My thoughts on: Reading TherAppy from Tactus Therapy
March 25, 2012 Leave a comment
Key details (taken from http://www.tactustherapy.com/reading.html)
From Tactus Therapy Solutions (website includes a video demonstration)
Cost:£10.49 / $14.99 (at time of writing) at the iTunes App store
Targets reading comprehension, attention, problem solving
Aphasia, Alexia, Alzheimer’s Disease, Dementia, Cognitive-Communication Impairment, Brain Injury, Early Language Learners, Language Learning Disability, Autism, English as a Second Language Learners
This was my first experience of using a Tactus Therapy app (experimenting on myself, not on a patient/client) and overall I’ve been very impressed with what the app offers both in terms of content and delivery.Even using an iPhone as opposed to the larger iPad I found navigating around the app fairly simple and the presentation was clutter-free (although the instructions are fairly dense with text which may present a challenge to someone with reading difficulties if they were using the app independently – although the exercises are relatively self-explanatory once you get into them).
Unlike Tactus Therapy Solution’s Naming TherAppy, and Comprehension TherAppy, Reading TherAppy doesn’t make claims to be based on current research (most likely due to the limited evidence base for reading therapy in aphasia and language impairments). It is therefore best viewed as an app offering ‘pratice’ as opposed to ‘therapy’ per se. However, the app does offer opportunity to practice reading comprehension in tasks which speech and language therapists/pathologists would typically use to assess reading comprehension.
The app offers four reading comprehension exercises:
1) Phrase matching (selecting an appropriate two or three word phrase from a choice of four to match a picture)
2) Phrase completion (selecting an appropriate word from a choice of four to complete a short phrase)
3) Sentence matching (selecting an appropriate written sentence from a choice to four to match a picture)
4) Sentence completion (selecting an appropriate word from a choice of four to complete a sentence)
One immediate point to note is probably that the exercises that a patient should undertake would probably depend on the nature of their reading difficulties.The tasks do vary intrinsically in their linguistic processing demands (i.e. single word level comprehension, phrase level comprehension, sentence level comprehension).Therefore when starting off with using the app, a patient will likely benefit from some guidance from a speech and language therapist/pathologist in order to ascertain an appropriate starting point.Otherwise there may be a danger that a patient may start at a level that may be beyond their current ability which may lead to frustration and rejection of the app.
I’d also say that some of the distractors (i.e. the non-target responses) may not be totally inappropriate in terms of syntactic and semantic well-formedness (i.e. they’d still make sense) but there are definitely preferred responses based on frequency of co-occurrence and word association.I noticed this mainly in the Phrase and Sentence Completion exercises, e.g. for completing the phrase ‘peel a ____‘ I was given the options: monkey, banana, salad, and bandage, and I would say that it’s plausible to peel both a banana and a bandage whereas the app would only accept banana as the correct answer. These could be explained in terms of frequency etc., but a patient may find it difficult to reconcile, and a speech therapist/pathologist may find it difficult or tenuous to explain why bandage is incorrect. I’d also admit however that some of my difficulties with these may be due to my usage of British English as opposed to American English.
The app offers a range of customisation options which may be specified by the patient or by a speech and language therapist/pathologist.
All four exercises are based around a core set of vocabulary items drawn from various word class (nouns, verbs, adjectives) and semantic categories (e.g. animals, clothing, people, places, etc.) which range in size from 10 (colors) to 107 (verbs) items.The patient or speech therapist/pathologist can choose a specific category or categories for exercise items to be based on or alternatively can select all categories to be included.Given that people with aphasia do have a tendency to show some word class effects (e.g. Druks, 2002) and some show semantic category effects (e.g. Capitani et al, 2003) this is a nice customisation feature which means exercises can be targeted to specific areas of weakness (or strength) or alternatively can present a broad range of content.The notion of semantic relatedness is also carried though in the distractor responses (i.e. the non-target responses for each item) as they present a mixture of semantically and associatively related and unrelated responses to the target (e.g. in the Phrase Matching task, for the target diamond earrings, the accompanying distractors are: diamond necklace, gold coins, and gold earrings). This naturally provides an extra demand on semantic processing and therefore reinforces the construct validity of the app (i.e. that the patient needs to utilise processes relevant to reading comprehension).
The number of items in one ‘session’ can be manually set to either 10, 25, 50, 100 items (or indefinite) and these will be drawn randomly from the categories that the user has pre-selected to be included in the exercises.The app will keep track of scores (items correct on first attempt) and a summary of the particular task and the results can be sent to an email address (e.g. for the patient’s own reference or for a speech and language pathologist to remotely monitor when the patient is using the app and how they are progressing).So this provides a convenient way to monitor progress across sessions and potentially over varying numbers items. Although, as far as I can tell, it doesn’t track and report which categories have and have not been been worked on in the exercise so if this was important to know then it would have to be done manually.
When an item is incorrectly answered on the first attempt, the patient can then re-select an answer until they chose the correct one.This is perhaps one of the major differences between the app’s delivery of the task compared to direct therapy given by a therapist/pathologist.On incorrect items, in direct therapy a therapist/pathologist would most likely offer feedback on why a particular item is incorrect and why another is correct.While the app will eventually allow the patient to select the correct answer, the patient may not gain the depth of understanding as to why something is correct as they would in a therapist/pathologist directed therapy task.I’m not sure how easy this would be to achieve with an app as such but it may be a consideration in terms of who the app may be recommended to – if patients suffer from pronounced reading impairment and are likely to be getting a fair number of trials incorrect, then the amount of information that they are needing to retain and relearn from these incorrect items may be too much if using the app independently and therefore it may be more beneficial if they can use the app with support from either a speech therapist/pathologist or carer/family member.
Overall, my opinion is that the Reading TherAppy app would definitely have potential to be of benefit to its intended target populations – it presents tasks which do indeed necessaitate comprehension of the materials in order to carry them out successfully and it also presents features which allow the exercises to be customised according to the individual and their specific difficulties (and strengths). I would probably suggest that the app would be of most potential benefit if the patient initially used it under guidance from a speech and language therapist/pathologist so that an appropriate level of difficulty (i.e. the task/s carried out) and intensity (i.e. number of items, number of ‘sessions’ per day/week) can be established before the patient begins to work independently.The fact that the speech therapist/pathologist can monitor the patient’s progress from a distance through email updates is also a useful feature as this will allow them to know whether to advise of any changes in difficulty/intensity.
As per my previous blog post I’d also suggest that if the app if being used under guidance of a speech therapist/pathologist that an additional outcome measure be employed. This would allow for measurement of true changes in reading comprehension ability as a result of using the app (e.g. written word/sentence to picture matching assessments in the Comprehensive Aphasia Test or PALPA, although exact outcome measures would depend on the population and native language, or variant of English).For example, with apps like this which present essentially a finite (albeit large) number of items, a patient could potentially do the exercises repeatedly so that they simply learn which response goes with each question without actuallyunderstanding why they are the appropriate responses.
However, I’ve also been informed by Tactus that there is an update due in April 2012 to allow further customisation of the app to allow users to update with their own materials (words/phrases/sentences and photos).This naturally offers a great opportunity to increase the longevity and functionality of the app (n.b functionality in terms of making the app as functional as possible for the individual by incorporating relevant and individualised vocabulary items).
(Disclaimer: if not obvious from the content of my writing, my main experience is with working with adults with aphasia and related conditions so this may influence my perceptions and interpretations of aspects of the app)