Using&a&Handheld&Computer&as&a&Cognitive5Behavioral&Tool& Tony%Gentry,%PhD%OTR/L% Virginia%Commonwealth%University% Assistive%Technology%for%Cognition%Laboratory% Department%of%Occupational%Therapy% % Apple's%ipod%touch%and%ipad,%and%the%growing%catalog%of%Android%and%Microsoft%tablets,%are% remarkably%versatile%and%agile%tools%that%have%taken%the%consumer%world%by%storm.%%%Within%the% disability%community,%it%has%become%clear%that%these%devices%can%be%readily%customized%and% adapted%to%address%cognitiveJbehavioral%challenges.%%Because%they%are%so%portable,%they%can%be% used%as%behavioral%supports%at%home,%at%school,%at%work%and%in%the%community.% % Because%these%devices%can%do%so%much,%it%can%be%challenging%to%figure%out%what%to%do%first.%%The% following%guidelines%are%based%on%a%decade%of%communityJbased%PDA%research%in%VCU's%Assistive% Technology%for%Cognition%laboratory.%%They%are%not%intended%as%strict%rules,%but%as%suggestions%for% ways%to%get%the%most%from%these%products.

% % Remembering&to&Do&Things% % The%very%first%Palm%Pilot%PDAs%came%with%to%do%list%apps%and%calendars%with%reminder%alarms,% giving%them%a%distinct%advantage%over%paperJbased%scheduling%products.%%Setting%an%alarm%for%daily% tasks%can%be%a%gameJchanger%for%people%with%memory%or%attention%challenges,%and%current%devices% offer%a%wide%range%of%tools%for%doing%just%that.%%%Apple%products%include%a%Calendar%that%allows% alarms%to%be%tagged%to%everyday%events;%the%iphone%and%ipod%touch%also%offer%a%versatile%Clock%app% that%allows%you%to%choose%a%customized%reminder%sound%for%each%task%(including%one%particularly% insistent%reminder%that%only%turns%off%when%you%tap%the%screen).%%Android%tablets%include%Google% Calendar,%and%Microsoft%tablets%include%a%tablet%version%of%Outlook,%both%of%which%incorporate% reminder%alarms.%%All%of%these%products%feature%noteJtaking%apps%that%allow%for%the%creation%of%to% do%lists.%%There%are%at%least%500%addJon%apps%available,%offering%variants%on%these%onboard% calendars.%%For%Apple%products,%the%online%iTunes%Store%is%where%you%will%find%them.%%For%Android% products,%search%the%online%Android%Market.% % Task5Sequencing&&&Wayfinding% % People%who%have%difficulty%learning%to%complete%multiJstep%tasks%independently%(morning% grooming%tasks,%complex%job%skills,%etc.)%can%use%these%devices%as%task%coaches.%%%Some%people%only% need%a%stepJbyJstep%written%task%list,%or%a%list%that%includes%a%picture%prompt.%%Errands,%Visules%and% HomeRoutine5are%inexpensive%apps%for%creating%such%supportive%task%sequences.%%You%can%also% create%a%Powerpoint%sequence%of%pictures%and%captions%for%any%task,%click%to%create%a%movie%version% and%download%that%for%playback%on%your%handheld%device.%%For%people%who%need%audiovisual% support,%you%can%create%a%video%showing%the%task%being%performed%successfully,%and%have%it% available%for%playback%when%needed.%%Most%current%PDAs%and%tablets%come%with%onboard%video% recording%capabilities.%%Using%these%videocameras,%it%is%easy%to%build%videos%showing%turnJbyJturn% routes%through%a%building%or%across%a%campus.%%For%many%people%with%cognitive%challenges,%these% videos%are%easier%to%follow%than%the%abstracted%images%on%maps.% %

