iOS App: RGB Express - Mini Truck Puzzle

RGB Express App

RGB Express on iTunes ($2.99, sometimes free)

What it is: A simple puzzle game where you plan a route for the game pieces: Trucks that deliver same colored packages to same colored houses. You start at the truck, you map a path through the via point(s) to pick up packages, to the destination house. Trucks can't use the same road twice (neither theirs nor each other's). After you map a path for each truck you hit "play" to watch them drive.

The screen Shots show an example of one puzzle at a simple/mod complexity level. Screen Shot 1 is the starting position, and in Screen Shot 2 you see how the puzzle is solved: you draw the path of each truck to pick up the appropriately colored package and deliver it to the appropriately colored house without using the same road twice by either truck. Once you draw the solution, you press "play" and the truck driving and picking up/delivering packages is animated. Previous levels had one truck and many possible solutions, and subsequent levels may have more trucks/colors, and more than one package per truck resulting in more complicated routing and fewer possible solutions. There is no time limit to solving the puzzles, and you can redraw the paths until you're ready to hit "play" and test them.

Screen Shot 1

How we can use it in Tx: There are 3 key features of this puzzle game that benefit its use for treatment activities. First, it doesn't involve a time limit for solving each puzzle. The time limit, to me, is what eliminates many puzzle apps from being used in Tx. We want to challenge our clients in the skills we are working on, not frustrate them. More importantly, we want them to take the time to USE those skills and improve them.

The second useful feature of this app for Tx is its gradual increase in complexity. Unlike many puzzles that get too complex for most cog patients within just a handful of levels, this one increases the problem solving task slowly, and the increased complexity is focused on the reasoning aspects - that is, the exact skills we want challenged are the ones slowly increasing in complexity. Again, not the time limit or the distractions, but the specific spatial reasoning tasks: more complex routing for planning, more via points, additional colors to match, and eventually sequencing how many packages can be carried at once.

The third useful feature of this app for Tx is the ability to self correct: One can draw the possible routing solution, and if one determines there's a problem with it, one can redraw it before pressing the "play" button to animate the solution. So your client doesn't only get a chance to take their time planning a solution, they can produce a visual plan and determine its value before proceeding. This isolates some of the steps in problem solving and allows you as therapist to work on the component skills that require help and not merely the overall macro skill. The benefit of this aspect to Tx cannot be overstated. It is very rare to find a fun, motivating, task that allows us a glimpse into the micro component skills of reasoning.

Screen Shot 2

Although I don't list it as one of key beneficial features, there's one more thing I like about this app: It's simple and while it has use of color (necessary to the puzzle) and some animation, the color and animation are not distracting to the user. It doesn't feel inappropriately childish

So to use this in Tx you just let your client play the game, preferably on a large screen of an iPad or iPad mini. I usually have the sound on muted, and offer cuing as needed. Keep track of how much cuing was required to solve a puzzle, and what was most difficult (matching colors, drawing a path to destination and via points, addition of more via points or addition of more trucks, determining correctness of solution before hitting "play", etc.).

Goals we can target in Tx with this app: Planning a route for each truck via the point where the "package" is picked up to the destination (the house) requires problem solving, spatial reasoning, planning and scanning. Other skills engaged in solving these puzzles involve direction following, use of full visual field (as such, it can be useful to tasks targeting visual field neglect of various etiologies), sequencing (e.g., the order of packages before reaching the destination while avoiding the path of other trucks), focus/attention, categorization (colors, stopping points, destinations), and--as I always suggest--memory (e.g., to carry out the plan one comes up with to solve the puzzle). Also, as mentioned above, this task breaks up some of the components of problem-solving and allows you a glimpse into what specific component (planning, carry through, etc.) may need the most work.

Some specific examples:

1. For a lower functioning client you may want to work on recognizing a solution rather than generating one. Start at the lower levels with simpler road paths (like the one in the screen shots) and one truck picking up one package (one path to draw, one via point, one destination). Draw a route and ask if it's the shortest route to the destination. Draw one that passes the destination before the via point, and ask if that will work as a solution. Press "play" to determine if it works or not.

2. If you determine which increased challenge leads to the most errors (e.g., more complicated map or more via points or more trucks/colors) you can skip along to the levels that increase challenges in other areas but not the specific one causing problems so your client can continue to be challenged but not overwhelmed.

