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: Missing Link

Missing Link App

Missing Link on iTunes (free)

What it is: A puzzle where 3 words are presented with missing letters, and solving the puzzle requires filling in the blanks to find these words. The main clue you get is that in all 3 words the same string of letters is missing.

There are 3 difficulty levels: easy, medium and hard. At easy level there's usually 2 letters missing (see Screen Shot 1), 3 at medium level, and at hard level there's shorter words with 3 blanks, so a larger part of the word is obscured.

Screen Shot 1: Easy Level

The layout is clean enough, even with the ads that pop up at the top in the free version. It resembles
an old-style typewriter (with sounds to match) and is obviously directed at adult populations.

How we can use it in Tx: As far as language goals go, even at simple level this is not the easiest game because the target words aren't the most common. As such, I would use this app for the higher functioning language client, stick to the simplest level and provide a lot of cues.

As far as reasoning goals go, the directions are simple (find 2 letters that would complete all 3 words) and yet not automatically familiar (there's not a lot of games/puzzles like this) so you have a chance to work on direction-following, and on recall of directions from one puzzle to the next. In this context, you can work with mod impaired clients as long as they don't have comorbid symbolic dysfunction.

Cuing could involve recognizing letter/sound combinations in English (e.g., if you have a verb like "keel" in screen shot 1, followed by blank-blank-g, familiarity with English should make one think of the "-ing" ending); or cuing could involve clues towards guessing the words themselves (e.g., "what's another word for 'airplane'?"). You can enter letters (even wrong ones) and ask the client whether they recognize each entry as a word. Word-recognition is an important aspect of symbolic dysfunction, although normally I'd choose simpler and shorter words for such a task unless the client was pretty high functioning.

Goals we can target in Tx with this app: Language goals involving reading, word-finding, symbolic dysfunction and intelligibility (see example 3 below); memory/recall goals related to direction following and sequencing, as well as reasoning goals.

Some specific examples:

1. Higher functioning client with language goals, you can solve the puzzle providing cues as needed (start with sound/letter familiarity cues as discussed above, then add word definition hints if needed). Once solved request client form a sentence with each word, followed by one sentence using all 3 (it can be silly, as long as it's grammatically correct).

2. For client with language goal, after solving the 3 words, have them make a list of 3-5 additional words that contain the string of letters missing from the current puzzle.

3. For a client with intelligibility goals, the simple level puzzles in this app provide great practice word lists since they are mostly 2 or more syllables long. So, solve the puzzle for fun, then use the words for intelligibility strategies practice, and to make sentences (silly sentences are really great for intelligibility practice because they lack context and thus have greater dependency on each word being heard and understood).

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: 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?

iPad/iPhone App: NumberOne Brain

NumberOne Brain app

NumberOne Brain app on iTunes (free)

What it is: A matching game where you are asked to locate a target number on a board tiled with several numbers (5-10 of them, see screen image #1). Very simple, but it gets more and more complex as you play: you have to learn to ignore competing stim to find the number you need.

Screen Image #1

As you can see from the screen image at a maximally simple point in the game (the start), the tiles are spaced so there's only one per column. Visual complexity is increased by adding more tiles to choose from, and/or lining them up to have more than one per column. Also, proximity of visually similar number tiles (to the target number) can add complexity, as can the extent of similarity between the tiles (so instead of maximally different from the target number as in the screen image, you may get 101, 110, 1, 211 and 11). The colors of the tiles may also work to draw your attention away from the correct answer, and at a more difficult level an incorrect tile may compete for your attention by shaking a bit. Possibly there's something in the sound as well, but I never play games like this with sound on. Either way, this is a great way to exercise your focus and quite fun as well.

Screen Image #2

How we can use it in Tx: There are several difficulty options available for this game, and as usual I recommend the simplest: "easy". All game play gets more complicated the better you do during the round though. Also, as usual I recommend playing this without the sound unless you have a pt with very high fxn that could use the extra competing stim.