Social&Stories&and&Behavioral&Cues% % As%with%taskJsequencing,%supports%may%include%a%written%set%of%directions,%a%captioned%picture% sequence,%or%a%videotape%modeling%appropriate%behaviors.%%See%the%attached%Video5Modeling5using5 Handheld5Computers%for%more%information%about%this%approach.% % Stress&Management& & Relaxation%apps,%art%and%music%apps%and%many%puzzle%and%game%apps%can%help%people%relax%in% stressful%situations.%%SimplyBeing,%for%instance,%plays%new%age%music%and%shows%relaxing%natural% scenes,%while%Tactical5Breathing5Trainer%and%Breathe2Relax%use%simple%video%graphics%to%teach% deep%breathing%relaxation%methods.%%%Bloom%and%Seline5HD%are%entrancing%music%apps,%WURM%and% Meritum5Paint%are%relaxing%finger%painting%apps,%and%there%are%thousands%of%puzzle%and%game%apps% that%may%appeal.% % Academics,&Healthy&Living&and&Beyond& & You%may%wish%to%use%your%portable%computer%as%a%homework%tracker.%%%iHomework%and%iStudiez5Pro% provide%comprehensive%support%for%classwork,%planning%and%reminders.%%Dictionaries,%algebra% helpers,%astronomy%maps%and%frog%dissection%simulations%are%just%a%few%of%the%thousands%of% academic%apps%now%available.%%You%may%also%use%your%handheld%device%as%a%health%coach.%%All5 Fitness,%for%instance,%provides%videoJguided%workouts,%Sleep5Cycle%purports%to%track%your%sleep% habits,%and%Lose5it!%is%one%of%many%calorie%counting%weight%loss%apps%on%the%market.% % Clearly,%it%is%possible%to%build%a%personalized%suite%of%supportive%apps%on%your%smartphone,%ipod% touch,%ipad%or%tablet.%%I%wish%you%luck%as%you%do%so,%and%would%like%to%hear%about%your%experiences.%% Please%contact%me%at%logentry@vcu.edu.% %

Video&Modeling&using&iPod&Touch,&iPad&or&other&Tablets& Tony%Gentry,%PhD%OTR/L% Virginia%Commonwealth%University% Department%of%Occupational%Therapy% Assistive%Technology%for%Cognition%Laboratory% % Of%all%the%assistive%technologies%used%to%support%people%with%cognitiveDbehavioral%challenges,%the% most%thoroughly%researched%is%video&modeling.%%%More%than%60%studies%have%been%published%in%the% past%20%years,%showing%that%many%people%with%cognitive%difficulties%can%learn%to%perform%complex% tasks%and%manage%social%behaviors%when%a%videotaped%representation%of%the%activity%is%used%for% guidance.%%% % With%the%recent%emergence%of%videocameraDequipped%smartphones,%ipod%touches%and%computer% tablets,%opportunities%to%utilize%video%modeling%strategies%have%grown.%%These%devices%typically% offer%simple%oneDtouch%video%recording%and%playback,%and%some%include%editing%software%that% allows%for%clip%trimming,%titles%and%soundtracks.%%For&the&first&time,&we&now&have&truly&portable&tools& for&creating,&editing&and&using&video&as&a&behavioral&aid.%%% % Opportunities%to%utilize%video%modeling%include:%%(1)%taskDsequencing%of%complex%everyday%tasks% (grooming,%packing%a%backback,%etc.);%(2)%wayfinding%guidance%(though%many%portable%devices%now% have%GPS%mapping,%many%people%with%cognitiveDbehavioral%challenges%find%transferring%what%they% see%on%a%map%to%what%they%see%in%the%real%world%difficult%DD%a%video%that%shows%exactly%where%they% are,%which%doors%to%use,%which%turns%to%make,%etc.,%can%be%more%successful%as%a%wayfinding%guide);% (3)%videotaped%social%stories%for%managing%difficult%situations;%(4)%behavioral%advice%and%guidance;% and%(5)%general%encouragement%from%a%loved%one.%%%& % Apple%has%recently%made%available%on%their%App%Store%a%simplified%version%of%their%iMovie%film% production%software,%which%allows%cutDandDpaste%and%other%editing%tasks%to%be%performed%directly% on%an%iphone,%ipod%touch%or%ipad.%%Android%devices%will%soon%have%a%similar%editing%product.%%In% many%cases,%however,%if%you%follow%the%guidelines%listed%below,%you%will%not%have%to%edit%the%video% at%all.% % Making&Behavioral&Guidance&Videos& % In%building%a%personal%library%of%video%modeling%supports%on%a%person's%handheld%device,%it%is% important%to%pay%attention%to%basic%production%values:% % 1) Brevity:%%%Videos%should%be%short%and%address%just%one%behavior.%%Strive%for%one%minute%or% less,%when%possible.%%It%is%easier%for%a%user%to%tap%on%a%new%task%video%than%it%is%to%scroll% through%a%longer%video%for%the%next%cue.% 2) CloseDups:%%Remember%that%the%device%playing%back%the%video%may%be%palmDsized,%so%it%is%a% good%idea%to%use%closeDups.%%% 3) Lighting:%%Make%sure%that%good%lighting%is%available.%% 4) Steady%hands:%%When%possible,%prop%the%video%recording%device%on%a%table%or%at%least%try%to% hold%it%as%steady%as%you%can%while%recording;%no%one%likes%to%watch%a%video%that%seems%to% have%been%shot%on%a%boat%in%a%pitching%sea.%% 5) Audio%Prompts:%%Record%verbal%stepDbyDstep%task%or%directional%cues%while%shooting%the% video,%since%adding%in%a%soundtrack%later%can%be%timeDconsuming.%

