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.


Other Important Influences

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


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 in the A-Z of MS

This A-Z entry 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.

More general information about MS

Making Sense of MS

If you've just been diagnosed, this small postcard-sized booklet is a good place to start learning about MS. It provides a brief introduction to multiple sclerosis and answers the questions most commonly asked after diagnosis.

At work with MS

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

MS and me

A self-management guide to living with MS. Looks at setting goals, problem solving and healthy living, explores how to better understand your symptoms and how working with health professionals can help you make decisions and treatment choices.

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.


Other Resources

The CEO of Self: the executive functioning workbook

Jan Johnston-Tyler (2014)

The Smart but Scattered Guide to Success: How to Use Your Brain's Executive Skills to Keep Up, Stay Calm, and Get Organized at Work and at Home Paperback

Peg Dawson and Richard Guare (2016)

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.

Strategies to support executive skills


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. Generally, executive skills tend to be linked to increased physical disability. When people with MS report difficulties in these areas, they are also likely to 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).

Reduced executive skills can also make people with MS less good at coping. They can find it harder to choose the right coping response and implement it successfully. People with MS who have reduced executive skills are also more likely to experience apathy.

Further Reading

Dagenais E, Rouleau I, Tremblay A, Demers M, Roger É, Jobin C, Duquette P. Prospective memory in multiple sclerosis: The impact of cue distinctiveness and executive functioning. Brain Cogn. 2016 Nov;109:66-74

Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. Executive function is an important consideration for coping strategy use in people with multiple sclerosis. J Clin Exp Neuropsychol. 2017 Jan 16:1-15.

Raimo S, Trojano L, Spitaleri D, Petretta V, Grossi D, Santangelo G. The relationships between apathy and executive dysfunction in multiple sclerosis. Neuropsychology. 2016 Sep;30(6):767-74.

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. Another study just using a computerised training programme improved executive skills. Planning in advance improves remembering to do something, especially when it makes the act more automatic.

Further Reading

De Giglio L, De Luca F, Prosperini L, Borriello G, Bianchi V, Pantano P, Pozzilli C. A low-cost cognitive rehabilitation with a commercial video game improves sustained attention and executive functions in multiple sclerosis: a pilot study. Neurorehabil Neural Repair. 2015 Jun;29(5):453-61.

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