I also recommend doing these on your own so you can access all the levels in Tx because, as with most puzzles like this, advanced levels are unlocked as you complete previous ones. So make sure you have access to various levels that doesn't depend on your current client's progress.

iOS App: Winky Think Logic Puzzles

Winky Think Logic App

Winky Think Logic Puzzles App on iTunes ($2.99, sometimes free)

What it is: A collection of 180 logic puzzles that involve very simple to mod difficulty levels. The puzzles all consist of variously shaped and colored tiles that need to be positioned in specific spots. Sometimes it's as simple as moving a tile to its designated spot, sometimes several tiles to several spots, and sometimes there's obstacles to overcome and sequencing to determine. Solutions require single - to - multi steps to reach, with skills that tap into shape and color recognition, path determination, figuring out the outcome of various objects in the puzzles, etc.

Screen Shot 1 shows a simple level where you have to choose the correct shape to move to the center. Screen Shot 2 shows a simple level where there's some restriction on movement, and more than one target shape - so one has to move the tiles in sequence to place them. Subsequent levels include some additional problem solving. It never gets too difficult and it's pretty fun. If you get stuck, you can restart a level at any point - there's no timer and no points to lose; you just keep solving until it's solved.

Screen Shot 1

How we can use it in Tx: There's no settings to consider except whether or not you want music. If you are working on focus and need some distracting stim, you can keep the music on.

The levels are made more complex by the addition of obstacles, and multi-step solutions to the puzzle. A few levels require the use of more than one finger--I'd skip those levels in therapy unless you have a very highly functioning and dexterous individual. There's also a few levels at the end of the game where very precise movement is required (the obstacles cannot be "touched" by the tiles); I'd skip those as well as they may just frustrate more than help. But overall, levels are realistically solvable, especially with some cuing.

Screen Shot 2

You get to move up levels as you solve them (solve one, get to move on to subsequent levels) but once solved, you can reuse the levels. So, I would recommend solving ahead (as far as you plan to use with any client; or all 180 puzzles - it's fun). That way you can skip over levels that aren't appropriate for a particular client, and not worry about any subsequent levels being locked. Otherwise, just choose levels and play.

One issue that may arise is that solving some of the levels may require dexterity beyond the ability of your client. In such cases you can either skip that level, or split the task into parts that would still provide experience with the problem solving and the planning: the client may solve the puzzle by making a plan (e.g., for screen shot 2, figure out the sequence in which tiles need to be dragged into the track), and then verbalizing directions for someone else (likely the clinician) to carry out the plan. Then the dexterity of maneuvering the tiles would be left to the participant without deficits in this area.

Goals we can target in Tx with this app: Direction following, problem solving, reasoning, symbolic dysfunction, visual field neglect or other visual-field dysfunctions (like hemianopsia--to get used to scanning back and forth to compensate), sequencing, sorting, focus/attention, categorizing, planning, and of course spatial reasoning. And of course, as per my usual logic, memory.

Some specific examples:

1. As noted above, if you have a client who lacks the dexterity to maneuver the tiles in any or all levels, you can separate the task into manageable bits and remove the part that requires skill beyond your client's reach: the client can make a plan to solve the puzzle, verbalize it (or discuss it), then provide directions for another person to carry it out. The clinician, or another client if you're working in a group, can maneuver the tiles.

2. You can use this as a break between other tasks, or as its own task for a certain part of your session. To document skill and progress I would keep track of the cuing required and the number of steps that were needed to solve each puzzle to determine the difficulty of the task at each level. You might also note if the multi steps were homogenous: That is, were they the same step each time, as in sequencing the order like the puzzle in screen shot 2, or heterogeneous steps, as when one tile needs to be put on a spot that opens an obstacle or has to be maneuvered to a spot that allows it to change colors. I would consider heterogeneous steps more complex. For someone with symbolic dysfunction, you 'd want to also keep track of how many colors and/or shape choices were provided and how much cuing they needed to pick the correct shape/color (e.g., in the puzzle shown in screen shot 1).

3. Memory: you can show the solution to a min/mod difficult puzzle, and then ask your client to re-solve the puzzle using their reasoning and their memory of your solution. See, I can ALWAYS involve memory goals.

