What working memory treatments are evidence-based for adult speech therapy patients? More importantly, which of these actually generalize to improve quality of life?
In this post, you’ll find the answer to these questions, PLUS functional working memory tasks for patients with mild-moderate cognitive deficits post TBI, stroke, or other neurological events.
For pre-made cognitive treatment activities, check out the bestselling Adult Speech Therapy Starter Pack!
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Working Memory: What Works?
Working memory is the ability to hold information in short-term memory while doing a task. A classic example is writing notes about what someone else is saying.
Computer-based working memory programs (i.e., APT-III, Cogmed) have been rigorously studied and shown to improve working memory. BUT, these gains don’t seem to generalize into the real world….what to do?
Some research shows that these working memory gains may generalize when therapists use self-awareness training, feedback, and patient education in addition to the computer programs.
But what if you’re like most clinicians and don’t have the access, funds, or time for specialized computer programs?
No worries! For the rest of this post, we’ll cover practical treatment tasks that you can implement today.
Read How To Improve Awareness.
Working Memory Treatment Tips
What working memory treatments actually get results? Below are evidence-based tips to use whether you’re doing functional tasks, a computer program, or following a protocol.
These tips were adapted from the ACRM Cognitive Rehabilitation Manual & Textbook (Second Edition).
- Practice working memory!
- For example, spell a word out loud. Have the patient mentally put the letters together then say the word
- Use plenty of repetition
- Provide feedback and cues
- Gradually and systematically increase the challenge of the task
- Vary complexity
- Amount of information to be held in short-term memory
- Number of distractions
- The similarity of information to remember vs distractions (more similar is more challenging)
- How long the information needs to be held in short-term memory
- Shifting the information (listen/scan for different numbers, etc.)
- Amount of cueing
- Make sure the task is functional and meaningful to the patient
- Stay involved (vs the patient just interacting with a computer)
Functional Verbal Working Memory Tasks
For your patients with minimal-moderate working memory deficits, consider the following verbal working memory tasks.
1. Listen Then Repeat Back Instructions
Read an instruction aloud, then ask the patient to repeat back the key information.
Here are some examples:
- Take tablet twice daily.
- Preheat oven to 450 degrees Fahrenheit.
- Bring photo ID and your insurance card.
- Stir until mixed.
- Take a left at the light.
- Take one pill daily for two weeks.
- Line up on the right if you prepaid.
- Enter your phone number and billing address.
- While pan is heating, mince two cloves of garlic.
- Take Exit 210, then take the first right.
Visit our shop for pre-made patient worksheets.
2. Listen To Then Summarize A Memo
To up the challenge, expand the task by reading a short memo and then having the patient summarize or answer questions about the memo. Have the patient take notes, as appropriate.
This is Dina from Dr. Lee’s office. I’m calling to confirm your appointment for Friday, January 10th at 8:00 am. Please bring photo ID and your insurance card.
- What doctor are you meeting?
- What day is your appointment?
- What time is your appointment?
Hello, my name is Danny, and I’m a physical therapist with Home Health NorthWest. I’m calling to schedule an appointment with you for a physical therapy evaluation. I hope to see you on Thursday at around 10:30 am. Please give me a call back.
- Who called?
- What was the name of the company?
- What time is the appointment?
3. Listen To Then Summarize A Paragraph
Read a paragraph then ask the patient to summarize or answer questions about the paragraph. Encourage them to take notes, as appropriate. When possible, choose meaningful reading material from the patient’s environment.
Example meaningful reading material:
- Novel
- Magazine
- Letter
- Medical paperwork
- Greeting card
4. Take Notes While On The Phone
When the patient is ready, practice working memory with people outside of the therapy setting by having them take notes while on the phone.
Example activities are:
- Schedule an appointment with the doctor’s office
- Pay a bill
- Check if an item is in-stock at a store
5. Take Notes While At An Appointment
Prepare the patient to take notes while at important appointments. This may be medical appointments, taking notes during class, or taking notes during a work meeting or Zoom call.
Help them problem-solve how they’ll remember and follow through with this task. Download the FREE Game Plan Worksheet to help with this.
Functional Visual Working Memory Tasks
For your patients with minimal-moderate working memory deficits, consider the following visual working memory tasks.
6. Take A Mental Picture
Have the patient visualize what they want to remember. For example, where they left their keys. Then have them take a mental snapshot and store it in their brain.
Example tasks:
- Remember the most recent move of a card or board game
- Remember the fee on a bill as they pay online/write a check
- Remember the date before filling out a form
- Remember the dose/instruction on their medication label before taking
7. Take Inventory On More Than One Item
Have the patient take inventory of items in their environment and ask them to write a list. When possible, choose items that are personally meaningful to them. For example:
- Inventory of medications
- School supplies for students (pens, chargers, notecards, etc.)
- Work-related inventory (items in supply cabinet for someone who works in retail or food industry, etc.)
8. Names to Pictures
Practice visual working memory with names to pictures tasks. Have the patient review a set of pictures with names written next to them. Then, ask them to recall each person’s name by looking at their pictures without the name written next to them.
See the example below.
For the following task, the same set of photos is displayed twice. The first set has the name next to the photo and the second set is without the name. Print these images out (copy and paste them onto blank documents) or prepare your own set of images.
Diego
Gigi
Anna
Frank
9. Reading Maps
Use a simple map to practice visual working memory. Have the patient read instructions then navigate through the map.
You can use worksheets (like the one below from The Adult Speech Therapy Starter Pack). Or better yet, use meaningful maps from their environment!
For example:
- Hospital map
- Mall map
- School campus map
10. Working Memory Compensations
What about your patients with moderate-severe working memory deficits?
Consider teaching compensations instead of having them rely on their working memory.
The following compensations are useful for all levels of working memory deficits, from mild to severe.
- Use visual aids. For example, a calendar on the fridge to remember appointments. Or leave the kids’ lunchboxes on the breakfast table to remember to pack their lunch
- Make routines. Once a task becomes a habit, it requires less working memory
- Make lists. Create a list before a task, so you can check off items versus remember the steps of a task
- Alarms & alerts. Set ongoing reminders. For example, an alert to leave for the doctor’s appointment and an alert during the doctor’s appointment to ask a question
- Jot down reminders. Write down reminders instead of multi-tasking
Adult Speech Therapy Materials
Visit our shop for everything you need to assess, treat, and document with more confidence and ease 🙂
References
- Brewer, C.H. (2021). The Adult Speech Therapy Workbook (M. Aparo, Ed.). Harmony Road Design, LLC.
- Cicerone, K. et al.(2019). ACRM Cognitive Rehabilitation Manual & Textbook Second Edition. American Congress of Rehabilitation Medicine. https://acrm.org/meetings/cognitive-rehab-training-second-edition/
- 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
- LA Concierge Psychologist. (n.d.). What Is Working Memory? An ADHD Specialist Explains. https://laconciergepsychologist.com/blog/what-is-working-memory-adhd-specialist-explains/#:~:text=Thanks%20to%20working%20memory%2C%20a,tasking%2C%20such%20as%20mental%20math.
- Zickefoose, S., Hux, K., Brown, J., & Wulf, K. (2013). Let the games begin: a preliminary study using attention process training-3 and Lumosity™ brain games to remediate attention deficits following traumatic brain injury. Brain injury, 27(6), 707–716. https://doi.org/10.3109/02699052.2013.775484