Therapy Task Ideas for Orientation

This post is a continuation of the series of cognitive therapy ideas taken from a student project by Janelle Barrett (who is not a student anymore!). These are ideas gathered from several SLPs and students.  Comment and let us know what you do for orientation!

• O-Log worksheet.  Do this before showing them their calendar and memory aides. (This is a standardized little task with 10 questions.  They are worth up to 3 points per question for a total of 30 points.  Practice "calendaring"
• Have the pt. fill out a blank calendar (numbering the days, labeling the month)
• Have the pt. cross out days that have past
• Write all holidays and important upcoming family events and birthdays
• Write all significant hospital-related days (surgeries, accidents, date of admission to Rehab, discharge date, last day of therapies, etc.)
• Have the patient answer questions (e.g., "According to your calendar, how long have you been here in the hospital?  In Rehab?  How much longer will you be here?  How long until the next holiday?  How long will your total Rehab stay be?") 
• Jot down up-coming appointments or to-do's (e.g., Write a birthday note to Julie before Friday.)
• I like to use a small post-it sticky on "today's date" if the patient is struggling each day to find it.  Each morning we practice moving the sticky and crossing off the previous day.
• Discuss different ways to find orientation info (environmental cues, calendars, newspapers, etc.)
• Have the patient go on a walk and find ways to answer orientation questions (Where are we?  Where could you go to find the answer?)
• Have a daily log book
• Have them write down what the patient did each session, who was there, any other significant events, visitors, the patient's thoughts and feelings.
• Have the patient review past entries each day to remind them of what's going on and who has been around.  
• Practice day planner use, including to-dos, etc. 
• Or for tech-savvy patients and teens, we work on electronic planners, calendar apps, etc.
• Practice using alarms (cell phone alarm to remind them to take pills, etc.)
• I'll put an enormous poster-sized calendar or orientation poster at bedside if needed.  Sometimes I'll have the patient put it together with me as part of therapy.

What other comments do you have?  Leave me some fresh ideas in your comments!

MORE Memory Therapy Task Ideas

 Memory troubles are just the worst!

This post is a continuation of the series of cognitive therapy ideas taken from a student project by Janelle Barrett (who is not a student anymore!).  I know I have posted about memory task ideas here and here in the past.  This post just has more!  These are ideas gathered from several SLPs and students.  Comment and let us know what you do for memory!

(The cat realizes she left something in the oven.)

• Functional Strategies
• Associations
• Chunking
• Calendars
• Visual Memory/Mental Imagery
• Use of Alarms
• Writing things down in a planner or notebook
• Daily log
• Daily checklist
• Mnemonics
• Visual reminders
• Post-its
• Written instructions to-self
• Rehearsal
• Tasks
• 3 Facts
• Prospective memory: ask them to initiate telling them to you at a specified time.
• Have them make up a memory strategy to remember each
• Word list retention
• The Simon Game app (there are several variations/apps like this)
• Recalling 4 categories as they go through a 4x4 categorization matrix
• The “Help for Memory” book is great
• Study a picture 1-2 minutes, then recall all they can.  THEN think of a strategy to remember them better and practice again or change pictures
• Flick Flag app (First we study the flags under the instructions.  I have them come up with a good association strategy for remembering each flag- the more creative the better.  Great for learning to make memory tricks and associations.)
• Hide 3-4 objects around the room (good for non-verbal patients)
• Have them remember a hand shake combo (also good for non-verbal patients)
• Apps with “concentration” game
• Practice strategies for remembering faces or photo cards
• Practice strategies for memorizing state abbreviations
• Chunking word lists (Help for Memory p. 52)
• Using visualization to remember information (Help for Memory p. 101)
• Taking notes from material presented out loud (Help for Memory p. 103)
• Associate visual objects (The Source for Memory Exercises p. 81, 83)
• Mental Manipulation - read patient 3 words, have pt. say them back in alphabetical/chronological/reverse order (ie. “October, April, February” → “February, April, October”)
• Visual Memory: Have the patient use a chunking strategy to recall 12 pictures (The Source for Memory Exercises p. 152, 153)
• Identifying “key” information: Read sentence to patient, have patient identify key words to simplify encoding. (Help for Memory p. 21)
• Repeat list of 3-6 words, then ask pt. to identify which items have certain attributes (e.g., which are animals, which are the softest, etc.)
• Cog-log worksheet (more difficult than it's famous sister worksheet- the O-log)
• WALC 10 workbook is great.
• Practice using day planner or electronic day planner (calendar app)
• Alternating card task: I show them one word or picture card (e.g., fork) and then another (e.g., ball) and have them say the previous card (fork).  We continue until they get lost.  I have found that ~11 is typical for my non-impaired co-workers.  Some people can go an even longer time!
• Mental math with no writing things down
• Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson - See more at: http://pathologicallyspeaking.blogspot.com/2013/05/email-slp-q.html#sthash.0EaYqvrC.dpuf
   Book: "Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson.
  "Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson - See more at: http://pathologicallyspeaking.blogspot.com/2013/05/email-slp-q.html#sthash.Ec7dO5e9.dpuf

Hope you got some new fodder for your sessions tomorrow.  :)   

Don't forget to comment- 

I need some fresh ideas!  

What do you use for working on memory deficits?

-Kristin

More Short-Term Memory Therapy Ideas

Thanks for your comments and requests.  Sounds like a couple of you would like another post about memory task ideas.

Memory is one of my favorite things to work on with patients. I love teaching compensatory strategies. Maybe it's because I need them so badly for myself?

Image courtesy of: http://mainepi.org/ALZ/Cafes.html

I usually start out each session with a quick memory quiz (What did you have for breakfast?  What was you first therapy session this morning?  Who is your nurse?  What was for dinner last night?  What time did your wife leave/arrive?)  We also use the O-log and the Cog-Log protocols around here quite a bit.

Here are a couple of books I use a lot:

• WALC 10
• HELP for Memory
• The Source for Memory Exercises
• One of my blog commentators recommended: "Memory Rehabilitation: Integrating Theory and Practice" by Barbara Wilson

Apps I like for short-term memory:

• Calendar App
• Flick Flag (I have the patient come up with a memory "trick" (association, elaboration, visualization, etc.) for each flag as we study them, then we play the game to see what they can remember.  It's great for learning how to come up with effective "tricks."
• Simon (remember this memory game from the 80's??  Love it.
• Brain Baseline has a couple of tasks for memory (and a lot of great tasks for improving processing speed!)

Much of the therapy focuses on compensatory strategy training.   
We practice using the tools they will use in their home: calendars, calendar apps, day planner, notebook, post-its, alarms, association "tricks"/mnemonics, elaboration, chinking, rehearsal, visualization...


Other fun tasks:

• Index cards with faces on one side and names on the back.  Again, we focus on associations to help remember the names (e.g., Nyla never likes to smile-a).  I make sure they are effective (e.g., she looks like another Allison I know) vs ineffective (Tyler starts with T, tooth starts with T-- Tyler has big teeth!  There are too many names that start with T.)  I also like to try it the first time with no strategies so that they can see what a difference the strategies make.

• Objects - I'll show a photo or drawing of several objects (or anything!  A magazine picture with a bunch of foods...).  I'll have them study it for 1-2 minutes and remember all they can.  Then we'll list them out.  Then I have them do it again with some strategies and associations (e.g., make up a story using the objects, or group them into meaningful categories).  THEN, I'll do yes no questions to see what they can remember (e.g., Was there a hammer?  Was there a beach ball?  Was there a shoe?).     

• Sometimes I'll read a story/article/bit of information and have them answer questions afterward.

• Prospective memory tasks:  Prospective memory involves remembering to do something at a certain time or in a certain situation.  Such as remembering to take a pill or feed your dog.  I will give the patient tasks to remember at a certain time.  This could be anything from remembering to hand my a paperclip every 5 minutes on the clock, to remembering to tell me the 3 facts I taught them about their favorite hobby (I pick facts they don't already know) at the beginning of our next therapy session.  Etc., etc.  There are a million ways to do this one.  I could go on and on but you get the idea.  They key here is that they try to initiate the task without my help.  If needed, we add compensatory strategies or reminders.

Image courtesy of http://cognitivepsyc.tripod.com/id10.html

Well, I could say more.  But I would LOVE to hear your ideas!  Do you have any to add?  Post them, por favor, in the comments below.

Until next time,

Kristin 

SLP Q&A's (from my email) Memory Therapy Task Ideas

Hi guys!

I get a lot of email questions from young SLPs.  I thought it might be fun to start posting their questions and my responses.  Feel free to add your own comments!

-Kristin

Hi Kristin,

I just graduated with my Masters in speech in May from the University of (withheld).  I'm now working for a hospital there where I was previously a student.  I mainly see inpatients, however my outpatient caseload is growing.  Ive been seeing one of my outpatients since I was a student and I was wondering if you had any tips for functional working memory therapy tasks that might spice up my therapy sessions.  Thank you for your time!  I am looking forward to any ideas/tips you may have!

Sincerely,

Haley S.

----------------------------------------
 Hi Haley,

Do you mind if I post your question on the blog?
Ummm, how about the following:

1)  I'll ask them to imagine a 4x4 matrix and I  name 4 letters and 4 categories.  (this is a high level task).
I'll have them mentally fill in the chart.  They have to remember the letters and categories on their own.  (E.g., for slot 1, they'd name an animal that starts with B)

2)  I'll ask them to listen to 3-5 words, and then repeat them back in alphabetical order

3)  Same task as #2, but repeat them back in reverse order

4)  Mental math problems where they have to remember the problem's elements as they work it out.

That's just a quick list.  I'm trying to be working memory-specific here.  I can think of a lot of other short term memory tasks I like (most of which focus on some aspect of compensatory strategy retraining).  Does this help?

Thanks for reading!

Kristin

***note:  Haley did agree to let me post her question.  :)
Can you add some more memory task ideas?  Also see my 2 other memory task posts!