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.

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.

iOS/Android App: Counting Dots

Counting Dots App

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

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

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

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

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

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

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

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

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

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

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

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

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

iPad/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/iPhone app: Hemispheres

Hemispheres App

Hemispheres app in iTunes (regularly $0.99, sometimes free)

What it is: Solve simple math problems while mixing two colors together. On their own, each of these tasks is simple, but carrying them out at the same time is quite a bit less simple, as your brain must switch between the two problems, simultaneously engaging the logical/math and creative hemispheres. Talk about split attention task! This task is timed, which ups the difficulty level.

How we can use it in Tx: There is no easy or relaxed level, so expect pts to only be able to get through the first couple of problems (the game ends with the third error on either side; running out of time counts as an error as well). But even a couple of rounds of this game can be useful, and it's definitely something to use with higher functioning pts.

Goals we can target with this app: Attention, focus, math, and to a certain extent visual field neglect since the problems presented by the app are side-by-side, so attention to each side is needed. It is definitely a worthy brain-training tool as well.

Some specific examples: Since this app only has one level and the tasks are timed, there is not really a way to make the task simpler. Therefore, I would be weary of giving it to pts working on the very simple or basic skills. I would target pts with more advanced goals.

1. The most obvious use is for a split-attention task for higher functioning individuals with mild executive function deficits. Set as goal trying to get through as many of the problems as possible (i.e., get the highest possible score).

2. For field neglect goals, instruct the pt to focus on the weaker side's problem (e.g., for left neglect have them only solve the left-sided problem, ignoring the one on right). This will make for a short round, as concentrating only on one side will ensure the other side will run out of time and add to the count of errors, ending the round after 3. But solving 3 problems on the weak side with competing stimulus from the strong side is actually not a bad task, especially since the game can be restarted as many times as wanted (so you can ask to solve the 3 problems at a time, x5 for the entire activity).

3. Brain-training: for the regular (not rehab-patient) population, switching between the hemisphere-heavy tasks makes for a great exercise of multitasking, prioritizing, attention and focus skills.

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.

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.