Empowering occupational therapy practitioners with a playbook of functional tasks to use with their geriatric clients

How to Grade Cognitive Activities

How to Grade Cognitive Activities

One of the most important skills for an occupational therapist to have is the ability to grade activities. This is especially important when delivering interventions which target cognitive abilities. Unfortunately, it can be difficult to know how to grade cognitive tasks and how to document this skill.

There are three primary aspects of tasks which can be graded to change the cognitive demands of the task: complexity, distractions, and time urgency. These three factors can be manipulated alone or together as needed to grade the activity to the client’s needs. This post will explore each of those ideas while following the example of a client making oatmeal.

The first way to grade cognitive tasks is to increase or decrease the complexity of the task. This means that when a client is struggling with a task, the therapist simplifies what the client is asked to do so that the client can be more successful. Conversely, when a client is doing well, the therapist complicates the task to provide a higher level of challenge.

In the example of making oatmeal, I would start an average client making oatmeal on the stovetop. As part of the task, I would require them to find the needed supplies such as oats, a pan, and measuring cups in cabinets in the therapy gym. To simplify the task, I could set the needed supplies out on the counter before the task. To simplify the task more, I could ask the client to make instant oatmeal in the microwave instead of preparing it on the stovetop. To make the task more challenging, I would ask the client to embellish the oatmeal with toppings such as fruit that needs to be cleaned and cut. To make the task even more challenging, I would ask the client to obtain supplies from the facility kitchen or the store. I could also ask the client to make the oatmeal for a small group and prepare a variety of toppings that multiple people would enjoy.  

The second way to grade cognitive tasks is to add or remove distractions. Attention is a major component of cognition. Often, what I observe among my clients is that when their attention is challenge, other cognitive abilities suffer. Conversely, when I remove distractions, it allows them to improve their performance with other cognitive skills. Unfortunately, many daily occupations take place in locations or ways that challenge attention skills, so it is important to be able to grade this factor effectively.

In the example of making oatmeal, I would typically start a client in my therapy kitchen, which is in one corner of a larger therapy gym that usually has at least a couple of people working at any given time. To grade this task to reduce distractions, I could complete this task when the gym is empty except for the client and myself. To increase the level of distractions during the task, I could complete the task when the gym is particularly load or busy, or when another therapist and client area also working in the kitchen. I could also make have the client complete the task in a cluttered kitchen.  

The third way to grade cognitive tasks is to increase or decrease a sense of time urgency. This means adding a realistic or arbitrary time limit to the task to increase the difficulty.

In the example of making oatmeal, I typically start clients with no set time limit. If I want to make it more difficult, I would set a twenty-minute time limit which should allow for the whole task to be completed reasonably easily. To make it even more difficulty, I would set a twelve-minute time limit which would make it significantly more difficult to complete.   

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