Sequencing, as it relates to TBI, refers to the ability to put the
steps or processes associated with speech, movement, memory, or daily activities in the
proper order. Sequencing difficulties that are related to speech and movements are usually
referred to as apraxias. Sequencing difficulties in academics or activities of
daily living are directly related to memory. In the cognitive sense, your family member
may be able to recall words, letters, sentences, and numbers, but he may not recall them
in the order presented. In his daily activities, he may no longer recall the sequence used
for performing household tasks. Laundry, dishwashing, and meal preparation may be
particularly difficult for your family member.
The following are examples of sequencing difficulties you may observe:
1. During your family member's inpatient stay, rehabilitation therapy
is directed toward resolving apraxia (sequencing difficulties). This occurs particularly
in the areas of speech and OT. Your family member may show signs of apraxia, in which his
speech is confused and difficult to understand, or he may not be able to sequence the
steps needed to comb his hair or brush his teeth.
2. Your family member may recall phone numbers or street addresses in
the wrong order. He may not be reliable in taking phone messages.
3. Your family member may have difficulty completing household tasks.
Very likely he will omit a step in the sequence. For example, he may forget to subtract
the checks in the checkbook or forget to add the soap when he does the laundry. Either
could have an adverse effect on the smooth operation of your household.
4. Your family member loved his computer. Now, however, he has a great
deal of difficulty recalling the sequence of steps to call up the programs he needs.
1. The apraxia (sequencing difficulty) you observe when your family
member is in an inpatient facility will resolve to varying degrees with time and therapy.
Nothing you can do will speed up that process. When you work with your family member,
encourage him to talk and attempt personal-care activities, but do not push him. More
therapy is not necessarily better in this case.
2. Sequencing difficulties can often be offset by compensatory
methods. Encourage your family member to ask people to repeat numbers and addresses.
Request that he write down all numbers, and that he recall numbers in chunks of two or
three. For example, the phone number 6-8-4-2-3-2-0 becomes (684) (23) (20). In that way,
he only needs to recall three series of two or three numbers instead of seven individual
3. Outline the steps in a task for your family member. Place the
detailed outline by the activity. For example, put the outline for doing laundry in the
laundry room. Keep the outline there as long as he needs it.
4. Set up the sequence for the use of the computer on a piece of paper next to the
computer. Keep it there even when it is no longer needed. Use the most user-friendly
software available. In particular, use software that contains a menu outlining the steps
needed to run the program.