One thing to keep in mind about this game is that, although a fairly simple concept and pretty fun to play, it is timed and graded, although as of March 2013 the grading can be turned off per new update. A round lasts a certain length, and you lose seconds when making mistakes, and I think gain some if have a good run. Here's an example of the summary that shows up at the end of a round if grading is not turned off (screen image #2). Some of the data is worth having, and may even be useful to us for keeping track of progress. However, the school-like grading of "brain level" is not for use in therapy (the original version of this app I reviewed did not allow grading to be switched off, and that's where the screen image is from). The new version does allow you to avoid this grading, which is a huge bonus for our uses! A great thank you to the developers for this, and their update re the matter on this post!

Goals we can target with this app: Attention, focus, following directions, scanning and visual field neglect goals, and of course memory goals (I suggest a way to focus on memory below). A pt with severe symbolic dysfunction may benefit from number matching as well, but they may need too much time for each match to get any real use out of this game. Worth a try.

Some specific examples: There's not really a lot of things you can vary in playing this game. You can vary the level of cues provided to help pt find matching tiles, and you can focus on specific results and/or progress. So for example:

1. If you're working on scanning and field neglect then accuracy becomes an important goal, and you should consider the number of mistakes per round. However, you should also pay attention to how many of those mistakes were due to competing stim from the dominant side.

2. If you're working on focus/attention, pay closer attention to what kind of competing stim interfered most (was it color, was it motion, was it placement, etc.).

3. Here's an idea for how to work on memory goals: Every time a new target number appears, after the pt has looked at it, pause the game (the screen will turn black, covering up the playing board). Check for immediate recall of the target number. If appropriate, distract the pt with something and then check for delayed recall. Then go back to the board, let the pt find the match, and do the same for the next target number (or skip one or two numbers, then pause for the following one to check recall). If you want to up the difficulty, upon pause ask to recall the current target number and the previous one.

4. Brain-training: for the regular (not rehab-patient) population, this game can provide great training for attention and focus, reflexes, scanning, and to some extent memory. For this population the graded summary may be a great motivator to do better each time you play.

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: NxtApp

NxtApp App

NxtApp on iTunes ($0.99, free sometimes)

What it is: A mental math puzzle where you have to find the next number in a sequence using basic math. For example, you may get the following screen: 5, 8, 11, 14, ___ and you have to solve for the missing number. Using simple math (in this case addition) and logic you deduce that the missing number is 17 (each number is the sum of the previous number + 3). The missing number in the sequence is not always the final one, it can be any of the numbers.

In each round you get 10 sequences to solve, although instead of just counting how many you solved correctly (which would have been much better) the round stops with the first error. But it lets you restart the round immediately so it's not a huge problem... it just means that if you want an accuracy % you'll need to keep track manually. There is a timer that runs while the sequence is being solved, but thankfully there does not appear to be a limit to how long one takes.
 
There are several categories of level difficulty: The first listed is "beginner" but it's actually a link to a different app from the same seller, intended for kids. The next level is called category 1, and it includes additions (+) and subtractions (-), category 2 multiplications (x) and divisions (÷), category 3 can have x, + or -, category 4 has powers, +, and -, category 5 has powers and x, category 6 is more powers and 7 is mystery. So as you can tell, the task gets more complex with each category.

How we can use it in Tx: When it's a game like this, simply have your pt play the game and adjust your cuing as needed. For most pts the most appropriate category would probably be 1 (limited to + and - math operations). For most pts when the operation that makes the sequence is adding or subtracting more than single digits (for example a sequence such as 2, 13, 24, 35 where each number is the previous + 11) they may need a pen and paper to calculate. And pts with reasoning goals may need additional cuing to determine what to calculate (to subtract the preceding number from the one that follows it).

Goals we can target with this app: Problem-solving, reasoning and specifically math goals, obviously sequencing goals, direction following and focus (focusing on a math problem in competing noise is quite the task), and of course memory--especially working memory--if the pt can do at least some of the task in their head (thereby having to retain the numbers and operations in memory).

