Oh hey – I’m back! I have been meaning to review this app for months. I’m *finally* getting around to it and quite excited to share. After all, it’s a pretty rare tool – not only is it an assessment app, but it’s for adults AND it’s fully standardized. As far as I’m aware, it’s the only one of it’s kind.
App: Standardized Touchscreen Assessment of Cognition (STAC)
What It Is: An app for standardized assessment of cognitive/linguistic function in adults. By Cognitive Innovations.
Price: Head over to this link for more details on their unique pricing model. Essentially, you can buy a certain number of “runs” (how many times you can use the app) at varying prices (starting at $19.99 for 2 runs and up to $299.99 for 100 runs), or you can buy the app for unlimited uses for $399.99.
OS: Apple
Version: 1.2
How It Works: The app is intended for healthcare professionals to assess cognition, and it does require a therapist (e.g., an SLP or OT) to set up the testing. After that, however, the user can self-administer it. At the end, to view the test, it requires a PIN (determined ahead of time by the therapist), so the user can’t continue on to view the results without the therapist.
The app starts by having the therapist enter information about him/herself and then information about the patient. This is mostly basic information, but it also includes some data that will be used to help with standardization (e.g., how comfortable the patient is with the iPad). There are built-in instructions for the therapist to set up the iPad (e.g., make sure the volume is maxed), and more instructions to then read to the patient.
There are a number of tasks within the app, testing for everything from orientation to attention to memory. For example, there is a task where the user must immediately recall and type 3 words s/he heard. In another, the user must press a button every time s/he hears a particular letter. Still others ask personal information, such as the patient’s age and name.
At the end, the therapist can choose to email the results or simply view them on the iPad. The results are presented by skill area (e.g., orientation, immediate recall, language confrontation naming, short term memory, auditory sustained attention, etc). The test item for each is described. The correct answer and patient’s answer are presented side-by-side, as is the response time, raw score, and percentile ranking. The percentile ranking takes into account response time AND raw score, so it is possible to have a low percentile ranking if the raw score is perfect but the response time is exceedingly slow. Visual layouts of responses are also displayed for several tasks, which is helpful for qualitatively assessing executive functioning and visual scanning/attention in particular.
Therapy Applications: Pretty straightforward here – it’s to be used for assessing adult cognition. Of course, as with any assessment tool, it can then be used to help determine plan of care.
Pros: 1. It’s standardized! Considering the push from Medicare and other insurances to provide standardized measures to justify treatment, it’s surprising how few standardized apps are available, particularly in the adult therapy world. Check out their website for more about the normative data and how it is continuously being updated (without having to update the app).
2. Qualitative data. It’s not all just about the numbers. For example, I love the clear visuals of the letter cancellation test and the trails test. Very helpful for demonstrating visual neglect.
3. It can be totally user-directed.
4. Confidentiality considerations. First, the user cannot continue on to see their results after the test, because the PIN is required. Second, you have the option in the settings to not store the results locally on the iPad. You can email them to yourself at the end of the evaluation instead, and that way you have control over the level of privacy. I would caution against storing results on the iPad, since anyone could access them if using your iPad. Having a home screen lock is a safeguard (and I always recommend it in general), but not fool-proof if you are allowing others to use your iPad.
5. Various pricing options. You can test out a couple for a relatively inexpensive rate before buying the full unlimited version, or you can just buy as-needed over time.
6. Love that the standardization takes into account accuracy and speed. The scored results demonstrate this nicely.
7. Thorough manual, as one would expect of a standardized assessment! This is very important to read for a number of reasons (e.g., knowing which cues are allowed throughout testing, understanding the breakdown of how the test is automatically scored).
Cons: 1. Price. Is it fair for a cognitive assessment? Most definitely! Is it hard to pay that much for an app? Um, yeah. It’s important to consider how much you will use the app. You may want to consider purchasing a couple runs for $19.99 before buying the whole thing. For me, it provided a means of assessment that I didn’t already have – one that focused on higher-level cognition.
2. Not exactly a “con,” but definitely something to keep in mind – this app is only appropriate for certain individuals. The scoring seems relatively heavily influenced by speed. It seemed spot-on for my patients with higher-level, specific deficits. It gave me great information for my patients who scored with only mild or perhaps even moderate deficits on the RIPA. On the other hand, my patients who had more moderate-severe-profound deficits on the RIPA were automatically in the 1% on the STAC, and it didn’t give me much information about them. Very broadly speaking, I would consider this a fantastic assessment for inpatient rehab/outpatient/home health, but only appropriate for maybe 10-20% of patients in skilled nursing/long term care. Of course, that depends on your individual caseload, but that is my experience to-date.
3. Relatively good fine motor skills are a definite requirement.
4. The tasks aren’t functional. They are excellent for breaking down the underlying skills needed for functional tasks, but don’t expect this to give you a clear picture of safety awareness, for example.
5. This may speak to *my* cognition more than anything else, but I have the hardest time attending to the instructions at the beginning, and my patients with attention deficits usually do, too! I do sometimes provide some extra verbal reinforcement of this and just clarify in my evaluation narrative that I did so.
The Take-Away: If you work with patients with higher-level cognitive needs, I would absolutely recommend this app. It provides excellent, normed qualitative and quantitive data. Just make sure you know your caseload – this probably isn’t the app for you if you’re mostly assessing individuals with more moderate-severe deficits who have poor fine motor skills. Not sure about the price? Try the cheapest bundle of two runs and see. Hint: If possible, see if your facility would be willing to purchase the app, since it is standardized testing material. If not, definitely use it as a tax write-off!
My Questions for You: Do you use any standardized apps already? With what populations? Would your caseload be appropriate for this app, based on what you’ve read in this review?
Disclosure: Cognitive Innovations provided me with a free copy of this app to review. I was not compensated in any way for the review, and they were aware that I would be discussing the app’s strengths and weaknesses.
