Friday, April 27, 2012

iPad/iPhone apps: ABA Flash Cards (free)

ABA Animals Flash Cards
ABA Food Flash Cards
ABA Alphabet Flash Cards
ABA Flash Cards Food free app from iTunes
ABA Flash Cards Animals free app from iTunes
ABA Flash Cards Alphabet free app from iTunes
[It's possible that these apps are only free in April 2012]

What it is: These are three flashcard collections, each one is a separate app, from Obviously these apps are intended for young 'uns, but settings can be customized to use with adult populations. Each app has a nice collection of mostly common words (animals, foods, and a word that starts with each letter of the alphabet). The animals and foods apps contain over 100 words, and the alphabet app has, obviously, 26 words.

Screen Image 1
As you can see in screen image 1, each word is presented as a picture and text (text labels can be turned off). There is an audio for each word, which also can be turned off (I prefer to read the words if needed instead of using the included audio because the audio just sounds like it's talking to kids, which of course it is). Other customization settings allow you to choose alphabetic or random order, and you can select which of the 100+ words to show, hiding the ones you know you won't use. Or you can just skip them as you go (that's what I do). As you flip through the flash cards, you can mark cards with the green checkmark or the red cross, or you can just flip through them without marking. The "i" at the top left of each card takes you to settings, and the graph icon on the right of the "i" takes you to the Data page.

Screen Image 2
The built in statistics make this app extremely useful for Tx (see screen image 2). It shows you how many cards have been shown (flipped through), how many were marked with checks (=correct) and how many were marked with cross (=incorrect), as well as how many remained unanswered (if I didn't bother removing some cards from the deck, I just bypass them and leave unanswered). So you can easily get accuracy measure (in this example, I don't count the ones I passed over, so there were 6 total cards attempted, of which 4 were correct). Below these stats you also get an overview of which cards were correct or not ("N" in the list = incorrect, "Y"=correct, and a blank would be unanswered). And as long as you haven't closed the app, you can go over the entire deck again and re-try the incorrect cards (or just read them from the list in stats) if it suits your needs. As you can see, there's also an "email" button if you want to email yourself the stats. I haven't tried that yet, but I'm sure it's straightforward.

How we can use it in Tx: Basically these apps are collections of vocabulary words with pictures, text, audio, descriptions, and some built in customization and stats. As an aside, there's a few other options that would only come in handy if working with kiddos (like reinforcement and chimes), so if you're interested in using the apps for the intended population be aware there's still more to love. As far as my intended population, adults, go, there's a few ways I can imagine using these apps for word-finding goals: I'd remove the text label and let pts name the words from pictures, or from the descriptions (the "description" button at the bottom of each card includes text and audio), or from both. I can use almost any app for memory work: choose a few words and ask the pt to remember them whether in sequence or not. But what I've used these cards the most for is my apraxia pt who is only just starting to be able to repeat words. This pt benefits from seeing the word he is trying to say in print (he does not need the picture, but it doesn't hurt, and down the road I'll want him to generate the words without modeling or seeing the text). This pt benefits especially from practicing the same list over and over, and from being able to go back and re-try the words he couldn't produce at first attempt. So basically, I use these apps for easy access to word lists with built-in text labels and built-in stats. He is starting to be able to say the words without having them modeled, although he periodically asks me to say it first. We have started short phrases, and I generate those using these flashcards (e.g., if he can say "cupcake" I ask him to also say "sweet cupcake", and on good days I add a carrier sentence like "I like cupcakes" and "I want bacon").

Goals we can target with these apps: The main goal I've used these apps for has been apraxia-related, but I think these could obviously be used for word-finding goals, descriptions, categorization, and other language-related tasks including some reasoning (name the word from its description). And as always memory: auditory or visual presentation of a group of related words followed by recall.

Some specific examples:

1.  For memory goals, as I mention above, present a pt with 3, 4, 5, or 6 words at a time either in pictures, in both pictures and text, or by speaking them and assess % recalled. For an easier level task you can use the food or animal apps so the word lists are of related items, and for a slightly more difficult level use the alphabet app because those words aren't related in meaning.

2. For language goals you can use the alphabet flash cards where there's a word for each letter of the alphabet, you can ask the pt to come up with 1-3 additional words for each letter.

