Daily Routines

Planning for better days

Routines are helpful for:

• Increasing ability to remember, problem solve, and plan ahead
• Increasing a sense of control over your day
• Decreasing unwanted behaviors
• Identifying activities that make you feel productive
• Identifying activities that give you enjoyment

The importance of a set schedule for memory

Having a set schedule helps someone remember daily events. Changes in memory are common after a brain injury. When events happen according to a familiar, set schedule, people tend to remember them better than if the order of things is constantly changing.

Aiding in problem-solving and skill regaining

When someone has a routine way of doing things, it helps with problem solving through activities. A person’s ability to organize, sequence steps, and problem solve through an activity are often affected by a brain injury. If individuals do things the same way, in the same order each time, it helps with regaining such skills.

Using tools for planning and structure

Tools can be used to create structure in one’s day, allowing them to plan ahead. Planning is a high-level thinking skill that is often impaired after a brain injury. When individuals have difficulty planning, it can be a challenge to structure their own day and complete everything needing to be done. When people have tools to prioritize and organize their day, they are better able to develop a routine.

Providing a sense of control through scheduling

With a framework for structuring their day and the opportunity to be involved in developing their schedule, people are given a sense of control. Following a brain injury, you or your loved one may feel a loss of control over events that happen in your day. This can create a lot of stress for you and the person with the brain injury. One way to reduce stress and give the person with the brain injury a sense of control is to include them in creating daily schedules and routines.

Preventing unwanted behaviors

Having a routine can prevent the development of unwanted behaviors. These can result from the combination of a loss of control, having lots of free time, and cognitive deficits such as poor insight into their deficits and poor judgment or decision-making. For all of us, when we know what events are, we know how to behave. But if we don’t know what events are or what to expect, we are left to figure out how to behave on our own. For persons with brain injury, this can often lead to agitation, impulsivity, and other unsafe or unwanted behaviors. Having a predictable, familiar, and structured daily routine helps to prevent unwanted behaviors.

Coordinating caregivers

Having a daily routine allows caregivers to more seamlessly fit themselves into the individual’s schedule. When an individual has multiple caregivers, it can be challenging to coordinate everyone’s schedules. However, when the focus is on developing and sticking to a patient’s routine, multiple caregivers can insert themselves into the one schedule at the times that work best for them.

Matching caregivers to the right tasks

Identifying the type of assistance needed and who can provide that type of assistance helps pair the right task with the right caregiver. Many factors need to be considered when you identify persons to help with daily routines. For each activity, you need to know the type of assistance the activity requires, and the type of assistance the caregiver can provide. Some tasks require supervision, while others require hands-on assistance. Some caregivers cannot lift but are able to provide supervision. Other caregivers are able to lift and provide hands-on type of assistance. Some caregivers can offer a few hours, while others can offer many hours. When a daily routine is planned for and consistent, multiple caregivers can be identified to help out with the different types of supervision, assistance, and time needed for routines.

Feeling productive and enjoying the day

Having a daily routine helps to make us feel productive and have enjoyment in our day. Doing things we enjoy helps improve our mood and give us a feeling of achievement. Scheduling tasks that are easy to complete such as having a cup of tea, taking the dog for a walk, going to lunch with friends, or folding clothes gives us a sense of accomplishment and that we are getting things done. Scheduling activities you enjoy and that make you feel productive gives you a plan for the day, gives you control over how much or little you want to do, and gives you purpose for your day. We then feel good about ourselves and want to continue to do more.

Note: This content was developed in cooperation with Craig Hospital.

Understanding schedules and routines

A schedule is a planned set of events that are done in a day. For example, you might use a calendar to write out or type what you plan to do throughout the day.

Routines are habits or steps needed to complete different parts of a schedule. They are usually done the same way each time. For example, doing the same things in the same order each morning like getting up at the same time, brushing your teeth, taking a shower, and then having breakfast.

How routines and schedules help after concussion or mTBI

Following a routine or schedule after concussion or mTBI can help people:

• Remember what is happening and what comes next
• Feel in control
• Be organized and plan what needs to be done, when it needs to be done, and where it needs to be done
• Choose healthy activities
• Reduce stress and worry, which can increase symptoms
• Decide what the most important tasks to be done are and what the best time to do them is
• Feel a sense of purpose
• Decrease stress and responsibilities on family members and others in their support system

How to create a routine or schedule

To make a schedule and establish routines, try these steps

• First, think about what would be helpful to plan ahead. This might include things like:
  • Breaks and rest
  • Appointments and meetings
  • Work, school, and volunteering
  • Home care tasks like cleaning, laundry, and cooking
  • Hobbies and fun
  • Time with friends and family
  • Setting the same time to get up and go to bed every day
  • Exercise
  • Time to complete tasks for work or school
  • When to take medications

Then, think about what tool you want to use to either write or type a schedule to easily see what needs to get done and when. Tools to use to write or type a schedule include:

• Daily planners and calendars
• Smart phone apps
• Smart watches
• Making lists
• Smart home speaker assistants
• Dry erase boards

Next, think about when you want to make your schedule. Here are some options for
when to make a schedule:

• Plan the night before for the next day.
• Plan your day each morning.
• Pick one day every week to plan for the next week. For example, every Sunday, sit down and plan out your schedule for the next week.