All in all, I think you can have a lot of fun with this puzzle both for direct Tx and for a motivating and useful break between other tasks you have planned.

Android and iOS app: Constant Therapy

Constant Therapy App

Apps: iPad Constant Therapy app on iTunes (free)
Android Constant Therapy app on Google Play (free)
Website: constanttherapy.com

What it is: A Speech Therapy tool for Cognitive-Communicative rehab. The app includes a large variety of language and cognitive tasks that can be customized to complexity level of your clients. It is free for clinicians, researchers and students; clients have to buy a subscription.

Here is how it works: As a clinician you would have this app on your device (again, for you an account is free). When you have a client with cog-com goals, you would create an account for them on your device (this is all still free). You would choose appropriate tasks customized to your client's diagnosis and severity, functional needs and skills.

The variety of their tasks is extremely satisfying. For language they have tasks for auditory compr, naming, writing, reading and sentence planning; for cognition they have attention, visual processing, mental flexibility, memory, problem solving and executive skill tasks. This list does not do justice to the variety and creativity of these tasks. I'm not sure the exact number but I counted 34 language tasks and 31 cognition tasks. To get a better idea very quickly, I urge you to hop over to this page and just glance at these tasks (when you mouse-over any task, it shows you a screen shot): http://constanttherapy.com/constant-therapy-tasks.

In Tx: The program allows you to select which tasks to use with your client, and at the level of each task you can adjust the complexity. You then get a baseline for each task for the individual client, and the program continues to keep track of progress (as well as usage). There's too many activities that address a large variety of goals to go into detail here. What I can say is that the activities I've seen and tried are created almost exactly how I would have conceptualized them, and I found it was very intuitive how to explain the clinical justification for spending time on these to patients and their families. Also, CT's website discusses Evidence Based Practice (EBP) implementation.

Outside Tx: You can select the tasks you want as "homework" for your client. This is where their own subscription becomes beneficial: The clients that can continue to complete these tasks outside of the therapy session can purchase a subscription (http://constanttherapy.com/pricing). They should do it using the account you create for them in session, so that the homework you assign can show up in their account, and their progress with tasks in sessions and on their own can be tracked (from within the account of the clinician that originally created their login). This extends your therapy outside the session: you, the SLP, are making clinically-informed choices re which tasks are most appropriate and beneficial, and are able to modify your decision based on progress feedback. Very few tools allow this kind of flexibility for clinicians to address patient needs beyond the therapy session.

My experience: I've used it only with adults for both cognitive and language intervention. I found it extremely age-appropriate, interesting and motivating. My clients seemed to enjoy the tasks, and I can't say enough about the ability to track progress in such an individualized (per client, per goal, per task) manner. A few outpatients have purchased a subscription and they (and their spouses) report good motivation to work on tasks at home.

Bottom line: I can absolutely recommend this program/service to both clinicians and clients. For the clinician, you will find this to be one of your most used apps on your tablet. For the client, based on the prices in 2014-2015 the feedback I've received is that it is well worth it.

iOS App: ICOON Global Picture Dictionary

ICOON App

ICOON App on iTunes ($0.99, sometimes Free)

What it is: Aimed at travelers ICOON provides a pictorial phrase book for the purpose of cross-language communication. It is simple to use and includes 12 categories that range from the basic/every-day (Hygiene, Health, Clothing, Food) to the travel-related (Measurements, World and Accommodation).

Screen Shot 1 shows a view of the categories, which is on the first screen of this app. Screen Shot 2 shows the view from inside a category ("Hygiene"), and Screen Shot 3 a specific item (toothbrush and toothpaste from the "Hygiene" category).

Screen Shot 1

How we can use it in Tx: When it comes to language goals,
pictures are always useful. Pictures divided into relevant categories are even more useful as one can make decisions about complexity level of vocabulary tasks based on context.

For word-finding goals, vocabulary that is relevant to the immediate environment of your client or is basic for their ADLs (e.g., food, hygiene, clothing) would be easiest. Emotions and Leisure a little more difficult, and Travel and World categories likely most
complex.

Language goals can be addressed in a variety of ways including confrontational naming, categorizing (top-down starting with the category and thinking of items then going over them, or bottom-up starting with items and determining categories). Pictures can replace word lists for motor speech and intelligibility practice. The picture lists easily lend themselves to various Q/A tasks, from simplest y/n to more open ended.

