Brain injury & reading a clock — it’s about time

Checking the time is firmly established in our behavior. Whether checking your watch, reading a clock on the wall, or looking at the time on your computer or phone, you’ve likely checked the time within the last few minutes. It’s habitual. However, during recovery from stroke or brain injury, you may need to relearn how to tell time.

“Read a clock ” and “Do clock math” are extremely functional and important skills. They help us to be oriented to the time of day when to wake up or go to bed, when to follow our routine, what commitments we have that day, and how much time these commitments will take.

For many, clock skills are taken for granted; however, challenges with clock reading and time-based math affects individuals across their lifespan. For example, one study found that children who have mathematical difficulties also demonstrate increased challenges in clock reading (Burney et al, 2011). Additionally, other studies found that clock reading and everyday numerical skills are affected in individuals with dementia (Schmidtke & Olbrich, 2007; Martini et al, 2003).

Problems telling time and time-based calculations as a result of brain injury

Difficulties reading clocks and time calculations can also occur as a result of a stroke, traumatic brain injury, or other neurological disorders. It can be affected by different types of impairments including visual processing, spatial neglect, cognitive, and/or language processing.

Are you in search of functional therapy activities for adults or children? Today, we will be featuring two tasks from our Everyday Skills category: Read a clock and Do clock math.

Why are “Read a clock” and “Do clock math” exercises important?

Clock tasks are among the functional activities for adults in speech therapy and occupational therapy because it uses an everyday activity to target a variety of goals. In terms of cognition, It targets cognitive processes including attention, memory, visuospatial skills, mathematical functions, reasoning, and executive functioning.

While clock tasks are often thought to be more of a cognitive speech therapy activity for adults, language processes also play a role. Numerical representations are mapped to meanings stored in your brain. Based on the configuration on the clock, your brain must convert this to a word in your head and then map this word to a meaning in your brain. These tasks are also functional for adults with aphasia.

Featured exercise: Read a clock

What is Read a clock?

Your client is presented with an analog clock and three multiple-choice questions. Your client must accurately read the clock and match to its corresponding written time.

How is Read a clock Leveled?

There are 2 levels, with the multiple-choice distractors becoming increasingly more similar as level difficulty increases.

How is Read a clock Scored?

Scoring is binary (response is either correct or incorrect). The client has the opportunity to review the response before moving on to the next item. Overall score is based on the % correct items given.

Featured exercise: Do clock math

What is Do clock math?

Your client is presented with an analog clock and three multiple-choice questions. Your client must accurately read the clock, and perform a mathematical calculation to determine how much time has elapsed.

How is Do clock math Leveled?

There are 3 levels:

• Level 1: Clock displays times only to the quarter-hour
• Level 2: Clock displays times outside of the quarter-hour
• Level 3: Clock displays times outside of the quarter-hour with more similar multiple-choice distractors

How is Do clock math Scored?

Scoring is binary (response is either correct or incorrect). The client has the opportunity to review the response before moving on to the next item. The overall score is based on the % correct items given.

Functional therapy activities in Speech Therapy and Occupational Therapy

How can Read a clock and Do clock math be used in therapy? These tasks are extremely functional therapy activities for adults and children because it targets activities of daily living and a variety of skill areas.

Examples of how clock tasks can be used in therapy sessions:

• Unilateral Left Neglect or Left Inattention: Train scanning strategies.
• Language Skills: For people with aphasia, clock tasks can be a functional language activity to improve reading comprehension of numbers during activities of daily living (ADLs).
• Executive Functioning Skills: For Read a clock, sequence the steps required to accurately tell time. For Do clock math, sequence the steps to solving the mathematical equation. Self-monitor for accurate responses prior to checking answers.
• Memory: This can be a functional memory task in speech or occupational therapy. Clients can practice internal memory strategies such as rehearsal as they determine the time and match it to the correct answer or complete calculations in their head.
• Reasoning: Do clock math is a functional cognitive activity that can be applied to several problem-solving scenarios (e.g. how much time elapsed after an appointment).
• Processing Speed: You and your client can monitor processing speed with Constant Therapy’s data and analytics. With both accuracy and latency scores available immediately upon response, this can provide helpful feedback to the client about how processing speed is improving in functional cognitive tasks.

References:

• Burny, E., Valcke, M., & Desoete, A. (2011). Clock reading: An underestimated topic in children with mathematics difficulties. Journal of Learning Disabilities, 1-27.
• Delazer, M., Bodner, T., & Benke, T. (1998). Rehabilitation of arithmetical text problem-solving. Neuropsychological Rehabilitation, 8(4), 401-12.
• Des Roches, C., Balachandran, I., Ascenso, E., Tripodis, Y., & Kiran, S. (2015, January). Effectiveness of an impairment-based individualized rehabilitation program using an iPad-based software platform. Frontiers in Human Neuroscience, doi.org/10.3389/fnhum.2014.01015.
• Funk, J., Reinhart, S., Kardinal, M., Utz, K., Rosenthal, A., Kuhn, C., . . . Kerkhoff, G. (2013). Effects of feedback-based visual line-orientation discrimination training for visuospatial disorders after stroke. Neurorehabil Neural Repair, 27(2), 142-52.
• Kerkhoff, G. (1998). Rehabilitation of Visuospatial Cognition and Visual Exploration in Neglect: A cross-over study. Restor Neurol Neurosci, 12(1), 27-40.
• Korvorst, M., Roelofs, A., & Levelt, W. (2007). Telling time from analog and digital clocks. Experimental Psychology, 187-91.
• Martini, L., Domahs, F., Benke, T., & Delazer, M. (2003). Everyday numerical abilities in Alzheimer’s disease. Journal of the International Neuropsychological Society, 9(6), 871-78.
• Schmidtke, K., & Olbrich, S. (2007). The Clock Reading Test: validation of an instrument for the diagnosis of dementia and disorders of visuospatial cognition. Int Psychogeriatr, 307-21.