6)

Titling:%%Be%sure%to%give%the%video%an%appropriate%title,%such%as%"make%lunch",%so%the%user%can% readily%scroll%to%it%on%the%device%when%needed.% 7) Partnering:%%It's%usually%a%good%idea%to%collaborate%with%the%end%user%in%making%the%video.%%% See%if%he/she%can%act%in%the%video%or%help%with%shooting%or%editing.%%This%can%improve%user% buyDin%for%independently%accessing%the%video%when%needed.% % Training&and&Follow<Along& & In%beginning%to%use%a%behavioral%guidance%video,%a%user%may%wish%to:% % (1) watch%the%video%all%the%way%through%just%before%attempting%a%chosen%activity,%% (2) have%the%video%onscreen%for%playDandDpause%guidance%during%the%activity,%and%% (3) watch%the%video%again%all%the%way%through%at%completion%of%the%activity%in%order%to%compare%the% video%to%her/his%actual%performance.%%% % This%strategy%helps%build%competence%and%insight%through%repetition%and%practice.%%In%many%cases,% users%eventually%wean%themselves%off%of%needing%the%video%prompt%at%all.%%Many%feel%reassured,% however,%that%they%have%a%readily%available%guide%on%their%device%whenever%it%may%be%needed.%%This% strategy%has%been%shown%successful%with%preschoolers,%students%and%adults%on%job%sites,%and% comparison%studies%have%shown%it%to%be%more%successful%than%other%forms%of%picture%prompting%or% behavioral%rehearsal%techniques.% % A%behavioral%guidance%video%will%only%be%successful%if%the%user%watches%it%and%tries%to%follow%the% videotaped%model.%%As%noted,%user%participation%in%choosing%what%videos%to%make%and%in%making% the%video%can%help%with%buyDin.%%Sometimes%a%reward%system%can%help%users%get%started%in%making% use%of%the%videos.%%When%people%see%that%using%a%behavioral%guidance%video%reduces%familial% nagging,%while%increasing%functional%independence%and%control%over%behaviors,%they%often%begin%to% use%the%videos%spontaneously,%and%may%then%think%of%new%videos%to%help%them%achieve%more%selfD efficacy.% % Premade&Social&Story&Videos& & If%you%do%not%feel%comfortable%making%your%own%videos%or%would%like%to%explore%professional%made% versions%on%your%portable%device,%you%can%do%so.%%There%are%a%number%of%video%prompting%apps% available.%%Two%good%ones%are:%%(1)%Going&Places,%a%free%app%that%includes%6%community%activity% videos%with%captions%(getting%a%haircut,%for%instance)%and%(2)%Everyday&Skills,%a%$40%app%that% includes%a%library%of%40%behavioral%videos%for%children%and%adults.% % I%wish%you%luck%in%your%filmDmaking%career%and%look%forward%to%hearing%about%your%efforts%in%using% handheld%computers%to%live%fuller,%more%independent%lives.%%Please%contact%me%at% logentry@vcu.edu.%

! !

iOS$Applications$Discussed$in$Presentation.$$All$are$available$only$on$Apple$ITunes$Store.$$(Prices$sometimes$change$ with$updates$and$specials.)$ Tony$Gentry,$PhD$OTR/L$ $ Reminders$ ! Reminders! Free! Task!list!plus!reminder!alerts.!!How!to!share!with!other!iCloud!users! with!iOS! (see!below).! 5! Clock! Free! Varying!sounds!for!alerts!!iPhone/iPod!Touch!only! with!iOS! 5! BugMe!!Stickies!Pro! 1.99! Add!photo,!draw!onscreen,!corkboard(like!appearance.!!Can!email!to! others.! VoCal! 1.99! Talking!alerts!for!non(readers/visually!impaired! Time!Timer! 1.99! Visual!pie(slice!countdown!timer!for!task!switching,!breaktime,!timed! tests,!etc.!!Has!been!used!to!teach!concept!of!time.!!When!will!we!get! there?! Tell!Me!Later! 1.99! Simple!reminder!and!list!app!!can!email!to!others! Due! 4.99! All!iOS!devices.!!Works!like!Clock!with!varied!reminder!sounds.! ! *http://howto.cnet.com/8301(11310_39(20122221(285/how(to(share(an(ios(5(reminders(list/! ! $ $

Gentry!(!2011!

