Saturday, October 22, 2016

WMS-IV iPad administration – part 2

Part 3 of the series on Q-interactive by Debbie Anderson

Welcome back to the second half of the WMS-IV administration.  

Verbal Paired Associates I
The administration screen starts with the test instructions, then lists the pairs for you to read out.  A little trap is that you have to scroll the pairs up to find all fourteen (for the adult version, they are all in view for the older adult version) to read out.  Then the pairs are presented individually, and you simply have to indicate if the response is correct or not.  You have the option of writing down incorrect responses (or transcribing them later as it is also recorded – but that will take a lot of extra time, so I would encourage you to do it during administration).   It tallies them up, and keeps presenting them to you to read out, until they are all done.  Once again you know immediately how your client is going, with a total score and age scaled score in the screen at the end of the subtests.

Designs I
So to what I believe is probably the least popular test to administer – designs.  Luckily, it is much easier on Q-interactive.  Once again the stimuli are presented on the client’s ipad, and they respond using the grid and the design cards. 

Now the great part is that you don’t have to deal with the confusing grid on the form to record the answers, nor pull your hair out trying to score them – this little treasure does it for you.  So, after the stimuli are presented (it removes it from the client’s screen after the correct exposure time) their screen is blank.  The examiner’s screen has a grid in the same orientation as you are viewing it (i.e. looking down on it).  When the client puts a card in place, you touch that spot on your grid.  A set of cards comes onto the screen, and you just tap on the design that they have put down.  Continue this for the number of cards.  It won’t let you record more than the correct number of responses (i.e. you know immediately if there is a rule violation, in case you weren’t counting along…). If you really like lifting up the grid and recording the numbers (or checking if you are doing it correctly) the program has a button you can press to convert what you have recorded into numbers.  This is SOOOOO much easier!  I, personally, transcribe those numbers to input into the scoring program, but you aren’t obliged to, because at the end it gives you the age scaled score! No more headaches with scoring this!

Spatial Span
Administration is so much easier on the iPad, the clients see the symbols (it counts the time, so the exposure is exact) then the choices.  They just have to touch on their answers in order.

Here’s the beautiful part, it tells you, the examiner, what responses they have chosen, and in what order.  So much easier than trying to watch what the person does and remember the order to write it down etc.  You then need to check if it’s a 0,1 or 2 point answer, and press on the appropriate button.  It does the rest – again keeping score, and stopping at the correct discontinue point. 

Verbal Paired Associates II
To avoid getting boring, I’m pretty sure you are getting the idea now. 
The item comes on the screen for you to read, and you record the client’s response, and whether it was right or wrong.  Recognition is done in the same way.

Designs II
No surprises here, you record the recall responses in exactly the same manner as for Designs I.  And the recognition is nice and easy – clients just touch on their responses.

So there it is – the WMS-IV on Q-interactive.

The advantages as I see them are:
1)     Much easier to administer
2)     Exact timing on the exposure of the visual items, so no errors
3)     Exact administration i.e. verbatim instructions are integrated and easy to use
4)     Does record verbal answers so that you can check them later
5)     Much easier to record and score all of the visual items, the ones that have made my life easier are Designs, Spatial Addition and Symbol span.
6)     Immediate feedback as to how the patient is scoring
7)     Can administer either the adult or older adult version as appropriate (and it will prompt you if you make a mistake with that choice).
8)     Gives all the index scores at the end – so once you’ve fixed up the scoring on items that were missed you know the scores straight away
1)     It does cost quite a few administration credits
2)     It still takes a while to administer, and some clients still don’t like the challenging items!
3)     Whilst it does do some comparisons with the WAIS-IV, the TOPF isn’t integrated, so you need to input the data into the scoring program to use this.

Later, a recap of the WAIS-IV on iPad and some more posts about other tests I am using.
Debbie Anderson

Monday, October 17, 2016

WMS-IV on iPad – part 1

Another great post by Debbie Anderson - enjoy!

