21 Effective Exercises for Cognitive Rehabilitation

Cognitive rehabilitation exercises aim to improve cognitive functions that were damaged by a TBI, stroke, or other brain injury.

If you’re a cognitive rehabilitation therapist—or someone motivated to recover after a brain injury—this article is for you! You’ll find 21 expert exercises for cognitive rehabilitation in the areas of executive functioning, memory, and attention.

Let’s get started!

What Is Cognitive Rehabilitation?

Cognitive rehabilitation uses targeted cognitive activities to restore or compensate for cognitive impairments caused by a brain injury.

An example of restoring cognitive function is improving one’s attention span enough to finish cooking a meal. An example of compensating for cognitive impairments is using alarms and checklists to cook the meal on time.

A successful cognitive rehabilitation program often includes both!

Which cognitive impairments a person has will depend on the type, severity, and size of their brain injury, as well as other patient factors.

Each patient should be assessed by a qualified cognitive rehabilitation clinician, such as a speech-language pathologist, occupational therapist, or neuropsychologist, to develop the best treatment plan.

The exercises in this article target specific cognitive skill areas: executive functioning, memory, or attention. But since the brain is complex and interconnected, each will also use and improve other cognitive functions.

Focus your treatment tasks on one function at a time to measure progress accurately—and enjoy any additional benefits!

Executive Functioning Exercises for Cognitive Rehabilitation

Executive functioning exercises help patients solve problems and gain control of their behaviors and emotions. This, in turn, allows them to make, plan, and achieve their goals.

1. Know The Executive Functioning Skills

First, familiarize yourself with the executive functioning skills. This can help you choose exercises that target your patient’s weaknesses while taking advantage of their strengths.

Be sure to also complete an executive functioning assessment, such as the Delis-Kaplan Executive Function System™.

Executive functioning skills include:

• Self-Awareness. Being aware of the existence and extent of a cognitive impairment
• Goal Setting & Planning. Setting an appropriate goal and creating a plan to reach that goal
• Problem Solving. Strategizing how to reach a goal when there are barriers to the plan
• Organization. Creating and using systems to keep track of things
• Self-Monitoring. Monitoring how things are going
• Working Memory. Holding information in memory long enough to do a task
• Task Initiation. Beginning tasks efficiently and on time
• Time Management. Estimating and allocating time to meet deadlines
• Task Persistence. Having the resolve and drive to finish a task
• Response Inhibition. Thinking before acting, not acting on impulse
• Stress Tolerance. Handling stress, demands, and uncertainty well
• Emotional Control. Managing emotions to achieve a goal. Acting in a way that is socially and culturally appropriate
• Flexibility. Adaptability and the ability to revise plans

(Cicerone, et al., 2022; Guilford Press, n.d.)

2. Use An Executive Functioning Strategy

Strategies give patients an internal framework for how to achieve their goals.

Teach them to use the strategy during executive functioning exercises. Then, have them practice the strategy repeatedly until they have internalized it. This way, they can use the strategy to achieve a goal even when you’re not there!

Goal Planning Strategy (for Milder Executive Dysfunction):

1. My Goal. The patient sets a goal
2. My Plan. They plan the steps to achieve that goal, including anticipating any obstacles and solutions
3. Do The Task. They follow the plan to complete the task
4. How Did I Do? They reflect on how they did. Then come up with ways to do better next time

Errorless Learning Strategy for (More Severe Executive Dysfunction):

This is a strategy that a clinician or care partner uses to help a patient with severe executive dysfunction reach a goal.

• Choose a specific skill or answer
  • “If you want to get up, use the call light. What should you do when you want to get up?”
  • Correct answer: “Use the call light”
• First, model the skill or answer.
  • “If you want to get up, use the call light. What should you do when want to get up? You use the call light.”
• Then, have the patient practice the correct skill or answer many times
• If the patient makes an error, correct it right away
• Emphasize not guessing by giving the cues needed to get the right answer

(Center on Budget and Policy Priorities, n.d.; Cicerone et al., 2022)

Learn more about Executive Functioning Strategies.

3. Problem-Solving Safety Exercise

Ask your patients to problem-solve useful safety scenarios. Give cues and ask follow-up questions.

For example, your patient says they would call 911 if they were to fall down at home. You then ask follow-up questions about how they will get to the phone if they’re on the ground.

