Visual Attention TherAppy: More than meets the eye

Tactus Therapy continues to fill the void with their quality therapy apps.  They have recently shifted their apps’ focus from language to cognition–specifically, attention–skills.  Again, while there are apps in the App Store that we can use to target visual attention, a good number of them were made in a gaming context.  Many come with timers, putting temporal stress on a task and making one wish there were ways to toggle the countdown off.  Visual Attention TherAppy puts more options in the clinician (or user’s) hands, enabling one to create specific visual attention tasks and generate information about the user’s performance.

Tap the app’s icon on the iPad and it immediately shows you the main screen. On the upper right corner is the Settings button.  It was a good idea that we checked out Settings first because there were a number of crucial options in it:

  • Number of Trials At Each Level: 1-5, and 10. You want to have 3 trials of Letter in Symbols? Tap 3.
  • Number of Lines: The more lines, the more targets and foils. 
    • Fewest: 4 lines
    • Some: 5 lines
    • More: 6 lines
    • Most: 8 lines (this pretty much fills up the screen)
  • Spacing: Small, Medium, Large.  The number of lines depends on the spacing selected.  If Small is selected, the activity can have as much as 12 lines.  Choose Large spacing however, there will be 6 lines.
  • Signal:  specifically added for clients with neglect issues, this gives the clinician the option to have a Red, Yellow, or Flashing signal at the side of the screen to direct the client’s attention to. The toggle for a Left, Right, or No Signal is found in the main screen.
  • Default Email Address for Results: As with Tactus Therapy’s previous apps, one can enter the receipient’s email address to whom the results will be forwarded.
  • Child-Friendly Mode: toggle this button to turn it off or on.

There are two modes on the app’s main screen: Practice and Test. One can access all of the app’s levels in either mode. The difference between these modes is that in Practice, the client/user cannot move forward and skip targets: he/she must tap and select all targets before moving on to the next line. In Test mode, anything goes, and the user can tap at the targets in any order.  Visual attention skills are measured by how many targets were selected until the Done button is tapped or until all targets have been selected.  One other difference is that the Test mode takes note which quadrant of the screen the user missed targets in.  The Results page includes this information under “Location of Missed Targets.”

There are 10 levels to choose from, and these are arranged by difficulty:

  • Same Symbol
  • Same Letter
  • Symbol in Letters
  • Letter in Symbols
  • Symbol in Symbols and Letters
  • Letter in Letters and Symbols
  • Dissimilar Symbols
  • Similar Symbols
  • Dissimilar Letters
  • Similar Letters

At the bottom of the Level Selection page, one can opt to show 1 or 2 targets.

The task screen is monochromatic, the letter and symbol font in black and is approximately Arial font size 14 or 15. The header bar shows:

  • the Home button
  • the Timer: the clock starts when the user taps the first target
  • the Instructions: centered in the header bar is the target (ex: Touch Every C, Touch Every I and T)
  • the Counters
    • Targets Found / Total Targets
    • Trials / Total Trials
  • the Skip button (Practice Mode) or the Done button (Test Mode)

On Practice Mode, tapping on a correct letter/symbol makes a soft “whooshing” sound. Tap on a wrong letter/symbol, one hears a “thunk” sound. Turn the iPad’s sound off or decrease the volume if you do not wish to hear these sounds.

The Results page is shown in email format, with a brief description on how the client performed (time it took to accomplish tasks, date, spacing, number of targets found, total targets, number of lines). The results are shown in tables with the following information:

  • the Targets
  • the Time it took to finish each trial
  • Number Correct (including percent correct)
  • the Location of Missed Targets (top/bottom left/right)
  • Number of Wrong Targets

What we love about Visual Attention TherAppy:

  • responsive to finger taps, area-specific:  this is worth noting because a good amount of effort in app development goes into programming which areas in every screen should respond to taps (and what happens when that area is tapped). Whether the spacing is large or small, or the lines many or few, the app responds beautifully to touch.
  • font size: consider the app as a tool to help clients manage written word better and pay attention to smaller, finer details. The font size is just right for older children and adults (who may use reading glasses if necessary, of course).
  • provisions for individuals with neglect issues: this one’s a good plus. A colored and/or flashing line at the neglected side of the screen always comes in handy for certain cases.  What’s even more awesome is the app’s ability to report what quadrants were neglected!
  • high customizability: # of trials, # of lines, spacing, levels of difficulty are all within the clinician/user’s control. One needs a thick book full of similar paper-based activities in order to get as customized a visual attention task as possible. And even if one has electronic copies of such activities, printing these out takes time and uses up paper, leading us to our final point…
  • Earth-friendly! some of us undergo a certain amount of guilt (well, we do) when we use up a lot of paper for visual attention tasks only to throw them away afterwards. Small whiteboards solved this problem somewhat, though making the letters and symbols eats up time.  This app saves both natural and time resources.

