Skill

Description

Neglect

Definition: Visual information presented on one side (e.g. right or left) is ignored.

Real Life Impact: Missing information presented on board or on paper

Safety concerns at home and in the community such as: driving, crossing the street, cooking
Difficulty completing ADLS: missing food on one side of plate, grooming one side

Recommendations:

• Neglect training to carefully scan from left to right
  
• Referral to optometrist and/or neurologist 
  
• Developing routines to ensure that you remember to scan and complete tasks
  

Acuity

Real Life Impact: Driving, reading, using computer, completing work or school-related activities

Recommendations:

• Referral for vision test and prescription for glasses/contacts (optometrist)
  
• Arrange to sit closer in meetings or presentations
  
• Accommodations for bigger font on computer screen or written instructions
  
• Receive instructions verbally instead of written/visually
  
• Use your vision aids (e.g. glasses) whenever possible 
  

Colour Blindness

Real Life Impact: interpreting traffic signs, ability to perform some occupations (e.g. pilot)

Recommendations:

• Referral to vision test (optometrist)
  
• Receiving services to help cope (e.g. clinician support)
  

Visual Perceptual

Definition: Being able to determine subtle differences in objects, pictures, letters/words; ability to recall visual traits of an object; being able to recognize a shape is the same even when rotated; being able to find a target object against a background.

Real Life Impact: Difficulty with reading and writing, safety concerns at home and in the community, driving (depth perception)

Recommendations:

• Referral for visual testing (optometrist)
  
• Referral to occupational therapy for visual training
  

Hearing

Real Life Impact:  Hearing important information (e.g. at work meetings, school lectures), conversations with family/peers, safety concerns in the community (e.g. pedestrian)

Recommendations:

• Referral for hearing test (e.g. audiologist)
  
• Asking others to repeat instructions
  
• Receiving written instructions to complement verbal
  
• Face the person who is speaking and try to focus on speaker’s mouth
  
• Situate self in quiet work/school environments to reduce auditory distraction
  

Fine Motor Coordination

Real Life Impact:  Handwriting, dressing tasks (e.g. buttons), typing, feeding, grooming

Recommendations:

• Referral to OT for assessment and treatment of fine motor skills
  
• Training of fine motor (e.g. TheraPutty, practicing dressing tasks)
  
• Request accommodations (e.g. extra time of exams/assignments, alternative methods)
  

Static Balance

Definition:  Ability to maintain balance while standing still in various positions.

Real Life Impact: Gross motor skills, sports, walking, sitting/standing for long periods in class or at work, driving posture, walking on uneven surfaces

Recommendations:

• Referral to OT/PT for gross motor assessment and treatment 
  
• Mobility aids or assistive devices (e.g. cane, walker)
  
• Energy conservation strategies (pacing, taking frequent breaks)
  

Impulsivity

Real Life Impact: Money  and medication management, emotional regulation, conflict resolution, risky behaviours (i.e. drug use, sexual activity), rushing through tasks at work or at school

Recommendations:

• Developing a routine/planner (money management, when to complete activities)
  
• Read instructions fully and ensure that you understand the task before participating
  
• Ask questions if you do not understand
  
• Pros/cons list to assist in decision making
  
• Reflecting on the consequences of your choices afterwards
  

Emotional Regulation

Real Life Impact: Social skills, communicating with others, relationships (working, friends/family, partners), emotional dysregulation, lack of insight into own/other emotions

Recommendations:

• Asking the person what they are feeling instead of assuming
  
• DBT skills training (distress tolerance, emotional regulation)
  
• Role-play with clinician 
  

Assertive communication strategies 

Memory – Immediate (Auditory)

Definition:  Ability to remember a small amount of information, presented verbally, immediately.

Real Life Impact: Meeting new people (remembering names), listening to lectures or meetings

Recommendations:

• Writing things down during class/work or into agenda
  
• Asking speaker to repeat instructions
  
• Mnemonic devices and repeating to yourself for recall
  
• Use audio recorder (with permission)
  
• Request accommodations at school (e.g. note taker, alternative format)
  

Memory – Immediate (Visual)

Real Life Impact: Instructions written on the board displayed visually at a meeting, traffic/construction signs while driving, meeting new people (remembering faces)

Recommendations:

• Mnemonic devices (repeating information in your head)
  
• Asking for instructions verbally
  
• Request accommodations (e.g. note taker, alternative format)
  

Memory – Immediate (Auditory, Complex, Novel)

Real Life Impact: Meeting new people (remembering names), listening to lectures or meetings

Recommendations:

• Writing things down during class/work or into agenda
  
• Asking speaker to repeat instructions
  
• Mnemonic devices and repeating to yourself for recall
  
• Use audio recorder (with permission)
  
• Request accommodations at school (e.g. note taker, alternative format)
  

Temporal Awareness

Definition:  Awareness of the passage of time.

