My Favorite Ways to Incorporate UNO into Treatment Sessions

Hey gang! Since starting my OT career in a SNF, UNO has become one of my favorite games to play with a variety of patients. It is just so versatile and easily adapted to so many needs and diagnoses. Here are a few of the ways I use this game clinically.

1. Play the Game

By simply playing the game, we work on so many things: sequencing, direction-following, critical thinking, visual scanning, attention to task, fine motor control, problem solving, and communication. It can be played during individual sessions, or in groups; it can be played in sitting or standing. There are tons of options!

2. Simple Sort by Color or Number

To simple sort is to sort by one category, and UNO is great for challenging attention to task since the cards can be sorted two different ways (by color or by number/symbol). So it can be the perfect just-right-challenge to ask a patient with cognitive deficits to sort by color or number.

I have found that I often have to start the piles for patients who have more progressed dementia/cognitive deficits, and I do this by either setting out cones of corresponding color or by finding four cards that each have the same number but are different colors (as pictured below). The same concept would work when sorting by number; start with (in this case) 9 cards that are all the same color but different numbers. Starting the task in this simplified way will maximize the patient’s ability to successfully comprehend the directions and initiate the task.

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Usually if I chose four (one of each color) randomly numbered cards, people often have a difficult time remembering which category I asked them to sort by. A visual cue card accompanied by repetitive verbal cues typically helps to keep the patient focused on the task.

Even if I start each pile with the same numbered card, the nature of the task will cause the numbers on the top of each pile to change and vary, which in turn essentially upgrades (or increases the challenge of) the task for you.

3. Complex Sort by Color and Number

To complex sort is to sort objects by two or more categories. With UNO cards, I have done this one of two ways; I either ask the patient to sort by color while keeping the cards in each colored pile in numerical order OR I ask the patient to sort by number while keeping cards of corresponding color clustered together within each hand/pile. Both usually require increased verbal cues as compared to the simple sorting task (obviously), but after repetition the patients catch on pretty quick.

4. Vertical Visual Scanning

Our external world often forces us into a very anterior, hunched over position and this is no exception as we age. So I will often use some painter’s tape to tape cards up on the wall; patients are then asked to retrieve individual cards following verbal direction (“Find the green 6”).

This task in-and-of-itself is very versatile. I often ask the patient to perform the bulk of the task in standing, and grade the task based on how widespread the cards are on the wall. If I want to further challenge a patient’s standing balance, I will ask them to keep their feet still and shift their weight in order to reach for the cards. Or I will ask them to stand on a wiggle or foam cushion to put a greater demand on standing balance and righting reactions (don’t forget those gait belts for safety!).

This task can also be used to increase lower extremity strength by asking the patient to stand up to retrieve the card and then sit down to place the card in the discard pile.

5. Environmental Scanning during Distance Ambulation

Easter egg hunts (as I like to call them) are perfect ways to increase environmental scanning during ambulation. So sometimes I will place UNO cards either around the gym or at varying heights on the walls in the hallways and ask the patient to retrieve them. Again, this will work on standing balance and functional reach as well as on visual scanning, but it forces them to move around the environment at the same time.

Side note: avoid making a rookie mistake and count how many cards you are ‘hiding’ as you hide them.

6. Hide the Cards in a Sensory Bin

For people who have low vision, I often use sensory bins to increase their tactile object recognition, since they often rely on their hands to compensate for the low vision. UNO cards are one way to do this because they are brightly colored and usually feel quite different than the other items in the sensory bin (like rice or beans or sand). This task could also be used with people who have poor dexterity, decreased sensation, or tight muscle/tendon contractures throughout one or both hands.

Hope this was helpful – I’d love to hear how you use UNO in your treatment sessions!

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