“Slow down. You must pace yourself!”  After brain injury, this is a common phrase that is said to people, but what does it mean?

Slow down, according to what? Ones’ pace of life before brain injury or their pace of life now? Or, does it mean, completing activities at a slower pace than normal. But what is normal, because the new normal is not the same as the old normal, right? And could you remember what the old normal was, while suffering with a broken brain and issues such as memory loss, fatigue, slow information processing etc. Confusing? You bet it is.

So, I am going to give advice and provide strategies on how to help people ‘slow down and pace themselves’ after a brain injury, to help their brain recover to its upmost potential.

Firstly, as hard as it is to accept, many people after a brain injury are simply unable to go about their daily life in the same way, or at the same pace as they did before. Fatigue is a huge factor for most survivors, and even what most people would view as a simple conversation, can quickly drain limited brain reserves.

In addition the world is full of stimulation, which is coming in from all angles; people, the environment, technology – especially mobile phones, tablets and computers. It is rare during the day, that our brain gets to ‘rest’ and be free to think about what it wants. Even in our breaks from work, or when we are waiting at a bus stop, waiting in the car for our children; instead of just sitting and thinking, the overwhelming majority of us will pick up our phones and check emails, social media, shop online, or phone/text people. This means that our brain is constantly stimulated.

In the beginning it is completely normal for people to try and carry on at the same pace that they used to, almost as a reassurance to themselves that they are ok. “If I push myself, I will get better quicker”, or thinking that it is just that particular day and they will be ok next week. Then fatigue kicks in because they have done too much, and so instead of resting, often people try and push themselves harder, feeling like they must just ‘push through it’.

But they will quickly realise that this is simply not possible; and that realisation may come as a big blow.

I have advised clients time and time again that if they ‘pick a fight’ with their brain, they will never win. A brain injury needs rest, nurturing, taking care of, and giving adequate time to heal, which means turning down the volume switch on life.

Pacing yourself during brain recovery goes against everything you have ever being taught, which is why it is so difficult to do less, and live life in the ‘slow lane’ for a while. We grow up being taught that if you work harder, you will get more opportunities. If you do more exercise, you will get fitter and stronger. If you put in more hours training, you will be more skilled and so on. So by telling someone that doing LESS is actually a lot better for them; it goes against all of the schemas that they have built up over the years, and putting it into practice is actually harder to do than you can imagine.

What is pacing and how to do it?

My interpretation of how to pace yourself after brain injury, means dividing the day up into ‘manageable chunks’, so as to not overload the brain during recovery. Pacing in this way, allows the brain to adequately process information from one task/activity, before jumping into the next. Using this strategy, in my opinion and experience, helps our clients to minimise fatigue and sensory overload and improve memory, energy and lift mood.

To do this, I ask clients to think of each component in their day as being an ‘activity’. And I suggest that the day is broken up into these activities.

For example, all of the following constitutes one activity;

  • Hoovering
  • A visit from a friend
  • Making & eating breakfast
  • Shopping
  • Taking the children to school
  • Sitting outside in the garden
  • Cleaning the kitchen
  • Talking on the phone with a friend
  • Reading a chapter of a book
  • Browsing/looking at social media
  • Paying bills online
  • Watching a TV program
  • Having a therapy session e.g. physio
  • Browsing on the computer

The daily activities then need to be put into a timetable, which allows the day to be viewed as a whole, with routine activities and rest breaks factored in. I know that many people will be thinking that creating a timetable of this sort will take way too much time, and looks way to full and confusing but we, as an organisation, have these printed out to give to clients to fill in, which has been very useful. It takes time getting used to a new format and way of doing things, but I tell people that after a while when it becomes a routine, it can make life so much easier to manage the effects of brain injury.