Screen Shot 2

The app could also be used to assess appropriateness of AAC using pictures. Does your client recognize the pictures? Are they able to read the category names? Their AAC needs are not likely to be fully met with this app (unless there is no symbolic dysfunction, and your client is only limited d/t voice issues) but you will be able to assess needs and abilities to determine what AAC app WOULD work if any.

Goals we can target in Tx with this app: Language goals
including word-finding, categorizing, question/answer and descriptions, speech goals that address dysarthria, apraxia and anything that affects intelligibility, and AAC (specifically to help assess needs and appropriateness).

Some specific examples:

Screen Shot 3

1. I recently had a client who has an existing Dx of severe expressive aphasia as well as a Dx for severe dementia. I have been working with her on pictures, and she is now able to generate around 30% (on a good day) of simple vocab from pictures. I show her a picture and ask what it is. I try to keep the pictures for each session from within the same category to help with context. If she is not able to generate the word, I give her a choice ("is this a toothbrush or a comb?"). She is able to reply with >90% accuracy. When we started she had <50% acc just repeating words. Her ability to express her needs has increased, and I have been able to educate staff re strategies to communicate with her (to ask her y/n questions as she demonstrates fairly high accuracy answering these).

2. S/P stroke client with expression limited to yes and no and conflicting reports of accuracy re same. These every day vocab pictures were useful in determining the severity of his symbolic dysfunction and helped determine that he is appropriate for an AAC device, and is able to navigate across categories to find his needs.

3. Used this app for a short task in a session with a high functioning language client presenting with mild word-finding issues at conversation level. This app was used to provide stim to jump-start conversations on a variety of topics.

Android, Windows and iOS app: 4 Pics 1 Word

4 Pics 1 Word App

4 Pics 1 Word for Windows RT, for Android devices on Google Play, and for iOS devices from iTunes (all are free at this time). Also available for Nook from Barnes and Noble, and for Kindle from Amazon (these cost $0.99, and possibly are from a different developer).

What it is: A simple puzzle that presents 4 pictures that have one word in common, and you have to guess what that word is. See screen shot below where the target word is "sweet".

The gameplay is simple. Just start it and it presents 4 pictures on the screen (beautiful and high resolution), 12 letters, and blanks for each letter of the target word. Figure out what word the 4 pictures have in common and fill in the answer. You can turn off the sound if you want (although it's not annoying, just sound effects for when you select letters) and you can turn off the notifications re "buying" hints and such. As you progress through the puzzle, you win "coins" with each correct answer, and then you can purchase hints with these coins. Players can also buy these "coins" via in-app purchase.

How we can use it in Tx: Solve the puzzles with your client, providing cues as needed. You can talk about each picture of the 4 presented per puzzle, ask questions and elicit replies. In many cases the target word has more than one meaning (e.g., "sign" where it could be a noun or a verb) which provides context for some great language intervention. Solving the puzzles is great, but the path to solving each puzzles provides context for some useful interaction.

The main problem with this app is that you can't go back to puzzles you've solved (unless you remove the app and reinstall it, presumably). The puzzles do get progressively more difficult but very gradually and not by much. It's not optimal but for now you can use it until it's too difficult for your population, then reinstall and start from the beginning. And hopefully down the road, there will be a setting to go back to solved puzzles/restart the progress. On the other hand, it's free so expectations for greater customization are rather low.

Goals we can target in Tx with this app: Language goals that involve word-finding and naming are addressed rather straightforwardly, but there's also good use of repetition and Q/A that can be useful in addressing apraxia and dysarthria goals. Describing and discussing the 4 pictures presents a great opportunity to practice verbal expression. Reasoning is addressed with solving the puzzles, and focus/attention can be addressed as well (presenting 4 different pictures to solve for one word would require some cuing for focus for quite a few of my current clients). A client with lateral neglect may benefit from having to give equal attention to all 4 pictures to solve the puzzle. And you can always address memory goals with recall of pictures.

Some specific examples: Just a couple of examples of the less straightforward uses of the puzzle.

1. Memory goals: after discussing each of the 4 pictures and, hopefully, solving the puzzle, turn off the device and recall the 4 images. Start by cuing with the common word, then provide additional cues as needed.