3. For word-finding goals simply show the picture (without text label) of each card and let the pt name it. If they are having trouble, read the description to them and see if that helps find the word. It's a great strategy to teach pts with word-finding issues.

4. For my own apraxia pt I use the app to repeat common words, generate common words, repeat short phrases, and repeat/generate short sentences. I love having such easy access to the stats: when we go through the word list we can stop at any point, whether it's after 10, 40 or all 108 words, and I note the % words repeated after the first pass, then we do a second pass of the words he couldn't say at first. Currently he is normally able to repeat about 60-75% of the words at first pass, and then tries again the ones he couldn't do, ending with 90% repeated. Phoneme accuracy is a different story, and that I have to assess subjectively.

Sunday, April 15, 2012

App for iOS and Androids: Let's Name Things (Free!)

Let's Name Things App
Let's Name Things Fun Deck by Super Duper Publications is available for free for iOS devices from iTunes, Android devices from Android Market, Kindle from Amazon App store, and for the Nook from Barnes & Noble.

What it is:  Super Duper Publications are well known for their resources for school-based SLPs. Their materials are meant for use with kiddos, and their illustrations and delivery reflect this. Go to Super Duper Publications for information about this app and others, including a couple of other free ones.

This app is a virtual deck of 52 cards with illustrations that prompt one to name items in a certain category, for example, things that are blue/black/red, things that can fly, things that you find in a zoo, things that are fruit, etc. To start, you "edit the player list"; in schools you may do this with more than one student, but for our purposes we'll only have one "player" at a time so it's not necessary to add a name unless you want to (e.g., if want to keep track of scores across several days or plan to use it with more than one pt).

After you've selected the player, you can select the cards. Most cards are well suited for use with adults, with just a few exceptions which you can deselect. I took out anything that refers to school or teachers (see screen image "select cards" on right). You can also just manually bypass these cards when they come up, but if you only plan to use the app with adults, you may as well just deselect the categories you don't need.

To start the task, you get one card at a time with the prompt "let's name things that...". The prompt is provided with audio, which I would recommend shutting off; just read the prompt yourself to make the task more suitable for adults. The screen for each prompt provides an illustration of the prompt (which, as expected, is on the childish side) and two buttons at the bottom: a red one and a green one, and each keeps count. The app keeps track of this count, and provides you with an overview of results at any point you choose to look at them from the menu (see "results" screen image below).

How we can use it in Tx: As noted above, this resource is targeted at schoolkids. As such, if using this app with an adult pt, I wouldn't bother showing the pt the screen or the the illustration, and instead just provide the verbal prompts myself (also remembering to shut the app's or my device's audio off) and use this application just for ideas of categories to ask about, and to easily count accuracy. The most straightforward use is to have pts name items within categories: I would ask for say, 3 items per category, and keep count using the buttons (green for each item that is appropriate, red for either an inappropriate item or a no-answer). Pretty much any simple reasoning/categorizing/naming task can be initiated with this list of categories, and I provide a couple such suggestions in the examples below.

I also believe that most tasks can be turned into memory tasks: when you are done with a specified number of cards, you can go back to the ones you covered and ask if the pt can remember the 3 (or however many) items they listed for each category.

Goals we can target in Tx with this app: Mostly reasoning and language goals such as organization and categorization (concrete and abstract), naming (divergent and convergent), and simple Y/N questions. And memory, always memory.

Some specific examples:

1. To target delayed memory goals, make this a recall of related items task: Deselect all but 5 cards. Go through all 5 asking the pt to name 3 items for each category, and letting them know that you'll ask later for these items again. When you've gone through all 5 cards (15 words), go back to the first one and see if pt can generate the same ones (from memory, or just from it being the same prompt; it's more functional than memorization of random lists). Use the scoring buttons to keep track of how many items were recalled (or re-generated to the same prompt).

2. Use the category prompts on the cards to generate your own list of items, say 3-5 items, and ask the pt to name the category. E.g., for the card that asks to name "things that are sweet" give the pt a list such as candy, ice cream, cookies, cake and sugar. Keep track of accuracy right on each card by selecting green if the pt got the category (or something close enough to it) and red if the pt wasn't able to name the category.

