Q&A: The thinking behind a solution for swallowing disorders

Ian Bolland spoke to the team at True Angle Medical Technologies, the developers of Mobili-T, a therapy solution aimed to address swallowing disorders.

Where did the idea for Mobili-T come from?

Twenty years ago, Jana Rieger (CEO of True Angle Medical Technologies) started a clinical research program at the Institute for Reconstructive Sciences in Medicine in Edmonton, Alberta, Canada to understand how treatment for head and neck cancer affected function. We learned very quickly that many patients had swallowing difficulties after their treatment. We also saw how devastating it was for patients to live with a swallowing disorder. We offered intensive in-clinic therapy using a biofeedback system, but very few patients were able to come in daily to get the treatment they needed. In fact, less than 10% of our patients who could benefit from the treatment actually came in to get it. That’s when Gabriela Constantinescu (CPO of True Angle Medical Technologies, and clinician researcher at the institute) said: “Wouldn’t it be great if we could create something so that patients could do this therapy at home?” With that prompt, Dylan Scott (CTO of True Angle Medical Technologies) set out to see what he could do to take a refrigerator-sized set of equipment and miniaturise it.

With our first prototype in hand, we received a five-year grant from the Alberta Cancer Foundation that allowed us to assemble a team that could develop all aspects of the system, including the hardware and a smart software system.

How does it work?

The system uses surface electromyography (EMG) to provide feedback about what the swallowing muscles are doing during prescribed exercises. The patient attaches a small EMG device under their chin with an adhesive. They then use an app on their phone to connect to the customised therapy program that has been prescribed by a clinician using the software we developed. In the app, patients are led through the exercises in their customised therapy program with a smart software-based at-home coaching. The technology tracks progress and connects directly to a clinician. Patients who have participated in our clinical trials tell us that the Mobili-T makes therapy easy and motivates them to stay on track.

What kind of technology was used to make this solution?

The Mobili-T hardware is designed to be a miniaturised version of those systems found in the clinic and as such it utilises similar sensory technology with respect to the base EMG signal acquisition. The EMG signal is acquired through reusable EMG electrodes, that are embedded within our miniaturised sensory package; this EMG signal is passed through custom signal conditioning circuitry, and is digitised and ready for wireless transport to a paired mobile device, all within our sensory hardware package, which measures in at roughly 40 x 40 x 15 mm. Wireless communication is accomplished using a Bluetooth Low Energy module, which makes mobile device pairing easy and limits energy consumption during use.

What are the swallowing disorders this solution addresses?

Swallowing disorders can arise from many different reasons, such as not having enough teeth and saliva to break down food properly, to not being able to quickly synchronise the many muscles involved in swallowing safely. While Mobili-T won’t be able to assist with lack of dentition or saliva, it can help patients needing to improve the strength and coordination of their swallowing muscles.

Mobili-T functions as an addition to regular swallowing rehabilitation exercise. It allows patients to complete that treatment from anywhere (e.g, home, work, hospital bedroom) rather than require them to travel to a clinic. These therapy exercises target various aspects of swallowing physiology that may have been damaged by surgery, radiation, stroke, or traumatic brain injury, to name a few.

What does the device actually do to help prevent people from choking or suffocating?

The rehabilitation exercises used by Mobili-T have been shown to improve the strength and coordination of the many swallowing muscles (over 30), thus making the swallow safer and more efficient. For example, one exercise has been shown to reduce the amount of food left over in the throat after a swallow, while another has been shown to reduce the amount of food going down “the wrong way”. Mobili-T provides access to this type of therapy to any patient who may benefit from it.

Is the device for use by clinicians or can it be used within the home?

The device is meant to be used at home by a patient, with remote clinician monitoring. We’ve had patients who regularly completed their exercises at work, instead of at home, and others who have taken the device with them on their beach vacation. It really is up to the patient to decide where and when they will use the system. The clinician sets the prescription for the patient, which means they program the system with a set of particular exercises and how many to do each day.

Are there plans for further development?

We’re certain that there will always be adjustments to be made, however the system that we are currently testing already has gone through five years of research and development. During that time, our R&D team included patients and clinicians in that process, every step of the way. The result is that we have a product that meets the expectations and desires of those groups.