Saturday, August 23, 2014

A Technology talk next week and the best IT resource of today

I'm giving a talk about technology in private practice for Pearson in Melbourne this coming Friday, 29.8.2014. I'm organizing nice, juicy lists of useful tricks and gadgets, and having a lovely time researching all sorts of stuff.

If anybody is interested in coming, there should still be spots. Check if interested. Please note, spelling is not mine.

Among all the lovely goodies, the juiciest resource I worked with today was unquestioningly the APS guide to practice management software. Beautifully compiled, with web information, contact details, cost and detailed comparison of features. Lovely.

The address is:

It is from April 2013, so somewhat out of date, but still worthwhile.


Friday, June 27, 2014

Neuro Pope

The links between John Paul II, miracles and neurological disorders explored in Mind Hacks blog:


Everything Oliver Sacks

I've recently found out that Oliver Sacks has a blog
He doesn't update it personally, but it is still worth reading

His official website is here:

and it includes a whole bunch of videos

He has also a dedicated YouTube channel
with lots of excellent stuff.

You can even sign up for a newsletter

He's also got a Facebook and a Twitter page - just search on Oliver Sacks.


Sunday, June 22, 2014

Last report from the Wild West

I never did get around to writing a post about a seminar on brain training that I attended in March, and it deserves a mention.

It was a whole day seminar on cognitive training by the Murdoch Childrens Research Institute, and the speakers included Professor Torkel Klinberg, the creator of Cogmed, as well as a wide variety of well-known names among Melbourne neuropsychologists. I strongly recommend the slides of presentations that can be accessed on!slideshow/c19lk.

I was particularly interested in the last part of the day, which was a debate. I was looking forward to seeing Professor Torkel Klinberg on one side of the equation, Professor Jennie Ponsford on the other side and Associate Professor Stephen Bowden as the chair. In my mind a debate cannot get better than that.

I've previously bugged Stephen Bowden re. his opinion on brain training. He is, after all, well known as the ultimate skeptic, intent on scientific proof. However, he claimed not to be involved in this area, so I was out of luck.

But he did not disappoint in the debate. One of the questions he posed was about the appropriate level of proof required before we recommend an intervention. He described three descending levels of proof: a meta-analysis, two randomised controlled studies and then one randomised controlled study.
The answers of the panel clarified my view on cognitive training, at least as far as Cogmed is concerned: Prof Ponsford admitted that most rehabilitation interventions have one randomised controlled study behind them, with not many interventions having two. Professor Klinberg said that he does not have to concern himself with level of proof, because he already has a meta-analysis that supports Cogmed. Hmm, that _was_ convincing.

And that's why this is the last post on brain training. I've decided to build a homestead in Neuropsychology's western reaches and to start offering Cogmed in my practice. As I now have a commercial interest in brain training, I no longer feel I can post on the topic in this forum. Also, it strikes me that my previous posts were meant to convince me as much as my readers, and I decided that I no longer need convincing.

So, final greetings from the Wild West, and it's back to the usual program of reporting the latest technological gimmicks.


Saturday, May 24, 2014

Playing with biofeedback

I am checking out the biofeedback possibilities of the iPhone. Not that I'm planning to seriously get into biofeedback, but it is a fun new way of avoiding report writing. If anybody has some experience and knowledge about this topic, please send us a guest post.

There are several interesting options out there:

a) heart rate and heart rate variability
It turns out that iPhone 5 rear camera can be used as a heat rate monitor. You put a finger on it, the flashlight lights up and it works pretty much like an oximeter. There are a few apps that use this option:

  • Cardiio app measures heart rate and feeds back your fitness level
  • Stress Check measures heart rate variability and records self-reported level of stress
  • iRelief does breathing exercises while measuring heart rate and then feeds back percentage of coherence (whatever that is)
  • CalmZone has some nice sounds and gives you some feedback on your heart rate variance (same as variability?)
  • StressCheck meaures heart rate variability and reports your stress level, with an ability to record data over time (mind you, this is buggy in the free version, may be better in the non-free app)

I have to admit that I haven't been really impressed by any of these. None of them does all they should, which would be feedback on heart rate variability, with clear explanations and maybe visual feedback, e.g. colour change, as the parameters improve. Also, I have to admit that I am still not  comfortable with the idea of heart rate variability, and can't quite wrap my head around it. OK, I've never tried terribly hard, but then again, if it takes trying terribly hard, then explaining it to the clients is going to be a tricky task.

Les Posen recommends a set of sensors with a dedicated computer program from emWave for heart rate variability training. They also have an option of attaching a sensor to an iPhone and monitoring heart rate variability on the go. Probably a more accurate and elegant option (but more expensive, drat).  Has anybody tried this in clinical practice?

b) skin conductivity
I like this idea of biofeedback much more. As Michael Carr-Gregg explained in his recent talk - you just tell the client that it works the same as a lie detector test, with more anxiety causing more sweating and more skin conductivity. Simple and convincing. He uses the sensors while teaching relaxation training to teenagers, so that they can see that it works.
The sensor is called eSense, fits on fingertips, attaches to an iPhone/iPad and can be linked to an app called eSense GSR. Very tricky to buy, as the original company's website is buggy, but can be bought from third parties for around $100. Don't try Amazon - they don't want to sell it to Australia. Seems a much better option for an average neuropsych who does not want to get too deep into biofeedback, but may want to convince a client that relaxation works.

c) breathing
There are apps that use the iPhone's accelerometer to teach deep belly breathing. You put your phone on your stomach and breathe away. One of these is BellyBio. Feels a touch silly, somehow, but I am impressed with the creative use of sensors.

