Comprehension TherAppy

To continue our celebration of National Aphasia Awareness Month, I am reviewing a great app that is specifically designed for adults with aphasia (but also can be used with children). In addition to the review, Speechie Apps is hosting its first app giveaway! Tactus Therapy has generously donated two promo codes for the Comprehension TherAppy app to the lucky winners. :) Check out the giveaway post for more details on how to participate. (By the way, if you’re having trouble keeping up with all the speechie-related awareness months, SLP Echo just compiled a great list.)

What It Is: An app that addresses listening and reading comprehension by Tactus Therapy Solutions.

Price: $24.99 (This price is for the single app. The app is also available in the Language TherAppy app bundle, which is a 4-in-1 app for $59.99. In addition, there is a free lite version of this app bundle so the user can test out the various apps before making a purchase.)

Version: 1.03

Choosing Categories

How It Works: This app contains three main modes: listen, read, and listen & read. Each mode contains an option to choose verbs, adjectives, or nouns. The nouns category contains ten subcategories (e.g. food, body parts, places). The user may choose any or all of these subcategories. The listen mode consists of a voice stating the target word while simultaneously showing pictures (anywhere from 2-6, as will be discussed in the “pros” section). For example, the voice might say “sewing” and there will be pictures of a woman sewing, someone putting gas in a car, and someone soaking their feet. (Did you catch that phonemic foil?!) If the user touches the correct answer, he or she is rewarded with a high-pitched “ding” and the picture is highlighted in green before the next set of pictures appears. If the user touches the incorrect answer, there is a low-pitched noise and the picture is highlighted in red before the user is allowed another attempt. (There is also a repeat button at the bottom in case the user needs to hear the prompt again.) The read mode is quite similar but the word is displayed at the bottom and no voice reads it. For example, the word “sweet” will be displayed under pictures of desserts, someone eating a lemon, a road, and duct tape. (Did you catch that semantic foil?!) The listen & read mode shows several words from which the user is to pick the word that is said aloud. For all of these modes, the settings options allows for changes in language, difficulty, field size, and number of trials; a default email for results; and a child-friendly mode.

Trial in “Listen” Mode–consider the phonemic (pizza/pencil) and semantic (pizza/cucumber) foils. I correctly answered this trial, so it is highlighted green.

Therapy Applications: For this section of the review, I’ve based my explanations and ideas on my experience as well as the experiences and thoughts of several SLPs in different settings. Hopefully this way you will get a well-rounded understanding of the various ways the app can be used. This app is most easily used with adults with aphasia. Clearly, it addresses auditory and reading comprehension. How it is used for these purposes is fairly straightforward–the developers have done the work for you in that regards; using the app will not take much creativity on the part of the therapist. However, it is important to note that the app can be used differently depending on the abilities and needs of the client. For example, a client with severe Wernicke’s aphasia may benefit more from utilizing the listen mode with the difficulty setting on “easy” and a field size of 2. Someone with attentional challenges may benefit from merely doing 10 trials while another individual may easily be able to complete 50. It is relatively easy to comprehend how the listen and read modes of the app can be used to address practical goals; however, another therapist and I had difficulty finding a functional use for the listen & read mode, where the user matches an auditory stimuli to a typed word. Upon asking the developers about this, it became clear in just how many situations this could be necessary. For example, if receiving technical support or paying a bill over the phone, people are often instructed to “find X under menu Z” (e.g. the serial number on an iDevice). Or, in a restaurant, a friend might ask, “Do they have fish fry on their menu?” To perform these tasks, it would be necessary to take auditory input and match it to written word, which is what the listen & read mode addresses. The developers also pointed out that this is a key component of ORLA therapy. Regardless of which mode(s) you find most useful, the app can be excellent for therapy activities but is also a straightforward, easy-to-use way for clients to practice working on these skills at home.

Trial in “Read” Mode–again, consider the foils.