It was a joyous day for me when the long-promised WMS-IV administration appeared on Q-interactive.  I suspect only a few (if any) of you have tried it, so here’s a run down of each of the subtests.
Visual Reproduction I:
You still need the pencil and paper response booklet for this section – so don’t forget that.  On the examiner screen it gives you the verbatim instructions to read.  The items are displayed on the client iPad, for the exact 10 second exposure.  So if you lose concentration, it takes it off the screen for you at the right time, so that the test is administered correctly.  You still have to remind the client to draw the items, and then swipe onto the next one.  It’s very smooth and easy to administer.  If you are quick about it, you can score it as you go (or most of it).  After the administration screen, there is a screen with all the scoring items for VR listed (with explanation and examples available when you touch on them).  For some you, you will be able to score on the fly (eg if the item is obviously correct or a 0), but for others you will have to come back to.  You can signal that you want to return to a screen later by touching the red flag in the top right hand corner, or it will do that for you if you don’t put in all the scores.  If you do put in scores, it gives you the total score and age scaled score on the final screen of this section.

Here’s the fun part, it starts counting down the timing for the delay (a small clock appears on the right).  You can tap on the clock to check how much time has passed.  It will change colours when it’s time to do something.  Unfortunately the colour change of the clock isn’t quite right at the moment, so make sure you check that actual time on the clock before recalling items.  Pearson are fixing it as we speak.  Nevertheless, having that on the screen – and not juggling the stopwatch is a big help.

Logical Memory I:
On the examiner’s iPad you see the story to read out.  When you swipe past that screen, you see the individual data points of the story listed.  You can just touch on them as the client recalls them, and voila – it works out the score for you!  If you have a client that is going too fast, or is difficult to understand, it records the audio for you, making it easy to listen to it and check your scoring later.  You can come back to it later, and indicate to look at it later, by tapping on the red flag in the top right hand corner.  You then swipe through to the second story (or whatever is age appropriate).  Don’t forget to scroll the screen up as there will be story details hiding down the bottom of the page when you are recording the answers.

Again at the completion of the subtest there is a screen with the score and its age scaled score.  I like to know how we are going, and this is great.  Again the clock starts at the end of this subtest (and the colour change element of this one is correct – it turns green after a 20 minute delay).

Spatial Addition
One of the things I didn’t like about the traditional administration of spatial addition was recording the responses for this subtest.  Now it’s much easier.  How it works is that the stimuli are displayed on the client’s iPad, and they still respond using the grid and coloured cards.  For the purists it isn’t the exact size as the grid, but pretty close.

The great part is that on the examiner’s screen you see the grid, and just have to copy what the patient is doing.  So no lifting the grid up, turning things in your head etc, you just copy what they do.  On your iPad screen you touch on the spots where they put the cards (once and it is blue, twice and it records white, three times for red and another tap to erase the answer).  The magic is that the iPad then works out if it is correct or not, and scores accordingly.

It also applies the discontinue and reversal rules –no flipping the pages around (and getting lost with them).  At the end of the subtest, it shows you the total score, and the age scaled score – much easier!

Visual Reproduction II
When it comes time to recall the VR items, you just need to swipe onto the subtest and it provides the examiner prompts.  The client draws them on paper, and if you can keep up (rarely, but I try) you night be able to score along – as each screen lets you indicate which figure was drawn and the scoring criteria for it.  Again if you can’t keep up, you can come back to it at your leisure.

Now the fun part – recognition.  Q-interactive doesn’t let you skip this – but it’s easy – the six options for each item come up on the client’s iPad, and they just have to touch on their choice.  If they want to change their mind, you can remove their response (on the examiner’s iPad) and let them put in the answer they want.  Lovely and easy.

Logical Memory II
Recall scoring is provided point by point, just like in the administration phase, and it records the response and you just touch on what the client says (i.e. just touching on the idea if it is correct rather than writing it out).  For the recognition component, the administration screen shows you what to read, and you just touch if the client’s answer was yes or no, and it tallies it up for you.  Again at the end you get a screen saying the scores and age scaled score.

Phew! That’s half the WMS-IV – next time the other half.

Saturday, October 15, 2016

iPad - based assessments - Part 1 - Introduction

A fantastic post from Debbie Anderson today. Enjoy!

Hi Neurogeeks
I’ve decided to do a series of posts about iPad based assessment for neuropsychologists.  Some of you might already be familiar with some tests, others might be totally new to it, so I will start with a brief introduction about iPad setup.  The later ones will be more detailed/technical about the tests themselves. 

