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[ARTICLE] Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period – Full Text

Abstract

Background Context

In today’s health-care climate, magnetic resonance imaging (MRI) is often perceived as a commodity—a service where there are no meaningful differences in quality and thus an area in which patients can be advised to select a provider based on price and convenience alone. If this prevailing view is correct, then a patient should expect to receive the same radiological diagnosis regardless of which imaging center he or she visits, or which radiologist reviews the examination. Based on their extensive clinical experience, the authors believe that this assumption is not correct and that it can negatively impact patient care, outcomes, and costs.

Purpose

This study is designed to test the authors’ hypothesis that radiologists’ reports from multiple imaging centers performing a lumbar MRI examination on the same patient over a short period of time will have (1) marked variability in interpretive findings and (2) a broad range of interpretive errors.

Study Design

This is a prospective observational study comparing the interpretive findings reported for one patient scanned at 10 different MRI centers over a period of 3 weeks to each other and to reference MRI examinations performed immediately preceding and following the 10 MRI examinations.

Patient Sample

The sample is a 63-year-old woman with a history of low back pain and right L5 radicular symptoms.

Outcome Measures

Variability was quantified using percent agreement rates and Fleiss kappa statistic. Interpretive errors were quantified using true-positive counts, false-positive counts, false-negative counts, true-positive rate (sensitivity), and false-negative rate (miss rate).

Methods

Interpretive findings from 10 study MRI examinations were tabulated and compared for variability and errors. Two of the authors, both subspecialist spine radiologists from different institutions, independently reviewed the reference examinations and then came to a final diagnosis by consensus. Errors of interpretation in the study examinations were considered present if a finding present or not present in the study examination’s report was not present in the reference examinations.

Results

Across all 10 study examinations, there were 49 distinct findings reported related to the presence of a distinct pathology at a specific motion segment. Zero interpretive findings were reported in all 10 study examinations and only one finding was reported in nine out of 10 study examinations. Of the interpretive findings, 32.7% appeared only once across all 10 of the study examinations’ reports. A global Fleiss kappa statistic, computed across all reported findings, was 0.20±0.06, indicating poor overall agreement on interpretive findings. The average interpretive error count in the study examinations was 12.5±3.2 (both false-positives and false-negatives). The average false-negative count per examination was 10.9±2.9 out of 25 and the average false-positive count was 1.6±0.9, which correspond to an average true-positive rate (sensitivity) of 56.4%±11.7 and miss rate of 43.6%±11.7.

Conclusions

This study found marked variability in the reported interpretive findings and a high prevalence of interpretive errors in radiologists’ reports of an MRI examination of the lumbar spine performed on the same patient at 10 different MRI centers over a short time period. As a result, the authors conclude that where a patient obtains his or her MRI examination and which radiologist interprets the examination may have a direct impact on radiological diagnosis, subsequent choice of treatment, and clinical outcome.

Introduction

In the clinical evaluation of a patient with back or leg pain unresponsive to conservative measures, clinicians may order a magnetic resonance imaging (MRI) examination to assist in explaining the patient’s symptoms to determine whether or not modification of the patient’s therapy is required, including referral for interventional pain management or surgical evaluation. Moreover, the results of MRI examinations play a central role when payers are reviewing whether or not to approve a recommended treatment. Therefore, an accurate diagnosis is paramount to timely and correct treatment. Several studies provide information as to the variability of interpretation of radiological examinations, including MRI examinations of the lumbar spine, and the importance of nomenclature when communicating radiological findings [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]]. However, these studies provide no information as to the variability and quality of interpretation of all MRI findings in a single patient imaged at different imaging centers. The authors believe that the study presented here is the first of its kind and provides critically important and novel insights into the variability and diagnostic performance between MRI examinations.[…]

Continue —> Variability in diagnostic error rates of 10 MRI centers performing lumbar spine MRI examinations on the same patient within a 3-week period – The Spine Journal

Fig. 3 Example from the reference examination for grading central canal stenosis. (Left) At the level of the L2 pedicles, the area of the thecal sac measures approximately 241 mm2. (Right) At the level of the L2–L3 disc space, the area of the thecal sac measures approximately 67 mm2. The reduction of the thecal sac is greater than two-thirds and was graded as severe stenosis.

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[BLOG POST] Epilepsy and Brain Surgery — The Basics

Epilepsy Talk

Since there so many different types of brain surgeries — and questions — I decided to learn about them and share my findings with you.

Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn’t interfere with vital functions like speech, language or hearing.

In these types of surgeries, your doctor removes the area of the brain that’s causing the seizures.

If your seizures originate in a part of your brain that can’t be removed, your doctor may recommend a different sort of surgery in which surgeons make a series of cuts in your brain.

These cuts are designed to prevent seizures from spreading to other parts of the brain.

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages.

The…

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The Perils of Discontinuing Your Meds

Epilepsy Talk

One of the most common questions is “when can I stop taking my meds?”

Especially for those whose seizures have been under good control.

