– Decision Making

(see below for video demos. More videos coming soon)

Decision Making / Reactive Training: Cognitive Training Concept #3:

In this concept of training, the primary goal involves speeding up reactive decision-making abilities. Here are a few examples:

  • Boxing: using a heavy bag or with the coach wearing boxing mitts, the patient wearing boxing gloves, and the coach cueing each punch, try a few of the following reactive decision-making ideas:
  • When the coach cues “right” the client executes a punch using their right hand. When the coach cues “left” the client executes a punch using their left hand. If the coach is wearing mitts, establish a protocol for punching, for example: when the patient punches with their right hand, they are crossing over to hit the right mitt and vice versa for left side punches.
  • Try putting colored tape or a colored sticker on the mitts. On my mitts, I have yellow tape on the left mitt and green tape on the right mitt. We now have the option of cueing the patient to hit right, left, yellow, or green.
  • Progress this as follows: “everything the coach cues, the client does the opposite.” For example, when the coach cues to hit right, the patient hits left. When the coach cues to hit yellow, the patient hits green, etc.

In each case, the client has to make the decision of which hand to punch with. Progressing to opposites creates a greater challenge as the client must think, decide, then react with the correct punch.

Try progressing this activity further. Here are some examples:

Enrich the proprioceptive environment by having the client stand on an airex pad, a wobble board, a Bosu (bow sue) ball, or some other somewhat unstable surface while boxing.

Add a cognitive challenge:

  • with each punch, have the patient name a city they have traveled to
  • have them tell you how to get from their current location to another location
  • have them imagine they are going on vacation and ask them to name every item they would pack that begins with the letter “S” (i.e., sneakers, shoes, sweater, socks, etc.)

Agility dots: agility dots come in multiple colors, anywhere from 6-24 dots per package.

Set up a pathway of dots on the floor and try cueing your client in various ways, i.e.,

  • Rotations: (Rotations are often a trigger for freezing of gait and increase fall risk. Rotation training is highly beneficial).
    • With each step, have your client rotate to step on the next dot. They can take their time and do this at a comfortable pace
    • Progress this by cueing each step, i.e.,
  • Right foot blue
    • Left foot red
      • Try cross over rotations. Have your patient cross the left leg in front of the right leg to rotate right and vice versa for the opposite direction, i.e.,
      • Cue left foot blue: the blue dot will be to the patients’ right side. The left leg crosses in front of the right leg to step on the blue dot and vice versa for the other side

Cognitive (decision making) Training During Boxing (punching the opposite mitt of what I que)

Rotations and Decision Making

Cognitive training for better dual tasking