! ! Task$Lists$ ! Notes! Corkulous! Voice!Memo! List!Recorder! To!Do! Things! ! TaskFSequencing$&$Social$Stories$ ! Visules! Home!Routines! iMovie!

Free!on!iOS! Typed!notes.!!First!line!of!note!is!its!title.! Free/Pro!is! Corkboard(style!stickies,!add!photos,!scribble,!rearrange!notes,!etc.! 4.99! .99! Talking!memos,!even!lectures.!!Share!via!email.! .99! Utilizes!VoiceOver!Accessibility!feature.!!A!bit!of!a!learning!curve!for!its! many!options!(tilt!list,!etc.)! 4.99! Simple!prioritized!task!lists!!links!automatically!to!iCal! 9.99! Task!Manager!app,!has!day!reminder!option!

Story!Kit!

Picture!Scheduler! First!Then!Visual!Schedule! Going!Places! Everyday!Skills! Gentry!(!2011!

4.99! Make!task!checklists!that!may!include!photos! 3.99! More!complicated!than!Visules,!but!more!options!for!reminders!and!sub( task!routines.! 4.99! Video!editing!app!allows!voice!over,!titling,!etc.!directly!on!device.!!Heres! a!Youtube!instructional!video:!! http://www.youtube.com/watch?v=MEaWuCrI24s&feature=relmfu! ! Free! Makes!talking!picture!books!with!photos!and!text.!!Works!well!for!task( sequencing,!too!!!Heres!a!Youtube!instructional!video:!! http://www.youtube.com/watch?v=RSWQkUS4kXk! ! 2.99! The!only!app!I!have!seen!that!links!reminders!and!video!task!sequences! automatically.!!Can!set!up!repeating!reminders.! 9.99! Picture(sequencing!prompt!with!checkoff!for!accomplished!tasks.!! Designed!for!younger!users!as!replacement!for!PECS.!!Can!add!audio! prompts.! Free! Introductory!social!stories!videos!for!iOS! 39.99! 40!everyday!community!routines!on!video.!

! ! $ Health$and$Behavioral$Apps$ ! FindMyiPhone! Ep(Detect! My!Epilepsy!Diary! Skype! Fring! Sleep!Cycle! iCounselor!behavioral!apps! Tactical!Breathing!Trainer! Breathe(2(Relax! Mood!Tracker!Pro! PTSD!Coach! Behavior!Tracker!Pro! Skill!Tracker!Pro! i(Reward! Simply!Being! Bloom!or!Trope! Pillboxie! Gentry!(!2011!

Free! Tracks!iPhone!whereabouts!using!GPS!coordinates.!!Only!works!when! wi(fi!or!satellite!link!available.!!It!does!work!! Free! Uses!accelerometer!feature!on!phone!or!pda!to!detect!grand!mal!seizure! activity!!sends!text!warning!to!caregiver!and!tracks!duration!of!seizure! Free! Record!and!track!seizure!activity!(after!the!fact!!you!type!in!yourself).! Free! With!wi(fi,!you!can!make!audio!or!audio(video!chat!calls!!on!ipod!touch! or!ipad!just!as!you!do!on!a!phone.!!! Free! Works!like!Skype.! Free! Uses!accelerometer!on!your!pda!to!track!sleep!quality.! .99! Apps!for!self(managing!anxiety,!OCD,!fear,!depression,!eating!disorder.!! Rate!current!symptom!for!coping!strategy.! Free! Does!one!thing.!!And!well.!!Walks!you!through!simple!instructions!for! deep!breathing!to!relax.! Free! Another!deep(breathing!trainer.! Free! From!Veterans!Administration.!!Choose!a!mood!disorder,!then!rate! current!symptoms.!!App!tracks!symptoms!over!time.! Free! Track!symptoms!over!time,!get!coaching!advice,!with!emergency!text! option!to!caregiver.! 29.99! For!clinicians.!!Allows!you!to!track!behaviors!over!time!and!plan!for! positive!antecedent!supports!or!report!changes.! 29.99! For!clinicians.!!Allows!you!to!track!skill!acquisition!and!success!at!tasks! over!time.! 4.99! Set!up!behavioral!contracts!and!track!successes,!announce!rewards.! 1.99! A!relaxation!coaching!app,!with!new!age!music,!nature!sounds,!and!a! yoga!instructor!to!talk!you!through!relaxation!cues.! 4.99! Designed!by!rock!musician!Brian!Eno,!a!drawing!app!that!creates!gently! repeating!onscreen!color!patterns!and!musical!tones!!hypnotic.! .99! Medication!reminder,!with!photos!of!pills,!tracks!your!routine.!