It makes sense. Because if you’re doing well, you start to wonder “why do I need these meds anymore”?

This review is organized around four issues: Does the duration of seizure-freedom influence the risk of recurrence?

Should the epilepsy syndrome influence the decision to stop or continue AEDs?

If daily AEDs are stopped, could intractable epilepsy ensue?

And what’s the risk that someone discontinuing AEDs will die during a recurrence?

Some of the reasons for stopping daily meds include concerns about side-effects…a feeling of well-being…relief from the chore of remembering daily medication…and freedom from the staggering financial burdens.

Most important of all is, an improved quality of life.

Others are seizure-free but choose to continue medication.

They’re happy with stability, concerned about the impact of another…

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What is Stress?

Broken Brain - Brilliant Mind

Shadow of hunchback walking up stairs Stress is the shadow that creeps up on me

Ken Collins sent along some great info about stress. Stress is by far one of the biggest problems after TBI. We experience it from all sides. First, we’re forced to deal with a very real change in how we function in the world. Second, we can get stressed about being stressed. And it builds…

I’ll add to Ken’s notes below:

KC: 99% of the stress you experience is caused by your thinking, your interpretation and your hardwired beliefs. Sure if you grew up in an abusive family, got assaulted, molested or raped, physically threatened or even wrongfully arrested those would all be examples of trauma/stress you have experienced. This trauma is buried in your sub-conscious and under stress is triggered – limbic system fight or flight response in the Amygdala.

True, true. Trauma does stay in the system, unless it is…

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[BLOG POST] Eye Tracking In Windows 10 Is Available Now As Beta Function

Just last week, Microsoft announced that it will have in-built support for compatible eye tracking devices in Windows 10. What that means is that Windows 10 users will not need any special software or interface to use eye tracking devices – they will be able use an on screen keyboard, mouse and text to speech experience to access areas of the Windows operating system, and perform tasks typically accomplished with a physical keyboard and mouse.

The new eye tracking feature is called Eye Control, and will be introduced in a future update. However, it is available as a beta function for now, and you can do the following to enable it, test it out and see its functionality.

  1. Have a compatible eye tracking device like Tobii Eye Tracker 4C. (Other eye tracking devices will be made compatible in the future)
  2. Download and update Tobii’s eye tracking hot fix release (2.10.11.6458) and run calibration with your own profile.
  3. Update your Windows through Windows Update. The latest update will download and install the Tobii Eye Tracker HIDClass Driver automatically.
  4. Enable Eye Control by Going to Settings->Ease of Access->Other Options->Eye control.

Screenshot of the "Other Options" screen. The "eye control (beta) option is set to "On".

Eye Control Launchpad

Once Eye Control is enabled, the launchpad appears on the screen, and gives access to on screen mouse, keyboard, text to speech, and ability to reposition the UI to opposite side of screen.

Launchpad has four options - 1) reposition the UI, 2) on screen keyboard, 3) text to speech, 4) on screen mouse.

Eye Control Mouse

To use and control the mouse, select the mouse control from the launchpad, and gaze at an object you want to interact with, and select an option that appears in the affordance (visual cue). You can double left click, left click, right click, and cancel with the eye control mouse. In the image below, a user is using the eye control mouse to open Microsoft Outlook.

Eye Control Keyboard

To use the eye control keyboard, select the keyboard from the launchpad, and gaze at the characters that need to be typed. Currently, the EN-US keyboard is supported.

The on screen keyboard also allows “shape writing” for faster typing. All the user has to do is gaze at the first and last letter of a word, and glance at the letters in the middle. The keyboard also shows word predictions when the last letter of a word is typed.

Eye Control Text To Speech

To interact with a family member, a user can launch text to speech from the launchpad, start typing in sentences, and have it spoken out loud.

Eye Control Settings

Settings for Eye Control can be modified by pressing the Fn key (bottom right of keyboard). This is where a user can change dwell times, turn on or off  shape writing and gaze cursor.

There are some known issues for now, which are listed in the source link.

So, there it is! The in built eye control (in beta) for Windows. Give it a spin, and let us know how it goes!

Source: Windows

Additional Reading: Eye Control Is Coming To Windows 10

Source: Eye Tracking In Windows 10 Is Available Now As Beta Function – Assistive Technology Blog

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[WEB SITE] Smartphone apps can be memory aids for people with brain injuries, and everyone else

 

Smartphone apps allow us to outsource remembering appointments or upcoming tasks. It’s a common worry that using technology in this way makes our brain’s memory capacity worse, but the reality is not that simple.

In fact, these platforms can be useful, not only for people with memory impairments, but also the general population.

Over two studies, we set out to explore the potential of smartphones as memory aids by investigating how people with traumatic brain injuries (TBI) or with stroke use them.

We surveyed 29 people with TBI and 33 non-injured people for our TBI study. For the stroke study, we surveyed 29 participants with stroke and 29 with no history of neurological conditions.