• How can you call for help during an emergency?
• What are some emergencies that could happen?
• What would you do if you forgot to take your medications?
• What would you do if you ran out of medications?
• What would you do if you fell down at home while you were alone?
• When should you use your walker or wheelchair?

4. Stop-Relax-Refocus

Teach patients the Stop-Relax-Refocus exercise to help them get back on task when their mind wanders.

• Stop. Stop what you’re doing
• Relax. Take a few deep breaths
• Refocus. Refocus on what you want to accomplish

5. Time Management Exercise

Make a time management plan for a task. They’ll use this plan to set a goal and anticipate and plan for potential problems. In the plan, include:

• The goal
  • For example, cook a meal within 20 minutes
• What might stop them from doing what they want on time
  • Alerts on their phone may distract them as they follow the recipe
• How to prepare for these obstacles
  • Print out the recipe instead and stick it to the fridge
• Make an emergency plan
  • If they get frustrated, they’ll take a break or ask for help

6. Social Communication Exercise

Social communication involves being aware of social rules and boundaries (Weightman et al., 2015). Social skills training, especially in a group setting, can help rehabilitate these skills after a brain injury.

Practice adding to conversations to improve social communication skills. Cue patients to ask a follow-up question, give encouragement, or express empathy.

For example: “I just got back from a vacation.”

• Follow-up question: “Where’d you go?”
• Encouragement: “That sounds fun.”
• Empathy: “I’m sure you needed it, your job is demanding.”

Social communication conversation prompts:

1. “I got front row tickets to the concert!”
2. “I was in the emergency room all night for my daughter’s asthma.”
3. “I’m graduating on Friday.”
4. “I might not get the promotion at work.”
5. “I’ve never been downtown before. I’m a little nervous to go.”
6. “This is a new coat.”
7. “I ran a 5k last weekend.”
8. “My car’s in the shop.”
9. “I’m hosting my parents’ 40th wedding anniversary.”
10. “I don’t eat fish.”

After the exercise, ask your patient to assess how they did. Help them problem-solve how to do better next time.

7. Emergency Safety Plan Exercise

Have your patient make an emergency safety plan. Help them problem solve:

• Possible disasters in their area
• How they will receive disaster warnings and alerts
• Local emergency resources
• Their contact people
• What to include in their emergency kit
• Where they will keep the emergency plan

Memory Exercises for Cognitive Rehabilitation

The following memory exercises can be used with all levels of cognitive rehabilitation, but be sure to adapt each as needed.

Be sure to complete an assessment, such as the Wechsler Memory Scale, to determine if there is a memory impairment and to gather relevant details.

8. Use TEACH-M For Severe Memory Impairments

TEACH-M is an acronym for 6 ways to teach new cognitive skills to people with severe memory and executive functioning deficits.

It was developed using best practices in the cognitive rehab space by researchers at Western Oregon University and the University of Oregon.

Follow these steps to rehabilitate memory:

• Task analysis. Help patients learn new skills by breaking down a task into smaller steps. Teach each smaller step, then ‘chain’ them together.
• Errorless learning. The goal is for your patient to make as few errors as possible as they learn a new skill or a step of a skill.
  • Model the skill first
  • Focus on accuracy
  • Emphasize not guessing by cueing as needed
  • If an error happens, give enough cues to elicit the correct response. For example, model the skill again
• Assessment. Monitor patient progress. For milder impairments, teach the patient to assess and monitor their own performance.
• Cumulative review. The patient regularly reviews all the steps they have learned at least once before attempting the task.
• High number of practice trials. The patient completes the entire task over and over again. But, prioritize doing the task correctly (errorless learning) over more repetitions.
• Metacognition. For treatment to be the most effective, patients need to be aware of their cognitive deficits.
  • Before the task, ask the patient to predict how they’ll do
  • After the task, ask the patient to assess how they did
  • After the task, discuss how their prediction compared to how they actually did
• Meaningful. We added an extra M! Tasks that are meaningful to the patient lead to better results.

(Cicerone et al., 2022; Ehlhardt et al., 2005; Ehlhardt et al., 2008; Powell et al., 2012)

9. Teach Patients A Memory Strategy

These strategies are for patients with milder memory impairments.

Think of the strategy as bumpers that help them stay in their lane to achieve their goal. Teach your patients to use a strategy during their memory exercises.