3. For a reasoning task, use the category suggestions on the cards to generate a list of items that belong to the specified category, and one that doesn't (e.g., for the "things that are sweet" category give candy, sugar, cake, ice cream, hamburger) and ask the pt to pick the "odd one out". Use the app to keep track of accuracy: Keep track of whether the pt was able to ID the odd item, and also whether they were able to explain why it didn't belong.

4. For a pt with simple Y/N question goals, use the prompts in this app is to generate such questions: Go through the categories and ask about the suitability of specific items, e.g., for the prompt "let's name things that are fruits" you can ask "is TV a fruit?" or "is watermelon a fruit?", etc. It's easy to come up with your own Y/N questions without this kind of app, but it's nice to have help generate them quickly AND keep track of accuracy.

It would surely be nice if this app allowed us to add or edit the cards... but even as is, it's not a bad little app to have on your phone (don't need a tablet for this as you won't be sharing the screen image with the pt) to help generate a few simple tasks quickly and keep track of accuracy.

Saturday, April 14, 2012

iPhone/iPad app Dragon Dictation (Free)

Dragon Dictation Free App
Dragon Dictation for iPhone/iPad/iPod-touch from iTunes

What it is: A rather well known application that translates speech to text. You speak into it, and it gives you a text version of what you said. I've noticed that sometimes it recognizes raised intonation as questions, but normally, I just say "question mark" or "comma" if I want those included in the text. It is quite good and amazingly accurate if you speak clearly with relatively little background noise. It lets you easily bring up a keyboard if anything needs to be corrected, and even has drop down choices for some common homophones (like if it wrote "do" and you select it, it may automatically suggest "due" instead). The application also makes up a database of names in your address-book to help recognize these in your speech and spell them right. You can then export the speech you dictated into a text message, an email, some of the social networking programs, or lets you copy it for pasting (like into a note or whatever else you choose).

How we can use it in Tx: In some ways, this application is a measure of clarity and intelligibility. Granted, the clarity and intelligibility for this app needs to be superior to what would be required in normal conversation, but that's not a bad thing for treatment purposes. A patient that is working on intelligibility, volume, or slowing down their speech can practice with this app. Whether the patient is working on word-, phrase- or sentence- level, they can practice saying a list of words or phrases to see how many of the dictated words were clear enough for the application to transcribe. Makes it pretty easy to quantify progress as well. It is also quite delightful how good this app is at transcribing speech, which helps build motivation. This is a good companion to the Bla | Bla | Bla sound reactive app which helps work on volume and timing (see my write-up of the Bla | Bla | Bla app from March 11, 2012).

Goals we can target in Tx with this app: Intelligibility, pacing (especially slowing speech down at sentence or conversation level), volume, phoneme accuracy... and well, most dysarthria related goals. My PD patients have found it challenging but fun.

Some specific examples:

1. For word-level intelligibility or phoneme accuracy goals, start with a list of common words that target the phonemes in question, or a range of phonemes. I suggest dividing your list up by syllable length (so have a list of monosyllabic words, disyllabic, and longer). Have pt pronounce each word, and quantify success by how many trials got transcribed accurately. You can have each word said 5 times, and find % that were transcribed correctly, or just do the full list with each word once, and take % of correct words from the whole list. The transcription errors produced by the app should also help highlight the problem areas, especially for monosyllabic words (if a word is longer and one or two phonemes are off target, the app may still figure out what word it is, but shorter words rely on less context and more accurate production to transcribe). As such, you could use this app for evaluation purposes (an informal look at what sounds may be toughest for a patient, if so indicated).

2. For sentence-level pacing goals, have pt read a sentence or paragraph into the app and check on % of the sentence that was correctly transcribed into text. The feedback to the patient is very quick, and it may be helpful to see a visual of just how much of one's speech is misunderstood due to fast speaking. Putting pauses between words will up accuracy very quickly, and that would also be a good visual for the patient.

Well, you get the picture. Patient speaks into the app, the app returns with a text of what it was able to transcribe from the pt's speech. Accuracy is easily quantifiable, and suggestions can be made to improve the accuracy. Strategies are discussed, practiced, and pt tries again. Hopefully, accuracy goes up.