Some specific examples:

1. For memory goals, play this game with the therapist looking at the screen and the pt having to solve the sequence either mentally or (more likely since some of the operations are a little harder) by writing the sequences down but from memory. That is, open a new sequence problem and read it to the pt all at once ("5, 8, 11, blank, 17"). The pt then has to remember all 5 numbers and repeat them before writing them down. If the pt couldn't repeat the sequence correctly immediately after it's read out, the therapist can read it again, and the pt can repeat it again. Repeat as needed until the correct sequence is repeated back, and then have the pt write it down. You can vary this task and make it easier by only reading out 3 or 4 numbers at a time. This way you are working on retaining lists of numbers (and subsequently writing them down) as part of a larger task making the list-repeating feel a little less rote.

2. For reasoning, sequencing and math goals simply play the game and choose the level of cuing your pt needs. The math required to solve each puzzle is fairly basic, but the logic and reasoning skills to figure out how to solve it may be rather difficult for many of our pts. Whichever of these goals is yours, pay attention to the cuing needed for that specific skill (i.e., your pt may need max cues to figure out which numbers to subtract or add to figure out the answer, and what to do with the answer when it's figured out, but may be able to independently carry out the actual math operation once it's determined).

3. Brain-training: for the regular (not rehab-patient) population, this is a great math and logic puzzle to train your mental math abilities. Try to beat the clock and do it quickly or aim for accuracy over speed.

iPad app: CountBattle

CountBattle App

CountBattle app on iTunes ($0.99, sometimes free)

What it is: A very simple sequencing game: you get circles numbered consecutively from 1 to 15, and you simply have to tap them in order, the main objective being to do it the fastest you can. There's 3 levels (easy, normal and hard). The easy level spreads the numbered circles throughout the screen and doesn't move them. Normal and hard levels involve random repositioning of the circles as you play. If you tap outside a circle or in the wrong order, you get moved back one number (so if you were on "7" and tapped "13" by mistake, you're now on "6").

You can play on your own, or two people can simultaneously play in split screen. See screenshots on right. The first screenshot shows the game with one player; the numbers that have been selected in order are dimmed, and the ones still to be tapped are brighter. The screenshot below it shows the game in split screen, where two sequences of 1-15 numbers are presented, one in reddish tones, one in bluish.

How we can use it in Tx: I envision it as a useful activity for any number of executive function, field neglect and aphasia related goals. For most patients you'd probably use the easy level (where numbers stay put) and full screen ("one player"). For more advanced patients you could use the normal level where numbers reposition randomly. Since there's no time limit on this task (you try to get the best time possible, but there's no limit in how long one takes) the more difficult level--while definitely a complex task--is still usable. You can also up the complexity of the task by asking the pt to play in split screen ("2 players") in easy mode (numbers don't move around).

Goals we can target with this app: scanning, sequencing, number recognition, field neglect, direction following, focus, and divided attention.

Some specific examples:

1. For a divided attention goal select 2 players for a split-screen task, and set it on easy level. The numbers for each side of the screen point towards the edge they are near (see the screenshot on the right: the two sets of numbers are right-side-up for the side of the screen they are on). Decide how you want to play the game (either set the iPad in a way that all the numbers are on their sides, but none are upside down, or let one of the colors be upside down and count that as another level of complexity for this task). Ask the pt to proceed on both sets at the same pace (so tap "1" on blues, then "1" on reds; then "2" on blues, then "2" on reds, etc.). A more complex version would be to do a few at a time (in 3's for example, doing 1-3 on blues, same on reds, then 4-6 on each, etc.). There's many variations.

2. For a simple scanning (or sequencing, or number recognition) task ask the pt to play the game in simplest mode (easy level, 1 player) and then try to beat their own time on a 2nd or 3rd attempt.

