Mind to Function

By Wieteke Idzerda, NZ based Occupational Therapist, CRT Therapist

If cognition came with a user manual, Occupational Therapists would probably read it cover to cover, highlight important sections, colour-code it, and then immediately lose it under a pile of paperwork and half-finished cups of coffee.

Because cognition is complicated.

Most people think cognition just means memory or intelligence. But in the OT world, cognition is the behind-the-scenes operating system that keeps daily life running — attention, planning, initiation, emotional regulation, organisation, problem-solving, processing speed, flexibility, and working memory (American Occupational Therapy Association [AOTA], 2020).

Basically, cognition is the reason you can:
remember why you opened the fridge,
pay your bills,
reply to that email,
get your child to school with shoes on,
and avoid putting the TV remote in the freezer.

(Although, to be fair, many of us are one stressful week away from doing exactly that.)

If cognition had a user manual, the first page would probably say:

“Warning: System performance decreases significantly under stress, fatigue, trauma, and poor sleep.”

OTs see this every day. People are often incredibly hard on themselves when cognitive tasks become difficult. They think they are lazy, disorganised, “bad at adulting,” or simply not trying hard enough.

But cognition is heavily affected by mental health, burnout, sensory overload, anxiety, trauma, neurodiversity, physical illness, and life stress (Crepeau et al., 2020). The brain is not a robot. It is more like an internet browser with 47 tabs open, music playing somewhere, and no one able to figure out where the sound is coming from.

Executive functioning skills — such as planning, organisation, task initiation, and self-monitoring — are particularly vulnerable during periods of stress and overwhelm (Dawson & Guare, 2018). This can significantly affect a person’s ability to participate in daily occupations, even when they appear “fine” from the outside.

Another important section of the manual would read:

“Your environment matters more than you think.”

Occupational Therapists know that cognition does not happen in isolation. A noisy waiting room, cluttered home, lack of routine, poor sleep, constant notifications, and unrealistic expectations all increase cognitive load (AOTA, 2020).

Sometimes support is not about “fixing” the person. Sometimes it is:

writing things down,
simplifying routines,
reducing distractions,
using visual prompts,
creating structure,
taking breaks,

or finally admitting that no human actually remembers passwords anymore (that is what “Forgot Password” buttons are for. Society has accepted this.)

OT practice focuses heavily on adapting environments and supporting participation through meaningful, achievable strategies rather than expecting people to simply “try harder” (Crepeau et al., 2020).

And perhaps the most important section in the manual would say:

“Fluctuation is normal.”

Some days people can manage work, parenting, life admin, meal prep, appointments, and social commitments with impressive efficiency.

Other days, someone stands in the kitchen holding a spoon wondering why they walked in there in the first place.

Both are valid human experiences.

Cognitive performance naturally fluctuates depending on stress, fatigue, emotional wellbeing, physical health, and environmental demands (Ylvisaker & Feeney, 2008). Occupational Therapists help people understand cognition in the context of real life — not just clinic rooms or assessments, but homes, schools, workplaces, relationships, and communities.

We help people build strategies that support participation, independence, identity, and wellbeing.

Because if cognition really did come with a user manual, the biggest takeaway would probably be this:

Humans were never designed to function like machines.

And honestly, that explains a lot.



References

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Supplement_2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Crepeau, E. B., Cohn, E. S., & Schell, B. A. B. (Eds.). (2020). Willard and Spackman’s occupational therapy (13th ed.). Wolters Kluwer.

Dawson, P., & Guare, R. (2018). Executive skills in children and adolescents: A practical guide to assessment and intervention (3rd ed.). Guilford Press.

Ylvisaker, M., & Feeney, T. (2008). Collaborative brain injury intervention: Positive everyday routines. Singular Publishing Group.