By: Elizabeth Lipton, CCC-SLP
Picture this: It’s your first day as a clinical fellow in the Speech Pathology department. You look up the information on your first patient; 55 year-old male with base of tongue cancer experiencing difficulty swallowing 4 weeks into his radiation treatment. You review his swallow study results and consider the best plans for swallowing treatment.
Your pager beeps. Hands sweating, you walk to the waiting room to call the patient back. Your supervisor accompanies you and your patient into the room. Sitting in the corner, she quietly judges your every move to assure you have what it takes to see patients independently – your dream for the last 6 years.
Confidently, you introduce yourself and ask the patient to share the reason for this visit. Suddenly, there’s a loud ring. You panic! You think you must have forgotten to leave your phone at your desk. Your supervisor will not be impressed.
A wave of relief hits as the patient pulls a cell phone from his shirt pocket, giving you time to unclench every muscle in your body and decide how to introduce the treatment plan.
After two minutes (which feels like twenty), the patient hangs up, sets his phone to “vibrate only” mode, briefly apologizes, and we get on with the session. You continue to hear the “buzz, buzz” coming from his phone every few minutes, which you pretend to ignore – a difficult task for everyone in the room. You review his current swallowing status and provide him with a great informational packet listing the changes to his swallowing that he may notice during his course of radiation and how to best manage these changes, many of which are unpleasant.
And then…the swallowing exercises! You hand the patient a description of all the recommended exercises. Everyone has warned you about poor patient compliance, so you developed the perfect system: a calendar checklist so that he can cross off each set as he completes the exercises.
Wrong! You realize this perfect system is a disaster as you hand him the checklist, as he promptly wads this up and stuffs it into his shirt pocket. And in case you didn’t recognize your mistake, the patient comments, “Sure hope this doesn’t go through the wash!”
Your supervisor asks you to reflect on the session. You light-heartedly comment, “If he were as dedicated to his treatment as he is to his phone, we might see some progress.” You supervisor turns this around on you, and it is now your goal to find a way to incorporate the patient’s cell phone into his treatment plan. Here is what you find:
Applications for Patients with Dysphagia
Description: This application allows patients, under the supervision of their swallowing clinician (a speech pathologist, physician), to develop a swallowing exercise program from a comprehensive list of exercise options. The clinician can program this device to alert the patient when it is time to perform the exercises and set the frequency of practice. The app is equipped with videos, audio, and text instructions for each exercise. The patient can keep a journal to record their adherence to the exercise program. After each regimen is completed, the app will prompt patients to select whether the exercise was completed fully, partially, or not at all.
Pros: The setup of the exercise program is simple, and allows clinicians and patients to choose from a list of 12 exercises. It also includes oral care as an exercise option. This app is very affordable for the amount of information it provides.
Cons: The app must be opened to see the alert to perform the exercises. It may be beneficial to set an additional alert/alarm on the phone using the “Clock” app to remind patients of when to perform exercises.
Availability**: Requires iOS 7.1 or later. Compatible with iPhone, iPad, and iPod Touch
**Currently unavailable until Spring 2017 due to upgrades
*Must be at least 17 years old to download the app. The app must be used with the support of a qualified swallowing clinician.
Disclosure: The iSwallow app was developed at UC-Davis under the guidance of Dr. Peter Belafsky, who serves at the Medical Director on the NFOSD Board of Directors. The app is also promoted by Endo-Education, an NFOSD partner.
Description: This application provides a list of 50 pre-recorded phrases for patients and clinicians to choose from to describe a patient’s eating/drinking equipment, level of meal assistance required, diet modifications, how to take medications, and compensatory swallowing techniques. It also contains four demonstration videos of how to perform compensatory swallowing techniques.
Pros: The application allows the patient or clinician to choose the voice settings as either male or female. Phrases can be easily reset based on the patient’s needs. Each phrase includes text, audio, and a supplemental picture. This app would be useful for someone with communication or memory impairments.
Cons: Initially time consuming to delete the phrases not required by the patient under “Settings.”
Availability: Requires iOS 7.0 or later. Compatible with iPhone, iPad, and iPod Touch
*Compensatory swallowing techniques and diet modifications should be determined by a qualified swallowing clinician
Description: This application provides reminders to swallow for patients who have difficulty managing their saliva, which is sometimes a challenge for patients with a variety of neurological conditions. This simple app allows patients to set the frequency of the reminders to swallow, ranging from every 5 seconds to every 3 minutes. The patient can set reminders either as a tone or a vibration.
