Sunday, March 29, 2015

iOS App: Winky Think Logic Puzzles

Winky Think Logic App
Winky Think Logic Puzzles App on iTunes ($2.99, sometimes free)

What it is: A collection of 180 logic puzzles that involve very simple to mod difficulty levels. The puzzles all consist of variously shaped and colored tiles that need to be positioned in specific spots. Sometimes it's as simple as moving a tile to its designated spot, sometimes several tiles to several spots, and sometimes there's obstacles to overcome and sequencing to determine. Solutions require single - to - multi steps to reach, with skills that tap into shape and color recognition, path determination, figuring out the outcome of various objects in the puzzles, etc.

Screen Shot 1 shows a simple level where you have to choose the correct shape to move to the center. Screen Shot 2 shows a simple level where there's some restriction on movement, and more than one target shape - so one has to move the tiles in sequence to place them. Subsequent levels include some additional problem solving. It never gets too difficult and it's pretty fun. If you get stuck, you can restart a level at any point - there's no timer and no points to lose; you just keep solving until it's solved.
Screen Shot 1

How we can use it in Tx: There's no settings to consider except whether or not you want music. If you are working on focus and need some distracting stim, you can keep the music on.

The levels are made more complex by the addition of obstacles, and multi-step solutions to the puzzle. A few levels require the use of more than one finger--I'd skip those levels in therapy unless you have a very highly functioning and dexterous individual. There's also a few levels at the end of the game where very precise movement is required (the obstacles cannot be "touched" by the tiles); I'd skip those as well as they may just frustrate more than help. But overall, levels are realistically solvable, especially with some cuing.
Screen Shot 2

You get to move up levels as you solve them (solve one, get to move on to subsequent levels) but once solved, you can reuse the levels. So, I would recommend solving ahead (as far as you plan to use with any client; or all 180 puzzles - it's fun). That way you can skip over levels that aren't appropriate for a particular client, and not worry about any subsequent levels being locked. Otherwise, just choose levels and play.

One issue that may arise is that solving some of the levels may require dexterity beyond the ability of your client. In such cases you can either skip that level, or split the task into parts that would still provide experience with the problem solving and the planning: the client may solve the puzzle by making a plan (e.g., for screen shot 2, figure out the sequence in which tiles need to be dragged into the track), and then verbalizing directions for someone else (likely the clinician) to carry out the plan. Then the dexterity of maneuvering the tiles would be left to the participant without deficits in this area.

Goals we can target in Tx with this app: Direction following, problem solving, reasoning, symbolic dysfunction, visual field neglect or other visual-field dysfunctions (like hemianopsia--to get used to scanning back and forth to compensate), sequencing, sorting, focus/attention, categorizing, planning, and of course spatial reasoning. And of course, as per my usual logic, memory.

Some specific examples:

1. As noted above, if you have a client who lacks the dexterity to maneuver the tiles in any or all levels, you can separate the task into manageable bits and remove the part that requires skill beyond your client's reach: the client can make a plan to solve the puzzle, verbalize it (or discuss it), then provide directions for another person to carry it out. The clinician, or another client if you're working in a group, can maneuver the tiles.

2. You can use this as a break between other tasks, or as its own task for a certain part of your session. To document skill and progress I would keep track of the cuing required and the number of steps that were needed to solve each puzzle to determine the difficulty of the task at each level. You might also note if the multi steps were homogenous: That is, were they the same step each time, as in sequencing the order like the puzzle in screen shot 2, or heterogeneous steps, as when one tile needs to be put on a spot that opens an obstacle or has to be maneuvered to a spot that allows it to change colors. I would consider heterogeneous steps more complex. For someone with symbolic dysfunction, you 'd want to also keep track of how many colors and/or shape choices were provided and how much cuing they needed to pick the correct shape/color (e.g., in the puzzle shown in screen shot 1).

3. Memory: you can show the solution to a min/mod difficult puzzle, and then ask your client to re-solve the puzzle using their reasoning and their memory of your solution. See, I can ALWAYS involve memory goals.

All in all, I think you can have a lot of fun with this puzzle both for direct Tx and for a motivating and useful break between other tasks you have planned.

Saturday, January 10, 2015

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.

Sunday, January 4, 2015

Expanding the scope of reviewed apps

I started this blog to help sift through available low-cost resources when I realized that I'll be paying out of pocket for Tx materials in a medical/rehab SLP setting. As such, I looked beyond the apps developed specifically for SLPs mostly because of their price tags, but also because the general apps that are free or cheap were often ignored in SLP blogs on technology and small device apps.

Listing apps that are targeted at the general population, I developed an organization that included description of the app in question, how it can be used in treatment, specific goals that it may help target, and some examples of its use or goal-specific tasks.

I've come close to running out of general apps to review (that aren't similar to previously reviewed apps). I shall therefore add some SLP-specific apps to the catalog of reviews. I will attempt a similar organization suggesting specific uses and goals (based on client diagnosis and disorders, as well as specific goals for Tx) and add my thoughts on each app's value for $.

One of the first apps/services I will look at is Constant Therapy (http://constanttherapy.com/), which is free for clinicians and students, but not free for clients/users. I've used it with several clients who went on to buy subscriptions to the service, and I can definitely recommend it for cog goals. Check back for a full review in a (near) future blog entry.

Sunday, July 27, 2014

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.

Sunday, September 22, 2013

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).

Saturday, September 14, 2013

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).

Sunday, May 26, 2013

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.