iPhone app: MouthOff

MouthOff App

MouthOff app in iTunes (currently free)

What it is: Purely entertainment, and yet it has been the most used app on my work iPod lately. This app has 58 reactive cartoon mouths. You pick a mouth, hold your iPhone or iPod Touch in front of your mouth, and talk (laugh, scream, whatever). The mouth moves in reaction to the sounds you make... or in reaction to any noise in a room, so in a loud room the mouths will move a lot. But in a quieter room it will match movements to your sound and make it look like the cartoon mouth is doing your talking.

How we can use it in Tx: For the most part, I use it for motivation, and frankly, to de-crabbify even the most annoyed nurses or CNAs at my SNF. This can make every person laugh out loud with delight. Sometimes the tasks we do with our patients are tedious... especially when it comes to mostly OMEs or airway protection exercises... this can just make it fun. But, being that it reacts to sound--and the louder the sound the bigger the reaction--it CAN be used for Tx with voice patients to work on volume and duration mostly. As such, it can be used much like the bla | bla | bla sound-reactive app I discuss in a previous post (see the bla | bla | bla post from 3/11/11) which lately I've been using with an MS patient with some great results.

Goals we can target with this app: I'm sticking with motivation building as an important goal (if not one I actually write for a pt); also voice, dysarthria, phonation, intonation and prosody with, for example, MS or PD patients.

Some specific examples: I think you'll see that everyone gets a kick out of this. Lately I've been walking into pts' rooms with this app in front of my mouth and just giving them a giggle before we get started. But here's a couple more ideas.

1. Play with one of the cartoon mouths with the pt to determine its maximum reaction (open mouth or tongue out, or whatever else it may be for the particular cartoon). Then have the pt look at the screen and repeat words trying to get the maximum response to either each syllable or to the stressed syllable. Write a goal for % volume at word or syllable level.

2. A more amusing variation on the first suggestion: have the pt do the same but instead of looking at the screen watching the mouth, have them hold the device in front of their own mouth in front of a mirror.

3. I feel this app can come in handy for OMEs... but I haven't quite put my finger on how yet. It'll come to me later this week I'm sure.

iPhone/iPad app Bla | Bla | Bla: A Sound Reactive App

Bla | Bla | Bla free app

Bla | Bla | Bla - Sound Reactive app Available in iTunes

What it is: 16 cute faces that react to sound, for example by opening their eyes and mouth wider, varying their reaction to correspond to the volume of the sound: The louder the sound, the greater the reaction from the faces. The length of the reaction also corresponds to the sound: The longer the sound, the longer the face is held in reaction mode. This app is free and it works on iPhone, iPad and iPod-touch. This is one of the apps that, for Tx,  works just as well on a small device (iPod or iPhone) and does not require the iPad to be useful. Oh and it's super fun to watch the faces change in response to sound!

How we can use it in Tx: While this is not a measure of clarity or intelligibility, it can be a useful visual feedback tool to show a patient how loud their speech, or part of their speech is, or how long they hold a vowel, or how much stress they put on one syllable as compared to another. I had a patient who would trail off on all but the first syllable except when using this app. And as I note above, it really is very amusing to watch the faces change: my pts enjoyed it a lot, and some liked getting to pick which face to use.

Goals we can target in Tx with this app: Intelligibility, dysarthria, stress/intonation, volume, voice, phonation, to name a few. I've used it with patients with Parkinson's, MS, and others with mild dysarthria.

Some specific examples (not an exhaustive list):

1. After going over intelligibility strategies of putting stress on each syllable and exaggerating each sound, a pt can practice a word list, starting with some automatic ones like days of the week, with the goal of getting maximum reaction from the app's faces for each syllable (not trailing off). Accuracy can be measured by how many of the words got equally strong reactions from the app's faces for each syllable.

2. For a pt with flat affect or disordered prosody, write a goal to practice phrases and mark the stressed elements with prolongation and increased volume, as measured by the reaction from this app. The list of phrases could include ones where the word emphasized is the only difference (minimal pairs with respect to prosody); e.g., "I want SOUP for lunch" vs. "I want soup for LUNCH" (the first meaning I want soup and not something else, the second one meaning I want it for lunch, not for dinner). The emphasis on the word in CAPS should be apparent from the Bla | Bla | Bla app's reaction to volume and duration. Accuracy can be measured by how many reps it took to get the reaction on the correct words.

3. For a pt with goals to increase vocal intensity, can write a goal to elicit maximum response from the app's faces to a list of words or phrases. It is easy to see what maximum response is for each included face by making a soft sound followed by a loud one and comparing the response. Then the pt can work towards getting the maximum response, which would entail speaking louder. Accuracy can be measured by what % of the pt's speech got maximum response from the app's face.

4. Pacing goals, for pts who need to work on slowing their speech, could also be addressed I think. I haven't had a chance to try this with a pt, but I imagine you could write a goal for the pt to space out the face's responses to syllables (since vowels are the loudest parts of speech, those are the ones the app's faces respond to). If speech is too quick, the face doesn't "rest" as much between reactions, so spacing these out can be a visual indicator of the speed of one's speech.

5. Another thing I haven't tried but feel could be appropriate is using this app with fluency/stuttering pts. Visual indicator of volume and speed can help pace and shape prosody. Affecting these characteristics of speech has been shown to increase fluency (using metronomes and delayed feedback all provide auditory feedback on pacing and affect prosody, but visual feedback, in the form of pointing to a word being read for example, has also been shown to be effective). Therefore using visual feedback such as this app to increase awareness of prosody and pacing to shape fluency is within supported reason, so to speak.