We found that memory apps like calendars can be helpful for people with brain injuries. And while it was a small sample, we also found that for participants without brain injury, there was no relationship between memory app use and memory ability.

This finding requires further analysis, but it is not consistent with the idea that memory aids make our brains lazy. Rather, such apps can free our minds to focus on other things, without using up mental resources worrying about what needs to be remembered.

How does brain injury affect memory?

Memory difficulties are common after acquired brain injuries such as a stroke. Everyday problems include forgetting appointments, names and details, losing track of conversations and misplacing personal items.

Research on rehabilitation of memory after brain injury supports the use of compensatory strategies. These include internal or mental strategies such as mentally rehearsing a speech and external strategies, such as calendars, lists, notes, alarms and photos.

Traditionally, external memory aids have been in paper-based formats such as diaries and notes, which are bulky and easily lost. Research shows early technological aids such as pagers and Personal Digital Assistants were helpful in approving improving memory function, but unfamiliar and difficult to learn to use for many people with brain injury.

Smartphones have the potential to address the limitations of earlier devices. They are familiar to most people, at least in the developed world, and are highly portable.

Are smartphones useful memory aids?

In both studies, we found that the majority of people both with and without brain injury used smartphones for three main reasons: for communication, as a memory aid and for internet access.

When asked about the biggest benefit of using a smartphone, users with TBI and stroke most often cited its helpfulness as a memory aid. This contrasted with those with no history of brain injury, who instead listed portability, convenience and access to the internet as the main benefits.

The memory apps used most often by participants with TBI and stroke were calendars, alarms, contacts lists, reminder text messages, notes, cameras, and to-do lists. These apps help the user remember appointments, tasks, details and locations without relying on their internal memory capacity.

A cerebral infarction (ischemic stroke) at the brain’s left hemisphere . Puwadol Jaturawutthichai/Shutterstock

For people with TBI and those without any neurological conditions, there was no relationship between use of memory apps and performance on objective memory tests requiring recall of a list of words. This suggests that relying on memory aids did not influence intrinsic memory ability.

This result was important in counteracting the fear expressed by some TBI and stroke survivors that using a memory aid may make their memory abilities worse, just like using a wheelchair may make leg muscles weaker.

Our results indicate that this idea does not apply to memory among our sample group – rather, using memory aids is helpful for people who struggle to remember things by supporting their injured brains without causing any further damage.

For stroke survivors, more frequent use of memory apps also seems to be associated with higher productivity, as measured by their engagement in work, study and volunteer activities. This may mean that using smartphone memory apps enabled them to be more productive by supporting them to remember and organise tasks.

What are the barriers to using memory apps?

In both studies, we found that younger participants were more likely to use smartphones, suggesting that older adults may require more support in using them.

TBI and stroke survivors were also more likely to have difficulty learning to use their smartphone, and preferred being directly shown how to use it rather than learning by trial and error. Stroke survivors with motor (physical) symptoms used memory apps less frequently.

To further increase access to the benefits of smartphone memory apps, we now need to work out how to help users with brain injuries who may find them difficult to learn.

Our future research will aim to work out the most effective methods for teaching smartphone memory apps to people with memory impairment.

Source: Smartphone apps can be memory aids for people with brain injuries, and everyone else

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[ARTICLE] The Recovery of Complicated Upper Limbs Movement Functions of Poststroke Patients – Full Text PDF

Abstract: In chronic stage of stroke, it is necessary to pay attention to the complex spatial movements training along with the traditional restoration of balance, strength of particular muscles, and paretic limb joints mobility. The aim of the study was to evaluate the effectiveness of robotic therapy in the recovery of upper limb function in the chronic stage of stroke. The study involved 52 patients with ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All patients (5 days/wk × 3 wk) got gymnastics by the standard technique, massage, laser, and pulsed currents therapy. Main group patients (n = 36) extra received complex spatial movements, speed, fluidity, precision and agility training by the robotic electromechanical device Multi Joint System (MJS) (40 minutes, 5 days/wk × 3 wk). Analysis of the results of the study showed a statistically significant difference in improving ROM of the elbow and shoulder joints, speed and accuracy of movement in the main group compared with the control. Hardware recovery of complex spatial upper limb movements in the chronic stage of stroke increases the functionality and independence of the patient’s domestic skills.

Full Text PDF

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[ARTICLE] Effects of dual-task and walking speed on gait variability in people with chronic ankle instability: a cross-sectional study – Full Text

Abstract

Background

Recent evidence suggests that impaired central sensorimotor integration may contribute to deficits in movement control experienced by people with chronic ankle instability (CAI). This study compared the effects of dual-task and walking speed on gait variability in individuals with and without CAI.

Methods

Sixteen subjects with CAI and 16 age- and gender-matched, able-bodied controls participated in this study. Stride time variability and stride length variability were measured on a treadmill under four different conditions: self-paced walking, self-paced walking with dual-task, fast walking, and fast walking with dual-task.

