005 TFCC: Decisions, Decisions.. Maybe?
The Functional Cognition Chronicles
Issue #5: Reducing Daily Decisions
Hello, XXX,
When supporting clients with cognitive barriers, the concept of decision fatigue and cognitive load becomes particularly relevant. Many of our clients experience challenges when faced with multiple decisions throughout the day, as each decision requires mental effort. Over time, this contributes to a higher cognitive load, which can lead to decreased participation, and reduced functional capacity.
In this issue, we’ll discuss how reducing the number of daily decisions can conserve cognitive energy, improve engagement in meaningful activities, and enhance overall independence. For more information on cognitive load, refer to Blog Post 2 in this series.
The Impact of Executive Function Impairment
Individuals with brain injuries or other conditions that affect executive functioning often experience difficulty with decision-making. Clients with executive function impairments may rely heavily on others to make decisions on their behalf. This can range from everyday choices, like what to wear or eat, to more significant decisions such as financial investments.
Clients with executive functioning challenges may also struggle with forward planning and future thinking, leading to impulsive decisions or risky behaviours. Since executive function involves planning, reviewing, and making decisions, this issue of TFCC outlines interventions to help reduce the number of daily decisions required for functional engagement. For some clients, this might involve basic tasks like choosing clothes, while for others, it could involve more complex decisions, such as managing finances.
The Impact of Cognitive Load
It’s important to recognise that individuals with disabilities typically face a higher cognitive load. As discussed in Issue 2, people with disabilities often have a significant amount of information to process daily, quickly reaching their cognitive load thresholds. Cognitive load refers to the mental effort required to process information, make decisions, and complete tasks.
Reducing daily decision-making can help not only individuals with cognitive impairments but also those with typical cognitive function who may become overwhelmed. Cognitive overload can lead to decision fatigue—a state where the brain becomes less efficient at making decisions due to mental exhaustion.
By implementing compensatory strategies, clinicians can help reduce daily decisions, allowing clients to focus their cognitive resources on essential activities. Let’s explore some strategies to minimise decision-making and promote functional independence.
Compensatory Strategies to Reduce Daily Decision-Making Load
1. Whiteboards: A Simple Yet Effective Tool
Whiteboards can serve as a powerful visual aid in helping clients externalise their decisions. By displaying a daily or weekly plan, clients can see all their upcoming tasks at a glance, reducing the need to recall information or make decisions in the moment. These can be personalised to best suit the person and they required occupation. There is really no limitations with whiteboards as long as you take into consideration the clients occupational performance issues.
Clinical Example: I have previously used whiteboards to allow my client to write down their weekly meal plan for the week. They would have a key support worker sit down with them at the start of each week and rewrite their weekly meal plan with looking into the fridge and storage options before they went grocery shopping. The client was able to write down their weekly meals and therefore it reduced the decision making of what they needed to eat for the day and also assisted with the grocery shopping for the week.
2. Assistive Technology: Digital Tools for Cognitive Support
Technology can be a game changer in reducing decision fatigue. There are many tools available that can streamline decision-making and reduce cognitive demands:
Voice-Activated Assistants (e.g., Google Home, Amazon Alexa): These tools can remind clients about key daily tasks, such as taking medication or attending appointments. They can also be used to set timers for routines, such as “time to get dressed” or “time for lunch.”
Digital Calendars and Apps (e.g., Google Calendar, Trello): Encourage clients to use apps that allow them to schedule and receive reminders. Include activities of meaning in their calendars as well to enable them to Plan out their week and engage in both have to and want to activities this is helpful for clients who are impulsive and perhaps want to go Out for dinner regularly however have a budget to adhere to and therefore support workers can support them with regard to for planning that they will be out on Friday night and will not need to go out tonight or understand the consequences of going out tonight means that they won't have any money to go out with friends.
Task Management Apps (e.g., Todoist, Microsoft To-Do): For clients with executive function difficulties, task management apps can organise and categorise daily activities. Some apps also have voice dictation features, which allow clients to quickly note tasks without the cognitive effort of typing.
Further Example: A client with significant cognitive fatigue may benefit from using a voice-activated assistant that can provide auditory prompts. For instance, “It’s 10 AM, time to get ready to to your doctor’s appointment at 11 AM.” is a more intuitive way to receive reminders than relying on memory or written notes. I would encourage you to review Issue 001 on voice prompting alarms.
3. Decision-Making Flow Charts
Flow charts are useful tools for clients who struggle with prioritising tasks or making choices. These visual guides help break down complex decisions into manageable steps, reducing mental effort and minimising confusion.
A simple chart enables clients to make decisions quickly without relying on internal cognitive processes. Previously I have implemented these flow charts and then removed them as their functional capacity has increased and they have created the internalised monologue.
Decision making flowcharts are great for financial planning, I typically find that clients who require support with budgeting due to their executive functioning difficulties require a prompt to assist them with understanding if they want to spend this money. A decision flow chart actually assist with understanding the consequences associated with spending the money this really enables engagement in choice and control although it is informed choice and control.
4. Pre-Prepared
Providing clients with templates for common decisions is another practical method to reduce cognitive load. Examples include weekly meal planners, self-care checklists, and daily task breakdowns.
You could even introduce the concept of a capsule wardrobe. Clients can prepare 2-3 outfit combinations to reduce decision-making in the morning.
This approach also works for self-care or personal hygiene. For instance, a checklist reminding clients to brush their teeth or apply deodorant can significantly increase independence, and eventually build capacity of functional independence.
5. Physical Environment Modifications
This was discussed in Issue 003 of TFCC. Optimising the client’s physical space can promote automatic decision-making. Simplifying the layout of their home or workspace ensures that needed items are always in easy-to-reach and familiar locations, reducing the need for unnecessary decisions.
Example: A client who struggles with executive functioning can benefit from labelled containers in their kitchen, organised into “breakfast items,” “snacks,” and “dinner prep.” This ensures that food preparation is simplified and less cognitively demanding.
6. Care Plans for Support Workers
Care plans can reduce decision fatigue for clients who rely on support workers. Rather than requiring clients to articulate what they need during each session, a care plan ensures the support worker knows what tasks to assist with, reducing the need for verbal prompting.
For example, if it’s a community access shift, providing a few pre-planned options can reduce the burden of decision-making, allowing clients to focus on life administration tasks noted in a to-do list.
In Summary
By incorporating structured routines, compensatory strategies such as whiteboards and flow charts, or leveraging assistive technology, clinicians can help reduce the amount of decisions required in a day to day task. This also reduces overall cognitive load on clients associated with decision fatigue. This empowers clients to use their cognitive resources more effectively, enhancing their ability to participate in daily life. Modifying the physical environment further supports reduced decision-making demands, promoting independence.
Your Clinical Challenge: This week, introduce one of these strategies with a client experiencing decision fatigue and observe the impact on their functional performance.
