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Functional Cognition and OT: Our Time to Shine

One of things I love most about being an occupational therapist is the huge diversity in our scope of practice. Bridging the gap between physical therapy and speech pathology, occupational therapy practitioners truly get the best of both worlds. We are able to dip our hands into orthopedic conditions as well as cognitive impairments (via neuro rehab).

While we typically consider speech therapists the cognitive and language experts, occupational therapists do play a big part in cognitive therapy. Functional cognition relates to the cognitive skills required to complete those meaningful daily activities that we all know so well.

So What Do These Self-Care Tasks Include?

For OTs, these instrumental ADLs (or IADLs) include tasks such as online shopping or planning a weekly menu and grocery list. Treatment for functional cognition is truly a place for OTs to let our creativity shine. You probably have endless books with cognitive worksheets for patients to complete. But I would suggest ditching those for a bit, and bring it all back to our roots (aka: function).

Think outside the box – I bet you can create some awesome activities or “worksheets” that are much more realistic and applicable to everyday life.

Everyday tasks don’t require just one cognitive component. We use memory, attention, problem solving, etc., cohesively to complete necessary tasks. So let’s think about the wide assortment of tasks we complete every day as adults.

Of course, some of these tasks will vary depending on the age range of your patients. Patients who are still working or have children will have different responsibilities, and thus a different set of IADLs, than those who are retired or are living in independent living/assisted living communities.

OTs are typically most attuned to two cognitively-related IADLs: paying bills and medication management. But adults obviously have so many more responsibilities, so why does our toolbox stop there?

As a parent, I can think about what I am responsible for and use that as a basis for forming challenging tasks for my patients.

  • Make a weekly meal plan and coordinated grocery list
  • Schedule my son’s before and after school sessions
  • Make doctor’s appointments and write them on our family calendar
  • Write checks to daycare
  • Pay lunch money online
  • Plan out a gift list for Christmas
  • Manage the spending for each of my kids and nieces or nephews
  • Figure out how long it will take me to get to various stores or offices using my phone map
  • Plan vacations and date nights

The list goes on! We are all responsible for so many daily tasks.. And so are our patients. So get out there and find out what they personally need to do to help them live life to their fullest potential.

Functional Cognition and Mealtime

Planning a weekly meal schedule is such a common and necessary task, and one that can change each week since we typically don’t eat the same things over and over!

Have your patient write out a week’s worth of basic dinners, and under each item include the required ingredients. They can use that list as their shopping list, or combine ingredients if the meals match up well.


Prior to shopping for ingredients, have them look through a local grocery store’s ads to find items on sale that might correspond to their list. Did they choose ordering pizza one night? Locate the pizza restaurant of their choice on their phone and identify what they want to order.

If you are working with someone experiencing aphasia or even processing difficulties, consider simulating a call to the restaurant with you providing the prompts for ordering delivery, which includes asking for their phone number, what they would like to order, how they will pay, and their address.

Scheduling and Timing Appointments

We probably all have used calendar tasks with patients, having them organize a series of events onto specific calendar dates. But simply writing appointments down on a calendar does not cover the entire task requirement. We can work on functional math when determining when to leave home for appointments depending on how early we need to be there.

For example, if you made a doctor appointment for 1:15 pm and the office is 15 minutes away from your house, how early should you leave to arrive 10 minutes early? Rather than simply work on writing a patient’s name, address, and phone number correctly on a blank piece of paper, simulate this requirement in a real-life situation – have them fill out a doctor office new patient form.

Money Management 

Managing money does not have to end at paying bills and balancing your checking accounts. As shopping online is so prevalent these days, it is a necessary addition to your intervention activities. Start with a designated task, such as planning a birthday party.

Involve all aspects of organizing the party, writing down whom to invite, food/snacks to be served, supplies needed, etc. Use the list to shop for supplies online and find a bakery that is close to their house (using their phone’s Map app) so that they can order a cake. Search for supplies on Amazon and write down the cost of each item.

Downgrade the task by providing a pre-fabricated list of supplies (rather than having them independently create one), and direct them to choose items that are most appropriate and required for a birthday party. Simulate a call to the bakery and take their cake order.

Have them calculate the total cost of the birthday party supplies and food (or separate these depending on how you grade the task).


You can use the same method for any entertainment activity and create varying challenges: going to the movies, planning a day out with a child or grandchild, or creating an estimated budget for a Christmas gift list.

Creating Your Own Scenarios

I seem to be making a case for task-specific simulation in intervention. We do this constantly with ADL practice, so why not up the ante on how we address functional cognition and use the same practice? With some spare time you can create your own scenarios, and you may enjoy doing it!

The University of Utah’s College of Health has a great resource for OT therapeutic activities that includes online bill paying (including utilities and credit cards) as well as a new online shopping activity – check this out to get you started.

Otherwise, have fun! Enjoy flexing your creative muscles and coming up with a product you can be proud of.

How do you like to incorporate functional cognition in your OT interventions? Please share your favorite functional cognition intervention tips and ideas in the comments below. 

And for even more about working in neuro occupational therapy in general, you can also check out Renee’s Day in the Life as an Outpatient Neuro Occupational Therapist here.

This post was originally published on April 6, 2020 and last updated on February 26, 2024.

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