Results

Under self-paced walking (without dual-task) there was no difference in stride time variability between CAI and control groups (P = 0.346). In the control group, compared to self-paced walking, stride time variability decreased in all conditions: self-paced walking with dual-task, fast speed, and fast speed with dual-task (P = 0.011, P = 0.016, P = 0.001, respectively). However, in the CAI group, compared to self-paced walking, decreased stride time variability was demonstrated only in the fast speed with dual-task condition (P = 1.000, P = 0.471, P = 0.008; respectively). Stride length variability did not change under any condition in either group.

Conclusions

Subjects with CAI and healthy controls reduced their stride time variability in response to challenging walking conditions; however, the pattern of change was different. A higher level of gait disturbance was required to cause a change in walking in the CAI group compared to healthy individuals, which may indicate lower adaptability of the sensorimotor system. Clinicians may use this information and employ activities to enhance sensorimotor control during gait, when designing intervention programs for people with CAI.

The study was registered with the Clinical Trials network (registration NCT02745834, registration date 15/3/2016).

Background

Recurrent ankle sprains occur in up to 40% of individuals who have previously experienced a lateral ankle sprain [1, 2]. Individuals who report residual symptoms, which include repetitive episodes of ‘giving way’ and subjective feeling of ankle joint instability are termed as having chronic ankle instability (CAI) [3]. The cause of these symptoms and the high frequency of recurrent ankle sprain is not fully understood [4]. It has been suggested that the residual joint instability and the high reoccurrence rates can be attributed to loss of sensory input from articular mechano-receptors, decreased muscle strength, mechanical instability of the ankle joint, and reduced ankle range of motion [5, 6].

Recent evidence suggests that deficits in central neural sensorimotor integration can contribute to impaired movement control in people with CAI [7, 8, 9, 10, 11, 12, 13, 14]. For example, Springer et al. [8] assessed the correlation between single-limb stance postural control (Overall Stability Index) and shoulder position sense (Absolute Error Score) among people with CAI and healthy controls. Correlations between the lower and upper limbs were observed only in the healthy controls, indicating altered sensorimotor integration in the CAI group. Several studies have observed altered gait mechanism in people with CAI, which was explained by compromised central nervous system (CNS) control [9, 14, 15, 16]. It was shown that people with CAI have a typical gait pattern of increased inversion kinematics and kinetics, lateral shift of body weight, increased hip flexion during terminal swing to mid stance, reduced hip extension and increased knee flexion during terminal stance to initial swing, and slow weight transfer at the beginning and end of the stance [15, 16, 17]. Altered biomechanical strategies during gait initiation and termination tasks (e.g., reduced center of pressure displacement), have also been demonstrated in this population [9, 14]. Studies that assessed movement variability, such as knee and hip joint motions during single leg jump landing, identified differences between individuals with and without CAI, which may also indicate central motor programming deficits [10, 11, 12, 13]. Hence, further investigation of motor control adaptations may contribute to understanding the underlying neurophysiologic mechanisms of CAI.

Gait speed and other spatio-temporal parameters during daily activities should reflect behavioral goals and environmental conditions [18]. Studies revealed that walking speed has a significant effect on joint coordination pattern and gait variability [18, 19, 20]. Therefore, assessing gait variability under challenging situations such as walking at different speeds might test CNS flexibility in controlling gait [19, 20]. Moreover, based on the understanding that for many daily activities even a fully intact motor control system requires attention and cognitive resources [21], the dual-task paradigm has been used to provide insight into the demands of postural control and gait on attention. Performance of a cognitive task has been shown to decrease postural control in participants with CAI as compared to healthy controls [7, 22]. However, no previous study examined the impact of cognitive task and walking speed on gait performance in subjects with CAI.

Balance during walking is reflected by precise spatial and temporal control of foot placement. Stride to stride fluctuations in time and length are related to control of the rhythmic walking mechanism. Thus, previous research has suggested that studying gait variability is a reliable way to quantify locomotion [23]. The mechanism of adjusting movement variability is considered beneficial for coping with changes, maintaining stability, preventing injury, and attaining higher motor skills [24]. Performing a cognitive task while walking or while altering self-paced walking speed has been related to changes in gait variability in populations with neurological and musculoskeletal pathologies, as well in healthy young individuals [25, 26, 27, 28]. Yet, there is no consensus in the literature as to how to interpret these changes. Decreased variability while performing demanding gait tasks may reflect voluntary gait adaptation toward a more conservative gait pattern [26]. Alternatively, it has been suggested that increased variability may indicate CNS flexibility and adaptability to changes in task demands [29]. A possible central sensorimotor control deficit in people with CAI may constrain the ability of the CNS to adjust to different task demands; thus, affecting central control over gait variability and reducing the ability to cope with varied tasks. Consequently, testing the mechanism of adjusting gait variability as a response to complex walking conditions in people with CAI compared to healthy controls may provide more information on sensorimotor control in this population.

