Routines are essential when living with brain injury. Even during treatment, and oftentimes after the brain injury is healed, they remain necessary. They take the cognitive load off of thinking, organizing, planning, and scheduling. When every thought requires conscious effort, trying to think through an event request immediately or plan in the moment is like a short circuit zapping your brain, stimulating a protective paroxysm of anger.
The Reaction In Absence of Routines
Think of it this way. Imagine you’re in a canoe for the first time in your life. A tippy canoe. You’re alone on a lake. At first the canoe tips back and forth, but the lake is placid and predictable like routines are, and you and the canoe settle into a slow, careful paddle. All of a sudden, two logs tumble towards you from either side, creating washes that splash up into each other over your lap, soaking you, freezing your favourite jeans. You have to adjust. Your body doesn’t know which way to lean. You cannot dig your paddle deep enough into the up-thrusting waves and sinking troughs to paddle to shore. You fall into the water.
You’d probably scream from frustration and fear. Your scream would look like anger.
That’s what it’s like in an injured brain when a sudden change in plans occurs.
Needs Understanding
A regular canoeist would wrinkle their brow at your panic. They’ve seen waves like that many a time and know how to paddle into them. Anyone can navigate a couple of logs on a placid lake, they’d think. What’s your problem?
That’s what the usual reaction is like to the injured person’s inability to handle a change that needs an immediate or short-term response. Understanding that an injured brain does not function like a healthy brain is the first step to understanding the importance of routines to achieving optimal functionality.
Benefits
Routines free up cognitive energy so that any task has a greater chance at success. Rest times before and after routines, or built in to the routines, store up and recover cognitive energy. Provide time to think through requests, scheduling appointments, or deciding on a task. Plan ahead of time how to tackle a task; work with another to figure out and write down the steps. Make it feel doable. Competency happens when we successfully execute a task or skill. Brain injury recovery ought to include restoring a sense of competence, and routines are key to that.
Habits and Alarms
Since habits don’t stick in a person with brain injury — for whatever reason — it’s important that routines are scheduled. Don’t assume that because exercise happens every Monday morning at 11:30am that habit memory will kick in every Monday morning at 11:30am to do it. A habit can vanish and routines become forgotten without them being scheduled in.
However, alarms annoy a person with sensory sensitivity. It’s important not to attach an alarm to every task and appointment. Instead, add alarms to critical ones, and use a smart speaker to remind a person about their less critical tasks. The speaker’s human-like voice intrudes less, doesn’t startle, and gives a sense of not being alone in managing the day.