Android and iOS app: Constant Therapy

Constant Therapy App

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

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

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

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

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

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

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

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

iOS App: ICOON Global Picture Dictionary

ICOON App

ICOON App on iTunes ($0.99, sometimes Free)

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

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

Screen Shot 1

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

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

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

Screen Shot 2

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

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

Some specific examples:

Screen Shot 3

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

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

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

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: 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.

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: 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!

Android app: Word Match

Word Match

Word Match (Free) from Barnes & Noble

What it is: A word association game for the Nook, very similar to the Word to Word app (see blog entry from 3/30/12), but free from the Barnes & Noble store. This version of the word association game contains 3 categories: Art, Food n Beverage, and Health. Like with Word-to-word there are two columns of words that have to be matched into pairs with more advanced levels including more than one possible match for each word, but only one configuration that allows for all the words to be paired. There is a timer that keeps track of how long it took, but there is no time limit on how long one CAN take. Timers are the one thing that can make a good game useless as a Tx task, taking it from fun to frustrating very quickly.

How we can use it in Tx: Since this is the same basic activity as Word-to-Word, I won't bother repeating myself. How to use it in Tx, along with specific examples can be found in my Word-to-Word entry from 3/30/12.

Goals we can target in Tx with this app: Language goals, word-finding, problem solving goals, and STM

iPhone/iPad and Android app: Word to Word

Word to word

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

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

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

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

Some specific examples:

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

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

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

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.

Android app: JABtalk (AAC, free)

JABtalk for Android devices

This program is currently free from JABstone, and is available from Android Market, Amazon App Store, & the Nook Store

What it is:  Originally developed as an AAC device for kids. It is fully customizable, and you can create categories and words with images and sounds for each. If your device supports a microphone you can record the words and categories right on it (Amazon's Kindle doesn't, but BN's nook tablet does and the more expensive Android tablets do as well). If you're using a device without microphone you can import sound files into your library and use them within this program (it'll take longer to prep a communication board that way, but it's doable). When it comes to images, you can take a photo if your device has a camera (Kindle and Nook do not), you can import images on any of the devices, and you can do an image internet search directly from within this program on any of the devices. There's talk of adding sentence building to following releases too.

How we can use it in Tx: I had fun building a default communication board with basic needs for my target population (call button, wheelchair, glasses, dentures, pain scale, yes/no, etc.). I carry this in my Nook as part of my default materials to always have with me. You can also make a language/word-building/problem solving task out of creating a new board with a patient that does not need an AAC device, but can use the practice thinking of common and safety-related objects.

Goals we can target in Tx with this app: Word finding, problem solving, AAC

Some specific examples:

1. Put together a menu for the three daily meals and write a goal for pt to use the device to order their meals (an AAC goal)

2. Have pt locate words within nested categories (e.g., apple would be inside foods & drinks/snacks/fruit) with certain % accuracy (a problem-solving goal)

3. Have a pt (who may not need AAC device) come up with as many suggestions for what to put in a given category (e.g., clothes or snacks) as they can (a word-naming goal)