Executive Skills

Tips and Tricks

Sometimes planning and organising daily life can become problematic. People with MS have reported difficulty with “problems making decisions and working things out”, or “I’m not coping properly with work/children’s schedules”. You can feel busy all day or even all week, but still not seem to have got the important things done. Being aware of urgent tasks and managing priorities are necessary for your relationships and also managing your health optimally. Scheduling and planning in advance isn’t the most exciting way to spend your time, but they are easy ways to solve this problem for many people with MS.

If you find it hard to stay on task, you can manage distractions by finding a quiet environment and letting others know when you can and can’t be disturbed.
Organisation and planning can be supported by written plans and schedules. Instead of just relying on your internal scheduling, you will probably find that a written plan or schedule will be helpful. It helps in two ways, once by thinking about something in advance and overtly considering what is required and how it can be done. Secondly, by providing a written guide to getting the task done.
Breaking a task down into sections can also be helpful, in a written schedule. For example, “pack suitcase” in your diary the night before going on holiday may be enough, but if not, you may need to list the items you want to take and schedule in your diary times to shop for extra items (e.g. sun cream) and launder the clothes you need to pack.
Decisions can be hard to take, particularly important ones (e.g. decisions relating to treatment). You might find it helpful to talk through the options and outcomes with a family member, friend, or health professional. You may want to ask them to write out the options and implications. If you are writing out the options yourself to help you think about the issues, you might want to list pros and cons under each option, so that you can fully consider the risks and benefits of each course of action. Be willing to ask for time to think through decisions and discuss them with other people. Be willing to ask for more information or repeated information.
If you find yourself stuck in a rut and trying the same old behaviours or strategies without success for a problem, it may be time to get help exploring new options. Just because something is hard or unsuccessful with your current approach doesn’t mean that success isn’t possible. Enlist the help of family, friends or professionals to generate options. Be open to different approaches and ideas. Consciously try to be flexible in your outlook.

Gadgets and Gizmos

These details are supplied for information only, not by way of endorsement. Items are usually available from several retailers and items are often made by several manufacturers. The MS Trust cannot guarantee that these items are available or suitable for any individual and accepts no responsibility or liability with regard to their usage.

Easy meal timer

Counts down from 99 hours 59 minutes, alarms for 30 seconds. Can be attached to fridge by its own magnet, or will stand on worktop.

Round the neck timer

999 minute timer. Can be attached to fridge by its own magnet, or worn round neck.

Touchman Electronic diary with appointment alarm

Designed for youngsters, which keeps the cost down. Personal digital assistant with backlight touch screen that has appointment alarm, diary, calendar, phone book and FM radio.

Digital organiser

Designed for youngsters, which keeps the cost down. Includes a “to do” mode, telephone directory, daily alarm, diary and calculator.

MEM-X Vocal Memory Aid

Memory aid that plays pre-recorded reminder messages at programmed times

This machine is designed for carers to record up to 90 distinct messages (max 10 seconds each) in their own voice. Each message can be programmed to play at the same time every day, or at the same time every week, or at just one programmed time. It uses a familiar, pre-recorded voice as a reminder at the precise date and time selected. Message can be repeated as often as liked by pushing large blue button.

Rigid A4 document files

Strongly constructed see-through, click-shut rigid cases. Can be labelled.

Zipper bags

Can store, protect and organise papers and almost anything else.

Other Important Influences

There are a number of outside factors that might make your mental skills less efficient:

Having an infection, or being otherwise unwell. If this is the case, seek medical advice
Some drugs given for MS symptom management, including drugs for continence management and spasticity. If you think this may be the case for you, discuss with your doctor
Fatigue has been shown to affect mental skills in MS. Cognitive fatigue has more impact than physical fatigue on mental efficiency. Repeating the same mental task over and over again is especially vulnerable to fatigue in MS. You may find varying your mental tasks, taking breaks, being rested and choosing your best time of day all help. You are also less likely to employ your preparation and strategies when you are feeling fatigued, which reduces how well you can manage your cognitive difficulties.
Download 'MS Trust Publication living with Fatigue'
Anxiety may affect your mental performance, especially if you are “on the spot” and feeling tense. Try to stay relaxed and work round the immediate block.
Depression in MS reduces performance on cognitive tasks that need a lot of concentration. It seems to take up capacity (“thinking space in your brain”) with worries and recurrent bleak thoughts. Like fatigue, depression can also reduce your motivation to employ strategies to manage your cognitive difficulties. Because depression gives people a negative view of the world, you are also likely to view your cognitive difficulties as worse than they are and underestimate the effectiveness of your management strategies. If you think that you may be suffering from low mood or depression, seek medical advice.

Professional Help

Problems with executive function can occur only occasionally and during very difficult activities (e.g. exams), whilst for other people they can occur frequently and repetitively (folding your wheelchair to fit it into your car).