In addition to working with adults with aphasia, the app can also be used with children. The app can easily be adapted to working with older children (mid-elementary and up) who are working on basic reading and listening skills. During my work with preschoolers, I have found the listen mode to be useful but have not had much use for the other two modes because of the reading skills required. (However, I do have one five-year-old who LOVES the read mode. She enjoys sounding out the first letter or two of the word and guessing which picture it belongs to. Because of some of the phonemic foils in the app, this isn’t always functional, but she still enjoys it, and it has turned into an unexpected reinforcer. This is, of course, the exception–I’m sure not many children can be bribed with “If you get through making cookies on Cookie Doodle, you get to play with the reading part of Comprehension TherAppy”!) Overall, I think the app is best used with adults and older children, but I’ve used it a surprising amount with the younger crowd, too. Incorporating it into games is an easy way to increase children’s motivation (e.g. playing checkers or tic-tac-toe while using it).

Trial in “Listen & Read” Mode in Spanish–note the red highlight around the word, which indicates I answered incorrectly.

Pros:  1. Sheer number of pictures and words. The amount of stimuli in the app is phenomenal. There are over a hundred verbs, over a hundred adjectives, and five hundred nouns.

2. Inclusion of verbs and adjectives. During my aphasia course, it was impressed upon me that nouns are great, but they should not be the only vocabulary addressed during treatment. I’m very pleased to see other parts of speech included in this app.

Settings Options

3. Settings options. There are four possible languages (North American English, UK English, Spanish, French), varying difficulty levels (easy, medium, hard), different field sizes (auto, 2, 3, 4, 6), different number of trials (10, 25, 50, 100, continuous), an option to add a default email for results, and a child-friendly mode (which takes out any references to, say, violence and also disables links to social media and iTunes via the app).

4. There is excellent reasoning behind the levels of difficulty and different field sizes, and the developers manage to execute this in a systematic manner. For example, the easy level of difficulty will contain words all from very distinct classes, while the medium difficulty will contain at least one foil (semantic or phonemic) and the hard difficulty will contain several foils from the same subcategory. For the “auto” option of the field sizes, three correct responses cause the field size to go up (e.g. from 3 to 4) while three incorrect responses cause the field size to go down (e.g. back down to 3). This clearly took careful thought and good planning. Not many apps attempt to include built-in dynamic adjustments. Of course, if the therapist does not want this (e.g. if they only want the app to show targets of three for a specific client), he or she can change the setting from auto to the preferred number.

5. High quality pictures.

6. Ease of use. Clients (and therapists!) are able to pick up on how to use this straightforward app with no difficulty.

7. Errorless learning. If the client chooses the wrong option, the data will reflect this but the app allows for further attempts. The ability to repeat auditory stimuli enhances this option.

8. The app is quick enough to keep up with impulsive clients. There isn’t a wait time in between the user’s response and the reinforcement, and the app quickly transitions to the next stimuli after the user has responded correctly.

Emailing Results

9. It is easy to stop in the middle of a session (e.g. after completing 13 of 25 trials) and still obtain data from the session. (This is surprisingly uncommon in apps.)

10. The results are organized by field size. For example, it will indicate the total percentage correct and then break it down further to show that 100% of the responses were correct with a field size of 2, 80% with a field size of 3, 50% with a field size of 4, etc.

11. Last but not least, the developers are knowledgeable, easily accessible, and great networkers. Months before this review and giveaway was even a thought, they were on Twitter interacting with me and others–answering questions, joining in discussions, and sharing resources beyond just their own promotion. While this may not seem to directly impact the quality of the app, it does on several levels. A developer that responds quickly to questions, concerns, and suggestions means that if you ever should have a problem with this app, they will immediately assist you. Their involvement in real-time social media and resource sharing indicates a desire to constantly improve their app AND base their app on good techniques and evidence.

Cons: 1. Price. Yes, I think the app is worth the $25. Yes, I understand that, compared to traditional (e.g. printed out) therapy activities, this is pretty darn cheap for the amount of pictures and variety of features. However, any app over ~ $10-15 causes me to think long and hard about whether or not I really need it, and I certainly don’t want to make light of that to my readers.

2. Lack of customization options (e.g. to choose target words or add in your own). I asked the developers about this, because it was a common question from the SLPs that consulted with me before this review. The developers explained (more eloquently and thoroughly than I am about to) that, because each picture can only show one concept, it would be difficult for a therapist to add a word that could fit perfectly with the randomized pictures (e.g. if the target word is “colorful” and the developers have a picture of something colorful, the therapist adding in another colorful photo could easily corrupt the trial). Basically, it would be very complex to add a customization option. While understandable, it is a downside that there is not a way to customize more.