Did we find anything we didn’t love about the app? Nope.  The app is fast and lightweight (less than 1 MB!), is highly specific in its role in its app-life, and costs only $10.00.  To get a feel of how the app works, get Visual Attention TherAppy Lite from the App Store.  This free version packs a one level activity and lets you try out its Practice and Test modes, put out 1 to 2 targets, and email results.

It is easy to take down an engaging app from the App Store and analyze how it can be used to target specific cognitive skills. Many do address sustained, alternating, even divided attention.  We knew we needed apps like these, but we also wanted highly specialized ones too.  At the back of our heads years ago, we wished for a better way to address visual attention and get measured results without using up so much time.  Seeing how Visual Attention TherAppy was designed to work, the bar is raised even further in therapy app development.  Visual Attention TherAppy is guaranteed to be one of those beautiful apps that, when you see it and try it out, will make you exclaim “Finally!”  We were this close to hugging it, to be honest.  Thanks for yet another amazing release, Tactus Therapy.

Price: $ 9.99 
Weight: 0.9 MB
Updated: 14 September 2012
Version: 1.01
Compatible with: iPad
Seller: Tactus Therapy Solutions, Ltd.
Target Population: children, adults
Awesome if you want to work on:
  • visual attention skills
Customer Ratings (iTunes): 4+ out of 5 stars
iSPeak App says: 4+ out of 5 smileys


Have fun with alternating attention & visual memory with Tiny Pants & X-Memory

Games are excellent cognitive exercises.  All sports require planning ahead and making judgment calls.  Same goes for anybody who’s played with PacMan, Tetris, and the very first Prince of Persia.  Things became more difficult when the developers upped the ante and created 3-D Pacman, Tetris and Prince of Persia.  What did we do?  We kept playing, and we kept getting better at these.

Some games challenged our cognitive skills a bit more than the others.  A goodexample of such game apps are TTGan’s Tiny Pants and X-Memory.  From the makers of Ah Up!, Ah Up! Planet, and PaPaBong,  TTGan‘s suite of games caught our attention because they were so appropriate for our field, helping us work on vocal intensity, cognitive skills and eye-hand coordination the fun way.

The idea behind both apps is simple:  objects pop out from the bottom of the screen.  Pay attention to the underwear patterns and colors (Tiny Pants) or the icon ball’s letters, animals and shapes (X-Memory).  When the selection screen comes out, tap on the underwear / icon balls that you had seen pop out.  That’s the basic rule.  The app makes things a bit more difficult via:

  • distractors that pop out along with the target objects, such as:
    • numbers:  tap on one and you get extra points.  Who doesn’t want extra points?
    • helper objects:  for example, tap on a potion botte and you convert all objects into the same pattern
  • the number of objects that appear:  as you move up in the game, more objects pop out.  The app gives you more helper objects (or objects that you must not tap).
  • the number of choices in the selection page:  at around Level 6-7, you are supposed to pay attention to 3 kinds of underwear patterns / icon balls.  The selection page shows you as many as 15 choices where you select which patterns came out in the game.
  • the pattern size:  Tiny Pants offers 3 difficulty levels basing on the area on which patterns appear:
    • boxer shorts:  biggest area, one can see more of the pattern
    • full underwear:
    • G-strings:  tiny space for patterns to appear on, challenges one’s ability to take note of the tiny details
  • the pattern type:  X-Memory, on the other hand, offers three kinds of graphics basing on ease of recognition and retention
    • letters
    • animals
    • shapes
  • the time limit:  one is allowed a few seconds to make their choices in the selection page.  The clock counts down as one attempts to compare across patterns, match it to one’s memory of which patterns came out, and make the correct decision.  Make three wrong guesses and the game’s over.

