Imagine for a moment that you’ve irrevocably lost your calendar.
Feel a little panicked?
Now imagine that you’re holding your calendar in your hand, but instead of being a useful tool it’s a source of frustration.
Many of our patients find themselves in this position, due to head injury, disease, or other conditions. The difficulties causing their frustration may lie at the level of language skills, cognitive-communication skills, or both.
Fortunately, we can address this problem in four steps:
- Identify a personally relevant goal.
- Select appropriate calendar-based therapy activities.
- Choose an appropriate calendar.
- Use an effective teaching method.
1) Identify a Personally Relevant Goal
In order to ensure that therapy is functional for each individual patient, we need to take the time to discover what is important to them. When we understand the ultimate goal of therapy, we can ensure that our therapy activities are personally relevant.
We should ask ourselves, “What will our patient be able to do in their daily life when we discharge that they couldn’t do at the start of therapy?”
2) Select Appropriate Calendar-Based Therapy Activities
Once we’ve identified our patients’ goal, we can choose appropriate therapy activities at the level of their impairment. Here are some ideas, broken down by language and cognitive-communication skills.
Reading and Writing
To address issues in reading or writing, we may ask our patients to answer (or read) questions such as the following:
- Which month is this calendar turned to?
- Please point to Monday, April 5th.
- Do you have any appointments on the last Friday of this month?
- What do you have planned for April 21st?
- Write down tomorrow’s date and appointments on this yellow sticky note and put it on your bathroom mirror.
- Do you have any appointment cards? Let’s add them to your calendar.
- Pencil in this imaginary appointment: Dr. Roberts, Monday, May 10th at 1:30 P.M. (Be sure to erase it afterward to avoid creating confusion!)
Impaired auditory comprehension can also limit our patients’ ability to accurately understand conversations with receptionists, medical professionals, caregivers, or family members. Work on auditory comprehension skills with therapeutic instruction and questions such as:
- Point to where it says “April.”
- Where is the first Monday in the month?
- Today is Friday, April 9th. Where is that?
- Point to your last therapy appointment.
- Show me your birthday (or name a holiday).
- Point to your next doctor’s appointment.
Impaired verbal expression limits our patients’ ability to make, confirm, or change appointments. To improve speaking skills, ask questions such as:
- What is your date of birth?
- Say the days of the week in order (from memory or read from the calendar).
- What is today? Yesterday? Tomorrow?
- Say the months of the year.
- What is the month? Last month? Next month?
- What appointment do you have tomorrow?
- When is your next dentist appointment?
- What would you say to a medical scheduler who wants to book an appointment at the same time as one you have with another doctor?
- Imagine I’m your doctor’s receptionist. How would you ask to change this appointment to another day?
While solid language skills are a necessary prerequisite for using a calendar effectively, they aren’t sufficient. Broader cognitive-communication skills are necessary as well, including visual attention, memory, reasoning and problem solving, and executive function skills.
To address these broader cognitive-communication skills, ask questions such as:
- What’s the next major holiday?
- What was the last major holiday?
- When is your next doctor’s appointment?
- What was your last doctor’s appointment?
- Let’s practice your short-term memory strategies by remembering that you have an appointment with your podiatrist at 9 A.M. on Friday. I’ll ask you every so often what your next appointment is.
- Imagine that your dentist calls and wants to reschedule your cleaning to 9:30 this Friday. What would you say? (It conflicts with the podiatry appointment.)
- I see that you have three appointments next Monday. Please tell me your plan for the day, starting with what time you’ll have to get up.
There’s nothing like performing meaningful tasks to reinforce the strategies we teach. Whenever possible, try to engage the patient in real-world tasks, such as:
- Call and confirm your appointment for tomorrow.
- Make a new appointment and record the details.
- Take a stack of appointment cards and add them to the calendar.
- Make a list of questions to ask at your next doctor’s appointment.
3. Choose an Appropriate Calendar
Once we know our patients’ goals and the specific skills we’ll be training, we must decide what type of calendar we will use. Will we use a patient’s existing calendar or introduce a new tool? Will we use a paper month-view calendar? A weekly schedule book with pre-printed hours? A white board? An electronic calendar? A virtual assistant like Google Home or Amazon’s Alexa?
In order to select an appropriate tool, we consider what our patient used prior to injury or illness and what they’re using now. We consider their strengths and weaknesses along with their goals. And, of course, we ask them what their preferences are. We can then make a couple of recommendations based on our clinical judgment and allow them to choose what they’d like to try.
4. Use an Effective Teaching Method
Finally, we must decide which teaching method we will use. While a teach-and-test method may be effective for someone who is only mildly impaired, many patients don’t respond well to this trial-and-error method. We may instead wish to use systematic instruction or another errorless learning protocol to teach language and cognitive-communication strategies and procedures.
Want more strategies? Add more patient-centered tools to your cognitive communication toolbox with these MedBridge courses: