iOS App: HOOK

HOOK App

Hook on iTunes ($0.99, sometimes free)

What it is: A simple, minimalist, puzzle game of sequentially unraveling "hooks". There are 50 levels, with a slight increase in complexity as you move up. The interface is aesthetically pleasing and elegant. There's no time limits, menus, or statistics. If you make a mistake it simply restarts. Higher levels allow 3 mistakes before the level restarts.

For each puzzle you need to find the sequence in which each hook needs to be removed (otherwise they block each other) and then trace the hook back to its starting point where the removal is initiated. Once you initiate removal of a hook, the animation of it drawing in helps visualize the process. As each hook is removed, its entire path disappears. I find this process of solving each level especially rewarding. The next step may still be complex, but it's slightly simplified by previous success.

Screen Shot 1

In Screen Shot 1 you can see a simple level - level 4 (the first level where there is interaction among the hooks; in previous levels you can remove the hooks in any order). You can see the black circle that you press to initiate removal, and the hooks to be removed. You can see where a hook would block another one if it's removed in the wrong sequence (the one that curves upward, if it's removed before the hook whose point is wedged in the curve, would be caught in place).

How we can use it in Tx: The game-play is so simple, there's not much to plan. Just let your client solve the puzzle. I suggest always starting with the first levels because they help train for what to look for, and get a user adjusted to how the controls in the puzzle work (press the dot, watch the hook pulled in towards it).

The levels get more complex gradually, and the complexity is built in very clever ways. First more and more hooks are added so unraveling becomes more complicated. Screen

Screen Shot 2

Shot 2 shows an example of a slightly more complex puzzle level (level 12), where there are 6 hooks, and some are layered. The two hooks with starting points at the farthest to the left part of the puzzle can be removed first. So you can see the problem solving becomes not just more complex, but acquires more steps: you have to figure out which hooks are removable without being blocked by other hooks, and then you have to trace back their origins.

In more advanced levels the origin point also becomes less straightforward: more than one hook might be triggered by the same origin point, and other complexities are introduced as well, such as wireless activation of hooks and hinges that can be rotated to adjust which hook is activated. Screen Shot 3 of level 34 has an example of all of these added complexities: Note that there is only one activation point (the black circle) which is "wireless", and you have to adjust which hook gets activated by rotating the hinges. So the hook removal must still be sequential, and in this level the sequence is relatively simple with only 4 hooks to control, but the problem solving complexity is shifted to which hook is activated.

Screen Shot 3

There are no directions to follow - you learn the game-play as you work the levels. So we get to work on a skill that we rarely get a chance to address directly: the skill of learning. All the while using an elegant interface that clearly favors mature users over childish animation and distractions.

The music is relaxing, but I personally would still prefer to mute it and focus on levels of cuing I need to provide to my client. I would encourage the client to verbalize as much of the problem solving as possible, to better discern the breakdowns so I could provide targeted support for the needed skills, and help build up strategies. Since there are many levels and they go up in complexity gradually, allowing one to build success through practice before new obstacles are introduced, I imagine that - choosing wisely and knowing when to stop - frustration on the part of your client will be kept to a minimum.

Goals we can target in Tx with this app: Attention and memory goals, planning, reasoning, sequencing, problem solving. While I argue that most apps I review have some utility for addressing memory, this one in particular directly addresses learning. Short term/working memory is taxed in the problem solving process: One can trace a hook from its switch to its end and figure out a sequence for solving the puzzle, which as to be mentally manipulated and thereafter retained long enough to follow through. And as one gets better at solving the maximally simple puzzles, the complexity slowly builds, utilizing the strategies developed for earlier levels. Solving these puzzles also heavily depends, obviously, on visuospatial reasoning. As such, any field neglect will hamper one's progress, so cuing can be provided to draw attention to the neglected side.

Some specific examples:

1.  Allow your client to verbalize a solution to a puzzle. E.g., "I would pull in this hook first because nothing is in its way, and then it would also get out of the way of this second hook, and then I can pull that one in". Discuss it a little to build up context and assist with memory encoding & consolidation. Then after a short delay return to the puzzle for your client to implement (or have to re-generate) their solution (retrieval of memory or strategy; capitalizing on procedural memory).

2. Since the switch to pull in the hook and the hook itself are almost always in different visual fields (left/right, up/down) almost any puzzle would require scanning the full field, even the very first levels with just one or two hooks with no interactions between them. When the cause is on one side, and the effect on the other, tracking is key. For lateral neglect, therefore, even the simplest first puzzles should work.

iPad app: Kokako 123 Audio and Visual Training

Kokako 123 App

Kokako 123 Audio and Visual Training app on iTunes (free)

What it is: Described as a game to "help auditory/visual training". This app's description on iTunes specifies that it is not intended to replace therapy, but to go hand in hand with it by providing repetitive practice to enhance skills. It definitely is targeted at children, but manageably so.

The game only does one thing: it gives a series of cards with numbers one at a time (see screen image 1) and asks the user to repeat them by using the keypad to enter each number below its card. One of the best things about it is that the user can choose what order to put the numbers in (same order they were presented from left to right, or backwards from right to left, or random).

Screen Image 1

Settings for this game include choices for how many cards will be presented (from 1 to 8; the example in the screen shots has 4 cards), and for how to present the cards (visually by flipping them over, auditory presentation where you can choose one of two male voices, or both visual and auditory). There is also a setting for how much time to space in ms between cards as they are presented.

Screen Image 2

Once user puts in the sequence and presses "go" feedback re accuracy is presented. As you can see in screen image 2, feedback includes which cards were correct, how long the turn took, and a count of how many turns were correct (screen shot 2 says "0" because not all 4 numbers were correct).

The themes are rather childish (you can choose car, flower or star; I have it set to the least annoying star) and there's a happy or sad star that comes up at the end of each turn. Not overwhelming, but nevertheless, it's there.

How we can use it in Tx: Set the activity to fit your client's needs in terms of how many numbers to remember (start with 3, and increase complexity to 4, 5 or even 6 if you think it's appropriate for your client's level).

Depending on the goals decide if you want the target number list presented orally or visually, and how fast. Maybe you'd like to have the client repeat each number as it is presented? That's a good memory strategy, and if you decide to go that path you may want to put in a longer delay between cards. Then have the client either tell you the sequence to enter or, if they have the dexterity, have them enter the numbers using the keypad.

What's nice is that you can also use this as a memory/mental manipulation activity and ask for the sequence backwards (since you can enter the answer in any order you want). You could also ask for the number sequence to be repeated in ascending or descending order. If you have the capability, you can enter the numbers in their correct spots; otherwise you can just enter the numbers in ascending or descending order and not worry about the game telling you the answer is incorrect--since it will flip the cards over at the end you'll be able to check accuracy that all numbers were recalled.

Goals we can target in Tx with this app: You can customize the settings and activity to target memory, immediate recall, spaced recall, working memory, attention,  and visual & auditory processing to a lesser extent.

Some specific examples:

The memory and attention activities are limited to numbers which is rather rote, so you don't want to spend too much time doing only this activity, but it can be useful for a short task or two.

1. As I mention above, if you want to work on memory and mental manipulation you can ask for the sequence of numbers to be given backwards or in ascending or descending order. If you ask for the numbers in reverse order, you can just enter them in reverse order and let the app tell you how accurate you were. If you do ascending or descending, you can just ignore the app's feedback on accuracy (since the game expects the numbers to be entered in their correct spots, not just be the correct ones) and judge for yourself when the cards are turned over whether all the numbers presented are accounted for. Should be just as effective and simple enough (except for the frowny star that will show up).

2. For spaced retrieval: you would think that you'd be able to use the running timer on the screen during the turn to space out input from output, but in fact this timer doesn't run during the turn--it merely returns the total time it took once the turn is over (and "go" is pressed). So you'll need your own watch/timer to space out this task. But otherwise, it's doable (although frankly, I'm not a fan of doing context-free numbers in this sort of activity).

3. If you are not working on mental manipulation that involves returning the numbers in a specific sequence, you can--like advised in #1 above--just ignore the accuracy of the order of the replies, and focus only on whether the client remembered all the items on the list. Again, you would not use the game's accuracy feedback for this and just keep track of it separately.

4. Brain-training: for the regular (not rehab-patient) population, this game can provide great training for memory and focus. Since you can set the game to provide you with a sequence of up to 8 numbers, with very little delay between them, visual or read, you can really set the task up to challenge anyone's function. You can also make yourself give the numbers back in ascending or descending sequence while getting them in their correct slots. And you can motivate yourself to return the answer faster each time as well.

iPad app: ScrapPad - Scrapbook for iPad (for sequencing)

ScrapPad App

ScrapPad - Scrapbook for iPad on iTunes (free!)

What it is: A sophisticated easy to use, and fun, scrapbooking application. It provides a variety of backgrounds, borders, embellishments and stickers (organized by themes like holidays, seasons, etc.). You can import images from your album (or take new ones from within the app with your camera), resize, move and rotate them however you want (except cropping--I didn't see that capability in the app; but there's native cropping in iOS already).

The app responds very smoothly to repositioning, rotating and resizing elements. You can work on the canvass with the tools at your ready or in full screen mode taking advantage of more space.

When you've made your creation you can email it, save (I'm assuming each page separately) to your album, share on FB, or send it to the app publishers to print (for a fee of course). They do not include the option to save your creation as PDF or some other format that can be read in iBooks, which is too bad for the scrapbooker, but not a big deal for our uses.

Screen Image 1

How we can use it in Tx: One obvious use for this app is to create family albums, logs, memory books and the like (much like what I wrote about in my review of My Story from 3/3/2012). I won't elaborate on that idea as it's fairly intuitive. My more interesting idea for this app though, is to use it for sequencing.

There's a few apps out there that are dedicated to sequencing tasks, where a user is presented with 3-6 step common tasks, with an image for each step, and asked to put the steps in sequence. I haven't seen any free apps for this, but here's a review from "Speaking of Apps" of a $4.99 app dedicated to sequencing called Making Sequences. It sounds great and the price tag is not too bad for a Tx-dedicated app. But it only comes with 15 sequences.

So here's what I did. I created my own sequence photos. For this review I very quickly made 2 sets of 3-step tasks (one making the bed, another folding laundry). I could have just as easily downloaded clipart. I put both of my tasks together to simulate what the screen would look like with a 6-step task (but if I was using each of these I'd have only the 3 steps of each task on the screen at a time).

I added all 6 photos to my scrapPad canvass, resized them for best fit and rotated them for proper aspect. I switched to full screen mode and basically created a space where the photos can smoothly be moved around as needed (see Screen Image 1). And there you have it: a sequence task. The reason it works so well is that (1) you can use the full screen so there's no dedicated sequencing app out there that can beat the real estate available for the task; and (2) the dragging/placing of the elements (the single photos) is so very smooth. They don't "snap to", but neither do photo cards you would use for this task if you didn't have an electronic version. There's also no music, no grading, no animation. It's just an improvement on the low-tech version in the sense that it's a lot easier to quickly make new sequences, and if you want, you can make them with images from the client's immediate environment.

Screen Image 2

One can make a page for each task, and create a "scrapbook" with as many sequencing tasks as they bother making with no limits. You can size the images to your liking (I wanted to make them as large as possible while still having enough room to move them around). You can also add titles to each page (if you want to add context; I like to ask my pts what the task is before they start sequencing, but some need the context to perform the task).

Just to show the full potential of this app (so well beyond what I'd use it for) here's a scrapbooked (albeit hideously... I'm not much for scrapbooking) version of my 6 pictures on the canvass with the tools open, and the "export" window open so you can see the options it comes with (Screen Image 2).

Goals we can target in Tx with this app: Memory/STM and orientation goals (which I didn't discuss much but they are fairly obvious), focus and direction following, spatial reasoning if you want to do some actual scrap-booking tasks, and the one I suggest it for: sequencing and sorting.

Some specific examples:

1) For sequencing--the main use of this app I recommend--snap some photos of common daily activities, even specific activities of your client if you feel it's appropriate, import them into the app and size them so all steps of the sequenced task can fit, then move to full screen and let the client order the steps. Just as I describe above. There's really no end to the possibilities.

2) For sorting, download or snap photos of elements you can sort (items or animals that vary in size or number, people that vary in age, foods that vary in size or calories, whatever you can think of... just keep it clear) and create a task just like the sequencing one. Save these and over time you'll have a ton of fun sequencing and sorting activities in one place.

3) A fun STM task that allows for use of memory strategies is to create a page for a specific event or season (e.g., for Easter or a birthday). Create it with the pt, discussing the various elements you're putting in there and color decisions, etc.; make all decisions explicit and together. Then find some filler task you can do for 5-10min (whatever you think is appropriate) and return to this task: ask for recall of the creation you made together, and carefully use cues as needed to get as much recall as possible (cues can range from visual to discussing some of the decisions you made together, etc.).

iOS/Android App: Counting Dots

Counting Dots App

Counting Dots on iTunes ($0.99)
There's also a version for Androids on Google Play (same price)

What it is: It is described as a colorful counting game for kids. The colors are vibrant but crisp and clean (if nobody told me it was for children, I'd just think of the layout as modern). Popping sounds and vibrations can be shut off as well. The task is one of counting, where you can count by 1's, 5's or 10's, and you can start with any number you choose (so if you start with "5" and count by 5's you'll get 5, 10, 15, 20, etc, just like in the screen image below; and if you start with "2" and count by 5's you'll get 2, 7, 12, 17, etc.).