! ! $ Games$to$Help$Learn$to$Use$Devices$ ! Labrynth! Bubble!Popper! Game!Center! ! Augmentative$Communication$ ! Proloquo2go! Voice4You! Speakit!!

Free!Lite!or! Teaches!tilt!and!react!features!of!iOS!devices! 1.99! Free! Teaches!finger!tap!interface.! Free! Many!iOS!games!are!interactive!across!wi(fi!linked!devices.!!They!are! played!in!Game!Center.!!Great!for!social!skill!building.!

Tap!to!Talk! Talk!Assist! iMean! Type(n(Talk! iBaldi!

Dragon!Dictate! Gentry!(!2011!

199! Fully(featured!substitute!for!freestanding!devices,!but!can!be! cumbersome!to!program.!!!Expensive.! 29! Build!a!library!of!icon,!text!and!spoken!phrases.!!Comes!with!starter! library.!!You!can!add!your!own!pictures!and!audio.! 2.99! Designed!as!a!PDF(reader,!this!inexpensive!app!allows!you!to!type!in! words!and!sentences,!save!them,!and!have!the!device!speak!them!back! in!one!of!four!naturalistic!voices.!!No!pictures,!so!users!must!be!able!to! read.! Free! Designed!for!children,!with!cartoon!pictures.!!Catch!is!you!need!to!pay! $99/year!for!subscription!to!full!dictionary!access.! Free! Totally!no!frills,!type!in!phrases!and!save!to!history!file.!!Robotic!voice! only.! 4.99! Full(ipad!screen!keyboard!for!building!phrases.!!Save!and!device!will! speak!them!back.!!May!work!for!people!with!dexterity!impairment.! Free! Free,!no!frills,!but!there!are!ads.! .99! An!animated!talking!head!that!reads!PDF!files!or!other!text!from! onboard!word!processors.!!Cutaway!view!shows!tongue!and!mouth! movement!during!enunciation.!!Can!change!facial!features!to!show! mood.! Free! Requires!wi(fi!access.!!Speak!into!mike!and!app!types!text.!

! ! Dragon!Go! Conversation!Builder! Talking!Tom!

Free! Requires!wi(fi!access.!!Ask!question!and!app!searches!Internet,!turns!on! device!apps,!plays!music,!etc.!!A!mute!version!of!the!famous!iPhone!4S! Siri!app.! 9.99! Teaches!successful!conversational!strategies!in!one(on(one!and!group! situations.!!!Your!voice!is!added!into!a!recorded!conversation!and!plays! back!for!guidance.!!! Free! A!cartoon!cat!that!listens!to!what!you!say!and!repeats!it!back!to!you!in! its!own!catty!voice.!!Great!for!encouraging!speech!and!for!mirroring! speech!patterns.!!Reacts!to!nice/naughty!taps!to!show!cause(effect!of! behaviors.!

! Academic$and$Home$Management$Apps$ ! SoundNote! 4.99! Notabiliy! Expenses! iStudiezPro! iHomework! ! ! ! 4.99! 1.99! 1.99! 1.99!

A!note(taking!app!that!allows!you!to!digitally!record!lecturer.!!On! playback,!tap!your!typed!note!and!the!device!plays!back!what!the! teacher!was!saying!when!you!wrote!the!note.! Like!SoundNote.! Simple!input(output!money!management!app!for!basic!expense! tracking.!!Great!way!to!begin!budget!training.! Homework!scheduling!app!that!links!to!iCal!calendar.! Homework!and!class!scheduling!app.!

Gentry!(!2011!

! ! Sensory$Impairment$Apps$ ! ! ! Catalog!for!vision!impaired:!!http://appadvice.com/applists/show/apps(for(the(visually(impaired! ! ! Tap!Tap! soundAmp! Ariadne!GPS! Looktel!Money!Reader! !

Catalog for hearing impaired: http://blog.youngthomsen.com/2011/06/updated-10-most-useful-iphone-apps-for.html

2.99! Device!screen!flashes!when!loud!sound!noticed!by!microphone!(dog! bark,!siren,!etc.)! 4.99! Turns!your!iOS!device!into!a!simulated!hearing!aid.!!App!picks!up!sound! using!device!microphone,!plays!it!back!through!speaker!in!real!time.!!! 5.99! Uses!Voice!Over!feature!to!read!Google!Maps!outloud!and!provide!audio! navigation!instructions!for!people!with!visual!impairment! 9.99! Uses!device!camera!to!read!paper!money!and!speaks!denomination! outloud.!

Gentry!(!2011!