Let’s delve into cognitive treatment, the bread-and-butter for many speech-language pathologists working in setting such as home health and skilled nursing facilities.
These tasks are also useful for caregivers, OTs, PTs, and RNs of patients who don’t have speech therapy but may benefit from cognitive training.
Soap Box Moment!
Remember to keep your treatment functional. Worksheets can be a great starting point, but please graduate to practical tasks as soon as possible.
Because the goal of treatment is to help patients become as independent and safe as possible.
It’s fun to improve Sudoku skills. But it’s even better to improve safety with medication management!
Encourage Daily Homework
- Remind patients to complete their “brain exercises” at least 15 minutes every day.
- We’ve had improved follow through with homework when we explain the importance of cognitive treatment as “Use it or Lose it.”
- Provide printed handouts when possible. Print on neon paper then laminate to avoid it becoming damaged or lost.
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21 Practical Cognitive Tasks
1. Set alarms or phone reminders
Patients can create alarms and reminders to wake them up, take medications, eat meals, call the pharmacist, or refill a pillbox.
Use cellphone alarms. Write simple directions for how to add or edit an alarm, then have patients review and practice the steps.
You can also program smart home devices, such as Amazon Echo with Alexa, with alarms and reminders.
2. Fill out pillboxes
Provide the handout (available here) and teach your patients the following steps:
- Fill out your pillbox at the same time and day every week
- Turn off the TV, silence your cellphone, and avoid having conversations while filling out your pill box.
- Place all your prescription bottles on the left side of the table.
- Open up all the compartments of the pill box.
- Take one prescription bottle and fill in one week’s worth of pills.
- Double check your work.
- Place the botthe to the right side of the table.
- Complete steps 5 through 7 for the rest of your prescriptions.
Encourage your patients to be systematic when filling out their pillboxes.
If the patient needs help, make sure a nurse or a family member is filling their pillboxes until they can do it safely and independently.
3. Meal planning
Help patients create meal lists and grocery lists for the week. Have them set reminders for when they’ll go grocery shopping.
For inspiration, pick a weekly ad from the local grocery store and review it with your patients.
Unfortunately, malnutrition is not uncommon with older adults. Connect patients to Meals on Wheels or other comparable community programs if they are unable to consistently feed themselves.
4. Follow recipes
If your patient enjoys cooking, a great functional task is to follow recipes.
Bring recipes in magazines or books or print out a few simple recipes from the internet.
Sometimes, you may even have enough time to make a nice snack during your session!
5. Use a cellphone
Although many of our cognitive patients have cellphones, most don’t actually know how to use basic features such as Silence, Alarms, Calendar, or Calculator.
Show your patient how to find the instructions for each online, then write simple, step-by-step directions for them to follow. Focus on one cellphone feature at a time.
6. Use a landline
Help patients learn how to listen to voicemails on a landline and how to delete them. Some patients may benefit from learning how to program numbers on the speed dial.
Place simple, step-by-step directions next to the voicemail box to help them remember how to use the system.
7. Browse the web
Review how to open web browsers, search on Google, check email, and close tabs.
Even these seemingly simple tasks can be life-changing for motivated patients.
8. Update a calendar
- What to add new dates and appointments on their calendar
- When to cross them out
- And to review their calendars daily, at least
You can find calendars at dollar stores or print them online for free.
9. Read the newspaper
Some patient still prefer to read a physical newspaper, although the small print and packed content can be difficult to attend to.
Use simple, sustained attention techniques during reading
- Train your patients how to use finger scanning
- Teach them to cover the parts they aren’t reading with a blank piece of paper
- Encourage them to read every word aloud
See How to Treat Visual Neglect for more reading strategies.
10. Read advertisements
Use reading strategies with paper or digital advertisements.
Review ways to keep track of the items the patient is interested in buying. They can circle items with a red marker or highlighter or make a list.
11. Sort through mail
After an inpatient stay, such as at a hospital or a skilled nursing facility, patients tend to receive a torrent of mail. These often end up in large, unorganized piles throughout their home.
Help your patients get organized by having them divide each pile into smaller piles:
- Keep pile
- Maybe Keep pile
- Throw Away pile
Next, closely review the Maybe Keep pile and help the patients thin down their mail even further.
Encourage further organization with labeled bins where can sort their mail into every day. Help them set a reminder on their phone or calendar to look through the mail in the bins every week.
12. Financial Management: Pay bills
You may need the patient’s Power of Attorney (POA) or a family member’s help with the following financial management tasks, but if a patient is cognizant and mentally clear, she may want to learn how to use her credit cards to pay bills over the phone or online.
You can also help your patient download apps or bookmark bill-pay websites, including those for her credit card companies, utility companies, medical clinics, etc.
For all financial management tasks, refer to your companys guidelines for obtaining permissions. As always, respect your patient’s privacy, personal boundaries, and needs.
13. Financial Management: Organize bills
Work on finacial management skills to:
- Help patients organize paperwork and/or digital communications (e.g. electronic bill-pay reminders)
- Create a system so that they can independently manage their finances.
Teach patients how to write due date on their calendar, set bill-pay reminders on their smart phones, organize bills into paid and unpaid piles, keep careful track on their calendar of when and how bills were paid, etc.
14. Financial Management: Set up automatic payments
Helps patients set up automatic payments via phone, app, or website.
15. Financial Management: Balance a checkbook
Review how to balance a checkbook with your patient.
Ideally, have an enlarged printout of the check balancing table to practice with your patient until they become more independent (available here).
16. Medication Management
Our patients often have a medication lists from the hospital, skilled nursing facility, or primary care provider’s offices.
Provide a blank Medication Management form and teach patients how to keep track of and organize their medications, vitamins and supplements, purposes of each, dosages for each, and what time to take each.
Teach patients How to Remember to Take Your Medications:
- Keep a routine: Take your medications at the same time and place every day.
- Make a list of all your medications. Include what they’re for, what doseage to take, and what time of day you should take each.
- Use a pill box.
- Place reminder notes where you’ll see them: On the bathroom door, refrigerator door, coffee pot, etc..
- Use alarms: Program a reminder each time of day you need to take your medications.
- Use a calendar: Write reminders to take your medications and cross them out only after you’ve take your pills. Also mark when to call to request a prescription refill.
17. Call offices for information
Guide your patients through the important process of getting information over the phone.
- How to find the correct phone number
- How to track down the correct contact person
- What questions to ask
- How to write down any pertinent notes during the call
18. Read the TV Guide
Some of our patients still receive physical copies of the TV Guide. For some, it’s fun reading material.
Turn reading “The Guide” into a cognitive task. Have patients:
- Scan for specific shows
- Plan what they will watch and when. Make it a calendar task.
- Memorize the times and channels of these shows
19. Make a phone list
Help patients organize important phone numbers. These may include:
- Their children
- Other medical providers
- Insurance companies
20. Use an iPad or other tablet
Many well-meaning family members buy their loved ones high-tech devices. These frequently gather dust because our patients don’t know how to use them!
If your patient expresses a desire to learn how to use their iPad or tablet, then create problem-solving and memory tasks around it.
For example, use spaced retrieval to help them learn how to unlock the iPad.
Once they are more proficient with the device, teach them to set alarms, check their email, read books, or even download free brain games for their home exercise program.
21. Use Smart Speakers, like Amazon Echo™
This is another well-meaning purchase from family members who hope that a smart speaker will make their loved one’s lives easier.
Unfortunately, many patients can’t even remember how to activate it. Spaced retrieval can help patients remember these details.
You can also make problem-solving tasks out of setting up alarms and reminders.
* Note the patient’s dexterity. Do they have difficulty pushing buttons on a calculator? Gripping a pen? Refer to occupational therapy if you suspect difficulties with fine motor skills.
Complete Digital Workbook
Handouts, Worksheets, & therapist treatment guides
A quick recap! Here are 21 Practical Cognitive Tasks!
1. Setting alarms or phone reminders
2. Filling out pillboxes
3. Meal planning
4. Following recipes
5. Using a cellphone
6. Using a landline
7. Web browsing
8. Updating a calendar
9. Reading the newspaper
10. Reading advertisements
11. Sorting through mail
12. Paying bills
13. Organizing bills
14. Setting up automatic payments
15. Balancing a checkbook
16. Medication management
17. Calling offices for information
18. Reading the TV Guide
19. Making a phone list
20. Using a tablet
21. Using Amazon Echo
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