Cognitive Activity using Peg Board for Speech Therapy in SNF

As a SLP, I work PRN providing speech therapy for a company that contracts into nursing homes/SNFs. Our patient caseload is heavily weighted for cognitive therapy specifically memory, problem solving, sequencing, and attention. These qualities are ALL necessary for a patient to complete simple ADLs (activities of daily living) such as eating, brushing their teeth, getting dressed as well as more complex activities like bathing, walking, climbing stairs or even more complex administering their own medication, preparing a meal or going to the grocery store.

Many a Saturday, I walk into a therapy room and have NO idea where any of their “speech stuff” is and don’t feel comfortable or have the time to dig through cabinets and file cabinets looking for what I tend to think are less practical worksheets for patients to squint their eyes/adjust their bifocals and attempt to use their less than steady hands to hold a pencil answering questions that have very little relation to their actual problem: What keeps them from getting HOME!

If you are working in a SNF therapy room, there will always be a few things. As I mentioned in my previous post: My favorite things in a SNF, you will see some pegs somewhere. I print and carry with me this document and trim it to whatever peg board they have available in their therapy room.

Most buildings have a 10×10 peg board. Some have the 5×5. If they only have a 10×10 and your patient’s attention doesn’t lean toward a board that big, take a blank piece of paper from the printer and cover up the other holes, making it into a 5×5 board.

Lesson learned: Carry your markers in your bag. You can USUALLY find highlighters to work with most of the colors, a crayon or two if you are lucky. Most pegs are Red, Blue, Yellow, Orange and Green. Some facilities have a Purple. These are the only colors I have seen.

I level the activity in a few ways and would love to hear in comments below if you have any NEW and Exciting ways to use the same template in your therapy sessions.

1. Make a simple pattern of only one or two colors to work on memory.

Ex: A red peg square filled in with yellow pegs.

Show the patient the picture and tell them to study it and remember it because you will be taking it away. Remove the picture and let them recreate it from memory. Cue as needed to help them be successful in the task.

2. For visual scanning, especially for a patient with left neglect, place the peg board on the left side of the table, the pattern on the right. Having them reach to cross mid line to recreate the pattern will help them when scanning the table for food, the sink for toiletries, the kitchen counter when preparing a meal,  or the floor for potential fall hazards.

3. For attention, reasoning, problem solving and sequencing, use all of the colors available and have the patient recreate a more complex pattern where they may need to keep one finger on the pattern and the other hand actively inserting pegs into the board. Ask questions while they work on the puzzle or have them name something of a category while they put in a certain color peg.

Depending on the ability of the patient, increase the complexity of the task. Make it fun and engaging most of all. You would be surprised the patients who HATE the peg board who end up LOVING it and asking for it the next time they do Occupational Therapy! Always leave your patterns at the building for the OTs to use during the week…we all learn from each other and a TEAM is the only way to get a patient home. It’s rewarding to come back a week or two later and pull out the same pattern to find that a patient has mastered it at one level and you need to increase the complexity to a higher level.

Here is a picture of a moderately complex pattern. It is a 10×10 and I used all of the colors. I had this patient performing the task in standing with a rolling bedside table because I was co-treating with PT part of the time. If the patient is independent with standing (read the other disciplines notes while you are working on your own) I have them stand according to what the other therapists say is appropriate and safe. Medicare doesn’t say anywhere in their regulations that a SLP can’t work on standing safety if they have a goal for problem solving and hazard recognition during ADLs!

Above is a picture of one way I increased the complexity for a patient who mastered doing it by following along row by row, color by color. I made a “key” at the bottom of the page for the colors and only wrote numbers on the template for them to reference. This requires alternating attention which is SO important. Think about walking down the hall and someone stopping and saying “hello”. That takes your attention off the task of walking, posing a risk of fall.

Notice I used the clothespin tree to hold my pattern. Look around, you will find something to use. Think outside the box!

Are you limited on time and creativity!?!