In rehabilitation, the ability to mirror real-world demands is crucial for promoting client independence and engagement. One often overlooked yet highly effective method is dual tasking—the ability to perform two tasks simultaneously. Whether integrating motor-motor or cognitive-motor activities, dual tasking is a key driver in bridging therapeutic exercises to functional performance. For occupational therapy practitioners, embedding this approach in treatment design provides a systematic way to progressively challenge clients and improve real-world carryover.

Dual Tasking in Rehabilitation – Why It Matters

Occupational performance rarely involves isolated tasks. From preparing meals to navigating a crowded space, multitasking is an unavoidable aspect of daily life. Dual tasking addresses this by layering cognitive and motor components into rehabilitation, closely simulating the demands of everyday environments.

For example, while walking (a motor task), a client may need to recall grocery lists (a cognitive task) or carry laundry (a motor-motor task). This layered approach reflects the true complexity of occupation—where executive functions coordinate not only motor control but also emotion, autonomic responses, and social engagement.

As practitioners grounded in neuroscience and functional cognition, we must recognize the cognitive load motor control places on the body. If our treatment plans don’t reflect this reality, we risk limiting progress and functional outcomes for our clients.

Simple Ways to Integrate Dual Tasking into Treatments

Incorporating dual tasking doesn’t require reinventing the wheel. By weaving these strategies into existing interventions, therapists can challenge clients within their current capacity, gradually increasing the complexity through progressive overload.

Here are a few simple yet effective ways to embed dual tasking into therapy:

• Laminated Number and Alphabet Circles: Use these during standing balance exercises or upper body reach tasks. Ask clients to recite or categorize as they engage in the motor activity.
• Load and Carry with Conversation: Engage clients in simple conversation or ask questions while they perform weighted load-and-carry tasks, enhancing both motor and social-cognitive engagement.
• Digit Span Reversals: While performing upper body exercises or working on spasticity management, introduce digit span reversal tasks to enhance working memory and divided attention.
• Balance with Categorization: While standing on a rockerboard or foam pad, introduce categorization tasks (e.g., naming animals by color or type). This integrates vestibular and cognitive components.
• Memory Recall with Three-Step Commands: After reading a short paragraph, have the client carry out a three-step motor task (like folding towels or stacking items) while recalling details from the reading.

Cognitive-Motor Integration in ADL Training

In fast-paced settings like acute care or inpatient rehabilitation, the goal is not simply to perform ADLs but to ensure clients can handle the cognitive and motor demands of these tasks in unfamiliar, often disorienting environments.

Consider the cognitive landscape of a hospital stay:

• Unfamiliar Environment: Clients face short-term cognitive impairment and disorientation.
• Psychosocial Factors: Constant interaction with strangers and shared spaces add emotional stress, increasing cognitive load.
• Neuroinflammation: Trauma or disease often introduces neuroinflammatory responses, creating extraneous cognitive strain even at rest.
• Fatigue and Healing: The body prioritizes healing, further reducing cognitive resources for daily tasks.

Case Example: Complex Client Care

Client Profile:

• Diagnosis: Stage 4 Kidney Disease, Type 2 Diabetes
• Treatment Plan: Dialysis three days per week, severe fatigue, muscle weakness
• Challenges: The client experiences cognitive fog due to dialysis, struggles with balance during transfers, and faces reduced energy for ADLs.

Intervention:

1. Seated Cognitive-Motor Exercises: While seated, the client performs light upper body exercises while recalling details from the previous dialysis session, strengthening cognitive endurance and focus.
2. Transfer Training with Dual Tasking: During bed-to-chair transfers, the client counts backward from 20 or categorizes groceries aloud, engaging working memory and postural control simultaneously.
3. Simple IADL Practice: The client organizes medication by color or size while engaging in a standing balance task, reflecting real-world multitasking challenges at home.
4. Fatigue Management: Sessions are designed with progressive cognitive demands that align with the client’s dialysis schedule, supporting gradual improvements without excessive fatigue.

The Future of OT is Complex – And That’s Okay

Dual tasking reflects the reality of occupational performance, challenging clients to synthesize cognitive and motor skills in meaningful ways. As OT practitioners, embracing complexity is the key to improving client outcomes and advancing the profession.

Start small—add one dual-tasking element to your next session.