A player is presented with dots in various colors and sizes with numbers on them, and the task is to select them in ascending order. The game playing happens in levels of increasing number of dots. First you're given one dot. When you clear that (by selecting the one dot) you are given 2 dots. When you clear those, you are presented with 3, and so on.

The background colors and dot colors are different each turn. The dots overlap, but the correct answer is always visible (though sometimes hidden by the previous answer). The sizes vary randomly (so 80 may be tiny and 85 large; but all fully legible and selectable). If you touch the wrong dot it shakes for a split second, nothing else happens. So there's no error reporting, there's no scoring and as far as I can tell, there's no end.

How we can use it in Tx: I'd shut off sounds and vibrations in the settings, and set the difficult appropriately for each client. Here's my opinion of settings ranging from easiest to most complex given the parameters of this app:

1. Starting with 1 or any number, and counting by 1's (1, 2, 3, 4, etc.)
2. Counting by 10's, starting with 10 (10, 20, 30, 40, etc.)
3. Counting by 5's starting with 5 (5, 10, 15, 20, 25, etc.)
4. Counting by 10's starting with something other than 10, for example 3 (3, 13, 23, 33, etc.)
5. Counting by 5's starting with any number between 1 and 4, for example 2 (2, 7, 12, 17, etc.)

Using an iPad with its larger screen is probably best. Ask the patient to perform the task (select the dots in ascending order, with a greater number of dots presented each after the previous one is cleared). You can keep track of accuracy by counting errors (error stats, as I mention above, are not kept; but the incorrectly pressed dot does shake for a split second providing a quick but not distracting or discouraging visual of an error if a therapist is watching for it). Maybe stop the game either after a certain time limit (play it for 5 minutes, for example, and note how many levels have been achieved in that time) or after the pt seems to get stuck a lot (hits the wrong dot several turns in a row). Definitely try to stop before frustration sets in, but do try to get to a level that is challenging for your client.

Goals we can target with this app: Sequencing obviously, providing a range of difficulty levels for this task. Certainly math (on the simpler level, although you'd be surprised how challenging it can be to sort the dots in ascending order as you get into the higher numbers). Memory (STM, working-memory) are addressed: it is actually pretty challenging to remember where you are in the sequence once you've been playing for a while, especially with distraction of colors and sizes of the dots. Visual field neglect and scanning are incorporated as the dots are spread across the screen, and again, the colors and sizes can provide competing stim. And if there's competing stim, focus and attention play a role as well as direction following. I wouldn't spend too long on this task, but it's a nice 5 minute exercise that can address a number of goals.

Some specific examples (or in this case, rather, just notes):

1. If you are working on memory goals, then note the fluency with which the sequence is carried out. That is, to play this game smoothly the player must remember what number they are on. If, however, they forget, they can still carry the task out by scanning the screen and finding the smallest number to select. So it would be up to us to see which strategy is being used.

2. If you are working on visual neglect or scanning, note accuracy involving the weaker side compared to the stronger.

3. Patients with focus goals will probably be most distracted by size differences between the dots. You may also want to add another layer to the task, where if a smaller number has a larger circle your client must somehow acknowledge it (verbally, for example) which will provide a divided attention aspect to the exercise.

4. For a reasoning/problem-solving (and math) goal you could set up the starting number and intervals, and let the client start playing with the goal of figuring out what the sequence is counted by (1, 5, or 10). Difficulty levels for this type of exercise are similar to those listed above, although it is fairly limited in that respect.

iPad App: A Memory Game

A Memory Game App

A Memory Game on iTunes (free)

What it is: Basic memory/concentration game where you start with 20 "face down" cards, and picking 2 at a time try to match pairs. When pairs are found, they are removed from the board. It is one of the few memory/concentration game apps I've found that is not targeted at children with cute pictures of animals and such. The images are crisp and clear and definitely favor adults. There's no distractions such as unnecessary animation. Very basic, very clean, and I can't believe it's free!

Screen image 1: playing with flags

You can play the game using flags or symbols. The first is flags of countries where the card shows both the flag and the name of the country (see screen image 1). Symbols are black and white simple images such as pencil, flower, airplane, etc. (see screen image 2); they are all very clear and easy to tell apart, but there is no text or color.

As you play the game keeps track of your tries and how many pairs have been cleared. At the end of a game you're presented with a message that tells you how many moves it took you to clear the board.

How we can use it in Tx: Obviously the way to use it is let your client play this game. I would consider the flags option as the more basic, easier, level. Flag images come with context: the name of the country is provided which gives a player something to hold on to in memory. There's also colors that help visually distinguish each card. The symbols option is definitely more complex as there is no text, and there are no colors. A player would have to name the image and hold on to just that word and location to continue matching.

Screen image 2: playing with symbols

The flag option provides you with plenty of opportunity not only for various cuing levels, but also to practice various memory strategies. As a card is opened the flag and country that is presented can be discussed. What do you know about that country? What continent is it in? Are you familiar with that region? Have you ever been there or wanted to go there? Did you recognize the flag? Do you like the colors of the particular flag? And references can be made to the location of the card itself (e.g., this country is a southern country, and hey, it's at the top of our board... it should have been at the bottom). OK, I'm reaching here, but my point is that this simple set of images presents us with lots of opportunities to model and practice memory strategies.

Goals we can target with this app: Memory (STM and to an extent working memory) obviously; certainly some scanning/visual field neglect. Focus/attention and following directions, as well as categorizing to an extent as part of flag/country discussion.

Some specific examples: I don't know that specific examples are needed in this case: just play the game using flags option, and decide on the level of cuing you want to provide. If you are targeting specific memory strategies (like repeating or visualizing) you can write goals for implementing those strategies while playing this game. And you can use the stats provided at the end if you want to help you measure accuracy and progress.

Brain-training: For the regular (not rehab-patient) population, this game can provide great training for memory. If you want it more challenging, certainly use the symbols option over the flag one. On the other hand, with just 20 cards, this will never get TOO challenging, just fun.

iPad/iPhone app: Spot Venture

Spot Venture app

Spot Venture from iTunes (free for a while)

What it is: A spot the difference game that is pretty straight forward and doable (unlike some that are so confusing they aren't even fun). You get 2 minutes per level, which is a lot of time to spot 5 differences for a regular player, but may not be quite enough time for a cogn pt (see ideas to get around that below). The nice thing is that the drawings are really clear and the differences are definitely visible to the naked eye (again, unlike some other spot the difference games I've seen for the iPad).

How we can use it in Tx: Obviously, play the spot-the-difference game. If your pt is able to, let them play the game as is, with the 2 minute limit on each level. If they need cues, figure out how much cuing you want to provide (see specific examples below). If they need extra, or unlimited, time, you can take a screenshot of the level at the start (with no differences found or circled yet) and use the screenshot in a photo annotating app to circle the differences. You can print them out too if you want (by emailing the screenshot to yourself).

Screen image #1: simple easy to see differences

This game has an additional task on every level, and some of these tasks include a useful "divided attention" aspect. See for example the screen image of the level with balloons (below, screen image #2). The task on this level is to find the 5 differences, as always, but also to pop the balloons as they come up on the right screen of the game. The balloons come out fairly slowly: I captured one of the few times that two balloons were on the screen at the same time; mostly it's one at a time with a delay, so it's not like a fast-paced balloon-popping game. This makes the player have to look for differences while periodically clearing the screen of balloons, and if any balloons are missed it doesn't affect the game playing (possibly the score, but nothing else). Perfect for focus-related goals.

Goals we can target in Tx with this app: Memory, visual field neglect and scanning, attention/focus and following directions come to mind. Some reasoning is involved, but this is more about visual tasks than solving problems.

Screen image #2: divided attention with balloons

Some specific examples:

1. For a higher fxn level pt who is able play the game within the 2 minute limit per levels, decide on how much cuing to provide. For example, I often ask the pt to find the first 2 differences independently, and then provide assistance (direction or hints) for the rest.

2. For a pt that needs extra time, use a screenshot of each level in a photo annotating app and circle the differences as you find them without a time limit. Don't forget to set your screen timeout to something long like 5 minutes so the screen doesn't go dark mid-task. For an added delayed-memory component, after finding the differences on the screenshot, go back to the game itself, and mark them within the game (this time going mostly from memory of having just found them). Then move up a level, take a new screenshot, and repeat.

3.  You can also print the screenshot (if you don't have a compatible printer, which most of us don't, you can just email yourself the screenshot and print anywhere, on BW or color printer). It takes a little more advanced planning, but it's just as good if you'd prefer to use a paper version for this task. In that case, you'll just be using the app as a source for spot-the-diff images.

4. For a pt with visual field neglect specify which side to mark the found differences on (both sides must be compared, which is good for this goal, but if you want to draw attention to a specific side then suggest that is the one where differences are to be marked; either side will work for marking differences within the app). You may also choose to alternate which side is marked as you go up levels.

In summary, there's not a lot more to this. It's a spot-the-difference task. Such tasks in workbooks are often drawn as cartoons (rather than photographs) so the cartoon quality of this app does not stand out as abnormal for this task aimed at adult populations. It's something that can be done in a lot of ways that does not involve an ipad, but it is extra fun and in some ways quicker as well as more versatile on the pad.

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?!

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

iPhone/iPad and Android app: Word to Word

Word to word

Word to Word app (from iTunes, currently free; from Barnes & Noble $0.99; and from Android Market $0.99)

What it is: A word association game. You get a list of words in column A, a list in column B, and you have to find pairs of words related either by being synonyms of each other, antonyms, or they may form a phrase together. The levels get more complex as more than one option from column B is possible for words from column A (or vice-versa), but only one combination will result in every word being paired up. A couple of examples of word pairs: salt-grains, college-coeds, zero-nought and thief-snatcher.

How we can use it in Tx: As you can see from the types of word pairs that have to be found, playing this game involves thinking about words and word use in a variety of ways and from different angles. It's not just about knowing the strict definitions of each word, but also about knowing how to use the word grammatically and pragmatically. In short, it is an easy game to learn, but involves some complex language skills. The game is not timed, which allows for as much time cuing a pt as needed to get the pairs of words figured out. As complexity of the levels is raised, having to negotiate more than one possible pairing for each word can bring in additional language use skills and the need to think up sentences with the game words (as part of the word game rather than a rote worksheet/drill).

Goals we can target in Tx with this app: Language goals, word-finding, a certain amount of problem solving goals (when there's more than one pair choice, how does one decide which to select?), even STM

Some specific examples:

1. For a pt with word-finding goals, take the words in column A and generate antonyms, synonyms and phrases that involve those words. Then look at column B to see if any of the words generated are in that column. Measure accuracy of this task by accuracy of the generated associated-word list (not by whether the generated list included the actual paired word from column B).

2. Higher level language goals can be addressed with the aforementioned additional task of generating sentences with either the target word from column A, its pair from column B, or both.

3. STM: I actually used this game for this with a pt who loves word puzzles. First we solved a puzzle level, then I presented words from that level and asked pt to recall the paired answer. It was more fun than recalling a random list of words or images, and the task provides context for the recalled information.

iPad app: Vismory (Visual Memory)

Vismory iPad app

Vismory - Visual Memory available in iTunes

What it is: Works on iPad, iphone or ipod touch. It is a memory game where you memorize a sequence of objects. It starts slow and while a quicker response will score more points, it gives the option to take your time. There are many versions of memory games for tablets and smartphones, but this one has a couple of advantages: First, in terms of number of objects to remember and time allowed to respond, quite a few of its levels can be used for players with more severe deficits (unlike many games that after a couple of easy levels amp up the difficulty or put you on a short timer, making the activities inappropriate for most patients with memory goals, going from fun to frustrating in mere seconds). In this game there are more challenging levels, but plenty of useful simple ones as well. Second, there is some mental manipulation required because it is the sequence of objects that must be recalled, not just the objects themselves. It is currently $1.99 (and worth it, I think) but every so often the price drops to free to bring in users and gather up ratings... that's when I managed to grab it, so keep a watch for if you don't want to spend any money.

How we can use it in Tx: This one's easy, just let your patient play this game, preferably on an iPad (not iPhone or iPod-touch as a larger screen will make all the difference). Practice different strategies to remember the sequence of objects in the game (you start with a very small number of objects; at first all of them are different colors so maybe repeat the colors in order... then there will be two objects that are different shapes but the same colors, so maybe repeat the object labels, and such).

Goals we can target in Tx with this app: short-term memory, working memory, sequencing.

Specific examples: Usually I end with specific examples for usage, but this app only has one function: playing the memory game, so there's not much variation in how it can be used. It's a memory and sequencing game. However, if you're targeting specific memory strategies (like repeating or visualizing) you can write goals for implementing those strategies while playing this game.

Brain training: This is also a great app in general for memory workout.