Real Life Impact: Remembering appointments, scheduling (work/life/leisure balance), becoming consumed in certain activities (e.g. watching TV or playing video games)

Recommendations:

• Set alarms for cueing (e.g. 45 minutes of studying, alarm, 15 minutes off, alarm)
  
• Use a scheduler/agenda to plan out your day and how long to spend on each activity 
  
• Asking others for reminders (phone calls)
  

Attention – Selective (Visual Distraction)

Real Life Impact: Focusing in class/while studying or while at work, driving , unable to complete tasks before starting new task

Recommendations:

• Place self in spaces with minimal visual distraction for work/school/homework
  
• Drive during non-peak hours and avoid construction, traffic, pedestrians 
  
• Request accommodations (ex. extra time for assignments, private work space)
  
• Grounding/mindfulness strategies (stay in present, deep breathing)
  
• Setting limits when working on tasks and recognizing when you’re overwhelmed
  

Attention – Selective (Audio Distraction)

Real Life Impact: Focusing in class/while studying or while at work, driving, unable to complete tasks fully before starting new task, becoming overwhelmed with sensory input

Recommendations:

• Wear noise-cancelling headphones when working independently 
  
• Study/work in quiet spaces with no audio distractions (e.g. TV, music)
  
• Request accommodations (e.g. separate room for writing tests)
  
• Grounding/mindfulness strategies (stay in present, deep breathing)
  

Memory – Delayed (Written and Cued)

Definition:  Ability to recall information presented in written format from some time ago (minutes, hours, days).

Real Life Impact: Test taking, remembering appointments/when to take meds, lectures/meetings

Recommendations:

• Create mnemonic devices or visualize information
  
• Reading over information several times, over a spread-out period (no cramming)
  
• Summarize/paraphrase into own words with key points 
  
• Repetition
  

Memory – Delayed (Auditory and Written)

Real Life Impact: Test taking, remembering appointments/when to take meds, lectures/meetings

Recommendations:

• Write it down information immediately after receiving it
  
• Mnemonic devices and repeating to yourself 
  
• Asking for clarification and reminders
  
• Scheduling in phone/laptop/calendar
  
• Active listening skills 
  

Memory – Working

Real Life Impact: Keeping track of conversations or test-taking, remembering appointments/when to take meds, lectures/meetings

Recommendations:

• Write it down information immediately after receiving 
  
• Repeating information to yourself and asking for clarification/reminders
  
• Mneumonic devices
  
• Scheduling in phone/laptop/calendar
  
• Active listening skills
  
• Reduce distractions (visual/auditory)
  

Problem Solving (Numerical)

Definition:  Ability to find a solution to an (arithmetic) problem.

Real Life Impact: Work (e.g. cashier), assignments at school, money, time, and  medication management

Recommendations:

• Use a calculator or other device for math-related problems
  
• Request accommodations (e.g. extra time for assignments involving math)
  
• Practicing basic math skills (division, multiplication, addition, subtraction)
  
• Use excel spreadsheet for budgeting available online 
  
• Seek out support for finances, budgeting, taxes (family, accountant)
  
• Have meds put into blister packs
  

Constructive Ability

Real Life Impact: Breaking down steps/tasks (e.g. cooking, building objects/furniture, school projects, morning/night routine), seeing big picture concepts from smaller things

Recommendations:

• Use an agenda/scheduler 
  
• Follow verbal/written instructions if provided 
  
• Creating a plan before completing tasks (i.e. know everything you need to do, how urgent each one is, how much time it typically takes)
  
• Practice doing puzzles, use brain training programs
  

Route Finding

Real Life Impact: Driving, navigating surroundings, managing time efficiently when going to destinations (e.g. jobs, school, classes)

Recommendations:

• Use a GPS/map app 
  
• Planning most efficient route before you leave
  
• Practicing route to become familiar with area
  
• Support from bus drivers, peers, taxi
  
• Identifying landmarks
  

Sequencing

Definition:  Ability to accurately arrange items in a particular order.

Real Life Impact: Cooking/baking, morning routines, school work, learning a new skill

Recommendations:

• Referral to OT for task analysis and recommendations 
  
• Following instructions, verbal or written
  
• Creating a plan before carrying out a task and following it 
  
• Using a planner/agenda
  

Attention - Divided

Real Life Impact: Multi tasking (e.g. listening to lecture while taking notes, certain jobs, driving, conversation in busy environment)

Recommendations:

• Try to focus on one task at a time
  
• Scheduling in advance so that you have enough time to complete all tasks
  
• Request accommodations (e.g. recording lectures, note taker)
  
• Reducing audio/visual stimuli (e.g. noise cancelling headphones, where you sit in class)
  

Memory – Delayed (Faces and Names)

Real Life Impact: Networking with people, social relationships, job interview, scheduling appointments (e.g. knowing who your clinician is)

Recommendations:

• Asking someone to repeat their name
  
• Repeating name back to them 
  
• Writing their name down (e.g. on appointment card)
  
• Remembering distinguishing features (e.g. wears glasses)
  
• Reducing audio/visual distraction when they introduce themselves
  

Memory – Prospective (Auditory – 2 Steps)

Definition:  Ability to remember to do something in the future that requires two steps to complete, starting with an auditory cue.

