iPhone app: MouthOff

MouthOff App

MouthOff app in iTunes (currently free)

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

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

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

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

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

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

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

iPhone/iPad app Dragon Dictation (Free)

Dragon Dictation Free App

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

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

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

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

Some specific examples:

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

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

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

iPhone app: Appzilla (90 apps in 1), free app

Appzilla free app

Appzilla! 90 apps in 1 in iTunes

What it is: A utility app with a little bit of everything... it's almost easier to sum up what it isn't. There are 90 mini apps in Appzilla, each does just one thing, and don't expect all of them to be useful. But some of them are rather good, which is amazing for a free app. Herein I will comment on the mini-apps that may be useful for ST, but to be sure there's quite a few utilities included that are useful to anyone, just not relevant to therapy (like area code look-up, currency converter, and battery life gauge). Since there are so many of these utilities, and most have limited uses, the format of this post will be a little different than usual. I briefly sum up the basic uses and goals that can be addressed by each utility rather than have a separate heading for goals and treatment suggestions as I usually do. But I'll try to give examples, especially for those utilities that seem far fetched as useful :-). Expect to constantly be amazed that this collection of utilities is free!

List of utilities included in Appzilla that may be useful for Speech Therapy:

Note: Some of these utils that gather information from the internet (like dictionary and news related ones) will need a server connection to work (if you use your iPhone you're fine, if you use iPod-touch or iPad, you'll need to be connected to wifi). Most of the utils don't need it though. I'll try to note which do below.

1. Bleep button (no, really): Just a button that you touch and it bleeps. Can be useful as part of a host of activities that we already do. For example, a memory/focus/attention task where a pt has to react to a specific suit or number or card in a deck: this bleep could be used as the manifestation of said reaction (i.e., pt presses the bleep button every time they see a red card or a spade as the cards are drawn one at a time). Another example is for a sorting/categorizing task, where the pt shuffles through cards with common pictures on them, and presses "bleep" for pictures that belong to certain categories (I like to have household items in pictures, and ask the pt to name each item--working on word-finding--and also pick out the ones that belong in a particular room in the house, say the kitchen).

2. Buzzer: Basically the same as the bleep one, but with a red button for buzzer sound and a green one with a ding. I wouldn't use them for their seemingly intended purpose (red for wrong and green for right) but a variation of the tasks I mention above could work: if a pt is looking for red cards in a deck, press the red buzzer for black and the green ding for red. This would be an easier task than just pressing one "bleep" button for red because having to respond to each card would make it easier to remember to respond... so it can be implemented for the simpler versions of the same goals.

3. Coin flip: I haven't thought of anything yet, but I *know* there's something I can do with it in Tx.

4. Cook timer: This thing is awesome: it has a picture of 4 electric stove burners and 2 oven doors. You activate each and a timer starts for that cooker. I love time-management games (you know, where you play the cook and customers ask for specific foods and you have to put them together in a certain order, taking care of all the customers... like the free and super fun iPad game "Order up" or the iPhone game "Bonnie's Brunch") and I think they would be useful for a host of cogn-comm goals, but they tend to be difficult and complicated. Using this utility is not as fun, but it can be a lot less stressful: the task would be to pretend you're cooking a meal and have to cook 2, 3 or 4 different things that each take different times to prep and cook. It would be great to have hard copies of pictures of foods... so for example you have to get the buns ready then you can put the hamburger on the stove and cook for 3 minutes, and in the meantime get the pasta ready and cook that for 4. That's a lot of directions to sort through (problem-solving, sequencing, direction following, reasoning) and would require some extra prep of materials, but once ready it can be adjusted to a lot of goals and a lot of deficit levels (make it simpler, make it more complex).

5. VU meter: Amazing that it is part of a free package! Visual feedback to sound levels... what can't you do with it in speech therapy?! For specific ideas see one of my previous blog entries, about the Bla | Bla | Bla app.

6. Dice roll: A few weeks ago I bought a game on Amazon called "math dice" (actually, I bought the Math Dice Jr. version, linked here, because it came with bigger dice and a carrying pouch). In this game you roll the 12-sided target die to get a number, and then roll the other 5 dice and try to reach the target number using addition and subtraction only; the more dice you use in your calculation to reach the target number, the more spaces you get to move on the progress board. I've used it in Tx for memory (to recall rules), problem-solving, reasoning, sequencing and more specific math-related goals if called for. If I don't have the game with me, I can make a virtual version of it using this utility. And loads of other game-like tasks could use this utility if you don't have dice available (I don't know about you, but my phone is always with me while my lucky dice I don't tend to bring to work...).

7. Dictionary: There's always a reason to have one around... I believe this one needs a server connection to function.

8. Drum pad: I don't know what I'm gonna do with it yet, but I'm sure it'll come in handy... eventually.

9. Grill timer: Variation of the cook timer but with only 4 burners (and link to cooking times for various foods). Could be used similarly to what I wrote in #4 above.

10. Hearing test: You'd think it's useful (if not particularly clinical) but it's mostly for high frequency sounds. Still, it's relevant to our field so I figured I'd mention it.

11. Facts, GoogNews, Horoscope, Hot Topics, Lyrics: These are examples of included utils that can be used to generate conversation topics if needed. Sometimes you just need free-style open-ended conversation (to address anything from pragmatics to focus to memory to voice and fluency). I think all of these require a server connections to function.

12. Match it: 4 x 5 card memory game with a choice of themes for the pictures. It keeps track of time, but doesn't limit players in how much time they can use, which makes it much more accessible for memory-impaired pts. It's super cute, and likely the only memory game you'd need.

13. Metronome: I can't believe there's a free one included! I was looking for one for an SLP friend a few weeks ago and couldn't find a good free one... and here it is in this generous collection of utilities. Its uses are obvious for pacing and fluency.

14. Reaction time: A simple game where you have to tap the screen as fast as you can when the light turns to green (options are green, yellow and red). I don't know if I'd use it all that much, but I can see it coming in handy at some point... Even if just as a memory/focus/attention task (goal for pt to remember to tap the screen when the green light comes on).

15. Rhymes: Give it a word and it'll look up rhymes (needs network connection or wifi to function). There's plenty that can be done with this... I used it with a pt when we were composing a simple poem together (honestly, it was a functional task and very appropriate for that pt... but this post is already getting long so you'll just have to trust me on that hahaha).

16. Tally: You can keep track of up to 4 tallies, where you just touch the screen for each tally to add to it. You can use it to keep track of just about anything; for example, if you want to keep track of % correct items on a task, you can select 2 items to score, keep track of correct ones on the first, and of all items on the second, and at the end see what percentage the first is from the second count. When I do problem solving scenarios, I keep track of % problems ID'ed and % solutions provided; with this tool I'd choose 3 tallies to keep track of, make the first ID, the 2nd solving, and the 3rd total scenarios. At the end of the task I'd have a very quick idea of task accuracy. If you're doing a stuttering eval you can keep track of disfluencies; pretty much anything, this tool will let you count it faster than keeping track on paper, and without alerting the pt to what you're keeping track of (or how many they got right or wrong). Very simple and efficient.

17. Translator: English/Spanish only; may need server connection to function.

18. Trip Wire: Sound activated where you select the trigger threshold, and it sounds a buzzer if there is sound louder than the threshold. Yet another visual feedback to sound tool that can be used for pts with voice or fluency goals.

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

Bla | Bla | Bla free app

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

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

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

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

Some specific examples (not an exhaustive list):

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

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

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

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

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