How breaking a task into more steps can ask more of a changing brain instead of less, and what actually helps when it does.
A woman at the adult day program where I worked could not get out of her chair. So we did what seemed like the obvious thing, we broke the movement down into pieces. Scoot forward. Bring your feet back. Lean forward. Push. Stand. Every one of those cues is exactly what I was trained to say as a physical therapist. And the more clearly I said it, the more stuck she got.
Then I would walk over, hold out my hand, and say, come with me. Often, she stood right up.
Same woman. Same chair. Same legs. What changed was not her body. It was how much her brain had to do to use it.
That gap, between what a person's body can do and what actually happens when you ask them to do it, is where the cognitive spoke of the Wheel of Function Framework™ lives. Once you start looking for it, you start noticing it everywhere a task falls apart, not just in a chair.
What the Cognitive Spoke Actually Means
Say the word cognition to most caregivers and the first thing that comes to mind is memory. Can she remember my name. Does he know what day it is. Did she already eat lunch. Memory is part of cognition, but it is a small part of something much bigger.
Cognition is how the brain pays attention to what matters and filters out what does not. It is how the brain understands what is being asked, holds onto that information long enough to act on it, figures out what comes next, and notices when something is not working so it can try something else. All of that runs in the background of almost everything a person does, all day, without them ever thinking about it.
In the Wheel of Function Framework™, cognition is called the driver of function for a reason. The brain is constantly taking in information from every other spoke, sensory, emotional, physical, and deciding what to do with it. When that process changes, an ordinary task can suddenly ask more of a person than they have available to give it, even when their body is fully capable of doing it.
Why More Instructions Can Ask More of the Brain, Not Less
Go back to the chair. When I said scoot forward, here is what that one instruction actually required. She had to notice she was being spoken to. She had to process the words and figure out what scoot forward meant. She had to hold that meaning long enough to translate it into a movement in her own body.
And while her brain was still working on that, here came my next instruction. Bring your feet back. Then lean forward. Then push. Then stand. Five separate pieces of information, stacked one on top of another, each one arriving before the last one had been fully used.
My intention was to make the task easier by breaking it into small, manageable pieces. But for a brain that is already working harder to process information, each new instruction is not a simplification, it is one more thing to hold onto. What looked like patient, careful guidance from the outside felt, from the inside, like being handed five things to carry when both hands are already full.
This is not only a dementia-specific pattern. Anyone can hit this limit under the right conditions, tired, distracted, overloaded. Dementia just lowers the ceiling for how much a brain can carry at once, so it shows up sooner and more often.
What Getting Dressed Really Requires
Think about how much thought getting dressed took you this morning. Probably none. You did not stand in front of your closet consciously deciding that the shirt on the hanger was a shirt, or working out which opening was for your head. You just got dressed. But your brain did an enormous amount of work to get you there, deciding it was time, choosing what to wear, knowing what goes on first, noticing if something twisted, and fixing it without being asked.
Now picture handing someone six pieces of clothing laid out on the bed and saying, go ahead and get dressed. She just stands there. You say it again. Still nothing. It is easy to land on she can't dress herself anymore and stop looking any further.
But there is a lot of room between here are your clothes and she is not getting dressed, and that space is exactly what the Wheel of Function Framework™ asks you to get curious about instead of guessing. Maybe she cannot see the shirt clearly against a bedspread that is almost the same color, that is sensory. Maybe she knows exactly what to do but feels embarrassed that she is struggling in front of you, that is emotional. Maybe her shoulder hurts when she lifts her arm, that is physical.
Or maybe she can do everything with the shirt once you put it in her hands. That single test, handing over one item instead of describing the whole task, tells you something real. It tells you the ability may still be there. What was missing was not the skill. It was getting started.
What Helps When Getting Started Is the Problem?
Getting started on a task, called initiation, is one of the cognitive pieces that changes early and often in dementia, and it is easy to mistake for someone refusing or forgetting how. Even research on technology designed to prompt people with dementia through daily tasks at home has found something similar, voice and text reminders could help someone keep going once they were already moving, but starting the task in the first place still usually needed a person, not just another prompt.
That matches what I saw with the toothbrush. Stand there and say, go brush your teeth, wash your face, comb your hair, and then we need to get dressed because we have to leave in twenty minutes, and you have handed someone four separate things to hold onto and act on in order. Hand that same person a toothbrush, without a word, and sometimes they simply start brushing.
Nothing about their ability changed between those two moments. What changed was the doorway into the task. The toothbrush did not require the brain to process language, hold a sequence, or remember what came next. It just needed a hand to close around something familiar. That is the same thing that was happening when I said, come with me, instead of walking someone through five steps to standing. I was not making her apraxia disappear. I was changing what I was asking her brain to do, and sometimes that was enough to change what she was able to do.
Reading the Cognitive Spoke Before You Read the Behavior
It is tempting to treat what we see, the refusal, the freeze, the pacing, as the whole story. But behavior is never the problem. It is always the signal, and the cognitive spoke is one of the clearest places to trace it back to its source. Before asking how do I get them to do this, ask a different question first, what is this task actually asking their brain to do right now, and what part of that is getting in the way.
That single shift, from managing the person to investigating the task, is what the Wheel of Function Framework™ is built to do. It will not hand you a script for every situation. What it gives you is somewhere real to look, and sometimes something you can actually change, the number of instructions, the order they come in, how much you hand over at once, how long you wait before saying anything else.
I talk more about this, including the full story of the woman in the chair, in the newest episode of Navigating Dementia: Audio
Notes
- Alzheimer's Association. (2026). What is dementia? Symptoms, causes and treatment. https://www.alz.org/alzheimers-dementia/what-is-dementia
- Cannings, M., Brookman, R., Parker, S., Hoon, L., Ono, A., Kawata, H., Matsukawa, H., and Harris, C. B. (2024). Optimizing technology-based prompts for supporting people living with dementia in completing activities of daily living at home: Experimental approach to prompt modality, task breakdown, and attentional support. JMIR Aging, 7(1), e56055. https://doi.org/10.2196/56055
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ABOUT THE AUTHOR
Carlyn Lenfestey, PT, MPT, CDP, CADDCT, is a licensed physical therapist with 25 years of clinical experience and 15 years specializing in dementia care. She is the founder of A Better Way: Dementia Care Solutions, LLC, the creator of the Wheel of Function Framework™, and the host of the podcast, Navigating Dementia.
DISCLAIMER
The information provided in this blog is for educational purposes only and should not be considered medical advice. Always consult with a doctor or a licensed physical therapist before starting any new exercise routine, using assistive devices, or following the recommendations mentioned. Every individual's needs are different, and professional guidance is essential to ensure safety and appropriateness of care.
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