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.

1 comment:

  1. Great post Debbie. Very comprehensive - loved the visuals as well.