2. Homographs/homonyms: address the various meanings of the target words as they come up in the puzzle. Since it will be as part of the puzzle-solving activity, and since the differing meanings of the words are in most cases what make the puzzle (e.g., in the screen shot above the actual taste of something vs. a synonym for "cute"), you'll have a great opportunity for this type of activity in  context (rather than a rote list of words as part of a structured task).

iPad app: Move & Match

Move & Match App

Move & Match app on iTunes (US $1.99)

What it is: Listed in the "Education" category, this app lets you create elements on a background and move them around freely. Elements can only be rectangular, but they can hold photos/pictures or words, they can be custom sized (as can the text within), they have a variety of background colors, and they can be cloned. If this description doesn't do much for your imagination, look at the screen images of examples I threw together really quickly (or look at the developers' examples of uses in iTunes via the link above).

Within the app you make a project file for each exercise that you create, and hence can build yourself a nice database of go-to tasks for a variety of goals. The developers also have a selection of pre-created projects that you can download off Dropbox directly into the app and use (this is accessible via the "i" information screen within the app).

Screen Image 1: Closed paragraph

How we can use it in Tx: This app allows easy creation of a host of closed-exercises that require either filling in the blank from provided choices (like in Screen Image 1), multiple choice answers, any kind of matching, or word/sentence building. For cogn goals you can create sequencing and sorting tasks. If you take the time you can build some useful visuospatial/executive function tasks such as completing a pattern or an analogy (you'd need to create some images externally--via an image editor and then get the pictures on your iPad first). I discuss some of these suggestions in the "specific examples" section below. But really, the possibilities are endless... just about anything you do with worksheets that involves multiple choice can be replicated and expanded on using this app!

Goals we can target in Tx with this app: Language and word finding goals through a variety of fill-in-blank, closed paragraph, matching, word/sentence building or multiple choice tasks. Higher level cogn goals like planning, sequencing and reasoning. Sequencing and sorting either words, numbers or images (e.g., photographs of various stages of some activity, just like photo sorting cards but all in one screen). You can make simple math problems with multiple choice answers (there's actually a few of these ready-made and freely available from the developers already). You can create a background monthly calendar with fill-in elements to work on orientation and recall.

Screen Image 2: Sequencing photos and/or text

Some specific examples:

1. Sequencing/sorting: As I mention above, you can take photos of various stages of an activity (e.g., doing laundry, heating up a pizza, making ice cubes, etc.). You can import pictures from your album which means you can use your camera or do image searches online, save them to album, and use them from album. Once you have enough steps to sequence you just let the client move them around into the correct order. You can also make text elements to sort or sequence (e.g., months, numbers, days of the week, or steps of an activity listed in text instead of as photos). See Screen Image 2 of a quick and dirty example where I use photos I took for another app I reviewed recently, but also added text that can be moved and reordered.

2. For language goals you can create just about any matching exercise you can come up with. Antonyms, synonyms, definitions, pictures of items and their names... etc.

Screen Image 3: Categorizing text and/or images

3. Categorizing task: create a few headings (e.g., furniture, food, countries, etc.) and a bunch of words or images that fit in each of these and have your client drag the words around to place them under the appropriate category name. See Screen Image 3 for a quick and dirty example I made for this task. The images I just downloaded after a very quick google search, and, you can see at the bottom of the screen the elements waiting to be sorted.

4. Scanning activity: create a whole bunch of elements (icons or words or letters or numbers or even just squares with colors) and direct your client to find (and, for example, move to a specific side of the screen) all the elements that fit some set of criteria (e.g., all the blue squares, or all the blue squares with "r").

Screen Image 4: Calendar

5. Orientation/recall: use an image of a calendar (in my example in Screen Image 4 I used a weekly view of the iPad Calendar that was blank) and add some elements that can be moved around (visitors, routines like therapy and meals, etc.). Work on today, or recall yesterday. I like the weekly view for this because it has all this room to hold the collection of elements while the client decides if to use them and where to put them in the daily list.

There's just too many things you can do with this app to list them all... Since these projects can be saved and shared, maybe if there's enough SLPs using this app we can have our own section on the developer's Dropbox down the road... or find some other way to share amongst ourselves. I know I plan to create a whole load of projects in this app, and although some may take great time and effort, I know I'll use them a lot.