Disclosure: I’m in private practice, and was part of the Pearson beta-test of the initial release, so they did provide me with two iPads to trial the WAIS/WISC/D-KEFS.  The trials of tests released later & non Q-interactive tests have been at my own expense.  Subsequent excessive purchase of Apple products has also been at my business’ expense!

So, if you are at all interested in using iPad based assessments, I would first recommend getting familiar with your iPad.  Fortuitously, I had one for about six months before I started using it for assessment.  You need to be familiar with how to move around it, how to check settings, download apps etc.  So, don’t just leave it on your desk, read books, take photos & look at websites to get used to the navigation.

Why use iPads for assessment?
Many of these reasons are based on the Q-Interactive tests (particularly the Wechslers).  They appeal to me for lots of reasons, here are just a few:
1)     They integrate the test instructions, stopwatch and test responses onto one screen.  Finally, no manuals etc. to fall over.  I think that having it all integrated makes me look a bit more professional and organised (… but maybe that’s just me!)
2)     Instant scoring – WOW!  You finish a subtest and straight away (if you’ve kept up with the scoring) you can know the scaled score. 
3)     No dirty fingermarks – looking at my test administration materials (the original booklets), the WAIS-IV & WMS-IV have been around for a while and are starting to show a bit of wear.  Even though people have clean fingers, somehow marks build up over the years on the books.  Not that I’m a clean-freak, but on some items it can show the right (or most popular) answer – because the others are unmarked.
4)     People love it!  Especially children & difficult teenagers.  I’ve got lots of WISC-IV forms (I don’t use it much) and every time a child comes I promise myself I’m going to use a form, but then the kids tell me that they really like to play computer games/iPads, and their eyes light up when they see my iPad collection, so I can’t deprive them.  Even elderly people who have never used technology seem to like it, because it is intuitive (they just touch their answer).
5)     Quicker and more accurate responding.  People can touch the screen, and their response is saved.  You don’t have to read numbers upside down, reverse things in your mind, or ask them to tell you the answer.  So that makes things much quicker, and more enjoyable for both of us.
6)     Reversal rules are built in.  I love the fact that the iPad automatically applies the reversal (and discontinue) rules of the Wechslers.  It always bothered me that the clients could tell that they got something wrong when you flip the book back, and now they can’t – so that in my view is a big win.
7)     They are easily portable, less books to carry around (but you still need Wechsler blocks, PSI response forms & the grid & cards for the WMS-IV & VR response booklets).  Even so, its much more compact to transport.
8)     You only pay for administrations you use – ie if you start giving a battery, and the person can’t or won’t complete it, you only get charged for the subtests you used.  That’s better than paying for the whole form (and wasting a lot of paper)
9)     Tree saving electronic storage – it saves my secretary from having to scan the forms in.  Plus we don’t have to waste time on form inventory/ordering in advance/paying for freight.
10)  If you suddenly need a test you don’t own (and its on Q interactive or in the App store) you can just pay for one administration of it (for example PPVT is now available, I’ve used it twice this year, had never felt I would use it enough to justify the outlay to purchase the materials)
11)  The manuals are available to you through Q-interactive.