3. Brain-training: for the regular (not rehab-patient) population, playing any of these levels, trying to get the best time, is good scanning and memory practice. The non-disordered player is likely to scan the screen quickly and mental-note where the numbers are so as to play faster. I find it fun and challenging myself.

iPhone app: Oh, My Word! 2

Oh My Word! 2 App

OhMyWord2 app in iTunes (free)

What it is: Dubbed a prettier and more interesting version of hangman, this is a game where you guess a common 5 letter word based on being given two words that would flank it if listed in alphabetical order. You enter a 5 letter word as your guess, and if it's not the target word, your guess replaces one of the flanking clue words, getting you closer to the target. For example in the screen image below, the target word if listed alphabetically would be between GYROS and OFFER. So the hidden word must start with G, H, I, J, K, L, M, N or O. Put in a few guesses of words starting with these letters, and you narrow it down to a word that in alphabetic order would be between LIMPS and LINKS and must therefore start with LI- (see screen image 2, below).

Screen Image 1

There are several levels at which this game can be played, including a relaxed (called "classic") un-timed easy level where you are given 50 guesses, and the goal is to see how many words you can find within that number of guesses. There's also hints where you can request to be shown one of the letters in the hidden word. After playing this game several times (ok, a whole lot of times... this is a fun game!) I can attest to the fact that the target words indeed are common.

How we can use it in Tx: Access to an un-timed level with truly common words makes this a useful Tx tool. Definitions do not enter into the game. It is more about word recognition and letter sequencing in alphabetic order. Word-finding in the traditional sense normally involves coming up with the word for a specific item, and as such the definition is an integral part. Coming up with words that start with a specific letter (or sequence of letters) is a skill that combines language and reasoning, but still relies on word familiarity and ability to access stored words. For my acute pts with Aphasia I developed a mini word recognition game: I would put two cards with consonants in front of a pt, for example "p" and "g" and then give them cards with all 5 vowels, and ask them to choose the vowels that would form a real word if placed between the the two consonants; so in this example 'e' (peg), 'i' (pig), and 'u' (pug). And I'd ask the pt to also tell me what each word means (often they would choose a vowel that does not make a word, and realize so when they couldn't come up with a definition). It was a multi-step simple word finding activity that first required to recognize the word, then access its meaning. In the same manner for this app, since the words are common, supplemental tasks involving word meanings can be incorporated for those pts who need it.

Screen Image 2

Goals we can target with this app: Word-finding and naming, language, reasoning, sequencing (since alphabetical order plays a large role in this game), question/answer goals (simple y/n where you ask the pt if this letter comes before that one, or if this word precedes or follows the other in the dictionary). For verbal expression deficits reading the words aloud could also be added, incorporating apraxia, dysarthria, voice, intelligibility goals as part of a fun activity.

Some specific examples:

1. For a pt working on using intelligibility strategies at word-level, this game can provide a nice set of short words to practice strategies on. Many of the words have consonant clusters, which provide great practice for exaggerating movements. And since this is a fun thinking activity, it is easier to gauge level of cuing needed to use the intelligibility strategies at word-level (since usually, a word-level task involves a rote list of words and the drill-like manner of the exercise often reminds the pt to use strategies; not that it's a bad thing to have this built-in reminder--in fact it is a great way to get the strategies practiced--but it's nice to have a halfway point where the exercise is still word-level, but the focus is elsewhere and strategy use is less in the forefront of one's mind.

2. For a pt with sequencing goals, this game is a great practice involving alphabetic order. If coming up with words is too difficult for the pt, the ST can focus only on the alphabetic sequence of letters and make word suggestions for the pt to respond. If the two flanking words are GHOST and ICONS, for example, ask the pt what letters come between G and I. If that's too hard, make it a Y/N question: Does K come between G and I? Does H? Then ascertain which letters the target word can start with (in this case G, H, I). Now say you've entered HORSE, and now the flanking words are HORSE and ICONS. What letters can our word start with? (H or I). If it's an H word, what 2nd letter can it be? (O-Z) If it's an I word, what 2nd letter can it be? (A-C). Anyway, you get the picture, just focus on sequences and then suggest the words to guess with.

3. For a pt with higher level language goals, just play the game. Add/reduce cuing as needed to come up with word guesses, and if relevant to pt's goals, ask for definitions of all suggested words.