Sunday, April 8, 2012

iPad/iPhone app: Success Story

Success Story App
Success Story from iTunes (free for a while)

What it is: A FUN (and kind of addicting) time management game. These types of games usually involve playing a role of a cook or waiter purveyor of some sort of goods or services, and your task is to complete your customers' requests (e.g., cook specific dishes to order, or arrange ingredients in a sequence) to make a specified profit and move up to next level. As requests become a little more intricate, and customers can get pissy if you don't deliver on time and walk away, you have to prioritize the steps to complete your tasks. That's the "time management" aspect of these games. I have long considered these types of games optimal for Tx for both adults and children, but the problem is that these games are often overly complex with too many steps to negotiate in too little time. My motto, which I keep repeating here, is that if it goes from fun to frustrating too fast, it's not useful as a Tx tool.

Screen image towards end of 1st level
"Success Story" is, finally, a time management game that takes it easy; while there is a timed aspect to this game, the complexity of the tasks is built up slowly, and I feel that a large number of levels (way more than needed for Tx) are usable. In this game you are making sandwiches to order; there is a grid of 11 plates where single ingredients are presented for a time, although not all the plates are full especially in the first levels so it's easier to choose (see screen image). If an ingredient is not used after a while the plate empties and is replace with another ingredient. Customers come up to the counter (it starts with one at a time, then two, and a maximum of 3 customers at higher levels) and order sandwiches (each customer needs 3 identical sandwiches). All levels start out with one ingredient sandwiches (e.g., hamburger, or lettuce or bacon). The "order" is shown as an image so you can see what is in the requested sandwich. You click on the ingredient (e.g., hamburger) once per sandwich (so x3 for an order) and then a few desserts pop up: each customer finishes a meal with desserts. The desserts you just click on, you needn't check what the customer asked for. Complexity is slightly increased with additional ingredients (two items, but in sequence: hamburger and lettuce, or lettuce and pickles; then three items, and more) and at higher levels there is less time as customers get impatient quicker, the ingredient plates time out faster, and of course there's more ingredients per sandwich. There's a few other details like powerups and between-level mini games, some of which are memory games. Let me tell you, it may sound complicated when you read about it, but it is really fun and addicting. And the initial levels are really easy to get through as you only need to serve a portion of your customers to move up a level.

How we can use it in Tx: Let a pt play this game, going through the first 3-5 levels where at most sandwiches include 3-ingredients. This game will work on an iPhone/iPod touch, but I'd recommend only using it on iPad for patients. The tutorial section is actually very useful, and is the virtual version of full modeling of the task. If a patient can get even one customer served (shouldn't be a problem in the first few levels no matter how long one takes) it's considered successful, and they can replay the same level instead of moving to the next one. You can quantify progress by how many ingredients were picked correctly, how few were picked incorrectly (incorrect ingredients require an extra step to remove from an order), or how many customers were served.

Goals we can target in Tx with this app: Direction following (this game involves 1-, 2-, 3-, and at later levels more, step commands). The game directions do get a little easier to follow as one gets used to the game, and the difficulty is increased very slowly so there's plenty of time to enjoy the game before it gets frustrating (if ever). Problem solving in the form of prioritizing (do you finish one customer's dessert order or take care of another customer's sandwich order first so they don't leave, do you grab the power-ups or finish an order, etc.), and as such there's sequencing of steps as well as sequencing of ingredients (if a customer wants lettuce topped by pickles, they will not take pickles with lettuce on top). Scanning goals can be addressed as well since there is a grid of 11 ingredients that need to be scanned to select the required ones, and during dessert time, the player has to distinguish all the dessert ingredients in the grid and grab them. Memory goals are also addressed with some of the mini-games between levels, where the ingredient grid is turned into a tiny memory game of matching two ingredients at a time. Attention and focus can also be indirectly addressed. Categorization skills are accommodated in the part of the game where desserts are sent to customers, since this part of the step involves scanning the grid of ingredients for any dessert items (rather than looking at the specific order).