Now some of you are probably a bit reluctant, so I want you to know that I can see the disadvantages too:
1)     Using the Wechsler tests costs slightly more (than just buying the forms).  Sadly, that is the truth.  I think the advantages outweigh the cost, and I price my service accordingly.
2)     You need to plan your assessment in advance.  This is not a disadvantage to me, as this is what I do, but whilst you can change the battery while you are giving it, it is a bit tricky.
3)     You need two iPads and access to the internet to set up the assessment.  So back to planning, it means that if you go out of your office to see someone, you need to upload it before you go (although you could use mobile data when out, be careful of relying on this, you never know if the location will have sufficient coverage – I recently had to see at patient at his house an hour’s drive inland from Dalby – and there was no mobile coverage there!).  Again this doesn’t bother me, I load up what I think I might need and if I don’t use them, I just remove them when I get back to the office.
4)     Some institutions (i.e. prisons) won’t allow you to take iPads in.  So, there is no two ways about it, you have to use hard copies there.
5)     On the Wechslers it does basic scoring which is nice to let you know how the client is going.  However, to do the fancy stuff, in my view you still need the Scoring software.  Maybe that’s because I like stats & numbers, it might be enough for you.  If you want to use it with the ACS (i.e. TOPF & Word Choice) you will still have to enter the results into your computer.
6)     Occasionally a technical glitch will stop things working.  That’s the nature of working with technology. 
Some other concerns people have are:
1)     Equivalence – I read the equivalence studies and in my view they are acceptable – the main difference seems to be that the iPad administration eliminates errors (of administration and scoring)
2)     Privacy – I understand that some institutions won’t allow people to use this system because it has to go through the cloud.  Sorry, but I haven’t got any useful information to help you with that.  I don’t like the idea of the data being in the cloud, but if it really bothers you, you can use pseudonym.  You need to have the date of birth right (or start points will be wrong, I made an error the other day and it was a real pain).
3)     Cost of set up – yes you need two iPads (… see why you need to put that on your Christmas or birthday list, or make use of your tax return).  They don’t have to be the latest ones, the technical requirements are on the website.  You can pay for your administrations in advance (I do this as you get a discount for buying a lot at once) or as you go.  There is also an annual licence fee.

So if you are keen to give it a whirl, here’s a couple of set up pointers.
1)     Get comfy!  iPads are light and comfortable, but it gets a bit tiring to hold them all the time.  I like mine up on an angle where I can see them and write/point, and initially propped it up with a stand.  I noticed on eBay that you can buy covers where the stand is integrated – see photos below.  So for about $20 I got an industrial strength cover and a stand built in.

2)     The client iPad is locked in one direction, I put a little sticker on the correct orientation to avoid the embarrassment of handing it to the client upside down.

3)     I downloaded some free images from the internet, and use them as the screensaver, so the iPads don’t get mixed up – see below

4)     You still need to write a lot of stuff & push buttons.  Your finger will get sore – my right index finger joints swelled up from over-use when I first got my iPad.  So avoid the pain by getting yourself a nice stylus.  For myself I use one of these:

The end looks like steel wool, but is soft material.  It writes easily and accurately
My experience is that the rubber tipped ones tend to ‘catch’ on the screen and are no good if you want to write a lot of things (or write / swipe quickly).  If you are feeling rich you can set yourself up with the iPad pro which has a pen to write with (… I’m saving up for that)

5)     Stylus for the client: I buy the rubber tipped ones cheaply on ebay, and give them to the clients to use if they are reluctant to touch the screen.
The screen has to be touched with a light bounce with the pad of their finger for it to record the response.  If they press too hard, or have long fingernails it doesn’t work.  So if they can’t get the pressure right, I give them a stylus to use.  The cheap rubber ended ones are fine, because all they need to do is point at their answer.

6)     In order to use the Wechslers, you will need to set up your iPads using the tutorials on the Q-interactive website.  Don’t skip them, the iPads have to be told how to talk to each other.
7)     Pearson have now introduced the opportunity for a practise administration – something I had muttered to the technical people about.  Regardless of whose idea it is – its great – so you can load up an administration and practise using it, without any cost (it won’t score it properly in this mode though, so you can’t get around the admin costs!)

8)     You should be ready to go!
Next time, Part one of the WMS-IV on iPad.

Monday, September 26, 2016

Comparison of different practice management software for psychologists

Another fantastic and informative blog post by Dr Bridget Regan. Enjoy!

She compared five practice management programs and summarized features of each in a table.  She wrote that all of these plans provide core servicdes such as: calendar and schedules, invoices, automatic text messaging to clients, patient records, andfinancial reports. All offer integration with xero. Bridget tried out Health Kit and Coreplus but has yet to look as closely at the other three.

Bridget has decided to go with Health Kit as it is easy to use and the cheapest option (for her relatively small one person practice) and with its online payment and claiming system enables her to avoid purchasing an eftpos machine.  It looks as if they will have better online booking systems and secure messaging soon. 