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 app: Match Panic

Match Panic app

Match Panic app in iTunes (was free for a while, now $1.99)

What it is: It is a matching game, where various tiles queue up in the middle of the screen, and you tap the right or the left to match them. Each level starts with just two tile images (see screen image #1), and every two levels or so one more is added at some point in the level (see screen image #2). It is timed, so if you don't finish a level in 30 seconds, you get a score but you don't move up to the next level (that is the only consequence). If a tile is matched to the wrong side, it turns into a sad face for a second (and costs a second of your allotted time).

Screen image #1

There's powerups too, which may add or reduce complexity of the task as they may affect the queue, e.g., by turning all visible tiles to the same shape, or "blowing up" the next few tiles in the queue, reducing the number of total tiles to be matched for that level. Powerups are a reward for a high scoring round, so a slow player isn't going to encounter this complication often. Don't let the "panic" in the app's name fool you: it's only panicky if you are gung ho about moving up levels and matching quickly. If you're playing the game in a more casual manner, there's nothing in particular that rushes you (other than the fact that the timer may run out before the level is finished, but if your goal is to play one level, no big).

Screen image #2

How we can use it in Tx: Pretty much assume you will only use the first 1-4 levels of this game, although there's nothing specific you have to do to select this. Just keep the goals simple. Turn off the sound so there's no "countdown" sound at the end of a level, and trust me, the music is super annoying anyway. It is designed to make the game feel more urgent (gives it that "panicky" flare) so it's best avoided.

This type of visual matching to right/left is a fairly good exercise for lateral neglect issues. This task is very similar to some divided attention activities that involve canceling a specific word or letter from a pageful of words/letters. Following directions is built-in, and memory plays a role as matching is easiest if one remembers the tiles on each side instead of having to compare each tile. As the number of tile shapes increases, so does the complexity of each of these tasks, including memory.

Goals we can target in Tx with this app: Following directions, sequencing, sorting, focus/attention, divided attention, scanning, visual neglect, and of course memory. This is also a great app for brain-training for the general population.

Some specific examples: Although this is a simple one-dimensional activity, I think it can be used in a variety of ways for different fxn levels and goals. Here are some examples.

1. For a slow, focused approach, possibly for a lower-fxn pt, prioritize accuracy of matching rather than total tiles matched, and ask the pt to take their time but send the fewest possible tiles to the wrong side. Let the progress be as slow as it needs to be, and set as goal for the task a limited number of tiles (10 or 20, for example). Have the pt count out each tile that is matched, and keep track of how many were initially matched incorrectly (then you can calculate % accuracy easily).

2. For a more advanced pt you can prioritize overall completion: Don't count how many were matched incorrectly (although that will play a role as each incorrect match reduces the level's time) and ask the pt to go through as much of the queue as possible in the allotted time. Calculate accuracy by points scored (since it's difficult to calculate percent of queue completed--you only see a piece of the queue at a time with no hint as to how much of it is still to come; if they ever add a % completed counter to this game it would be even better for Tx).

3. For visual neglect goals prioritize the neglected side, and ask the pt to say out loud the tile on that side each time it is encountered. So for example, focusing on the left side of the level in Screen image #1, each time a cactus is encountered have the pt say "cactus" before touching the left side. That way, not only is matching required on the weaker side, but it's also emphasized verbally.

4. Brain-training: This app is also great for normally (or close to normally) functioning individuals who want to get some cognitive training. This kind of thing is now popular with sites such as Lumosity, with more popping up. Everyone wants a piece of this neuroplasticity performance training. And if you feel the need for brain training, an app like this matching one will certainly do the trick as an attention-enhancing activity much like those offered on the paid "brain training" sites.

