Daily Schedule Can Be Valuable Strategy to Combat Apathy and Inertia

by ALLAN GRILL CRC, MFT
Reprinted from HDSA Nucleus Fall/Winter 2000

A daily routine can be a beneficial therapeutic tool in combating apathy and inertia, common HD-related psychiatric and cognitive symptoms. 

In spite of some of our conditioning to resist and resent routines imposed upon us and to value unstructured time, a written daily schedule of activities can be a most useful external device to encourage initiation when the ability to initiate from inside oneself is impaired.

Because of the changes in brain function related to Huntington’s Disease, many people have difficulty in initiating activities, even activities that were once pleasurable.  A written daily schedule can provide structure to an otherwise unfilled day, where the only activity might be sitting and watching television.

While Huntington’s Disease may rob the affected individual of taking initiative, the use of a written daily schedule or routine is one strategy to seriously consider.

Here is a sample of a daily schedule, but do note that it is a sample (you’ll probably want to be more specific than my general outline).  For a daily regimen to work and be effective, it should be modified it to suit your personal preferences, needs, and abilities.

Of course, be reasonable about it.  If you tend to be a night owl and go to bed at 2 AM, don’t set your alarm clock for 7 AM.  Get plenty of sleep and wake up at a reasonable time.  Give yourself ample time to accomplish your activities, and perhaps most importantly, structure in pleasurable activities.


Sample Daily Schedule:

* 8:30 AM

Wake up (set your alarm clock daily!)

Personal care (bathing, grooming, dressing, etc.)


* 9:30 AM

Eat breakfast.

Be sure to allow enough time to comfortably prepare and eat your meal.

Remember: consuming a sufficient amount of high quality calories is an essential part of treatment for some HD-related symptoms.

Also, make sure you consume enough fluids, and remember to take your medications and vitamin
supplements.


*10:30 AM

Do some pleasurable activity.

This may be a hobby that you’ve enjoyed doing in the past, or perhaps something new that you’re willing to try out for the first time.  This can be done solo or it can be an opportunity to share with a family member or friend.  Keep in mind that this should be fun and enjoyable, as well as therapeutic.


* 12:00 PM      

Eat lunch.

Try to do so in a relaxed environment without multiple distractions.  If you have problems with swallowing or choking, watching TV, reading, or talking while eating will distract you from the concentration necessary to chew and swallow safely.


* 1:30 PM      

Walk around the block.

The distance covered and amount of time spent walking is dependent upon your mobility and safety in walking.  If possible, have a regular walking companion for some added safety and fun.

If you find yourself tripping or falling, consult with your doctor about a referral to a physical therapist.

I know of one person with HD who regularly and successfully uses a treadmill for both exercise and stress reduction, as an alternative to walking outside. 

Modify your exercise to suit your ability to do it safely.  Ask your doctor for additional suggestions for exercise. 


* 3:00 PM      

Snack/small meal


*4:00 PM      

Quiet time.

Try putting on some soothing music and resting for a while.  If you have a garden, try sitting outside, maybe even do a bit of gardening.  Make those phone calls to people that you’ve been meaning to call.


More Tips:

If you can arrange to do so, it is preferable to eat several smaller meals spread throughout the day as opposed to eating larger meals.  This will help keep you from feeling ravenous when it’s meal time, an  will hopefully slow down how quickly you eat, reducing the risk of choking on solid foods and liquids.

Each time you eat or drink is an opportunity for calories, preferably high-quality calories, and particularly if you are underweight.  While diet sodas and potato chips might be quite tasty, they are not the best snack foods and can be difficult foods to swallow if you tend to choke when eating.

A swallowing evaluation done by a speech therapist can help you in figuring out what types and textures of foods are best suited for your particular needs, as well as suggestions about body positioning to reduce the risk of choking when eating.

In addition to preparing your own activity schedule, there are Adult Day Health Care Centers and other recreational programs that may be available in your community that are well-structured programs.  These programs can provide both structure and an opportunity to socialize with other people during the day.

Ask your friends, family, or health care professionals for help if creating a schedule feels like it’s an overwhelming feat.  It might sound corny, but that pad and pen sitting over there on the table could turn out to be a valuable, helpful  friend.