Your health professional may teach you how to break down tasks into sections and plan in a very structured, step-by-step way. This is a skill that can be applied to any situation or problem that needs solving. After a few practices in real-life situations, they will leave you to apply your new skill on your own to all activities that require it.

If learning a procedure to apply to many situations is too much for you, your health professional may concentrate on the particular steps that are necessary for a specific task. These steps will be rehearsed. They may be written down or cued in some other way (e.g. letter or number prompts).

MS Trust Publications

Cognition Factsheet

This factsheet describes the range of cognitive problems that can occur with MS difficulties with short-term memory, concentration, verbal fluency - and discusses ways to approach managing the various problems.

Cognition problems chatroom Transcript

Transcript of an open forum chatroom where issues raised about cognitive problems are answered by health professionals. The views expressed by participants are not necessarily those of the MS Trust.

More general information about MS

MS explained

MS Explained is a book for anyone who wants to understand the mechanisms of MS and what is causes symptoms to occur.

It describes the immune system and the central nervous system and then explains how MS is thought to cause them to malfunction and the symptoms that result.

MS: what does it mean for me?

If you have recently been diagnosed with MS, you will almost certainly have a number of questions about how it will affect your life.

In our experience, one of the best ways of learning to adjust to your new circumstances is to have access to clear and accurate information. This booklet provides a practical introduction to MS to help you to maintain a positive attitude to managing your MS.

At work with MS

The book considers some of the ways in which MS might affect work, the protection afforded under the Disability Discrimination Act and what adjustments can be made for a successful working life with MS.

Tips for living With MS

A compilation of nearly 150 useful ideas sent in by people with MS. The book contains practical suggestions on saving time and energy, getting around, making the most of benefits and getting equipped and more. There is also an extensive section of contact details for useful organisations.

Living with fatigue

Fatigue is one of the commonest symptoms of MS and can have a major impact on daily life. Living With Fatigue was written in conjunction with an MS specialist occupational therapist and illustrated with comments by people with MS who know what it is like to live with the symptom.

Open Door

Quarterly newsletter that contains articles news and research relevant to people living with MS and their families.

Practical management of cognitive impairments associated with MS

Patrick Carroll, Clinical Specialist Occupational Therapist, Gosport War Memorial Hospital, Gosport Way Ahead 2004;8(2):4-5.

Other Resources

Organise yourself. revised ed.

Eisenberg R, Alley K London: John Wiley & Sons; 1997 ISBN 0028615077

The personal efficiency program: how to get organized to do more work in less time. 3rd ed.

Gleeson K London: John Wiley & Sons; 2003 ISBN 0471463213

Time management for unmanageable people

McGee Cooper, A London: Bantam; 1994 ISBN: 0553370715

How to be organized in spite of yourself: time and space management that works with your personal style. revised ed.

Schlenger S, Roesch R. New York: Signet; 1999 ISBN 0451197461

Clear your desk!: the definitive guide to conquering your paper workload - forever!

Treacy D Chigaco: Upstart Publishing; 1992 ISBN 0936894385

Websites

Openlearn

The Learning Space, on-line modules from the Open University to support study skills. Includes problem solving.

Mind Tools

Cognitive skills and tips for work environments, including problem solving. decision making and memory improvement.

Involving Family and Friends

Difficulties with planning, organising and prioritising can be harder to explain to other people. These are rather abstract things. Usually when someone doesn’t manage to plan, organise or prioritise as expected, other people may regard this as laziness, or poor motivation, or that they just couldn’t be bothered. If other people don’t understand that there is a reason for poor planning, or not getting a task finished on time, they may make a negative judgement.

If you are able to explain your difficulties to those around you, they may be able to work out when a task is likely to be difficult for you. They can then prompt you to take special care, or ask for help with that task. Or they may be able to present a task to you in sections, which you can easily manage. Or they could write it down in sections, giving you a sort of “game plan”.

Research

Cognitive difficulties

The term executive skills covers a range of supervisory processes. It includes monitoring, error detection, flexibility, planning, prioritising, remembering to do things and other aspects of organisation. In general novelty and departures from routine may prove difficult. This range of skills can be affected in patchy and individual ways for any one person, which makes characterising this cognitive domain hard to do. When people with MS report difficulties in these areas, they are also likely to do poorly on clinical cognitive tests and manage less well on everyday tasks. In an experimental study that asked people to complete as many simple tasks as possible within a given time, people with MS were less good at optimizing their responses, compared to people without MS. People with MS also often find tasks that require switching between different parameters and rules challenging. Remembering to do things can also be a problem for people with MS (confusingly, remembering to do things is known as “prospective memory”. This is different from pure memory because it is not what to do that is forgotten. It is the organisation and alerting process of remembering to do something at a given time or point in a sequence of events that is an executive skill).

Rehabilitation

One study that used a computerised training package and also a general compensatory package (which included building up routines of behaviour, problem-solving and planning) showed an improvement on clinical tests of executive skills after treatment. Planning in advance improves remembering to do something, especially when it makes the act more automatic.