The Importance of Routines for TBI Neurorehabilitation

Daily routines can be essential to maintaining physical and mental health, as they increase productivity, help manage stress, and enable us to make progress towards our short-term and long-term goals. Disruptions in daily routines and activities can be upsetting, particularly for those navigating the recovery process. It is natural to want to return to our baseline level of functioning after suffering injury; however, successful recovery is centered on a gradual return to previous activity levels. For survivors of traumatic brain injury (TBI), a flexible routine is an essential component of treatment, as it seeks to address impairments and promote normative functions.

Cognitive Processes and TBI

Cognitive symptoms and deficits are common following traumatic brain injury. The APA Dictionary of Psychology defines cognition as, “all forms of knowing and awareness, such as perceiving, conceiving, remembering, reasoning, judging, imagining, and problem-solving.” Executive functions, including planning, attention, problem-solving, working memory, emotional self-regulation, initiation and inhibition of behavior, decision-making, motivation, and flexible thinking are more complex cognitive tasks. These cognitive abilities are often compromised following traumatic brain injury, highlighting the importance of a consistent routine that seeks to re-establish these functions. It can be especially challenging when tasks that used to be second-nature feel strenuous or unmanageable. A predictable daily routine can help survivors of TBI regain their cognitive skills and enhance executive functions.

How Routines Can Improve Quality of Life

Sleep Hygiene

All individuals can benefit from a consistent bedtime routine in order to ensure that they are getting adequate, quality sleep and maintaining a healthy circadian rhythm. However, for individuals who have suffered a TBI, rest is even more crucial, as it promotes recovery and healing of the brain. Waking up and going to bed at the same time every day, in addition to establishing both a bedtime routine and morning ritual, can improve quality of sleep and reduce fatigue. Given that sleep disturbances and fatigue are common symptoms of TBI, treatment may involve psychoeducation on sleep hygiene and promoting the practice of activities that optimize energy levels, such as mild physical exercise.

Routines with ADLs

Activities of daily living (ADLs) are life skills that foster independence. They include hygiene practices, eating, getting dressed, mobility, and continence. Due to cognitive deficits, ability to perform ADLs may be significantly impacted following TBI. For instance, memory impairments and attention deficits may impede the ability to shower and get dressed in a reasonable time frame. Practicing these skills at a set time each day and in a specific order can create automatic habits, as well as increase awareness surrounding particular areas of need that should be addressed in treatment.

Instrumental activities of daily living (IADLs) involve higher-order cognitive abilities and include medication management, finances and budgeting, shopping and preparing meals, as well as housekeeping. An unfamiliar aspect of one’s daily routine following TBI may include remembering to take medications or engaging in rehabilitation exercises, such as those learned in physical, occupational, or speech therapy. Daily structure can increase the likelihood that these tasks will be completed and allows survivors to focus on one task at a time without distractions.

Self-Care Activities

Engaging in self-care via physical activity, relaxation techniques, engagement in hobbies or special interests, and social interaction is part of a well-rounded routine. Self-care practices can promote emotion regulation, stress management, a positive outlook, as well as improve overall well-being. Daily routines should involve some form of self-care based on the unique needs and preferences of the individual. For some, self-care may involve journaling or spending time alone while others might find that spending time with loved ones is what they need to recharge.


Focus of Treatment and Rehabilitation

A routine that is adapted to meet our current needs and abilities will promote the most growth in recovery. It is imperative that survivors of TBI understand and acknowledge limitations in order to prevent overexerting themselves early on in the recovery process. It is normal to feel disappointed about diminished independence and difficulty managing life skills. For instance, an individual who worked a full-time job, drove independently, and multi-tasked throughout the day may have trouble adjusting to a less strenuous routine.

Clinicians at PNBC can foster acceptance in regards to current impairments, encouraging and empowering clients to execute a rehabilitative routine that will eventually lead to a more familiar lifestyle. Psychotherapeutic treatment at PNBC can assist clients with improving insight into their symptoms and recovery, practicing compensatory strategies to manage deficits, and processing emotions related to impairments. TBI survivors require both predictability and flexibility in their routines, keeping in mind that sensory overload can have adverse impacts on their well-being. Taking a slow and steady approach while remaining motivated and committed to making gradual improvements day-to-day will create long-lasting improvements.


Written by Beverly Sharifian, MS, APCC. Ms. Sharifian is an associate professional clinical counselor working under the supervision of Dr. Delia Silva at PNBC.