Then, start to use your scheduling tool. Consider using the goal-setting guidance to help keep you on track and plan things that are important to you.

Other tips to start and keep up with schedule and routines include:

• Pick one place to put a schedule, like in a planner or a phone app, instead of keeping things in lots of different places.
• Check your schedule often and change it as needed for balancing what you have to do, what you want to do, and what would be fun.
• Give yourself more time than you think you will need to finish tasks. If you think something will take you 30 minutes, then give yourself an hour in your routine to finish. This can reduce the feeling of being rushed and overwhelmed.
• Give yourself free periods of time at the end of the day to plan ahead for the next day.
• Schedule smart. Plan activities for times when you feel your best and have fewer symptoms.
• Be flexible. Sometimes things change and that is okay. Adjust as needed based on what is most important versus what can wait.

Plan ahead to ensure safety

When creating daily schedules, it is important to know what you have to get done in a day. It is also important to know how those tasks will get done and if we need another person’s assistance or supervision. Different types of tasks require different levels of assistance and supervision. Planning ahead for how much supervision or assistance you will need is beneficial.

Consider these aspects of activities when planning for supervision:

• The type of activity: Our activity worksheet (PDF) will help you categorize activities in your life. Doing this worksheet may only need to happen once. Or, as time passes, the types of activities you want to be doing may change and you would want to redefine what type of assistance or supervision you need.
• Level of assistance or supervision needed: How you develop your daily and overnight routine will depend on how much supervision you or your loved one may need.
• Ability and expertise of caregivers: Different caregivers will be able and comfortable with assisting in different tasks. Identify who can assist with what task(s).
• Scheduling times, tasks, and who can help: Our daily schedule worksheet (PDF) will help you categorize activities in your life. Consistency and repetition is the key to creating a routine following a brain injury. Unplanned tasks such as restroom breaks are bound to occur, so add extra time into your schedule for these.

Getting the right kind of help

The Supervision Rating Scale (SRS) is a tool used by healthcare professionals to determine how much assistance and/or supervision is recommended for a person with a brain injury to remain safe while completing daily activities. How you develop your daily and overnight routine will depend on how much supervision you or your loved one may need.

• Direct supervision at all times: The injured person is supervised at all times and cannot be left alone for any period of time.
• Indirect supervision: The injured person lives with one or more persons (roommate, sibling, parent, spouse, etc.), who is present at all times, but the caregiver is not physically in the same room or checking on the patient more than once every 30 minutes.
• Part-time supervision: The injured person lives with one or more persons (roommate, sibling, parent, spouse, etc.) who is present during overnight hours and during most all waking hours. The caregiver can be gone for 2 to 3 hours at a time, while the patient is able to be left alone safely.
• Overnight supervision only: The injured person lives with one or more persons (roommate, sibling, parent, spouse, etc.). The patient can stay at home all day alone, but still needs someone with them overnight.
• Independent, no supervision needed: The injured person is living alone and is responsible for all of their own daily needs without needing assistance from another person. However, they should not take responsibility for another person (a child, an elder adult, etc.).

Matching caregiver support to activities

One important step to building a day of routines is identifying what people can provide specific types of assistance or support. It is helpful to know who can provide help and what type of help they can provide.

Some activities like transfers, dressing, or preparing meals may require physical or hands-on assistance. Other activities like doing exercises, reading, or dusting require supervision or monitoring for cognitive or safety support. You will be able to expand the types of activities you do and the number of people who can help if you first identify which people can help with which kinds of tasks.

You can think about the amount and type of supervision by using these definitions:

• Physical assistance: Hands-on assistance, steadying or lifting during transfers, toileting, dressing, eating, behavior, communication
• Supervision: A set of eyes for monitoring safety, judgement, and interaction

For example, Grandma is comfortable providing supervision or a set of eyes throughout the performance of a task but is unable to provide physical assistance. However, Brother is able to provide both physical assistance and supervision. You may choose to use Grandma’s support during a task that only requires supervision, such as eating lunch, while you use Brother’s support for physical assistance to get in and out of the car.

Create and maintain a reference list that identifies who can help; whether they can provide physical assistance, supervision, or both; and when they are available.

Note: This content was developed in cooperation with Craig Hospital.