Use of iPad and iPhones In Speech, Language, and Cognitive Therapies

October 6, 2016

Presented by: Julie Zahareas, MS, CCC-SLP

Inpatient Speech-Language Pathologist

Northeast Rehabilitation Hospital

Salem, NH

Goal

  • Participants will become familiar with use of iPads and iPhones for patients with speech, language, and cognitive impairments to gain improved functional independence and carryover of skills learned in therapy.

Objectives

  1. The participant will list two iPad and/or iPhone settings that may be utilized as compensatory strategies by patients with speech, language, and/or cognitive impairments to gain improved functional independence.
  2. The participant will list two appropriate applications that may be utilized as compensatory strategies by patients with speech, language, and/or cognitive impairments to gain improved functional independence.
  3. The participant will list two appropriate applications that may be used for homework practice/treatment carryover by patients with speech, language, and/or cognitive impairments.

Review of Various Speech, Language, and Cognitive Disorders

  • Motor Speech Disorders
  • Dysarthria
  • Impaired movement of the muscles used for speech production, including the lips, tongue, vocal folds, and/or diaphragm (breath support)
  • Speech may be “slurred”, breathy, difficult to understand
  • Apraxia (apraxia of speech; verbal apraxia)
  • Impaired ability to initiate and execute voluntary movement patterns necessary to produce speech when there is no paralysis or weakness of speech muscles
  • Errors with production despite effort
  • Language Disorders
  • Aphasia
  • Communication disorder that results from damage to the parts of the brain that contain language.
  • May cause difficulties speaking, listening, reading, and/or writing
  • Does not affect intelligence
  • Pragmatics/Social Skills
  • Using language for different purposes (greetings, requests)
  • Changing language according to the needs of the listener or situation
  • Following “social” rules for conversations/storytelling (turn taking)
  • Cognitive Disorders
  • Impairments in orientation, attention, memory, learning, perception, problem solving, insight, and self-regulation

Prevalence of Smart Devices and Relevancy to Technology in Rehabilitation

  • Nielsen (2012) reported that 54.9% of U.S. mobile phone owners have a smart phone; More than 22 million tablets have been sold in the United States for use by the general public.
  • Prevalence of smart device use among general population destigmatizes their use by individuals with disabilities for compensation.
  • “The increasing use of technology to help individuals compensate for cognitive impairments is one of the most notable advances in neuropsychological rehabilitation in recent years” (Sohlberg and Turkstra (2011).
  • According to the American Congress of Rehabilitation Medicine, the use of external memory aids/ATC into cognitive rehabilitation is considered a Practice Standard for individuals with mild memory impairments and a Practice Guideline for those with moderate– severe memory impairments (Cicerone et al., 2011; Haskins, 2012).

Prevalence of iPad and iPhone

  • iPad
  • 225 million sold since its introduction to market in 2010 (10/14)
  • 80% of mobile web traffic from tablets attributable to iPad alone (6/14)
  • Average cost approximately $467.00
  • Does not require a “data” package
  • iPhone
  • 700 million iPhones sold all time (3/15)
  • 101 million users of iPhone in US (11/15)
  • iPhone has 36.7% of US smartphone market (5/15)
  • Average cost approximately
  • Requires “data” package
  • All apple/IOS products share same basic hardware design and “user friendly” interface
  • Apple technology considered a mainstream choice for Speech-Language Pathologists (SLPs) in a clinical environment (Dunham, 2011);Considered the latest “therapy tool” for both pediatric and adult patients (Fernandes, 2011b).

Objective 1: Manipulating iPad/iPhone Settings for Compensatory Strategy Use to Meet Unique Needs

  • SettingsGeneral Accessibility
  • Vision (visual/perceptual needs)
  • Voice over (speaks words selected on the screen); can adjust rate of speech as needed
  • Braille (newer iPhones/iPads)
  • Zoom (zooms in on screen for patients with visual impairments)
  • Invert Colors (increase attention; adapt to perceptual needs)
  • Grey scale(takes away color contrast)
  • Larger text (adjust to smaller or larger as needed)
  • Bold text
  • Button shapes (increase attention to buttons with shape around options)
  • Reduce Motion (for patients with movement disorders/spasticity)
  • Interaction (physical and motor needs)
  • Switch Control (adaptive accessory features)
  • AssistiveTouch(customize if difficulty touching the screen/adaptive accessory, create gestures)
  • Touch accommodations (how screen will respond to touch; hold duration: how long must touch the screen before it’s recognized to increase accuracy; tap assistance: allow any single finger gesture to perform a tap)
  • Keyboard(which keys show, auto correct options, spell check, key repeat)
  • Home button access
  • Hearing
  • Hearing Aids (iPad Hearing Aids, others paired with blue tooth capability
  • Mono Audio (Adjust balance of volume between right and left channels)
  • Media
  • Subtitles and Captioning
  • Auto Descriptions (will play audio descriptions automatically whenever available)
  • SettingsDisplay & Brightness (adjust brightness of screen, easy access to text size/bold option)
  • SettingsPasscode (may create passcode needed for patient-sensitive info on device)

Questions to consider:

* What setting modifications do you utilize to help you better manage/access your smart device?