The present study was designed to compare the effects of dual-task and walking speed on gait variability in individuals with and without CAI. Previous reports, including a meta-analysis, indicated that simple postural tasks do not always discriminate between participants with CAI and those without [6, 8, 30]. Consequently, we hypothesized that gait variability among individuals with and without CAI will be similar during “normal” self-paced walking, whereas gait will vary under complex walking conditions.[…]

Continue —> Effects of dual-task and walking speed on gait variability in people with chronic ankle instability: a cross-sectional study | BMC Musculoskeletal Disorders | Full Text

Fig. 1 Stride time variability results of the two groups under all gait conditions. CAI- chronic ankle instability, SP- self-paced, DT- dual task

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[WEB SITE] Life-Changing Mobile Apps for People with Brain Injury – BrainLine

Apps photo no caption

Almost every day, we hear of new mobile device applications (“apps”) developed for just about everything — from staying organized to finding pharmacies or restaurants while on the road. It’s hard to keep up.

The BrainLine team sorted through many resources to compile this list of apps for mobile devices for people with a brain injury, their families and caregivers.

Some of these apps have proven to be especially helpful for people with brain injury. The phone can be used to remind you of an upcoming appointment or to take medication, or it can be used like a traditional paper notebook to keep all your addresses, telephone numbers, calendar items, lists, and ideas. Please note that BrainLine does not endorse these or any specific products.

Organize and sort the mobile apps in this table by clicking on the title of the column you would like to sort by. Or view our slideshows of iOS apps or Android apps.

 