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: Christmas Delights

Christmas Delights App

Christmas Delights app on iTunes ($0.99, sometimes free)

What it is: An app that lets you decorate a tree, with a few choices of trees and backgrounds (additional options as part of in-app purchases, but not really necessary for our needs). The ornaments that come with this app are sufficient in variety of colors and types. The lights have a dynamic display (they light up and dim) so the effect is rewarding. The resulting decorated tree can be saved and printed or emailed (or shared on social media, as with everything else in this world these days). Here is the emailed card of the tree I decorated with the app:

How we can use it in Tx: I would turn off the sound (there's a variety of holiday themed music as background; unless you want to provide competing stimuli to work on focus, I'd keep it quiet). Then you can either let the client free-form decorate a tree and put presents under it, or you can request the client follow a particular color scheme or other directions.

Goals we can target with this app: I think this would be a great task for visual field neglect needs, especially motivating at this time of year although I imagine this would still be fun any time. You can work on direction-following (written or oral) and memory if you give one or two step directions verbally. Attention and focus, with competing stimuli if you want to keep the music on. Sequencing and sorting can be implemented (see examples below). Temporal orientation if you talk about the holidays in general.

Some specific examples:

1. For visual field neglect goals simply let the pt decorate the tree and cue as needed to avoid neglecting the weaker side.

2. For direction-following goals provide written directions at the complexity level your goal targets, and assess ability to follow them. For example, specify what type and/or color of decorations should go at the top of the tree, what in the middle, what at the bottom. Maybe specify how many rows and how many decorations per row at various heights of the tree. How many gifts and what color wrapping... etc.

3. For memory goals give directions in 1 or 2 steps at a time verbally; have the pt repeat the directions (e.g., "put a yellow ball on the tree, then a red one" or "put 2 blue bows at the top of the tree") then follow them from memory. You can control the difficulty level of the task by how many details are included in the directions.

4. For sequencing goals you can give directions that involve sequencing, for example asking a pt to put one ornament at the top, then 2, then 3 with each row towards the bottom having one more decoration than the previous row.

5. For sorting you can include requests that involve sorting ornaments by color or shape or type.

Just have fun with it. Anything is better than crossing out specific letters or numbers on a page... right?

iPhone/iPad app: Speed Match

Speed Match App

Speed Match on iTunes ($0.99, sometimes free)

What it is: a game where you are presented with two columns of 5 icons, and you have to remove them by matching icons from each column. Sometimes there's a few icons that are the same in both columns, sometimes only one (as in the screen shot here). Once you've matched and removed all the icons you win the round.

While playing, you can swipe a tile off the board from either column as needed, and these tiles are replaced by different ones. There is no "punishment" for doing this except for wasting time if you do it too often. There are no untimed rounds, sadly. There are several levels: you get the same total time to complete the rounds (4 minutes) and with each level you have a larger number of tiles to clear. The easiest is 25 tiles, then 50, 100, 125 and 150.

Screen Shot

As I mentioned already, all levels are timed. Additional challenges include that you can only mismatch 3 times (see 1 of the 3 spaces under the time left in the screen shot is lit up); once you mismatch 3 times the round ends. Waiting too long between matches will also cost a "mismatch" light. There are also several selections of tile styles, but I think the ones in the screen shot (the default ones) are probably easiest.

One other thing: this game is optimized for the iPhone/iPod screen sizes, but works really well in x2 mode on the iPad. I recommend only using the larger iPad screen in Tx.

How we can use it in Tx: I have written the developers and asked if they'd consider adding an untimed mode that could be used for practice or younger players in general, and our target population in particular. But until such a mode is added, I envision using the easiest level (matching 25 tiles) and setting realistic goals of how many tiles to remove before the clock runs out rather than expecting a pt to clear the board completely. You can vary the level of support provided to reach the goal. You can also make it maximally simple by finding a match yourself, and then touching the pair-able tile on one side, and asking the pt to find that tile on the other side. But remember, to play this you can't select tiles, you have to be actively/continuously touching both at the same time (however, you can be touching one side and take time before touching the other side; the tile will be removed once both sides are touched).

Goals we can target with this app: attention and focus, following directions, problem solving, scanning and visual field neglect, and of course memory.