The example timetable is only an EXAMPLE, and the format on this particular example timetable is designed with 30 min breaks in between each activity. These breaks may need to be longer for people very early in recovery, or shorter, as people move through the recovery process. In no way am I suggesting that there should be that amount or variation of activities; that is a matter for the individual and their case manager, professional, or family member to decide what is appropriate. Obviously it will need to be filled out, taking into account the individuals cognitive, physical and emotional capabilities at that particular time, and adjusted at regular intervals.

Each day, there should be one activity that is outdoors in the fresh air and daylight, such as a gentle walk, sitting outside in the garden, a hike in nature, or a push around the village park in a wheelchair. I believe fresh air and daylight is an essential element to making a good recovery from brain injury. Try to make the outdoor activity in nature or a low stimulation environment, for maximum benefit.

PACING TIMETABLE

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Morning routine Morning routine Morning routine Morning routine Morning routine Morning routine Morning routine
Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast
30 min Rest 30 min Rest 30 min

Rest

30 min

Rest

30 min Rest 30 min

Rest

30 min Rest
Activity 1 HOOVER PHYSIO

SESSION

FOOD SHOPPING WASHING & HANG ON LINE GENTLE

WALK

OUTDOORS

OT

SESSION

DAYTIME

TV

30 min Rest 30 min Rest 30 min

Rest

30 min

Rest

30 min Rest 30 min

Rest

30 min Rest
Activity 2 VISIT FROM FRIENDS SIT OUTDOORS IN THE GARDEN READ

BOOK

VISIT

SOCIAL

GROUP

PUZZLE

BOOK

DAYTIME TV PREPARE & COOK SUNDAY LUNCH
Lunch Lunch Lunch Lunch Lunch Lunch Lunch
Rest/nap Rest/nap Rest/nap Rest/nap Rest/nap Rest/nap Rest/nap
Activity 3 ONLINE SHOPPING CHECK

SOCIAL

MEDIA

SPEECH THERAPY WATCH

DOCUMENTARY

ON TV

ONLINE

BROWSING ON LAPTOP

SIT

OUTDOORS IN THE GARDEN

VISIT TO A PARK FOR A WALK
30 min Rest 30 min Rest 30 min

Rest

30 min

Rest

30 min Rest 30 min

Rest

30 min Rest
Activity 4 SHORT WALK

OUTDOORS

VISIT FROM

SISTER

LONG PHONE CONVERSATION

TO FRIEND

READ

MAGAZINE

TV CHANGE

ALL BED

SHEETS

FAMILY VISIT
Tea Tea Tea Tea Tea Tea Tea
30 min Rest 30 min Rest 30 min

Rest

30 min

Rest

30 min Rest 30 min

Rest

30 min Rest
Activity 5 TV

PROGRAM

BOARD

GAMES

TV

PROGRAM

FAMILY

GATHERING

WATCH

FILM

KNITTING BROWSE ON COMPUTER
SLEEP SLEEP SLEEP SLEEP SLEEP SLEEP SLEEP

Rest breaks

Ideally, rest breaks should be taken in a dark room away from noise and stimulation. An example would be, to sit in an armchair or lay on a bed in a room with all external light minimised and with the eyes closed. Set a timer, phone alarm or ask a loved one to do so, for the allocated time and just allow the brain to rest and process the activity which has just been done

It may be hard at first not to fall asleep, which is why some people prefer to sit, rather than lay down. The rest break after lunch, is the break that promotes having a 20- 30 minute nap to recharge the brain for the afternoon’s activities. Not everyone likes to nap during the day, but after brain injury, that often changes and a nap becomes essential for functioning.

This is my view on pacing and how you can structure a day for someone who has had a brain injury, and is not intended to override advice specifically given to an individual by their Neuropsychologist or other healthcare professional. Please use the information given as a guide, and if it works for you and your family/loved one, then that is fantastic. However if it becomes a source of negativity, struggle or adds to the many problems that are experienced after brain injury, then please do not continue with it. This is my advice for a strategy that works for many of my clients and has very positive results, and not a clinical opinion that must be followed at all costs.