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SEQUENCING PROBLEMS

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.

Examples

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.

Management Techniques

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 numbers.

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.