3. If selecting another language, it will only be applied to the target words (auditory and written). So the category names and results will still be shown in English.

4. For someone with visual acuity difficulties, the pictures may be too small. It would be nice to have a way to zoom in or increase the picture size. There is currently a lot of white space in the app.

5. If the home button is touched accidentally, there is a “try again” function, but the data collection restarts, so the previous data will be lost if you return to the trials. The data is still reported at that point–it just won’t continue, so you will need to email it to yourself or write it down. *Update: The developers are currently working to add a cancel button to avoid this problem.*

The Take-Away: This is a thorough app with systematic execution and plenty of settings options. The developers are fantastic and will respond to you in a timely manner with informed answers. It is worth making room for in the budget (if you don’t win it first!) and can be useful for a wide range of clients. I would highly recommend it on its own or in the bundle app. Download the free lite version to test it out before purchasing.

My Questions for You: How have you used this app in therapy? Was it easy to generalize to functional progress with your clients?

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17 thoughts on “Comprehension TherAppy

  1. Pingback: APP GIVEAWAY: Comprehension TherAppy! | speechie apps

  2. Aubrey – Thanks so much for your very thoughtful and thorough review! We’re so glad to hear that the app is useful for kids and adults alike. Your pros and cons are very well-received. Here is a little more information in response to your acute observations: We hope to incorporate a “cancel” button on the results pop-up in a future update so accidental hits of the home button can be cancelled. Our rationale for not translating the menus/results for other languages is that most of our users are in the US or other English-speaking countries. We wanted to add Spanish for US-based SLPs who have bilingual or Spanish-speaking clients, but still need to recommend settings and interpret results in English for charting. We added French for our Canadian colleagues who work with French and bilingual clients. We are also trying to balance the picture size and white space. The idea of having so much white space is to be visually uncluttered for client who have difficulty with overwhelming graphics and to have items spaced far enough apart for users with less-than-accurate dexterity. For example, it’s nice for stroke survivors to practice pointing at the pictures with their hemiplegic hands when they have recovered enough function to begin using them – pictures too close together would result in more errors. As with customization, every detail is a balance or compromise between opposing desires – ready to go vs fully customizable, visual deficits vs access difficulties, foreign users vs foreign SLPs, affordability for users vs cost of development and small market…. And on a personal note, thanks for valuing the social networking! I am a SLP first and developer second, so I strive to stay on top of best practice and strive to incorporate that into all of our apps. Your blog is an excellent resource with creative ideas for “in-the-box” and “out-of-the-box” speech apps. Keep up the great work!

    • Thank you for your explanations! I’m glad that both the pros and the cons were well-received. I’m VERY excited to see a cancel button soon and will update the post regarding that. And of course, I’m aware that there is a flip side to every suggestion I’ve made. (E.g. bigger pictures would be better for people with visual acuity difficulties but would mean I could complain about how they cause more errors in people with hemiplegia!) I think you have done a wonderful job balancing the needs in this area, and I am pleased that you are so readily willing to respond to suggestions. Glad you’ve found the blog to be a helpful resource!

  3. Great review! I would love to get this app! I love your comment about errorless learning. This is a concept I recently learned about, and I feel it is very important! Thanks.

    • I had a professor who really stressed the importance of errorless learning (not necessarily in all situations, but many), especially for people with brain injury because they are faced with such huge feelings of failure in their everyday lives. I love apps they provide subtle feedback when something is incorrect but still allow the person chances to complete the task successfully.

      • In designing the app (actually all of the apps), we wanted each trial to end in success. There’s a rush of dopamine the brain gets when it’s excited that enhances learning. While it’s just a little “ding!”, it’s still positive and helps cement the knowledge. Thanks for recognizing this small, but important, feature!

  4. I have not used this app, but think it would be a terrific addition to bag of goodies. When working with aphasia patient in the home care setting, I am constantly lugging boxes of pictures and words around with me. This app seems like it would make life so much easier, not to mention freeing up some space in my car :)

    I have found that some of my elderly patients are intimidated by the use of technology during speech sessions, but most find it interesting.

    • I have loved being able to downgrade my bag(s) size since buying the iPad. It’s interesting how people react to technology. When people seem nervous about it, I’ll often bring out an app like Cookie Doodle or My PlayHome, and they get so caught up in it that they forgot it’s scary. :)

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