* What setting modifications could your patients/families benefit from to improve their ability to access technology offered by the iPad/iPhone?

Objective 2: Use of iPad/iPhone Applications for Compensatory Strategy Use

  • Built-in (“Native”) Applications
  • Calendar
  • Improve orientation (address memory/confusion)
  • Help patients manage schedule/appointments
  • Improve planning and recall
  • Include date, time, reminder alarms, notes, repeat options
  • Monitor potential fatigue when viewing appointments by day, week, or month
  • Clock
  • Prospective Memory
  • Set alarms and reminders. Add labels (ie: take meds, check insulin).
  • Choose how often to repeat (ie: never, only Mondays, weekdays only, etc).
  • Improve time management
  • Timer function; stopwatch function.
  • Notes (yellow “notepad” on all apple devices)
  • Improve recall and planning
  • Take notes at a doctor’s office, work meetings, etc.
  • Use for grocery list
  • Make notes for important points to remember to bring up with doctor, friend, co-worker, family member
  • Option to email, copy, send in message, or print notes; Search option.
  • Reminders
  • Improve organization, task management, and prospective memory
  • “To do”, shopping lists, sequence of steps (daily or novel tasks)
  • Option to share via email with family members/friends for accountability
  • Contacts
  • Recall phone numbers, addresses, birthdays, anniversaries
  • Include notes that might help with remembering specifics about a person/place
  • Assign pics to contact for easier access for patients with visual/reading needs
  • Assist patients who have difficulty dialing sequence of numbers
  • Create shortcut to home screen for specific contacts (wife, “911”)
  • Camera/Photos
  • Memory (take pics to remember details, locations, info)
  • Assist with Sequencing (pics in order to improve task recall/accuracy)
  • Point to pictures to communicate needs, preferences, interests (aphasia, dysarthria, voice disorder)
  • Organize photos in different labeled albums for various needs
  • Important people (ie: family members, friends)
  • Commonly encountered items (ie: foods, medications)
  • Regular activities (ie: going for walks, knitting)
  • Facial expressions/different moods (ie: happy, sad, angry)
  • Frequently visited locations (ie: grocery store, friend’s home)
  • Voice Memos
  • Improve memory
  • Record conversation or leave personal reminder in audio form for later recall
  • Improve communication
  • Play pre-recorded script/utterances needed in various social situations in presence of dysarthria, apraxia, or aphasia
  • Option to send voice memo via text message or email if unable to type/spell
  • Siri Function
  • Use to make verbal requests to look up information
  • Helpful if difficulty reading/typing for internet searching
  • Maps
  • Use for difficulty remembering or following verbal directions
  • Help with decreased navigation skills
  • Family can send location via message. Simply click on map for directions.
  • Text/Messages
  • Written communication with auto spell/correct
  • Useful if difficulty understanding or producing spoken language; impaired voice
  • Audio message available if unable to type/spell.
  • Pre-prepared “script” text options
  • Email
  • Written communication
  • Email script templates for patients with difficulty composing thoughts in writing (See handout example).
  • Calculator (built into iPhone only; free to download on iPad)
  • Assist with working memory and mental calculations for daily problem solving
  • Calculate cost of items at the grocery store, discount in stores, tip at restaurant
  • Health (iPhone; newer devices/software updates)
  • Create Medical ID (can be accessed from emergency dialer)
  • Include Name, DOB, Medical Conditions, Medical Notes, Allergies/Reactions, Medications, Emergency Contacts, Organ Donor Status, Weight, Height
  • Track health info (fitness, nutrition, sleep, vitals)

Questions to Consider:

*What other ways do you use some of the built-in apps to improve your ability to manage daily responsibilities and communicate with others?

*Think about your caseloads now. Which of these applications could be used to help one of your patients or families more comfortably, confidently, and effectively manage his or her daily responsibilities?

  • Additional Apps for Download To Use for Compensatory Strategies
  • Augmentative and Alternative Communication (AAC) Apps: assist patients with dysarthria, voice dysfunction, and language impairments communicate their needs more effectively and across contexts
  • Text to Speech (Free)
  • Transfers written text to speech as needed
  • Verbal expression for confrontational situations (ie: ordering food)
  • Pre-requisite: vision, reading, spelling, navigation skills/memory for selecting phrases from saved options
  • Lingraphica AAC Apps(basic-free)
  • Small Talk Aphasia (female or male option); pre-programmed communication boards with common phrases
  • Option to select phrase playback speed
  • Allows practice speaking along with video models for production
  • MyTalkToolsLite (basic-free)
  • Pre-program app with pictures/recorded voice to help communicate in a variety of scenarios
  • Alexicom AAC(basic-free)
  • Choose from and create a variety of boards for different needs
  • Doodle Buddy (free)
  • White board which allows patient to draw/write to compensate
  • Give context for first letter when
  • Dragon Dictation(free)
  • Record speech which is translated to text
  • Useful for patients with decreased writing/reading skills who need to communicate or take notes in writing
  • Compensatory Memory
  • Pill Box (med monitor-basic version free)
  • Include medicine list (type, dosage, time of day)
  • Set alarms for specific meds with special instructions assigned
  • Check off when meds taken (helpful for family checking in)
  • Did I Do That?(basic version free)
  • Provides reminder for when task last completed
  • Check off tasks upon completion (family can check)
  • Organization/Time management
  • -“DO” (free)
  • “To Do” list with reminders; cross off items after completion
  • Use for patients with executive function disorders, initiation issues
  • -Pomodoro Time 1.4(free)
  • Create “to do” lists and set goals for task completion time
  • Set timers to be held accountable and manage time more effectively
  • Keep track of completed items and items to be completed

