieve goals over periods of time, be aware of how long a given task will take them, and manage their daily routines. Such skills are essential for various areas of occupation, including work, self-care, community mobility, socialization, and recreation (Green et al., 2011). Individuals who experience challenges managing their time may struggle to meet deadlines, have decreased awareness of time throughout their day, and have trouble effectively planning and organizing their daily schedule in order to fulfill their responsibilities. Consistent hardship with time management may lead to frustration, overwhelm, and decreased ability to believe in one’s own abilities (Kennedy et al., 2008).
Individuals living with TBI commonly experience challenges with time management due to impairments with working memory, attention, and other executive functions (Conti, 2017). Executive functions (EFs) are characterized by a group of mental processes governed by the brain’s prefrontal cortex. EFs are utilized when an individual completes intentional, effortful actions in order to adapt to the task in which they are engaged or other aspects of the external environment (Conti, 2017). EFs are not utilized when an individual performs rote, routine actions that do not require behavioral adaptation. Additional EFs that may be impaired after TBI that can contribute to challenges with time management include decision-making, mental flexibility, and planning and organizing of tasks. Executive dysfunction brought about by a TBI can cause the person to experience hardship with time management and subsequent occupational disruption to daily participation in meaningful activities and routines.
One strategy to help an individual struggling with time management is to have them complete a time awareness exercise (Marks, 2020). Since awareness of time and how long a given task may take can be challenging for these individuals, this exercise helps to increase awareness of how long a task actually takes them versus how long they perceive it to take. For this exercise, have your client select a task they have trouble completing in a timely manner. They will then break down the task into various subtasks and write them down. Have your client estimate how long they believe each subtask takes them, then have them perform the task while timing each subtask. Compare the client’s estimates to actual time taken for completion.
Example: Doing the Laundry (discounting preset wash and dry times)
1. Collect laundry basket and bring to washer
a. Client estimate: 2 minutes
b. Actual time: 5 minutes
2. Load laundry into washer and add detergent
a. Client estimate: 2 minutes
b. Actual time: 4 minutes
3. Start machine (including configuration of machine settings)
a. Client estimate: 30 seconds
b. Actual time: 2 minutes 30 seconds
4. Load laundry into dryer and start machine (including configuration of machine settings)
a. Client estimate: 2 minutes
b. Actual time: 4 minutes
5. Take laundry out of dryer and place in laundry basket
a. Client estimate: 3 minutes
b. Actual time: 5 minutes
6. Clean lint trap
a. Client estimate: 30 seconds
b. Actual time: 1 minute
7. Fold laundry
a. Client estimate: 20 minutes
b. Actual time: 45 minutes
8. Put laundry away in designated storage spaces like closets and drawers
a. Client estimate: 5 minutes
b. Actual time: 8 minutes
9. Total client estimated time: 35 minutes
10. Total actual time: 1 hour, 14 minutes, and 30 seconds
This exercise can also be helpful in distinguishing which subtasks of the overall activity take them the most amount of time, thereby determining where additional strategies and support may be needed. Additional strategies for effective time management include:
● Create a To-do List: have your client write down each day’s tasks and help them set an alarm on their phone to remind them to review their list a few times a day.
● Technology: encourage your client to use alarms, reminders, and a smartwatch or timer to keep track of time and pacing of tasks throughout their day.
● Minimize distractions:
○ Help your client create a work space that is visually less distracting like a clean, uncluttered desk.
○ Discourage the use of television and cell phones during task completion.
● Visual aids: visual aids help ease the burden of your client’s working memory.
○ Educate your client on color coding calendars or other organizational materials and placing reminders or their to-do list in easily visible places around their home and workspace.
● Take short breaks: Encourage your client to give their brain a chance to reset and refocus on the task at hand.
● Rely on social support: friends, family or caregivers can be a great tool to help keep your client accountable and organized.
Although challenges with time management can be detrimental to clients living with TBI, there are numerous strategies that can be utilized to better support your client and increase their level of independence with daily task completion and improve their overall occupational participation.
Guest Blogger: Julie K. Suto, OTS
References
Conti, G. E. (2017). Acquired brain injury. In B. J. Atchison & D. Powers Dirette (Eds.), Conditions in Occupational Therapy (pp. 363-381). Wolters Kluwer.
Green, J. M., Hughes, E. M., & Ryan, J. B. (2011). The use of assistive technology to improve time management skills of a young adult with an intellectual disability. Journal of Special Education Technology, 26(3), 13-20. https://doi.org/10.1177/016264341102600302
Kennedy, M. R. T., Krause, M. O., & Turkstra, L. S. (2008). An electronic survey about college experiences after traumatic brain injury. Neurorehabilitation, 23, 511-520.
Marks, T. (2020, Jul 15). How to master time management: ADHD skills part 1 [Video]. Youtube. https://www.youtube.com/watch?v=fWRF6BJ1OQk