Then, have them practice the strategy repeatedly until they’ve internalized it. This way, they can draw on the strategy whenever they need to in their daily lives.

Memory strategies:

• Write it down. Take notes. Write down, voice record, or take a video of what you want to remember
• Repeat and rehearse. Say what you want to remember, such as a person’s name, over and over again
• Take a mental picture. Visualize what you want to remember, such as where you left your keys. Take a mental snapshot and store it away in your brain
• Make associations. Connect what you want to remember with what you already know
• Sort and organize information. Organize what you want to remember into smaller groups

(Brewer & Aparo, 2025)

10. Calendar Exercises for Memory Rehabilitation

Calendar exercises can be very functional for people with mild to severe memory impairments. A calendar can improve orientation, help them remember appointments and important events, and teach them to create a system for remembering important things.

Have a blank monthly calendar or planner handy. Look for a simple design that isn’t distracting, with a large and easy-to-read font.

Orientation calendar tasks for more severe memory impairments. Have patients add:

• The year
• The month
• The date
• Holidays

For milder impairments and for people comfortable with tech, consider using a digital calendar, such as Google Calendar.

Calendar tasks for milder memory impairments. Have patients:

• Add appointments, such as
  • Medical appointments
  • Social events (e.g., coffee with friends, birthday parties, etc.)
• Plan an event or task. For example, preparing a holiday dinner:
  • Date to send invitations
  • Date of dinner
  • Date to go grocery shopping
• Bill pay and financial management, such as
  • Payday
  • Bill due dates

11. External Memory Aids

We all use external memory aids such as alarms, alerts, and to-do lists every day to make our lives easier.

External supports are especially important for people rehabilitating from a brain injury. These tools can alleviate cognitive burden, allowing patients to focus on their goals.

Memory Aids for severe memory impairments include:

• Visual schedule
• Memory book
• Labels (in the closet, on cabinets)
• Posted signs (“Bathroom”, “Step”)
• Reminder cards (“Wash your hands,” “Lock your wheelchair”)

Memory Aids for milder memory impairment include:

• Smartphone apps (alarms, voice memos, task lists, maps, passwords, texting)
• Planner
• Calendar
• Checklists
• Post-it notes (“Pay bill,” “Bring homework,” “Defrost the chicken”)

(Jones et al., 2021; Scullin et al., 2022; Sohlberg et al., 2007)

12. Daily Remembering Exercises

Use the memory strategy Sort and Organize, Association, Visualization, and/or Repeat and Rehearse to remember daily information.

You can practice the strategies during a game, with functional worksheets, or with real-life tasks. The Cognitive Rehabilitation Bundle includes guided activities for all 3.

Here are some daily remembering exercises:

• Grocery list. Sort and remember a short grocery list
• Directions. Visualize and remember short walking or driving directions
• Cooking. Remember a few steps of a recipe
• Morning packing list. Repeat and Rehearse to remember (“keys, coffee, coat,” “keys, coffee, coat”)
• Verification codes. Improve working memory by using Repeat and Rehearse and Visualization to memorize short verification codes when logging into a website
• Remember people’s names. Use any of the memory strategies to remember a new person’s name. For example, a new therapist
• Party guests. Up the challenge by using photos to sort and remember guests they’ll meet at a party. For example, if attending a wedding, they can sort people into the bride’s family and the groom’s family
• Card games. Go Fish, matching, even magic tricks!
• Crossword puzzles
• Board games like Guess Who?, Scrabble, Pictionary, etc.

Attention Exercises for Cognitive Rehabilitation

Attention deficits are common after a brain injury. In fact, most patients with aphasia also have an attention deficit (Varkanitsa et al, 2023).

Attention exercises for cognitive rehabilitation can help patients focus long enough to accomplish a goal. Again, assess attention first to create the best treatment plan.

13. Know The Types of Attention Impairments

One way to approach attention treatment is by choosing exercises that target a specific type of attention. Again, complete an assessment to know if and what types of attention deficit your patient has.

Here is a well-known hierarchy of attention developed by Sohlberg & Mateer (2001):

• Sustained attention. The ability to attend to a chosen task for a sustained period of time (impairment looks like short attention span)
• Selective attention. The ability to attend to a chosen task in the presence of distractions (impairment may look like losing attention when they hear a noise)
• Alternating attention. The ability to switch between dissimilar cognitive tasks. The ability to allocate where you pay attention (impairment looks like having a hard time switching between tasks)
• Divided attention. The ability to complete two tasks at the same time while maintaining a certain level of accuracy (impairment may look like having a hard time answering questions while folding laundry)

14. Self-Awareness Exercise

Before your patient can improve their attention deficit, they need to believe that they have one!