Some specific examples:

1. For memory goals, the therapist can find a pair-able tile, bring it to the pt's attention and ask for the pair, then cover the tile up (thereby "selecting" the tile by touching it, so when the paired tile is touched it is removed) for the pt to find the matching tile from memory. Set a goal for how many tiles you want matched before the round ends (either due to time running out or 3 errors).

2. For visual field neglect just playing this game and having to simultaneously touch tiles from both sides is a great activity. A variation could be having the ST find the pairs and, like in #1 above, pointing out a tile on the pt's stronger visual side (but not covering it up like in #1, just pointing at it) and having the pt find the corresponding tile on the neglected side.

3. To target problem solving make a goal that involves removing unmatchable tiles while looking for matches. For example, tell the pt to remove 2 tiles they consider in their way every time they are stuck looking for a match. On the go reasoning is required to make these decisions (play the game for a bit and you'll see yourself).

4. To target direction following the ST, again, can be the one locating the matches, and communicating which tiles to touch to the pt. This information can be communicated by describing the tile (shape, color) or their location in the column (at the very top, halfway down, etc.) or both. This will take quite a bit of time so don't expect to clear too many tiles before time runs out. Maybe if an untimed mode is added.... :-)

4. Brain-training: for the regular (not rehab-patient) population, this game can provide great stimulation for attention/focus, memory, reflexes, scanning, decision-making and prioritizing. It's kind of addicting, but for short bursts of game playing (not one of those games you'll find yourself wasting your whole day on).

iPad/iPhone app: Writers App

Writers App

"Writers App" app in iTunes (usually $0.99, sometimes free)

What it is: An application to help authors plan a story/novel. A place to enter notes about characters, places, the plot, individual chapters, etc., and to keep it in an organized database. It is very intuitive to use, and does not require each field to have content.

You start out by adding a story (you can work on several at once, each with its own entry). For each story you then add relevant details: a title, information about the story (synopsis, premise, plot), chapters, characters, places, and there's room for further notes. You can add as many characters (or chapters, or places) as you want. For each character there are fields for name, general info (role, occupation), attributes such as strengths and weaknesses, habits, biography, hobbies, personality, and physical characteristics (hair, age, eyes, etc.), and of course further notes. Each entry for "Places" also expands to the name of place, about it, environment, description, characteristics and further notes.

So as you can see, it's structured but has a lot of fields and room for freestyle notes. There's no customization for the fields (I'm sure future updates will include this; it is always something users request once they start using an app like this). There's also no way to include pictures, and I'm not sure there ever will be, but if needed that can be added via export: Currently there's only one way to export, which is to email yourself the list: whatever level you export from, will include the info on that level and below it. So if you export from one character's view, you will only get the info for that character; if you export from the main story level, you will get everything you have entered for the entire story (all the characters, places, etc.). The emailed text can be copied and pasted into a simple document, and if needed pictures can be added. Format nicely and print.

How we can use it in Tx: This is a great tool to keep track of characters and plot twists for an author in the planning stages of their great novel... And for us, it's a great tool to help pts slowly put together their own life story. While there are a few fields in this application that won't play a role (and may confuse a pt if they are doing this independently) I think this is a great tool to use *with* the SLP to work on reminiscing, map out one's family members, one's life story, and even better--all of these. Since the information is so well fragmented into characters, places, story... we can concentrate on one section at a time (for several sessions, as needed). And the best part is that the resulting information from these sessions can be printed for the patient to keep.

This may not be the perfect app for doing this, but it's a nice start. And it lets you keep a list of what the pt has already contributed, go over it in future sessions, and proceed from there. And of course this can also be achieved with just a pad and paper, or any number of note-taking apps (some that also allow pictures and sound attachments). But I like the organization of this one that makes this open-ended task into a structured exercise, easier to follow through with and to pick up where you left off in future sessions.

Goals we can target with this app: Memory goals mostly, and since it uses a pt's personal information about their life and family, one hopes there's increased motivation to participate in the task. Sequencing and categorization, attention and question/answer goals are addressed almost inherently as part of the task, and there could be added focus on these goals as needed. For example, a pt could be asked to recall something from grade school, something from high school, something from college (if they attended) or military service (or whatever else they did after HS) and work on sequencing these stories into chapters (which came first in life, which later). Orientation is also addressed as part of discussing previous events, younger age, different locations (that was then, this is now).

