• Reach out, then touch something: a review of Tactus’ “Advanced Comprehension Therapy”
[Editor’s Note: In honor of #BHSM, and since #DysphagiaAwareness happens in a couple weeks anyhow, we are foregoing our regularly scheduled programming in favor of a dive into one of our favorite tech-based therapy tools for language, auditory processing, and cognitive-communication, in lieu of our usual swallowing-only MO. Again, we promise not to make a habit of it. If you want a dysphagia-centric app review, there’s one here.]
Tactus Therapy’s Advanced Comprehension Therapy has a deceptive name. Ostensibly, it’s exercises in sentence-level auditory comprehension. In the right hands, this tool addresses not only auditory and reading comprehension, but also syntax skills, visual discrimination, sequencing, immediate recall, and cognitive flexibility.
The app is broken down into three main subheads: Identify, which provides field choices for concept identification at sentence level; Build, a sentence construction task; and Follow, for following directions.
Identify provides sentences of customizable complexity, anywhere from “The woman reads,” to “She is being told a secret by him,” and, “The man is sprayed by the woman.” As I’ve said before, Tactus has always been truly adept at choosing distinct, appropriate, engaging (and sometime eminently memeable) visual stimuli, and the images here are no exception. I personally love to use the pronoun-centric stimuli for my patients who keep keep calling me “ma’am.” Stimuli can be presented written, via built-in text-to-speech generation, or both.
Build is intended as a “copy what you hear” exercise, but I prefer to hit the mute switch and use it as a generative syntax and constraint-based cognitive flexibility task. “You’ve got 5 blanks here, and 8 words. Make a caption for this picture that makes sense.” The complexity of stimulus can be configured here just as it can in “Identify,” and the images come from the same bank. Targets can be dragged to their intended location, or simply tapped in sequential order.
Follow is where I get the most mileage. One-, two-, and three-step directives. Conditional directives. Directives with adjectives. Directives with multiple adjectives. Semantic and syntactical variation in the directives. Auditory stimuli. Written stimuli. I’m not going to say the possibilities are endless, but the possibilities are endless.
This is great for immediate recall and sequencing skills, and—unlike some other rehab-centric app subtasks I’ve used—it provides enough flexibility to use with patients that have a variety of functional barriers. Have trouble with touch-drag skills? Have unaided hearing loss? Have low educational status or limited semantic memory? Bad with spatial concepts? Honey badger Follow don’t care, you can still exercise those sequencing skills.
From an app design perspective, Tactus has really settled on an aesthetic that is modern but not flashy, and they clearly strive to strike a balance between complexity/customizability and simplicity/ease of use.
Animations are snappy and provide a sense of place when navigating through task setup, and then within the tasks, dynamic motion is replaced by subtle fades between stimuli, which are generally appropriately paced for the target patient population. As with all their patient-focused apps, data keeping is straightforward and easily exportable as a PDF via email, or—if you have a relatively modern iPad—via drag and drop/copy-paste from the email screen.
I’ve used this tool extensively since I purchased it, and find it to be tremendously powerful. Still, there are a few things I would love to see in a 2.0:
The option of which order “before/after” directives are presented for 3-step directions in addition to 2-step.
Use of the system default voice for spoken stimuli. Maybe this isn’t possible with the APIs available (I’m not a programmer, so I don’t know), but I would love to hear Siri reading those sentences rather than Samantha.
Some slightly more semantically complex targets for “Follow,” like the images you’d see in Naming or Comprehension Therapy. I’ve had a number of patients comment “this would be great for kids” or something similar for that task in a way that never occurs with any other Tactus stimuli set, and I suspect it’s the restriction of the directives to the objects that can be displayed effectively in multiple bright colors to accommodate the “+ adjectives” complexity levels. “Before you touch the jumping girl, touch the open envelope” as an option might help to mitigate that.
An option for Build to only play the auditory stimulus when you hit the “repeat” button to allow it to more naturally be partially generative syntax task.
If, like me, you are always looking for ways to replace paper in your cognitive exercise sessions, Advanced Comprehension Therapy is a solid choice. At time of publishing, this—and all of the Tactus apps—are on sale for Better Hearing and Speech Month. They seem to do that every year, but their pricing is usually a pretty good deal even when it’s not on sale, especially when you think about what a WALC book costs. The Tactus library keeps expanding, and Advanced Comprehension Therapy is an excellent addition to any clinical toolbox.
[Finally, a couple disclosures. Disclosure the First: Tactus gave me a copy of “Conversation Therapy” gratis a few years ago—back when they still called their software “TherAppy”—to review. Since then, I’ve had to pay for everything, and the software reviewed here is no exception. Disclosure the Second: Even though I’ve had this review in mind as long as I’ve been using the app (a few months at least), it’s being published at this particular moment in time as a thank you to Megan for laughing at one of my stupid memes. She didn’t solicit the review; one good turn deserves another. Disclosure the third: In the title of this review, I am consciously using Anglo-style possessive construction for collective nouns. Don’t @ me. Or do @ me.]
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