Insight in to a client of mine.

I wasn't too sure what to write this week, so I reflected on a recent client that I saw. 

This client has a complex physical presentation as the result of a workplace accident.
When we think about functional cognition, we are taking in to consideration the entirety of the persons environment:

• Their parent that has dementia still living at home, having regular falls

• Their partner who does more complaining then supporting

• Their lack of control of their physical capacity, relying on equipment or physical carers. 

• Their grief and frustration surrounding their accident.

• Two funding bodies

And although these roles/occupations/ presentations aren't 'cognition' perse - we can view these as a huge impact on the way they're able to absorb information, deal with change and why they present with such significant frustrations around their carers and their a equipment; because that's what they can control. 

As a care team we currently have barriers with consistency of care, and satisfaction with equipment. There has been query around undiagnosed underlying psychological presentation too due to information not being aligned amongst care providers - we don't have that diagnosis, nor acceptance to seek this diagnosis. 

I know this is a common theme amongst participants in the community, this whirlwind of context that causes therapy to be hard to implement.

So how do we view this from a cognitive lens:

Current  barriers

• High cognitive load

  • Looking after parent, husband & going it 'alone'

  • High mental load with lack of emotional debrief opportunities

  • High carer program turnover

  • Lot's of equipment, and outstanding requests

• Lack of engagement in meaningful activities/roles

  • Fixated on equipment and carers

  • Wants to be home provider, unable to fulfil

  • No community/recreational activities

So what have I done to help? (And trust me I am not yet there, but I know all of this helps):

• Providing guidelines for care staff, and looking at training (due to high turnover really trying to reduce this)

• Looking at providing visual checklists to keep both people accountable 

• Providing equipment summaries, and how to follow up equipment if anything occurs

• Strong communication with broader team to improve expectations and boundaries.

• Listening, acknowledging barriers, providing solutions, and when they don't accept solutions asking; what would you like me to do about this? As this usually causes them to either stop complaining, or recognise a solution. 

• When emphasising a situation or complaint, working on summarising what the core of the issue; communication? equipment? education?

Learning about functional cognition really helps to drive the holistic view of the client. If I didn't know the depths of cognition, how cognitive load works, I would likely have burnt out from this client and they would've continued the cycle of changing providers. This is a common story for me, and a lot of my complex clients, who churn through therapists, stick by me even through the tough times. 

I'd love to hear your perspective on how understanding cognition impacts your practice?

Imogen.

I currently have one spot remaining for 6 week 1:1 support to get professionals feeling organised, efficient and ready to clock of for Christmas. If this sounds like something you might like to do have a looksee here. 

We are hiring for 2026. If you’re an occupational therapist with 2–3+ years’ experience ready for a fresh start in the new year, in Geelong, Vic, I’d love to hear from you: Careers at Occupationally Neuro