Specific examples:

1. For scanning or visual neglect write a goal to use a certain % of the ingredients on the neglected side during a level. So for example, if one is making a bacon and tomato sandwich, the 11-ingredient grid will have plates of bacon in random locations, and a player without visual neglect would normally not favor either side of the grid; so ask your pt to specifically grab available ingredients from the side they tend to neglect, and then quantify what % of bacon plates were selected from that side.

2. For memory goals, at a level where more than one ingredient is needed per sandwich, quantify how much cuing was necessary for the 2nd and 3rd sandwich for each order. That is, when a customer orders a burger, cheese, tomato sandwich, you have to make 3 of these to complete the order. The first one requires looking at the order image for each ingredient, but the next two sandwiches should be built from memory or verbal repetition. As an aside, completing these tasks is a great way to contextually practice holding an increasingly larger list of (related) items in memory using visual and verbal cues.

3. Brain-training: this is also a great app in general for exercising one's memory, reaction time, attention and focus.

And hey, how appropriate is the name of this app for Tx purposes?!

Monday, April 2, 2012

iPad/iPhone app: Occupied

Occupied app from iTunes ($0.99; was free for a while)

What it is: A sorting game where you have to get plane passengers to the correct, um, bathroom. The levels are timed (always a bit of a bummer for treatment's sake) but start out simple with just men and women and the two corresponding bathrooms. It doesn't require a lot of dexterity, and accuracy can be measured by how many passengers were correctly directed in the allotted time. Following levels get a little harder, first with the bathrooms themselves moving (switching sides, so sometimes the women's room is on the right, sometimes the men's, and you can see them trade places), then the passengers are all kids who need to be sorted quicker or they run off; the next level includes a third type of passenger (babies, who need to be directed to their own area) and then the bathrooms start moving on the screen so dexterity becomes an issue (as is motion sickness.. not part of the game, but what I get from trying to play at these levels). So I would recommend only the first 3 or 4 levels for Tx, which should be plenty. There are additional scenarios and more difficult level settings, but those don't interest me for therapy.

As an aside, I sent an email to the developers explaining how I plan to use their game for cognitive therapy, and why, and asking if they'd consider adding a simple, slower, or untimed set of levels for rehab purposes. Who knows, their response may be positive... although I can see how adding a set of levels for such a small specialized market may not be worth their trouble.

How we can use it in Tx: There's really only one way to use it, which is let the pts play the game. As I mention above, I'd stick with just the first 3 or 4 easy levels. The game provides feedback regarding accuracy of each completed level (% better or worse from previous attempt) which can be noted for the pt if you want, assuming it's the same pt completing the level (i.e., being compared to self and not another pt).

Goals we can target in Tx with this app: Attention, focus, scanning, reasoning, categorization, following-directions

Specific examples: Since there's only one way to use this app--that is, to play the game--there's no need for specific examples. However, goals can be worded to reflect each pt's intervention needs:

1. For a pt with left-neglect, the target of playing this game could be to match the accuracy of the right-sided sorting to that of the left side (e.g., for the first level if the men's room is on the left, then the goal would be to approximate accuracy of getting men to their destination to the accuracy of getting women to theirs).

2. For an attention goal, target overall accuracy of whatever levels are played.

3. For direction-following goals, pay attention to the amount of cuing needed to initiate and carry out each new level (since each new level involves a slight change in instructions).

4. Brain-training: this is also a great app in general for exercising one's attention, focus, and reaction time.

Android app: Word Match

Word Match
Word Match (Free) from Barnes & Noble

What it is: A word association game for the Nook, very similar to the Word to Word app (see blog entry from 3/30/12), but free from the Barnes & Noble store. This version of the word association game contains 3 categories: Art, Food n Beverage, and Health. Like with Word-to-word there are two columns of words that have to be matched into pairs with more advanced levels including more than one possible match for each word, but only one configuration that allows for all the words to be paired. There is a timer that keeps track of how long it took, but there is no time limit on how long one CAN take. Timers are the one thing that can make a good game useless as a Tx task, taking it from fun to frustrating very quickly.

How we can use it in Tx: Since this is the same basic activity as Word-to-Word, I won't bother repeating myself. How to use it in Tx, along with specific examples can be found in my Word-to-Word entry from 3/30/12.

Goals we can target in Tx with this app: Language goals, word-finding, problem solving goals, and STM