And that's all I've discovered. If anybody knows a nice and useful gadget, please write a guest post or let me know at IzaWalters at, and I'll post it up.


Simple, customised mobile phone

With thanks to Katie Kirby and Gloria Smith-Tappe:

OwnFone was launched in Australia last month:
Some reviews:

I have had a look at the website and I'm very impressed: instead of a keypad, you can set up from one to 11 buttons with a name or a photograph. A very nice, simple design. And not too expensive (handset under $100 + plans from $20 per month). You can even make free changes to the buttons up to three times a year.Very impressive.



Tuesday, April 1, 2014

Izabela's second trip to the Wild West

I enjoyed my first trip into brain training, which I wrote about a few posts back. It was reasonably easy and felt like a success. My useful field of view improved quickly and I noticed a change in real life. Not surprisingly, I decided to do it again. This time it was working memory.

Now, working memory is my personal weakness. In the interest of full disclosure, I have a digits forward span of 7 and digits backwards span of 5. Visually, I can do a block span of 5 consistently, and repeat a sequence of up to 7 blocks inconsistently. I can reverse five blocks consistently, and 6 inconsistently. Not bad, somewhere in the Average range, but not great either.

In practice, this interfered a bit with my functioning. Telephone numbers had to be copied down in chunks of 4, and double-checked for errors. I could at times feel overwhelmed, for example when integrating information from multiple sources when writing complex reports. Yes, I know that this is normal, but I wanted a better function.
When report-writing, I needed more frequent breaks than optimal, and felt that my brain power got used up by about 3pm. And I developed a whole system for avoiding inattentive, 'silly' mistakes - very important to prevent in a private practice. Working at home and being interrupted by requests from Dear Daughter resulted in feeling overloaded and frequently snapping at her. Thus, I avoided working when she was not at school or asleep. As all mums do, I also snapped a lot in the morning, during the school run.
Not an uncommon set of problems, really, but worth improving on. Especially that I could do my own training AND acquire Cogmed coaching credentials all at the same time and price. Mind you, the price was 1,500 and it did hurt the wallet.

So, I did the full Cogmed training, and it was tough. 45-60 minutes of major effort for 25 days. The effort was not that surprising - after all working memory tasks are by definition effortful. So I persevered, despite serious sweat running down my brow. I wonder, however, how one keeps ADHD kids doing these tasks. Now I understand the requirement of a training aide to supervise all the kiddie sessions, and a coach to call every week with feedback and reinforcing chat. Trust me, if you do Cogmed, or if you are a training aide you really need someone to support you.

There are three versions of the program: for preschoolers, children and adults. The children and adult tasks are the same, apart from the interface - the adult interface is more boring. I chose the kiddie version and strongly recommend everybody does the same - when you are trying to remember multiple locations, it really helps if you are tracking aliens rather than gray circles. Also, exploding asteroids is fun.

One of the tasks was digits backwards. By the end of training I could reverse up to 11 digits (very occasionally, mind you). This was not auditory working memory only - by this stage I coded some of these digits visually, some auditorily and some by meaning. Nevertheless, I believe that my actual auditory working memory store did stretch, if only by a digit or so.

Unfortunately, while I managed to get a pre-test (see results above) I had not much luck getting myself re-tested. I can just say that after the training I can hold in mind the entire 8 digits of a phone number or a credit card number when copying them onto various online forms. So I remember one more digit forward than before the training. The training was in September, and if anybody wants to check this n=1 experiment for persistence of working memory effects, I'm game. We'd just have to think up some other task instead of digits backwards, as it was one of the tasks being trained.

Now, did the results generalise? I was expecting to be able to work longer without mental exhaustion, and that seemed to happen. I can now comfortably work until 5pm, and report writing became a bit easier. This is always nice, even if the effect was small. Whether this was an effect of Cogmed or placebo effect, it is hard to say. This levels of mental energy and being able to work a lot persisted till Christmas, but took a dip over the start of the year, when I got truly fed up with the heat. The mental energy has now come back. However, I am not entirely sure that the cognitive effect of Cogmed was worth the money.

What I did not expect, was that the training would stop me snapping at Dear Daughter.  After about a fortnight, I noticed that I became overloaded less and less often when she interrupted something. By the end of the training, my snapping completely disappeared - I no longer lose my temper.  This effect, I am glad to say, is continuing to this day, and has not diminished.
Surprisingly, this effect, which I was not expecting, ended up to be the most worthwhile outcome of Cogmed training. I think that ultimately, this one was worth the money I paid.