A complete and robust understanding of number takes time to develop but can be achieved through numerous opportunities to learn and practice counting with a variety of experiences and materials. Helping students with significant cognitive disabilities develop this understanding of number requires structure and repetition to support their learning as well as the demonstration of procedures, concepts, and mathematical language. Instructional routines offer one way to meet these multi-component instructional needs. A multi-step routine that draws upon principles of distributed learning combined with brief periods of explicit instruction is described. The routine provides students with significant cognitive disabilities with the kind of extensive and repeated instruction they need while allowing teachers to develop appropriately adapted materials and means of accessing information that match the routine.