After a brain injury, it’s common for people to not realize the extent of their cognitive deficits. Use this exercise to respectfully help them see and understand what they need to work on.

Here’s a simple self-awareness exercise you can add to any task. Download our free self-assessment worksheet to make it easier.

• Before the task: Ask the patient to predict how they’ll do on it
• After the task: Ask the patient to assess how they did
• Compare. Ask the patient how their prediction compared to how they actually did
• Make a plan. Together, think of what they can do to have a better result next time

14. P.A.S.E. Attention Strategy

We developed P.A.S.E. using evidence-based attention rehabilitation strategies, including self-awareness, mindfulness, and problem-solving.

Teach patients to use P.A.S.E to stay on task or get back on task:

• Pause. Pause your mind and body and take a slow, deep breath
• Ask. Take a mental step back. Ask yourself, “What do I want to be doing?”
• Steps. Make a plan. What are the steps to accomplishing your goal?
• Execute. Follow your plan to complete the task

(Brewer & Aparo, 2025)

16. Sustained Attention Exercises

Work towards paying attention to one task for longer periods of time:

• You may start with a worksheet or curated rehabilitation activities to teach strategies and build confidence
• Do any functional task with minimal distractions for an extended period of time (reading, writing an email, sorting laundry)

17. Selective Attention Exercises

Work towards paying attention to a cognitive task when distractions are present.

• Add background noise
• Do a task in a busier environment (cafeteria, open a window, when the kids are home)
• Use a smartphone to do a task

18. Alternating Attention Exercises

Work towards switching between 2 different cognitive tasks while improving accuracy.

• Cook while following a recipe
• Read a bill and then pay it online
• Do a construction task while switching between reading instructions and assembling it (craft, building furniture, Lego® kit, origami)
• Use a map to navigate
• Sort coins, cards, or other small objects
• Fill out a survey or questionnaire

19. Divided Attention

Work towards doing 2 tasks at the same time while improving accuracy.

• Cooking task with 2 components that require simultaneous monitoring (boiling noodles and simmering sauce)
• Take notes in real-time
• Have a conversation while doing another task
• Teach someone a familiar activity, while doing it (knitting, card game)
• Listen to a podcast while sorting coins, cards, or other small objects
• Keep score during a game while playing it

20. Working Memory Exercises

Working memory is the ability to hold information in short-term memory while doing a task. People with attention deficits often also struggle with working memory.

Here are some working memory exercises:

• Listen to a word spelled aloud, then say the word
• Listen to short instructions, then repeat them back
• Listen to a short paragraph (email, memo), then summarize it
• Do mental math
• Follow a tutorial (YouTube tutorial or multi-step instructions for makeup, cooking, fixing something, drawing)
• Consider a computerized working memory program like Attention Process Training III (Johansson & Tornmalm, 2012)

21. Use The Cognitive Rehabilitation Bundle

The Cognitive Rehabilitation Bundle is 275 pages of evidence-based brain injury rehabilitation interventions.

We translated the cognitive rehabilitation evidence into functional activities that progress patients toward their cognitive goals.

It includes treatment activities, worksheets, and educational handouts in 4 workbooks:

1. Executive Functioning Workbook: Treat problem-solving, social communication, time management, IADLS, and more
2. Attention Workbook: Treat sustained, selective, alternating, and divided attention/working memory
3. Memory Workbook: Includes memory aids and functional ADLs (activities of daily living) and IADLs (instrumental activities of daily living) for patients with memory loss
4. Visual Neglect Workbook: Includes visual neglect scanning strategies and functional reading and writing activities

Visit our shop for the full table of contents.