Questions to Consider:

*What other downloadable or purchasable apps do you utilize to better manage your responsibilies? How could patients/families you work with benefit from using them?

*When might patients/families need more advanced, specialized applications available through download or purchase?

Objective 3: Use of iPad/iPhone for Functional Practice/Carryover of Skills Trained in Therapy

  • Considerations for Use of Applications in Therapy/Recommending Apps for Home Practice
  • Cost
  • Oftentimes use of technology not covered by medical insurance
  • Consider patients with fixed incomes; need for wifi, contract, data plan?
  • Can a built-in app serve same purpose? Is there a similar, free app available
  • Trial “lite” (limited access) first.
  • Appropriateness/relevance
  • Does the app allow for opportunity to practice skills/goals of patient and family?
  • Is the patient likely to utilize it on their own? Do they enjoy it?
  • Accessibility
  • Consider app’s visual, perceptual, hearing, and physical demands
  • Usability- is it “busy”? Are there clear and effective instructions on how to use?
  • User feedback
  • Is patient able to track progress using app feedback?
  • Avoid negative feedback (especially if more frequent than positive feedback)
  • Sufficient Training/Education
  • Problem solving opportunities with clinician present for future trouble shooting
  • Thorough practice before recommending independent use before recommending independent use
  • (Motor) Speech Practice
  • Breathe2Relax
  • Practice diaphragmatic breathing for increased breath support, endurance, volume, pacing
  • Set goals and modify as needed
  • Decibel 10thand BlaBlaBla
  • Provides visual feedback for volume produced
  • Talking Tom
  • Cat repeats what he hears
  • Patient can learn how much of spoken utterance is understood and use feedback to self-monitor/practice
  • Speech Trainer
  • Practice producing specific sounds in isolation
  • Video instruction with “mirror” screen to see own face/mouth to self-monitor
  • Practice speaking with visual feedback (lips moving)
  • Langauge/Communication Practice
  • Therappy
  • Practice auditory comprehension, verbal expression/naming, reading, writing/spelling
  • Modify field size and level of difficulty; modifystimulus items for relevance
  • Provides feedback/accuracy percentage
  • Categories
  • Practice language/reasoning skills
  • Match items belonging to same categories, classify items, ID exclusion (which one does not belong), add to category
  • Provides feedback/accuracy percentage; able to modify level of difficulty
  • Conversation
  • Practice describing pictures and answering questions for different pic scenes
  • Word Games
  • Word Dominos (free)
  • Problem solve towords using letter combos
  • Chain of Thought (free)
  • Problem solve to match associated words/phrases
  • Chicktionary(free)
  • Create as many words as possible using letters given
  • Memory
  • Spaced Retrieval Therapy
  • Practice recalling target question (can create own) after set amount of time with distractions
  • Beat Peat(free)
  • “Simon” Memory game
  • Working memory practice with colorful visual and audio feedback
  • Attention
  • Visual Attention
  • Cancellation tasks; used to improve L or R inattention/neglect
  • Option to select additional help for target field (red highlighter on L)
  • PicknStixClassic
  • Attention to detail, self-monitoring
  • Find the Differences
  • Practice finding errors/differences between two pictures
  • Count 25
  • Scanning practice; improve processing speed
  • Math/Functional Skills
  • Bills and Coins, Money Counter
  • Telling Time
  • Dial Safe Pro
  • “Brain Training” Apps
  • Rush Hour (planning/problem solving)
  • Constant Therapy
  • Brain Training
  • Think Gym

Thank you for sharing this time to learn more about the use of iPhone/iPads for patients with speech, language, and cognitive disorders! I hope you found this time to be both practical and informative! 

**The information on above noted devices/applications is for educational purposes only. Neither the speaker nor Northeast Rehabilitation Hospital Network endorses any specific devices or applications mentioned in this presentation. To obtain more information on any of the content discussed or to share any questions/concerns, please contact:

Julie Zahareas, MS, CCC-SLP

Inpatient Speech-Language Pathologist

Northeast Rehabilitation Hospital, Salem, NH

(603) 681-3172

References

Neilson Wire. (2012, November 4). Two thirds of new mobile buyers now opting for smartphones.Retrieved from

Sohlberg, M.M., & Turkstra, L. S. (2011).Optimizing cognitive rehabilitation: Effective instructional methods. New York, NY: Guilford Press.