The Memory Unit OT

Silverware sorting is one of the most basic of activities, but it can become one of the best skilled sessions when transformed by strong Activity Analysis skills.

There are countless ways we can modify this task, but let’s look at 3 different types of Residents with 3 different care plan examples (all of whom are living with a cognitive impairment or disease).

Resident 1 is working on Sustained Attention to Task. She really does not enjoy structured therapy sessions and can be difficult to engage at times.

I’m starting her session by getting everything set up before I even go get her. I’m putting a mixture of silverware into a bin on the table, alongside an empty silverware tray.

When I got to get her for therapy I say “I’ve been working on something in the other room and I could really use your help”. Then we head down to the therapy space together.

The only thing I want her to do is sort the silverware. If we’re early on in her care plan, maybe we’re only sorting by 2 types; if we’ve been working on this task for a few weeks we’re likely sorting by 3 types.

When I objectively document, I’m including the number of sorting categories, the amount of time she could attend to the task (in minutes), the number of cues she required to maintain attention, the number of cues she required to successfully sort, and how many times she was successful out of the number of opportunities (aka. she sorted 12 utensils correctly out of 15 total).

Resident 2 is working on Upper Body Strengthening. He does not enjoy rote exercises and will not complete more than 3 reps of a basic weighted exercise.

I’m initiating his session the same way I initiated Resident 1’s session; I’m asking him to help me with something.

Except his session is entirely in standing. The silverware is spread out across the entire table and the silverware tray is placed directly in front of him. I apply weighted cuffs to his wrists to increase resistance and ask him to retrieve each utensil 1 at a time. Depending on his level of cognition, I’ll choose either a 2-type or a 3-type category sort.

When I objectively document, I’m including the weight applied to the wrists, the number of reps he could tolerate before requiring a break, the number of times he could attend to the task (in minutes), and the number of cues he required to successfully sort each utensil.

Resident 3 is working on Visual Perceptual Skills. He frequently grabs just to the side of a cup during meals and often will not position himself close enough to a chair before sitting down.

For his session, I’ve got everything set up at a table in a well-lit, minimally stimulated environment. I only have one type of silverware to sort, but the utensils are varying sizes and I’m asking him to sort by small and large (or small/medium/large once we’re ready to upgrade the task).

When I objectively document, I’m including the number of categories we’re sorting by, the amount of time (in seconds or minutes) it takes to determine the size of each item, the number of cues he required to successfully sort each utensil, and how many times he was successful out of the number of opportunities (aka. he sorted 18 utensils correctly out of 20 total).

Here’s the main take-away: it’s not so much what activity you choose to do with your Residents, but how you’re using your Activity Analysis skills to make that activity work for each individual.

I hope this example gives you some inspiration into how this can work practically. I tend to love the simpler activities because I often can come up with more intervention styles the simpler the task is.

If you give utensil sorting a try, I’d love to hear how your sessions go!