Real Life Impact: Test taking, remembering appointments/when to take meds, remembering tasks given at work or school, instructions from bosses

Recommendations:

• Write it down immediately after getting information
  
• Repeating information to yourself or using mnemonic devices
  
• Asking for clarification and reminders
  
• Scheduling in phone/laptop/calendar
  

Mental Flexibility

Real Life Impact: Conversations/communication with others (e.g. seeing their point of view), problem solving around barriers (e.g. driving and construction, everyday routine tasks)

Recommendations:

• Have a routine, and alternatives for potential barriers 
  
• Keeping a schedule and being able to prioritize and switch out tasks if a challenge arises (e.g. it’s raining so I can’t bike – switch it out for another task)
  
• Brain training apps
  
• Role playing/assertive communication strategies
  
• Distress tolerance skills
  
• Learning to calm down and think of a rational solution
  
• Asking for help if you are stuck
  

Abstract Reasoning

Real Life Impact: School lectures (e.g. picking up on key themes), transferring skills (e.g. math with money management), training at work/school and applying into daily life scenarios (e.g. scheduling with all tasks for remembering, school)

Recommendations:

• Guided discovery and cognitive mediation
  
• Breaking down a activity/scenario and identifying all the concrete skills
  
• Working in groups or with peers on assignments to learn how they do tasks and their point of view
  

Judgement for Safety

Real Life Impact: Cooking, driving, independent living skills, risky behaviours

Recommendations:

• Having emergency plan in place if living independently or trying new skills (ex. cooking)
  
• Assess with verbal reasoning scale of CCT to determine how they view emergency situations
  
• Discussions through emergency situations and what to do
  
• When in doubt, call for help
  
• Referral to OT for home safety assessment
  

Foresight for Safety

Real Life Impact: Risky behaviours (sex, drugs, smoking), cooking (e.g. leaving oven unattended), other independent living skills

Recommendations:

• Having emergency plan in place if living independently or trying new skills (ex. cooking)
  
• Assess with verbal reasoning scale of CCT to determine how they view emergency situations
  
• Discussions through emergency situations and what to do
  
• Err on the side of caution. When it doesn't seem safe, don't perform activity
  
• Referral to OT for home safety assessment
  
• When in doubt, call for help
  

Comprehension and Humour Inferences with Distraction

Real Life Impact: Conversations, social interactions, self-awareness, understanding leisure activities (movies, TV, comedy shows)

Recommendations:

• Roleplaying with clinician
  
• Teaching to pick up on non-verbal body language (smiling, laughing) 
  
• Asking others to clarify what they mean (e.g. if they were literal)
  

Executive Functioning and Combined Skills

Definition:  Ability to make decisions; ability to arrange things by importance; ability to list activities required to create a desired future action; ability to arrange elements according to one or more rules.

Real Life Impact: IADLs (laundry, med management, driving, prioritizing activities, scheduling), decision making (weighing pros and cons)

Recommendations:

• Creating pros and cons list
  
• Breaking down activity into activity into steps and then prioritizing most urgent first
  
• Writing down incoming information to organize for later
  
• Ensuring all options explored (ex. before choosing a gym, weighing cost of membership, environment, goals)
  
• Referral to OT for task analysis and goal setting
  
• Guided discovery through tasks with therapist
  

Information Processing Speed

Real Life Impact: assignments/exams at school, work projects, completing tasks at home, driving, cooking

Recommendations:

• Request accommodations for extra time during exams/work
  
• Having information verbally or written down to reduce time and increase attention 
  
• Planning steps beforehand to follow (e.g. recipes when cooking)
  
• Potential supervision on complex or potentially unsafe (e.g. driving, cooking)
  
• Ensure good sleep hygiene practices
  

Mood and Behaviour

Real Life Impact: Relationships, self awareness, motivation/confidence/self efficacy to complete tasks

Recommendations:

• Emotion regulation strategies (DBT, CBT, de-stress tolerance, motivational interviewing)
  
• Behavioural activation strategies (ex. action over Inertia workbook)
  

Endurance

Definition:  To sustain cognitive processes without degradation of abilities.

Real Life Impact: Being able to complete a full work or school day, completing complex tasks (ex. online banking, cooking), potential for burnout or safety concerns (rushing), additional carryover fatigue into other activities

Recommendations:

• Energy conservation strategies (e.g. take frequent breaks, pacing, breaking tasks down into smaller steps)
  
• Reducing divided attention (audio, visual stimuli)
  
• Accommodations for extra time at work/school
  
• Ensure good sleep hygiene
  

Comprehension and Communication

Real Life Impact: School and work, reading and writing, driving

Recommendations:

• Following instructions (recipe, steps)
  
• Alternative communication (ex. pictures, video, Dragon Dictation) 
  
• Asking for simplified instructions
  
• Pacing and taking frequent breaks