References

• Brewer, C., Aparo, M. (2025). The Adult Speech Therapy Starter Pack: Second Edition. Harmony Road Design Publishing.
• Center on Budget & Policy Priorities, Global Learning Partners, & Annie E. Casey Foundation. (n.d.) Goal Plan Do Review/Revise: An Executive Skills-Informed Goal Achievement Framework for use in human services programs. GPDR/R. https://www.gpdrr.org
• Cicerone, K. D., Dams-O’Connor, K., Eberle, R., Fraas, M., Ganci, K., Langenbahn, D., Shapiro-Rosenbaum, A., Tate, R. L., Trexler, L. E., & American Congress Of Rehabilitation Medicine. (2022). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition: Translating evidence-based recommendations into practice.
• Ehlhardt, L. A., Sohlberg, M. M., Kennedy, M., Coelho, C., Ylvisaker, M., Turkstra, L., & Yorkston, K. (2008). Evidence-based practice guidelines for instructing individuals with neurogenic memory impairments: what have we learned in the past 20 years?. Neuropsychological rehabilitation, 18(3), 300–342. https://doi.org/10.1080/09602010701733190
• Ehlhardt, L. A., Sohlberg, M. M., Glang, A., & Albin, R. (2005). TEACH-M: A pilot study evaluating an instructional sequence for persons with impaired memory and executive functions. Brain injury, 19(8), 569–583. https://doi.org/10.1080/002699050400013550
• Johansson, B., & Tornmalm, M. (2012). Working memory training for patients with acquired brain injury: effects in daily life. Scandinavian journal of occupational therapy, 19(2), 176–183. https://doi.org/10.3109/11038128.2011.603352
• Jones, W. E., Benge, J. F., & Scullin, M. K. (2021). Preserving prospective memory in daily life: A systematic review and meta-analysis of mnemonic strategy, cognitive training, external memory aid, and combination interventions. Neuropsychology, 35(1), 123–140. https://doi.org/10.1037/neu0000704
• Powell, L. E., Glang, A., Ettel, D., Todis, B., Sohlberg, M. M., & Albin, R. (2012). Systematic instruction for individuals with acquired brain injury: results of a randomised controlled trial. Neuropsychological rehabilitation, 22(1), 85–112. https://doi.org/10.1080/09602011.2011.640466
• Scullin, M. K., Jones, W. E., Phenis, R., Beevers, S., Rosen, S., Dinh, K., Kiselica, A., Keefe, F. J., & Benge, J. F. (2022). Using Smartphone Technology to Improve Prospective Memory Functioning: A Randomized Controlled Trial. Journal of the American Geriatrics Society, 70(2), 459. https://doi.org/10.1111/jgs.17551
• Guilford Press. (n.d.). Definition of terms – smart but scattered kids. Smart but Scattered Kids. Retrieved August 2024. https://www.smartbutscatteredkids.com/about/terms
• Johansson, B., & Tornmalm, M. (2012). Working memory training for patients with acquired brain injury: effects in daily life. Scandinavian journal of occupational therapy, 19(2), 176–183. https://doi.org/10.3109/11038128.2011.603352
• Jones, W. E., Benge, J. F., & Scullin, M. K. (2021). Preserving prospective memory in daily life: A systematic review and meta-analysis of mnemonic strategy, cognitive training, external memory aid, and combination interventions. Neuropsychology, 35(1), 123–140. https://doi.org/10.1037/neu0000704
• Sohlberg, M. M., Kennedy, M., Avery, J., Coelho, C., Turkstra, L., Ylvisaker, M., & Yorkston, K. (2007). Evidence-based practice for the use of external aids as a memory compensation technique. Journal of Medical Speech-Language Pathology, 15(1), x–li. https://www.ancds.org/assets/docs/EBP/sohlberg_et_al_jmslp2007-2.pdf
• Sohlberg, M. M., Kennedy, M., Avery, J., Coelho, C., Turkstra, L., Ylvisaker, M., & Yorkston, K. (2007). Evidence-based practice for the use of external aids as a memory compensation technique. Journal of Medical Speech-Language Pathology, 15(1), x–li.
• Sohlberg, M., & Mateer, C. (2001). Cognitive rehabilitation: An integrative neuropsychological approach. (2nd ed.). The Guilford Press.
• Varkanitsa, M., Godecke, E., & Kiran, S. (2023). How Much Attention Do We Pay to Attention Deficits in Poststroke Aphasia? Stroke, 54(1), 55–66. https://doi.org/10.1161/STROKEAHA.122.037936
• Weightman, M., Vining Radomski, M., Mashima, P., & Roth, C. (2015). Mild Traumatic Brain Injury Rehabilitation Toolkit. Borden Institute. https://medcoe.army.mil/borden-tb-tbi