The World of Apps- They keep on coming!

My thoughts on some of the challenges of using apps to help individuals with communication and learning impairments

It’s astounding how much this new world of apps is changing the way I do therapy and run my practice. iPad apps. Droid apps. Google apps. Android apps. Mac apps. They just keep on coming!

I recently gave up my Blackberry for my first iPhone- the iphone 4s just began to explore my KindleFire which arrived a few days ago, ordered a Velocity Micro Cruz Android 7 inch Tablet on Woot two days ago for a deep discount of $70.00, and am about to get a hand-me-down Mac from one of my kids that I will upgrade to run the Lion operating system so I can start to learn about Mac apps rather than just read about them. I strive to use all apps prior to suggesting them to clients or speaking about them in my presentations. In my spare time while I take my son to swimming practice or my daughter to piano lessons, I find myself bringing along my iPad 1 or iPad 2 with headphones to review apps.

My private practice has constantly evolved over the past 19 years, but lately there has been so much to learn I find myself spending more and more time keeping up with the cutting-edge technologies. I feel like I have become an “app consultant.” Calls keep coming in. Everyone wants to know which apps are right for their situations. It’s overwhelming to start from scratch in the iTunes store, Mac Apps store, Amazon store for Kindle Fire apps or Android Marketplace. An increasing number of bloggers feature their favorite apps and offer reviews, but there again, the lists now are quite long. Apps are usually not very expensive except for some of the AAC apps or very robust professionally developed apps, but the cost adds up quickly and it takes time to download and give them a try.

Yesterday I talked to families about apps to help: a woman who had a brain tumor removed, another woman who has memory loss, a man with aphasia and apraxia after a stroke, a 5 year old boy with severe autism, a 3 year old boy with Down syndrome, a 12 year old boy with executive functioning challenges and an 8 year old girl with severe apraxia of speech. I can’t offer concrete guidance on the phone. I have to see each person, learn about their individual strengths and weaknesses as well as goals and interests, explore their environments, speak to others who help them in daily activities and try out what I think may work with the person before sending them on their way with apps that are customized as needed to practice. With each new client I find myself doing research to make sure they have the latest information. I am also preparing for a few presentations and it is incredible how much has changed since the last full day presentation I gave just this past summer. No two presentations are ever alike. Too much changes.

Although I truly believe that the new tablets have quite a bit to offer and may be the most appropriate tool to use in a variety of activities- they aren’t always the most appropriate solution and there are still plenty of challenges to be faced. Some recent publicity has made them appear to be the perfect solution when, in reality, many hurdles still have to be jumped. We can’t forget about the often more robust computer programs which may be more effective for cognitive retraining, reading and studying, communicating or writing essays.

Here are a few of my concerns and thoughts regarding app use and the reasons why I don’t have generic lists of apps to recommend for different diagnoses:

  • It is challenging to select the most appropriate apps as well as online programs and other technology tools to make sure that they are a good fit for the client and their needs and interests.
  • There are some apps that the user is meant to practice with alone, apps that are more appropriate to be used by an education or rehabilitation professional, apps which need to be customized to be effective, and apps which don’t work directly on the skills to be developed but which are great to use for joint attention or to encourage interaction while working on skills in person.
  • Many individuals need to be behaviorally managed while using the apps. These individuals may try to exit the apps, mistakenly touch the wrong locations and need skilled human intervention (with good training from a clinician such as a speech-language pathologist) to maximize the benefit from them.
  • Not everyone has the motor control to interact with apps and may need special accommodations such as switches for input or a different type of device.
  • Insurance companies and schools are now starting to suggest iPads be used as primary dedicated communication devices when children or adults can’t speak, when a more robust dedicated communication device (which is typically much more expensive and takes longer to acquire) with integrated environmental controls, and features to accommodate for poor motor control or learning abilities may be more appropriate. Finding the most effective communication tool is a process and setting it up, teaching the client how to use it and integrating it into daily routines to promote communication skills takes time and expertise. In most cases purchasing an iPad and an app to use is just the beginning and may not always be most appropriate but is often the least expensive and easiest way to provide fast access to a communication tool. In some cases using it as an intermediate step or backup system is more appropriate.
  • Individuals who are “let loose” with a tablet computer to entertain themselves are often difficult to pull back and structure in therapy tasks using apps on the device.
  • If the iPad is going to be an individual’s primary means of communication, these individuals need another device with a different color cover to use as a learning tool or for entertainment. There are now less expensive devices such as the Kindle Fire which makes having two a more affordable option.
  • It is important to keep in mind that if an individual does have a tablet such as an iPad, we should take advantage of the many wonderful integrated tools it has to enhance learning, executive functioning and communication. There is a calendar, address book, still camera, video camera, email, Internet access and many accessibility options such as enlarging print and reading aloud. When used creatively these are also really wonderful supports for individuals with communication, cognitive, learning and literacy challenges.

I’d really like to hear from those of you who are reading this to let me know which apps or computer software/ websites you use and find helpful and whether or not you agree with my concerns. It’s one of my favorite parts about speaking to large groups of people and interacting with you all online. I am always learning from everyone else.

I can be reached at if you would like to discuss the possibility of setting up an individual consultation or  webinar/presentation for your group or organization.

4 Responses to The World of Apps- They keep on coming!

  1. As always, your thoughtful commentary on technology and ST very much appreciated.

  2. Brian Walker says:

    I think you are right on the money with your concerns, and in particular, trying to come up with a “set list” to match a DX. I get this question quite a bit from other therapist and I am tempted to ask, do you have a set “material list” to match a DX? And do you never stray from that?

    Each app, program and piece of technology is one more item in our repertoire. And part of our job as a therapist is to help decide which ones (app, technology, program) are best for a particular client, as well as what supports and cueing they need when using it. But this is another issue with carryover at home regardless of what tool you are using: sometimes the parents/caregiver will need to provide support, structure and cueing to effectively use the app. So again we run into an issue where a great app isn’t a good option for a particular client because there is no one capable of providing the necessary support at home.

    I was really glad you mentioned the issue of a client “going off” on the entertainment component of the device. I have clients who become overstimulated with the iPad, so it doesn’t matter how great the app is, if the client can’t use it.

    As for favorites, I am very fond of the ArtikPix app. This is particularly useful for my bi- and multi-lingual clients who may not have a solid English model for home practice. The Mobile Education Store has a series of apps I really like. Favorites by them are the conversation builder which can be used with Winner’s tree building conversation technique. This one works well in 1:1 and group sessions. Really like the control I have over the amount verbal cueing and structure the program provides. Their preposition builder is nice, but has some limitations. The sentence builder is a great help to many of my bi-/multi-lingual clients. Rantek Inc has some nice Montessori based apps that I am finding a variety of uses for. There is an app called Story Kit, and another called Toontastic which provide differing amounts of structure to create a story while using the other features, such as photos, or the camera on your device.

    Have fun with your latest bits of technology Joan! I look forward to hearing more of about how you navigate your caseload with these added options.

  3. I am glad to see that I am not the only one having these concerns about the use of Apps in S&L Therapy. Whilst they can be a really effective learning tool, they should be one tool in a whole toolbox of other strategies that are guided by the Speech Therapist to ensure progression of skills. I welcome the use of Apps but I’m not going to get carried away with them just yet.

  4. […] article on the need for care in choosing appropriate assistive technology, in her new article, “The World of Apps- They keep on coming!” Among other things, she illustrates the complexities of choosing appropriate technology, which is […]

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