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Name Description Price Device Helps With
Audible Listen to books on your mobile device. Great for people who have trouble reading or who retain information more effectively by listening. Free iOS, Android Reading
Answers:YesNo Easy to use, affordable way for you to communicate with those around you if you are nonverbal. The app has two, large, color-coordinated buttons–one for yes, and one for no. Press either, and a voice will read you selection. $1.99 iOS Communication
Awesome Memory Card game to help you improve your memory. All of the cards are laid face down on a surface and players take turns flipping two cards face up. The object of the game is to reveal pairs of matching cards. Similar to the traditional game of “concentration.” * Paid version available that includes advanced levels and functionality. Free* iPad Memory
Behavior Tracker Pro Application that allows caregivers, behavioral therapists, aides, or teachers to track behaviors and automatically graph them. Option to record video of behaviors or interventions to later review with doctors, parents, teachers or therapists. $29.99 iOS Behavior
Breathe2Relax Hands-on stress management tool with diaphragmatic breathing exercises. Designed to help you with mood stabilization, anger control, and anxiety management. Free iOS, Android PTSD, Anxiety, Stress
Clear Record Premium Audio recording app that suppresses ambient, background noise allowing the user to record conversations in noisy environments while maintaining clear voices. Control play-speed without modifying pitch-quality. Slow down conversations to a manageable pace for the user. $0.99 iOS, Android Speech, Communication
Concussion Recognition & Response Helps coaches and parents recognize whether an individual is exhibiting/reporting the signs and symptoms of a suspected concussion. In less than 5 minutes, the app allows a coach or parent to respond quickly to determine whether to remove the child from play and the need for further medical examination. Free iOS, Android Concussion Screening
Corkulous Pro Collect, organize, and share ideas on virtual cork boards. “Pin” notes, labels, photos, contacts, and tasks. Group ideas visually on one board or spread ideas out across multiple boards. $4.99 iOS Organization
Cozi Family Organizer Family life organization app that includes a shared calendar, shopping lists, to do lists, family journal. This app allows you to stay in sync with your family. * Paid version available for advanced functionality. Free* iOS, Android Organization
d2u Dictation and Transcription Voice recorder with integrated transcription service* provides you with a comprehensive dictation and transcription solution. Record, edit, and upload a digital recording then have the file transcribed to text. HIPAA compliant. * Transcriptions are a paid feature. *Free iOS Communication
DialSafe Pro Learn proper phone usage and safety with an app that allows for hands-on practice. Learn these critical skills through the use of animated lessons, skill building games, practice sessions, and a realistic phone simulator. Free iOS Life-Skills
Dragon Dictation Voice recognition app that allows users to easily speak and instantly see their words on the screen. Send short text messages, longer email messages, and update your Facebook and Twitter statuses without typing a word. Free iOS Communication
Evernote Help remember everything across all of the devices you use. Stay organized, save your ideas and improve productivity. Take notes, capture photos, create to-do lists, record voice reminders, and make notes completely searchable. Free iOSWeb, Android Organization
Find a Pharmacy Immediately find the closest pharmacies to your location based on your device’s location or address. Free iOS Locating Services
Find My iPhone Location app for iOS that tracks wireless devices and enables a you to track where the devices are, where they have been, and enables you to send warning messages or tones to those devices. Free iOS Memory, Location Monitoring
Flashcards Deluxe Flashcard app which can be used to study just about anything you want. Built in dictionary, capacity to include pictures and sounds, zoom into pictures, and auto-repeat sounds on the cards. $3.99 iOS, Android Memory
Hello My Name Is Use your fingers to write or draw your own personalized “hello my name is” name tag. Good for conferences or situations where a digital name tag may help you stand out. Free Android Social Situations
iBooks with VoiceOver Search and instantly download thousands of popular book and magazine titles. iBooks works with VoiceOver, which will read the contents of the pages out loud. Free iOS Hearing, Reading
ICE (In Case of Emergency) Store all the information you might need in an emergency in one convenient location. Names of doctors, medications you are taking, medical conditions, allergies, and insurance information can be accessed with the tap of a finger. You can also use the app to find hospitals nearby in case of an emergency. $1.99 iOS, Android Emergency
iMazing Skill–based maze game where you must find your way through a challenging maze. Unlimited mazes created for you based on your skill level. Free iOS Problem Solving
Index Card Non-linear writing tool that helps capture your ideas and store notes as they come to you. Organize the flow of your thoughts by using a familiar corkboard interface and compile your work into a single document. $4.99 iPad Organization
Learning Ally Audio s downloadable DAISY formatted books. Learning Ally members can explore the library of more than 64,000 audiobooks that are designed for people with print and learning disabilities.* To use RFB&D Audio, membership is required. Membership is free for eligible people with visual impairments or dyslexia. Free* iOS, Android Reading, Vision
Lumosity Brain exercises targeting memory, attention, speed, flexibility, and problem solving. You can design your own personalized training, including “courses” with TBI- and/or PTSD-specific content. *Paid subscription available for advanced features. Free* iOS, Web Brain Training
MakeChange This app will show you the best way to count change so that you use the least number of coins. Slide and stack coins until you have the amount shown on the register display and check your answer. $1.99 iPad Life-Skills
Matrix Game Helps you develop visual perception skills such as visual discrimination. It can also help you to develop attention and concentration, spatial orientation and principles of classification and categorization. * Paid version available for advanced levels and more functionality. Free* iOS Problem Solving
n-Back n-Back is designed to improve your working memory through actively memorizing and recalling information. Free iOS Memory
Naming TherAppy Word-finding app to help people with aphasia and children with special needs practice important naming and description skills. Allows users to add their own images. $24.99 iOS Communication, Speech
Penultimate Handwriting app that helps you get the fast, tactile gratification of writing on paper, with digital power and flexibility. Take notes, keep sketches, or share your next breakthrough idea — in the office, on the go, or at home. *Advanced functionality and features are paid. Free* iPad Memory, Organization
Pictello Create visual stories and talking books. Each page in a story can contain a picture, a short video, up to ten lines of text, and a recorded sound or text-to-speech using natural sounding voices. $18.99 iOS Communication
Pic-Z Tag Nametag application that lets you identify yourself to others at a conference, business meeting, or any social gathering. $0.99 iOS Social Situations
Pocket SCAT2 This application is a shortened version of the SCAT2 test and is designed to be used in a field setting by coaches or parents to help identify possible concussions. Free iOS Concussion Screening
Proloquo2Go An alternative communication solution to help you if you have difficulty speaking. Natural sounding text-to-speech voices, high-resolution, up-to-date symbols, powerful automatic conjugations, a vocabulary of more than 7,000 items, and advanced word prediction. $219.99 iOS Communication
Proloquo 4 Text Text”‘based communication app that gives a voice to people who cannot speak. It offers a customizable single screen layout for easy conversation, free natural-sounding voices in 15 languages, word and sentence prediction and social media. $64.99 iOS Communication
PTSD Coach Designed for veterans and service members who have, or may have, post-traumatic stress disorder (PTSD). Education about PTSD, information about care, a self-assessment for PTSD, help finding support, and tools that can help you manage the stresses of daily life with PTSD. Free iOS, Android PTSD
Quick Talk AAC This app gives a voice to those who cannot speak for themselves. Quick and flexible app designed to help you talk as quickly as possible. $0.99 iOS, Android Communication
SpeakWrite Recorder Voice recorder that turns your phone into a fully functional dictation system. Record, edit, and send your audio. App integrates with SpeakWrite’s 24/7 paid transcription service. Compile your dictation, upload, and within a few hours receive your transcribed document. Free Android Speech, Communication
SoundAmp Assistive app that turns the iPhone into an interactive hearing device. Using the microphone or a headset with a microphone, it amplifies nearby sound making it easier for you to hear. $4.99 iOS Hearing
Spaced Retrieval TherAppy Facilitates recalling an answer over expanding intervals of time (1 minute, 2 minutes, 4 minutes, 8 minutes…) helps to cement the information in memory, even for those with impaired memory. $3.99 iOS Memory
T2 Mood Tracker Designed for service members and veterans, this app helps you self-monitor, track, and reference emotional experiences associated with common deployment-related behavioral health issues like post-traumatic stress, brain injury, depression, and anxiety. Free iOS, Android PTSD, Behavior
Tap2Talk Alternative means of communication app. Push pictures of items to have a voice speak them for you. Free Android Speech, Communication
TextTwist Word game app where you try to find the word that uses all of the letters on the screen as fast as you can. Crossword mode lets you complete a crossword puzzle using a limited number of letters. Word of the Day mode offers a daily puzzle. $0.99 iOS, Android Problem Solving
Today Screen One-stop app for quickly viewing your upcoming agenda, tasks due, and your local weather forecast. Tasks and events are intuitively highlighted based on date and time, so that what you need to look at right now stands out clearly. $2.99 iOS Reminders
Touch Calendar Touch Calendar makes viewing your calendars easy. See your whole calendar at a glance. No more flipping between different calendar views. Touch Calendar does it all from one zoomable and scrollable view. This app is especially useful for people with attention problems who do better with fewer steps. $3.95 Android Organization
Unus Tactus Developed to assist people of all ages with mild cognitive and/or motor deficits by allowing you to have an easy to use cell phone, with a simple set up. It utilizes a one–touch photo dialing system to generate phone calls using phone numbers from your existing contacts or those that you import directly. $9.99 iOS Communication
Voice4U Picture-based, augmentative and alternative communication (AAC) application that helps you express your feelings, thoughts, actions, and needs. $59.99 iOS, Android Communication, Speech
Verbally Comprehensive Augmentative and Alternative Communication (AAC) app for the iPad. This app enables real conversation for those who have challenges speaking. Just tap in what you want to say and Verbally speaks for you. *Premium features available with an in-app purchase. Free* iPad Communication, Speech
Visual Schedule Planner Customizable visual schedule iPad app that is designed to give you an audio/visual representation of the events in your day. In addition, events that require more support can be linked to an activity schedule or video clip. $14.99 iPad Organization
Voice Cards Are Not Flashcards Create voice flashcards with an autoplay and shake option. Create sets of flashcards just as you would with paper flashcards, except you create a voice recording of your questions and answers in sets of Voice Cards. You can “flip” between questions and answers by swiping or shaking the phone.* Two versions, lite with limited functionality, $0.99 for full version. Free* iOS Memory
Where Am I? View and share your location, including your city, zip code, telephone area code, and approximate street address as well as the times of sunrise and sunset and GPS latitude and longitude. Free Android Location
Word Warp Game with which you can create as many words as possible from a selection of letters. If you’re stuck, just press the “warp” button and it will help you out. Free iOS Brain Training

