The 10 Best Working Memory Activities For Your Adult Speech Therapy Client's

Gina Britt
Jan 22
5 min read

This post is about working memory activities

Why Working Memory Matters in Adult Speech Therapy

Before we dive into activities, let's get clear on why this matters:

Language comprehension: Adults need to hold the beginning of a sentence in mind while processing the end. This is critical after stroke or brain injury.

Following directions: "Take your medication, then call the doctor's office to schedule a follow-up" requires holding multiple steps

Expressive language: Formulating sentences requires juggling grammar, vocabulary, and meaning simultaneously. This is especially challenging with aphasia.

Conversation: Remembering what was just said while formulating a response is essential for meaningful communication

When working memory is weak, everything we're teaching becomes exponentially harder. This is especially true for adults recovering from stroke, traumatic brain injury, or experiencing cognitive decline.

Simple Activities to Build Working Memory

1. Backward Chains

Start with any information and have clients repeat it backward.

Examples:

Say 3 numbers: "4-7-2" → Client says: "2-7-4"
Say grocery items: "milk-bread-eggs" → "eggs-bread-milk"
Use their medication names, appointments, or functional vocabulary

Why it works: The brain has to hold AND manipulate information, which strengthens working memory capacity.

Progression: Start with 2 items, build to 3, then 4. Most adults plateau around 5-7 items depending on cognitive status.

2. Missing Item "Game"

Show 4-5 household objects or picture cards. Have the client close their eyes. Remove one item. They identify what's missing.

Speech therapy twist:

Use functional vocabulary (kitchen items, tools, clothing)
Use medication bottles or appointment cards
Have them use complete sentences: "The _____ is missing"

Level up: Remove TWO items, or rearrange the order and have them restore the original sequence.

3. Instruction Following with Interference

Give a 2-3 step direction, but add a distraction before they complete it.

Example:

"Check your phone for the time, then write down tomorrow's date, then hand me the blue pen"
Before they start, ask: "Wait! What did you have for breakfast?"
THEN let them complete the original instruction

Why this is gold: Real life is full of distractions. This teaches adults to hold information even when interrupted. This happens constantly in medical appointments, family gatherings, and workplace settings.

4. Story Retell with Increasing Details

Read a short news article or describe a recent event. Have them retell it. Then reread it and ask them to add MORE details.

Scaffolding:

First pass: "Tell me the main idea"
Second pass: "Now add WHO was involved"
Third pass: "Now add WHEN and WHERE it happened"

Each pass requires holding previous information PLUS adding new information. It's a true working memory workout.

5. Continuous Story Building (great for group sessions!)

You start a story with one sentence. Client adds a sentence. You add another. Keep going. This one can be so much fun! It works great in a group setting as well!

Example:

You: "Sarah woke up and realized she had overslept."
Client: "She rushed to get ready for her doctor's appointment."
You: "On the way, she stopped for coffee."
Client: "But the coffee shop was unusually crowded."

Working memory demand: Each person must remember the entire story so far to add a logical next sentence.

Bonus: This is excellent for narrative language and executive functioning skills too.

6. Category Recall Under Pressure

Name items in a category, BUT add a challenge.

Examples:

"Name cities while tapping the table" (each tap = new city)
"Name medications while walking in place"
"Name foods you'd find in a refrigerator while I snap my fingers" (they speak only when you stop snapping)

The motor or timing challenge taxes working memory because the brain is juggling multiple demands.

7. Auditory Bombardment with Recall

Say a list of words or phrases. Client tracks specific information.

Example: "Listen to this shopping list and count how many items are from the dairy section: bread, milk, cheese, apples, yogurt, chicken, butter"

Client should answer: 4 items (milk, cheese, yogurt, butter).

Why it works: They're processing categories AND holding information AND counting. All of these are working memory skills essential for daily living.

There is a wesbite with short audio clips you can play with WH questions ESL LEARNING LAB

8. Same/Different Sentence Pairs

Say two similar sentences. Client determines if they're exactly the same or different.

Examples:

"I have a doctor's appointment on Tuesday" / "I have a doctor's appointment on Tuesday" → SAME
"Take two pills in the morning" / "Take two pills in the evening" → DIFFERENT

Increase difficulty:

Make sentences longer
Make differences more subtle ("the doctor" vs. "a doctor")
Add more sentences to compare (3-4 instead of 2)

9. Mental Manipulation Tasks

Give information and have them change it mentally before responding.

Examples:

"Your appointment is at 2:00 PM. If you need to arrive 30 minutes early, what time should you leave your house?" (factor in travel time)
"The word is 'make.' Change the /m/ to /t/. What's the new word?"
"Today is Wednesday. What day will it be in 5 days?"

These tasks require holding the original info, applying a rule, and producing a new answer.

10. Working Memory Bingo

Create bingo cards with functional vocabulary, current events, or categories. BUT here's the twist: DON'T mark the cards immediately.

Call out items. Clients must REMEMBER which ones were called and mark their cards from memory at the end.

Start simple: Call 3 items, then mark cards

Increase: Call 5 items, then 7, then 10

Pro Tips for Maximum Success

Start where they are:

If a client can only handle 2 items in working memory post-stroke, start there. Frustration shuts down learning and can trigger emotional responses.

Use their interests and functional needs:

Working memory tasks related to their hobbies, job, or daily routines are exponentially more engaging and motivating.

Provide visual supports initially, then fade:

For adults with significant cognitive impairments, allow them to use written notes, calendars, or smartphone reminders as external memory aids first.

Celebrate effort, not just accuracy:

Working memory is HARD, especially after neurological injury. Acknowledge when they're really trying to hold information.

Short bursts are better:

5-10 minutes of focused working memory practice is more effective than 30 minutes of frustrated struggling.

Consider fatigue:

Cognitive fatigue is real. Schedule working memory activities when your client is most alert (usually earlier in the day).

How to Track Progress

Watch for these signs that working memory is improving:

Following longer directions without repetition
Retelling conversations or events with more details
Less need for written reminders or visual supports
Better carryover of compensatory strategies
Increased independence in daily tasks (medication management, appointment scheduling)
Improved conversational participation

The Bottom Line

Working memory isn't just a cognitive skill. It's the foundation for functional independence. By embedding these activities into your sessions, you're not just addressing speech and language goals.

You're giving clients the cognitive tools to manage medications, remember appointments, participate in conversations, and maintain their independence.

Start with one activity this week. See how your clients respond. Adjust and build from there.