Which one to download?  It actually depends on you and your target clientele.  Many kids might find flying underpants amusing, but some may actually prefer letters, shapes and animals instead of patterns.  Tiny Pants and X-Memory seem like simple enough games, until it gets harder and harder.  Try it out for yourself.  One can’t go wrong with $0.99 apps.

Tiny Pants has English and Chinese versions.  Click here for the English iPhone/iPod Touch and iPad versions of Tiny Pants.  Links to Tiny Pants’ Chinese versions for iPhone/iPod Touch and iPad are here.  Click here for the X-Memory’s iPhone/iPod Touch and iPad versions.

Price:  $0.99 
Weight: 12.5 MB (Tiny Pants), 17.0 MB (X-Memory)
Version: both 1.1
Compatible with: the iPhone (and iPod Touch) and iPad
Seller:  Zeyu Luo, copyrights 2011
Target Population: adults and children
Awesome if you want to work on:
  • focused attention
  • alternating attention 
  • visual memory
Customer Ratings (iTunes): 4+ out of 5 smileys
iSPeak App says: 4 out of 5 smileys



Skill Game: You versus your cognitive and fine motor skills

Warning:  game is insanely addictive!

We downloaded Skill Game and Skill Game Arcade into the iPad 2 hoping it may be used as an app for cognitive rehabilitation.  We’ll talk about its (possible) usability in the work setting.  Right now, let us tell you what this app is all about.

Up front, Skill Game may look like your ordinary connect-the-dots app.  Play it and you see that the rules makes this game difficulty and frustrating (in a funny sort of way).  Just four rules to adhere to while you’re using your finger to connect the dots:

  • connect the dots in the correct order (makes a lot of sense of course)
  • you can’t draw across or cross any lines, whether pre-drawn lines or lines you have already drawn.  No can do.
  • you can’t go off the page’s edge
  • you may, however, go through the numbers you have already connected

It’s the no-crossing-lines that makes the game challenging and frustrating.  We put this to a test with our own colleagues at the clinic.  It highly depends on how one copes with the challenges Skill Game presents.  It appeared like the (frustrated) worst in us were brought out by the game.  One of our occupational therapists was positively growling in utter exasperation. But we had to give her credit for her frustration tolerance.  She stuck to the game until she finished a few pages.

Great pluses for Skill Game:

  • on the iPad 2 (no, we haven’t tested this on the iPhone nor iPod Touch), the nice big screen gives a fair amount of maneuverability (until you fail to plan ahead and find yourself drawing very very carefully to avoid touching other lines
  • beautiful paper patterns: does not wash out the numbers nor the lines
  • varying challenges:  your skill meter rises for each challenge you managed to finish.  It dips when you decide to skip a page, merely because it assumes you cannot (or would not) finish that particular challenge
  • the app adjusts itself to your skill level:  that way, if you can’t finish a challenge, it makes the next challenge slightly easier for you (thus making the app addictive)
  • magnifying glass on the upper left corner for extremely hard drawing:  this is where one’s visual perceptual skills are put to a test:  you want to cross a number but that number is bordered by two ominous lines.  You need to carefully maneuver your finger between those lines, draw carefully, and cross the target number safely so you can reach your next number
  • comes with a Magic Pen option:  if you’re stuck, tap on the Magic Pen and it allows you to cross lines only once.  You have to buy an add-on to refill the Magic Pen
  • unlimited, random levels! The challenges stretch on and on.

Of course, you CAN use this app for therapy, either as a game or as a way of working at your client’s cognitive skills.  One thing’s for sure, using Skill Game will inadvertently work on (and test) anybody’s frustration tolerance.

It is apparent, though, that Skill Game was not designed with the challenged population in mind.  As we mentioned earlier, we hoped to use this with our clients for cognitive rehabilitation, particularly our dementia clients.  Here’s hoping that the app developers may be able to come up with a stripped down version (without the no-crossing-lines rule).

Price: FREE (Skill Game Arcade is $0.99)
Weight: 18.5 MB
Updated: 13 May 2011
Version: 1.4
Compatible with: universal! Compatible with both the iPhone / iPod Touch and iPad
Seller: Good Apps UG
Target Population: clients and clinicians with good fine-motor skills and a lot of patience
Awesome if you want to work on:
  • fine motor skills
  • visual perceptual skills
  • visual attention skills
  • eye-hand coordination
Customer Ratings (iTunes): 4 out of 5 smileys
iSPeak App says: 4 out of 5 smileys