Pricing, availability, and features accurate as of the last update January 16th, 2014.

Share with us

Technology is always changing. New iterations of mobile devices and apps are constantly being released. Please share with us what apps have and haven’t worked for you in the comment section below.

Posted on BrainLine December 16, 2013

Source: Life-Changing Mobile Apps for People with Brain Injury | BrainLine

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[WEB SITE] Top 18 Apps for People with Brain Injuries

Note: This content was updated in February 2017. Some of the apps from the original post are still listed; however, we’ve found many more that can be extremely helpful…

We know what you’re thinking: don’t people with a traumatic brain injury have enough to relearn without training in new smart phone technology? Our answer: Yes and no. Yes, absolutely, which is why the apps we recommend are meant to complement existing therapies and programming. No, because the more frequently the mind is exercised, the greater the possibility of neuroplasticity rewiring the brain to be more functional in the future.

Technology today is working harder than ever to improve our lives. There are literally hundreds of apps for people with brain injuries and similar problems. We have selected these apps because they build on the day-to-day needs of an individual living with a TBI. We focused our research on these areas:
.         Social/Emotional
.         Functional
.         Cognitive
Specifically, these apps help clients work on the following: short-term memory loss, communication/socialization problems, anxiety, behavioral and organization issues.

Alarmed
Free with $1.99 Upgrade Available (iOS)
(Android Counterpart: Lists Alarmed!)
Alarmed augments short-term memory while the user is rebuilding his or her own. A productivity app for the masses, people with traumatic brain injuries can use Alarmed to create multiple reminders with unique, memorable tones for each task. Reminders can be customized with a “To Do” list and send multiple email reminders/updates. This app also comes with a timer to assist in programming.

Cozi Family Organizer
Free (iOS & Android)
Families can stay in sync on multiple platforms using this app that combines a shared calendar, shopping and “To Do” lists. With everyone on the same page, organizational skills are enhanced and frustration diminished.

EverNote 
Free (iOS & Android)
EverNote helps improve memory, organizational skills and even creativity by syncing ideas on multiple devices. The user can take notes, capture photos, create “To Do” lists and record voice reminders. The searchability function can be a tremendous boon for those with short-term memory loss.

Productive Habits and Daily Goals Tracker
Free with In-App Purchases (iOS)
(Android Counterpart: Habitizer) 
This app helps users develop positive habits in their lives by keeping them organized, tracking their progress and maintaining motivation. It allows users to set the habits they want to develop and receive reminders when tasks are to be completed. Users can color code these based on the priority or category of the habit. This app can also allow a therapist or caregiver to set priority levels for each task.