Global Health
Power Diary


Free to use core software
22c for each online medicare/ DVA claim
$1 for each credit card payment 2% merchant fee
22c for each text message

$45 per month for ehealth plan

$45 per month (one practitioner)

$46 per month

$46 per month (but currently 50% off)
General Comment

Really easy to use.  Making an appointment allows you to set up everything else (invoice, referrer etc.).  They include as drop down options all of the possible codes for services (e.g., medicare code, DVA code, APS code etc.) .
OK to use - encountered a couple of minor issues when trialling(e.g., you MUST enter a provider number for referrer). Might be really good and more cost effective for larger practices. Has the most ad on programs including  Health Engine (for online booking and inclusion on their website), speech recognition software, marketing options etc.
Very easy to use. Can use across multiple platforms (e.g., mobile app available)

Recommended by APS mainly due to secure messages (I suspect).
Easy to use.
Medicare and DVA claiming

Can be undertaken online using the software – you don’t need an eftpos machine
You can link to Tyro Eftpos ($39 per month + merchant fees).  Once you create your invoice on coreplus it  transfers the information via blue tooth to tyro.
Creates invoices but you need a separate eftpos or HICAPS machine.
Website says that it supports Bulk Billing, Easy Claims, Medicare Online & HICAPS – but I think you still probably need a separate eftpos machine
Creates invoices but you need a separate eftpos or HICAPS machine.
Online booking options

They currently have a directory (free to register) on which you can add a booking button for clients to book online (apparently they will offer a more attractive month per view format that you can add directly to your own website soon)
This is available via Health Engine (extra $49 per month)
Gorgeous looking month per view online booking tool that can be added direct to your website.
Not mentioned as a feature.
Has a client self-booking portal for website.
Secure Messaging*
They say they are in the process of developing their own system that will be launched in the next few months.
It is possible to receive messages from Argus and Health Link but not to send them!
Not available and no plans to develop this in near future.
They currently seem to offer the most comprehensive system “referral net” which enables both sending and receiving of messages.  Can be purchased separately for $315 per year.
Not available.
*Secure messaging as well as capacity to communicate with “my health record” is likely to become more important.  At Congress Lyn Littlefield mentioned that in order to communication with PHNs and participate in newly emerging mental health initiatives that psychologists are going to require these options.

Thank you, Bridget!

Monday, September 19, 2016

Peeking outside of the Wechsler Box

A terrific post from Dr Bridget Regan today. Enjoy!

Like most of us, I have been happily using my Wechsler WAIS and WMS as the backbone of my assessments throughout the 15 years I have been working as a neuropsychologist.  If ever in doubt, administer more subtests and gain more indices with increased psychometric rigor!  I’ve always been reassured that these tools and our face to face approach is the most reliable and most studied in brain disordered groups.  The most attention I have given to technology and neuropsychology was to trial the computer based versions of our existing scales and the vague thought that if possible I would like to be able to administer some tests online or via computer in my practice instead of administering all of them face to face.  However, there have always been some residual concerns about the reliability and validity of self-administered cognitive assessment tools and the challenges involved of keeping test takers motivated.
At the 2016 APS Congress, however, I became aware of some new approaches and technologies that have the potential to substantially improve the quality of our assessments (including online and self-administered) and it made me realise it is now well and truly time to start taking proper notice of what is happening outside of the Wechsler comfort zone! (and to keep reading this blog).  I learnt about these approaches in a conversation with a research psychologist who works for the military (Eugene Aidman also an Adjunct Ass Prof at Sydney Uni), in a talk by Jason Mattingly on the neuroscience of learning, and in the sports psychology seminar on neuro-technologies. 
New approaches include:
1)     CAT – Computerised Adaptive Testing.  This involves an approach to test development in which a very large number of test items are generated and for each item the level of difficulty is measured.  When a person is undertaking the test the computer decides which item to give next based on how well they have answered the previous items (as I understand it using something called Bayesian statistical inference).  CAT has the potential to improve the test experience (with items that match skill level) as well as to reduce the length of the assessment with better targeted items and to better test limits for high and low scorers.  There already seem to be a number of well researched and validated tools in the educational context (e.g., ACCUPLACER).  I’ve searched around the internet and found a few references in plain language such as the following article which describes CAT in educational settings. which I found at the International Association of Computerised Adaptive Testing (IACAT)
I only been able to find a few references to the use of this approach in the development of neuropsychological tests (one using matrix reasoning) but although it might be more challenging to develop than educational type assessments I can imagine it being done– does anyone know of any other new developments in the use of CAT for neuropsych/ cognitive assessment?

