Have you seen all the 🚩 red flag posts on social media lately? People are pointing out what they consider to be warning signals that someone or something is no good.

I can only get behind a trend to point out what's wrong as long as there's a way to make it better. So taking my cue from an SLP colleague, this week I'd like to talk about some trouble with cognitive therapy in our field (red flags), and how to make it better (green lights).

🚩 Playing games to practice planning, organization, and problem-solving skills.

While it's true that playing games often requires these skills, they don't improve just through use. Skills should be practiced in the environment in which we want to use them. That means if we want to improve planning a daily schedule, we should practice schedule planning, not planning the next move in a game. (If the goal is to improve your game playing, then by all means, go right ahead!) This is the specificity principle of neuroplasticity.

The INCOG recommendations for cognitive rehab state: "Metacognitive strategy instruction should be used with adults with TBI for difficulty with problem solving, planning, and organization. These strategies should be focused on everyday problems and functional outcomes." (If you haven't read all 5 INCOG articles, I strongly recommend them!)

✅ Work on the thing you want to improve, incoporating feedback and strategies for self-monitoring and self-regulation.

🚩 Handing out a list of strategies or practicing a new skill once.

It's not enough to go over memory, word-finding, or executive functioning strategies once and consider them taught. People with cognitive challenges especially need hands-on practice, multiple times, and in all the different scenarios they're going to use the skill. This is the repetition principle of neuroplasticity in action.

If a person isn't in therapy very often, it's important to teach the people around them how to encourage repetition of the new skill or strategy. Or use technology like apps to allow for independent practice between sessions.

✅ Repeat the steps over and over, and plan ways to get practice between therapy sessions.

🚩 Practicing memory strategies on lists of random words.

People with memory impairments struggle to remember important things, so it stands to reason they'll struggle even more to remember new strategies that help them remember things that are meaningless to them. That's why we need to work on meaningful memory targets, like safety procedures, answers to repetitive questions, or the use of a memory book. This makes use of the salience principle of neuroplasticity.

And rather than ask the already-damaged declarative memory system to learn something new, we can make use of procedural memory using a technique called spaced retrieval training. This research-based technique can help people with moderate memory problems recall important information and procedures over increasingly longer intervals.

✅ Use evidence-based memory training techniques, like spaced retrieval, on personalized memory targets.

The Spaced Retrieval Therapy app

We've made it super easy for you to implement spaced retrieval traininig in your therapy with an affordable app that takes care of the data tracking, time intervals, and reminders for you!

Track up to 3 personalized memory targets at a time, and email clinical reports after each session. You'll never miss another interval again, and you can keep your attention on your client instead of the clock.

Get the Spaced Retrieval Therapy app on your iOS or Android device for just $4.99 USD!

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Thanks for reading! I'm so glad you're open to improving your practices for better patient outcomes. ✅

Have a great week,

Megan

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P.S. Follow me on Instagram or Facebook for more posts about cognition all this month! 🧠