BrainHQ
Free with In-App Purchases (iOS)
(Android Counterpart: Luminosity)
Brain HQ tailors a training program for each persons’ unique mind. Therapeutic exercises are personalized based on performance and can help improve cognitive skills. Exercises are designed to improve attention, memory, people skills and navigation.

Brainscape – Smart Flashcards
Free to $9.99 with In-App Purchases (iOS & Android)
Pick a subject from geography to vocabulary-building and Brainscape has a set of smart digital flashcards. What makes these flashcards so smart? Besides being color-coded to aid recall, users are asked to indicate prior knowledge of the answers. Questions the user did not understand or answer correctly are repeated more frequently than those answered correctly.

Constant Therapy
Free for 30 Days (iOS & Android)
Constant Therapy is a speech therapy app for individuals who are looking to increase their cognitive abilities. This app is scientifically proven to improve speech, memory, cognition and comprehension skills. While this app can’t take the place of therapy, it is a great way to augment existing treatment by completing progressively challenging tasks right from your very own phone.

Spaced Retrieval TherAppy 
$3.99 (iOS)
(Android Counterpart: Spaced Retrieval)
Spaced Retrieval is a scientifically-proven way of improving recall of names, facts, the routines of several people and more. People with brain injuries can rehearse memory skills by recalling an answer over expanding intervals of time (1, 2, 4 or 8 minutes) that helps to cement the information in their memories. Please note: this app is not intended for use without therapy.

Answers: YesNo
$1.99 (iOS & Android)
For non-verbal clients, this app utilizes two large, color-coded buttons, green for “Yes” and red for “No”. When either button is pressed, the app vocalizes the client’s decision. This is a wonderful tool to help those with a brain injury or speech problem communicate without a struggle.

Audible
Free (iOS &Android)
Audible is for individuals who love a good book but are having difficulty reading, retaining information or who simply enjoy closing their eyes and having a good book read to them. With Audible, users do not have to give up their literary passions, they just have to listen.  This app is also compatible with Amazon, so books can be downloaded right from your account.

Clear Record Premium 
Price ranges from $.99 to $1.99 (iOS) depending on upgrades
(Android Counterpart: AndRecord)
This audio recording app allows the user to record conversations in practically any environment and play it back at the speed and volume of their choosing. Unlike many other voice-recording apps, Clear Record Premium filters out ambient sound to ensure pitch and clear voices.

Dragon Dictation
Free (iOS & Android)
Speak and this app will recognize the users voice and transcribe what they say into text messages, emails and even update social media. Dragon Dictation is a perfect mass media communication tool for anyone with a physical limitation.

Type ‘n Talk
Free (iOS)
(Android Counterpart: Type and Speak)
This app is incredibly useful for non-verbal individuals and other individuals who have difficulty with speech due to physical limitations. Type ‘n Talk allows the user to type what they need to say and their verbalized audio will play through whatever device is being used. This app also allows the user to copy text from websites and messages and provides a variety of languages.

Pocket Verbal Ability 
Free (iOS & Android) 
Users can increase their vocabulary with this user-friendly vocabulary app. Pocket Verbal Ability asks questions that will help prepare for job interviews, exams, and day-to-day life.

Social Skills 
$3.99 (iOS) 
(Android Counterpart: Talkingtiles)
This app includes the most common topics in the functional social skills system for people with brain injuries to model for appropriateness. Topics include the following: meeting/greeting people, taking responsibility, being polite, joining others in groups, apologizing/excusing self, following directions and handling criticism. Users watch a brief video of a person performing the correct behavior for the social situation and can then pattern their own behavior accordingly.

Breathe2Relax
Free (iOS & Android)
For anyone who could use a time out to relax, Breathe2Relax has been proven to help mood stabilization and control anger and anxiety. Users should simply indicate their level of stress and follow the audio instructions to breathe their way back to serenity. Essentially, this app provides on-site audio diaphragmatic breathing exercises.

WeFeel
Free (iOS & Android)
WeFeel is a mental health app that users can use to track their emotions and monitor how they change over time. This app can help manage emotions by allowing the user to visualize their anger, fear, stress, etc and then offer coping strategies. With a subscription, a counselor, therapist or caregiver will be able to monitor the users recorded emotions in real time from their own smart phone.

In Case of Emergency
$1.99 (iOS & Android)
This app allows people to store their medical information in a single location that is convenient for medical personnel in the event of any urgent situation. This app can also use to locate the nearest hospital.

All apps labeled iOS can be found at the Amazon.com: Apps & Games. Apps for Android can be found at either Google Play or the Amazon App Store for Android.

Since this is by no means an exhaustive list, we are always working to improve and add to it. We would love to hear from individuals with a traumatic brain injury and their physicians and caregivers about which apps they use.

Source: Top 18 Apps for People with Brain Injuries – LifeSkillsVillage.com

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