2)     Game based assessment approaches.  In order to improve the motivation and interest in undertaking computer based assessments some researchers are now attempting to embed psychometric assessment within a computer game format.  The Educational Testing Service (a large non for profit organisation in the US) has been at the forefront of test development and theory for many years has recently developed new protocols for this approach.  Here is an example of one of their developments Eugene Aidman has also previously pioneered embedded game based assessments see: Aidman, E. V., & Shmelyov, A. G. (2002). Mimics: A symbolic conflict/cooperation simulation program, with embedded protocol recording and automatic psychometric assessment. Behavior research methods, instruments, & computers, 34(1), 83-89. (See also 

3)     The use of neurophysiological measures such as EEG and eye movements in combination with cognitive assessment to increase their sensitivity to brain functioning.  My understanding was that in neuropsychology (at least from an assessment viewpoint) this type of approach is still largely within the research domain (e.g., Jason’s learning research), however, the sports psychologists at the congress seemed to be using a huge number of physiological measures in their assessment and treatment of athletes– including EEG.   A google search led me to a start-up company in the US called Neurotrack (who have 6.5 million in seed funding) and have a tool that combines a visual processing task with eye movement tracking (assessed via webcam) which is apparently very sensitive to preclinical Alzheimer’s disease.  See:
Apart from learning about these new technology based assessment techniques, of course we must not forget that modern cognitive neuropsychology researchers also keep gradually reworking and improving on some of our traditional measures.  At the congress there was a key note lecture from Prof David Babcock from UWA that outlined how his program of research has helped to update and improve on the use of the embedded figures test (and its sensitivity to autistic spectrum disorder) with more targeted and less noisy protocols for assessing local feature detection versus global sensory integration.  They have also developed an ipad testing kit.
Finally, if you are like me and wondering how on earth we are going to keep up with and integrate all of these developments (and still provide an affordable assessment!), I found this handy (2013) review of technology in neuropsychology on computer based assessment and virtual reality assessments.  Somewhat reassuringly it suggests there is still quite a bit of work to do in the application to brain disordered groups:
I guess that none of these developments are going to radically disrupt the basic (Wechsler) neuropsychological assessment approach for now…..

Monday, May 2, 2016

Power Diary for the management of a private practice

I just came across information about Power Diary - a practice management and scheduling tool - and I really like it.

It gives you scheduling tools that, apart from normal functionality, includes goodies such as client self-booking portal one can put on a website and the capacity to sync with Google Calendar. It can be used by a single practitioner or a whole practice. It keeps client data and has capacity to claim from Medicare. It handles billing and payments, and exports data to Xero accounting package if required.  Nice!

It promises good security - both in terms of backup and privacy. The product has been developed in Australia (by Damien Adler, a psychologist from Ballarat), so it likely meets all the privacy criteria we need - but always check this information for yourself.

I use a practice management system I developed for my needs, and I am unlikely to change, so I can't give you a personal review. Unless, that is, I get seduced by the joy of having a self-booking client portal on my website.

In the meantime, is anybody using it, and if so, can we have a review??



PS: Some good information sent by Daniel Jarvis:
Practice management software can get very convoluted.  Personally Power Diary wasn't going to work for me but was a close runner up. 
I would be really interested to see peoples thoughts on Power Diary measured against Healthkit and other services.  The APS had a resource on different services as well although I think it is starting to get dated now ( 

 Thank you Daniel!

Monday, February 8, 2016

Prosopagnosia goodies

Some famous people with prosopagnosia (mostly developmental):

1. Oliver Sacks - talks about living with face blindness here.

2. Dr Karl Kruszelnicki - his podcast on the topic here.

3. Brad Pitt - more info here.

4. Portrait Painter Chuck Close - an article and video here.

5. Jane Goodall - some information here.

Australian Prosopagnosia Register at Macquarie University for those who want to participate in research:

This website includes a link to face memory test you can take to find out how good you are at recognising faces. Here is a direct link.