iPad/iPhone app: Writers App

Writers App

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

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

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

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

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

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

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

Some specific examples:

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

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

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

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: 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.

Word List Generator (a quick update)

In March I wrote a post titled "App Wishlist: Word list Generator". Until "there's an app for that", here is a web version: Word List Generator (part of the Free-Reading project, www.free-reading.net). This engine allows you to generate a word list by selecting various parameters. The ones relevant to us include word length (or number of syllables), CVC form, and initial sounds. I would have liked to also control medial context and specific phoneme parameters, but until there's something better, this can help.

I would use this to create word lists for word-level (obviously) tasks for voice practice, fluency, exercises for coordinating speech and breathing, and especially to practice intelligibility strategies.

iPhone app: MouthOff

MouthOff App

MouthOff app in iTunes (currently free)

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

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

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

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

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

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

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

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.

Neuroplsticity and Brain Training

This is a short post, not about specific apps, but all of them in general. Sort of an added goal for this blog.

Sites such as Lumosity are becoming popular with the general population for training their brain and enhancing attention and memory performance, as well as focus, organization, problem-solving, learning new things, etc. These sites and apps are based on research into neuroplsticity, and boast success stories from customers about their improved cognitive skills since starting the "workouts". As such, I decided to go back and re-tag my older posts where I discuss apps that could be used for this kind of brain training (tagging them as "brain-training") and adding a note to the "examples" section at the bottom for each app that could be useful for the purpose of enhancing cognitive function in normal adults. Whatever "normal" means...

I also went back and tagged apps relevant to brain-training with this icon.