Some specific examples:

1. Reminiscing: for a pt that isn't able to remember a lot about their own life, you can create a chapter for certain decades (20's, 30's, 40's, 50's, 60's...) and think of famous characters from each era (Marilyn Monroe, Shirley Temple, Churchill, Charlie Chaplin, etc.). and famous events... If you don't remember much from your grade school history classes you can do some minimal research online and find enough famous events and people for each decade within minutes, surely. Or you can do the research together with your pt, and let them participate and recall some of these milestones. I had a pt who had a really hard time remembering anything about his own life, with LTM and STM goals. I brought in a reminiscing task with pictures of famous events or people from various decades, and we went through them. My pt said he won't remember any of it when we started, but as we went through my list he did in fact recall quite a few of the events and people, and had a few bits of information to contribute about them, some even from personal experiences. It was a very successful session that left both of us smiling.

2. External memory cues: work on a pt's family tree using this app by adding each family member as their own character. Go over each character on multiple occasions trying to get pt to recall additional attributes; maybe add descriptions based on photos in the pt's room... You can get additional info from visiting family members if possible. Just have fun with it. And this is certainly something you will want to export, format, and print for the pt when you are done.

3. Write a pt's life story, especially if it's a pt who has lived in several places. Write a chapter for each time in their life (as I mention above, one for grade school, one for high school, etc.) and again, let them fill in bits and pieces over several sessions (give the specifics recalled previously and ask for more detailed info, e.g. "so last time we talked about your time in the army and you mentioned you were stationed in Italy. How long were you there?").

iPad/iPhone app: Numbers Addict Free

Numbers Addict App

Numbers Addict Free app in iTunes

What it is: A simple matching and adding game that could not be more fun (or addicting for that matter). It's reminiscent of Tetris, where balls with numbers (each number has its own color so it's easier to recognize) are stacked along a grid of 5 columns, 8 rows. You can see the next 3 balls that need to be stacked (see screen shot below).

There are 3 difficulty levels, and the "easy" one has no time limit: the balls don't drop until you place them, but a new row of balls appears at the bottom every few rounds. You have to match by number to pop them (remove them from the grid), and you need that number of balls to pop them. So you need two 2's, three 3's, four 4's, etc. to clear them. The first levels start with 1-5, and after a few completed levels you get the 6, then the 7, up to 9. You can also move two balls together to create a ball of the sum: if you move the "2" to the "1", it becomes a light blue "3" ball. The sum has to be within the limit of the highest number on that level (so on a level where you only have 1-5, you cannot make a 6 or above). You're scored by total number popped, so six 6's will give you a higher score than two 2's. There's also a paid ad-free version of this game.

Screen Shot Level 1

How we can use it in Tx: Assume you will only use the "easy" relaxed level that has no time limit, and most likely only the first few rounds of it (where you don't have to match anything above a 5). And let the pt play this game (preferably on a larger device like an iPad). Cue as needed, depending on your goals. In the specific examples section below I make some suggestions.

Goals we can target with this app: Attention and focus, following directions, math, problem-solving, scanning, sequencing, and sorting are the main ones.

Specific examples:

1. If you want to target sorting and/or visual neglect and scanning, direct the pt to sort the numbers in adjoining columns (so only put the 1's in the first column, the 2's in the second, and the 3's in the third... etc.). For added complexity ask the pt to predict when a column will get cleared (e.g., when you add the 4th "4" ball to its stack).

2. To target higher level reasoning and math, for higher functioning pts, make the game's goal to add together as many balls as possible (e.g., drag the middle "4" to the "1" below it in the screen shot to create a "5") to direct attention to the more complex possibilities within the game playing than just matching numbers and colors.

3. For a cool scanning and problem solving task ask the pt to fill up the grid with balls allowing as few as possible to pop. It's not possible to control this altogether because every few balls that are placed a new line of balls appears from below, and some of those may create a match. But the pt's task would be to go for the lowest score possible by placing the balls under their control in a way that doesn't allow two 2's or three 3's, etc. This would be a scanning-intensive task.

4. Brain-training: this is also a great app in general for exercising one's multitasking, math, problem solving, reflexes, planning ahead, prioritizing, attention and focus skills.

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 kindergarten.com. 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.

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.

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?!