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: Word Cracker (free for a while)

Word Cracker app

iPhone/iPad app: Word Cracker in iTunes (free for a while)

What it is: A word game where you are presented with (mostly) common words with missing vowels, which you have to fill in. In terms of game options, there are 3 settings that affect difficulty level: First, there's a choice of how much information is missing from the target words: you can have the words presented without spaces (e.g., "VWLS" for VOWELS), and you have to figure out which vowels to put and where, or you can go a level easier by having the word presented with blanks where the vowels go (e.g., "V_W_LS" for VOWELS), and all you have to do is figure out which vowels to insert. Second, and a nice benefit for Tx purposes, you can control how much time is given for each round: in minutes the choices are 1, 3, 5 or infinite, which is equivalent to untimed. Third, there are 3 levels of word difficulty: easy, hard or random. There's also a multi-player option, but that's less interesting for us

To play the game, you are presented with the vowel-less word, and the vowels (a, e, i, o, u) below it, and you drag the vowels into the appropriate spaces in the word. As far as I can tell, when there's more than one vowel option to form a word, the game will accept any of possible vowels. You can also "pass" turns if a word is too difficult, which is nice. And if you submit an incorrectly spelled word, you lose some points but you can continue the game nevertheless. Easy levels, ability to pass, un-timed option and "redos" are what make this word game especially useful for Tx purposes.

Screenshot of game

How we can use it in Tx: Simple answer to this: play the game with your patient. Decide how much cuing to provide (e.g., word definition or example of use), and which words to pass if they are too difficult. But be aware that the easy level of this game is still not that easy (it certainly doesn't qualify as an easy level language task). You can reduce difficulty by inserting all vowels but one in each word, and letting your pt figure out the last vowel only (and pass difficult words).

Goals we can target in Tx with this app: Apraxia, and other language goals. Some reasoning and sequencing is involved in playing this game, but mostly it's about accessing language information and recognizing the words. Surprisingly, I cannot think of a useful way to address memory goals with this app (if you look at my previous posts, you'll see that I can almost always think of memory-related applications to any task) but give me time...

Some specific examples:

1. The most obvious use for language goals is to play the game, at whatever difficulty level is most beneficial to pt, and choosing the amount of cuing to provide. If you need to make the game easier than the easy level with vowel locations marked by blanks, you can add all the vowels but one (in most cases the words have at least 2 missing vowels). You can further reduce the difficulty by narrowing the choice down to just two vowels (e.g., for the word in the screenshot above "str_ng_" add the final "e", and then ask the pt if it's missing an "a" or an "o"; and if needed you can use the two choices and ask "is 'strange' a word or is 'stronge" a word?"). Additional cues can be added with descriptions or definitions. If you want to up the difficulty a little (not so much as to move the word difficulty to "hard" or "random") you can let the pt fill in the vowels and then ask them to provide a definition and/or have them use the word in a sentence. Basically start with what the game provides, and add cues or additional tasks as needed for each pt's goals.

2. For lowest-level language goals, a good task is to work on text/word recognition. Set the game to easy level with no time limit and showing blanks, and pass any words that seem too difficult (here's an easy way to determine: if you couldn't tell what the word is at first glance, it may be too hard for a low-level lang goal pt). Add all but one vowel, and then that last one--fill in with the correct or the wrong vowel and ask the pt if it's a word or not. Determine accuracy based on how many correct words are recognized as such, and how many incorrect words are recognized as non-words.

3. Apraxia goals (this is what I've used it for, with very good results): just play the game at whatever level is appropriate for your patient. Play it together, so if the pt can't figure out the more complex words, help (I cue with either a definition or description at first, but then I'll say the actual word if my pt needs it--this particular pt still needs to see the word written and also benefits from hearing it spoken to attempt to produce it). I have the pt figure out the vowels by saying the word (giving the answer to the puzzle verbally) and then I move the vowels into position (my pt does not have use of his dominant hand or the dexterity in his other hand to grab the vowels on the screen). Once the vowels are in place I have the pt repeat the word again. So we use this game to access higher level language as well as for spoken language practice. I find that my pt is able to produce words with complex consonant clusters that are normally much more difficult for him because attention is on solving the puzzle instead of on how hard it is to produce the sounds. This has been a great find for treatment with the apraxia pt!

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?!