Pro: Patients can connect to a Bluetooth headset or to headphones to reduce distractions to others. May help patients develop a more frequent automatic swallow pattern.
Con: This app tends to quickly drain your device’s cell phone battery. Frequent device charging or back-up batteries are recommended.
Availability: Requires iOS 5.1.1 or later. Compatible with iPhone, iPad, and iPod Touch
Description: This application provides reminders to swallow for patients who have difficulty managing their saliva, which is sometimes a challenge for patients with a variety of neurological conditions. This simple app allows patients to set the frequency of the reminders to swallow, ranging from every 1 second to every 6 minutes. The patient can set reminders either as a tone or a vibration.
Pro: The newest version allows patients to connect to a Bluetooth headset. May help patients develop a more frequent automatic swallow pattern.
Con: This app tends to quickly drain your device’s cell phone battery. Adjusting the settings of the device to “Stand By” mode allows the device to preserve battery longer.
Requires iOS 6.0 or later. Compatible with iPhone, iPad, and iPod Touch
Requires Android 4.1 or later
Applications For Swallowing Clinicians
Description: This new application, released at the end of October 2015, is designed to help clinicians assess swallowing disorders and determine appropriate rehabilitation options. It consists of four sections: Assessment, Treatment, Therapy Finder, and Resources. This apps contains information about swallowing anatomy and physiology, the cranial nerves, treatment options, and downloadable patient handouts.
Pros: Once you become familiar with the app, you can design a treatment program for a patient and easily export this as a PDF or text file that includes instructions for the patient, sent directly to their email. There are over 45 swallowing management techniques that are included, which can be filtered by type of option (e.g., exercise, strategy, etc.).
Cons: Although you can export the recommended therapy options to a PDF/text file, you cannot add a specific regimen to each option (for example, adding “perform 10 reps three times a day”). This may be something that could be added in future updates, but you can currently work around this by adding information in the exported PDF/text file.
Availability: Compatible with iPad/iPad mini/iPhone/iPod touch, Android and Amazon Kindle
*Must be at least 17 years old to download the app.
Description: This application serves as a visual tool to help clinicians educate patients about swallowing disorders using animated videos. The video control options allow users to control the speed, pause the video, and view frame-by-frame. The application contains ten videos: 2 normal and 8 abnormal videos demonstrating the anatomy and physiology of swallowing.
Pro: Visuals help to give patients a better understanding of what is happening when they swallow. This app has the potential to improve patient’s buy-in to treatment by providing the patient with a more concrete understanding of their swallowing impairment(s).
Con: The videos of the abnormal anatomy and physiology depict only one specific impairment, which rarely exists in most patients. Videos only depict adult – not child – anatomy/physiology.
Availability: Requires iOS 7.1 or later. Compatible with iPhone, iPad, and iPod
Description: This clinician-focused app allows swallowing clinicians to quickly document observations and data relevant to swallowing evaluations at the bedside. You can record results of the oral mechanism examination and bedside swallow trials. You can also document recommendations for diet and positioning modifications, treatment, and follow up. The information entered into this app can be exported as an editable report, printed, or e-mailed. Information can be saved on the app for later reference.
Pro: This app reduces the need for paper note-taking and charting. Provides a detailed template for clinicians to follow during swallowing assessment. Clinicians can save data on the application to use for later reference.
Con: If the device (iPad) is not protected with a password, the information stored in the application is not compliant with HIPAA standards. If printing or emailing the report, users must assure that they are using a secure connection.
Availability: Requires iOS 5.1.1 or later. Compatible with iPad only.
*Clinicians should check with their IT Department if they are unsure if the app and device is HIPAA compliant prior to entering sensitive data.
Continuing Education Opportunity
If you are a clinician interested in learning more about swallowing apps, please visit Endo-Education’s website to view the online course: “iPhone Apps for Voice & Swallowing Disorders.” This course is $25 and upon completion, you can receive .05 CEUs. This course was designed to offer information to clinicians on how emerging technology can impact the delivery of treatment for voice and swallowing disorders. Endo-Education is a partner of the National Foundation of Swallowing Disorders.
Are We Missing Any?
If you are aware of other dysphagia apps for patients or clinicians, please share these with us in the “Comments” section below. We will review and add them to our list. If you use any of the apps listed above, we invite you to share your feedback below.