Why I’m not recommending an Apple Watch for TBI clients (Updated post watchos2)

To start — let me just say that this article talks about why I am NOT recommending an Apple Watch for brain injured clients at my clinic.


For the past week, I had the opportunity to try out an Apple Watch Sports model — not because I want one or will ever use one (I don’t wear watches — didn’t Smartphones do away with wearing watches?).

But that’s not what this is about — I specifically tried out the watch to see if there would be any value-added for my brain injury clients who already use iPhones, iPads, and Androids as their day-to-day notebooks/tools/memory devices.

This, in short is my experience.

Look and Feel:

The watch looks and feels great! I had a 42mm sport model which has a soft polyurethane band (which actually caused a rash on my wrist, so apparently its not for me anyway). Its neither too large nor too small. Mine was space grey with a black band — and it was clear and easy to see the watch face, except in full sunlight – which made it near impossible to read, and if wearing polarized sunglasses completely impossible.

From a hardware/software point of view — the small icons used to open programs are too small. Similarly, whenever prompted to enter your password (which is every time you take it off and put it back on) the keys are too small to accurately hit the numbers easily and often took several tries.

The phone has haptic feedback – that is, a small vibration taps your wrist when you get a notification or an alarm goes off. I set this to the strongest setting and could still barely feel it. I think someone who might be even slightly sense-impaired will feel nothing at all.

Volume for alarms and alerts is very low, even when set to the highest setting. The only sound cues I found that were loud enough were when my phone rang and the watch notified me of the ringing.

The one thing I did very much like was the various watch faces — from simple clock to more complicated information screens and even a Mickey Mouse tapping his foot. For the record, while Mickey looks amazing, you can not tell what time it is between 4 pm and 8 pm because the dancing feet interfere with seeing the clock’s hands.

Setting up the Watch:

Setting up the watch is difficult and it has a long learning curve. It doesn’t work like an iPhone, and requires learning a new set of responses and routines. Most of my clients would not be able to set this up on their own without a therapist helping them. In fact, most of my clients will be so frustrated by the systems required to make it all work that they will stop using the watch within hours and go back to their iPhones and iPads.

Notifications and Alerts:

Some watch faces provide better information than others — the one I found most useful was one called “Modular” in which you could set the time, see your next upcoming appointment, the temperature, and other settings you might choose. The other watch faces were too small for any type of realistic cognitive strategy use.

Dependency on iPhone 5 or 6:

Your new Apple Watch will do NOTHING if you do not have your iPhone 5 or higher in your pocket or within two feet of your watch (i.e in a purse or messenger bag). You really think of the Apple watch as an external display for your iPhone. No iPhone, the only thing that works is your watch — and it does not display any calendar events or anything else without your phone nearby.

Apple states that notifications (i.e. you have a test message, or facebook message, or reminder) should show up on your Apple Watch a second or so before your phone. I found this was not the case and my iPhone always sounded or vibrated in my pocket first, and then I got the haptic tap and alert on my watch.

Responding to them requires tapping on short pre-programmed responses (“yes”, “no”, “I’ll call you later”, “I’m running late” etc) and not practical for brain injury purposes. You can dictate a response with Siri. I found accuracy to be very poor and get much better dictation results from my iPhone.


Apple’s proprietary software works beautifully out of the box. I did not find a single third-party application (and there are now thousands of them for the Apple Watch) that was not laggy or unreliable.

In general, you load the applications on your iPhone, and a sync process copies the Apple Watch version over to the watch wirelessly. It works well though I found several programs (such as Shazam) that “failed to install” and ended up requiring deleting.

As mentioned above, it is difficult to manage the small icons on the home screen, which I frequently ended up touching the wrong program and opening stuff I didn’t need.

A special selection of “Glances” can be arranged on your phone for quick looks. These are tied to the full version for any type of updates. Example, weather comes into your main app, and a quick “glance” of it can be seen on a special screen with a couple clicks. Again, Apple’s own programs work fine here. Third party software is buggy and unreliable. For example, neither my MLB scores updated, nor radar, nor map updated appropriately, and location services are poor. I was getting Romulus Michigan updates hours after returning to Ann Arbor. By the time the spinning dial finally starts to show your results, I had long pulled out my iPhone and checked my updates there instantly.

Day to Day Use:

I struggled the first few days with the watch — as I said, I hate wearing watches and I had to make a conscious effort to put it on. It took at least a couple days to start feeling comfortable with the different touches, the crown, the buttons. So how did the day to day trial go?

Well, I mostly found myself using the Apple Watch as a Watch — what time is it? That was always instantaneous.  — PASS

I loaded my Delta boarding pass on my phone and it copied to my Apple Watch, It worked well in Detroit — though it was awkward to turn my wrist upside down to get it to read in the scanner. It didn’t work at all at the other end — the scanner at the opposite airport required you to put your boarding pass UNDER it and there was insufficient room to put your wrist let alone wrist with watch under it. I ended up pulling out my iPhone and using the boarding pass on that. — FAIL

Sunny day — FAIL

Sunny day while wearing polarized sunglasses — COMPLETE FAIL

Movie Theater — SUPER FAIL…..every time you move your wrist in the movie theater the lighted watch face brightens — annoying to me so much I ended up taking the watch off and putting it in my pocket because if it was annoying me, I know it was annoying my neighbors.

The only way to turn off the volume when at a movie or anywhere else is to put it in Airplane Mode. It is supposed to mimic what you have set on your iPhone but I found that was not reliable when a phone call rang through on the watch while everything else had been silenced on the phone. Too many settings that need to be adjusted for a typical user.

Glances — Partial Fail, partial pass. Flicking my wrist to see the updated Tigers Scores should have been a no-brainer (25 years ago there were already digital watches that updated MLB scores in real time). Instead, it was so laggy that if I wanted to see it instantly I needed to check my iPhone — FAIL….but checking upcoming appointments on the glances worked just fine – PASS.

Note — no notes on the Apple Watch. You can’t just pick it up and use Siri to dictate yourself a note because notes don’t exist on the Apple Watch — FAIL

Coolness factor — PASS….people seemed genuinely interested in seeing the watch, checking it out, and trying it on. Here’s the rub — once they tried mine on, I had to open it with my password.

Apple Pay — PASS — and maybe one day this might be the watch’s redeeming factor — Apple Pay worked like a charm at the very few places that accept Apple Pay. Because it is so hard to organize and use your passes though, I would recommend you add no more than one single default credit card to your Apple Pay queue on the watch.


The Apple Watch is not ready for prime time, and quite frankly, I am not sure why I would personally ever use the watch. But I can very clearly state that for cognitive rehabilitation purposes, the watch will not be usable by the average client because of its difficulty in set-up, steep learning curve for learning usage routines that are DIFFERENT than those used on the iPhone and iPad, and its unreliability is application usage. It is also too quiet when notifications and alarms go off, and haptic feedback is not strong enough. In short, it doesn’t work to “nag you” with memory cues the way an iPhone or iPad does.

It is, however, a gorgeous watch by itself. And for that, you don’t need an electronic gizmo that needs charging every single night.

UPDATE September 21, 2015:

The watchOS 2 arrived today. After a (long and error-filled) installation process, I find that the new OS adds nothing to the day to day functionality of the watch for Brain Injury cognitive strategy purposes. I continue to not recommend the watch as a cognitive strategy.

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