Development and Evaluation of a Mobile Health Solution for Patients with Dysphagia

• Author / Creator

  Constantinescu, Gabriela

• Mobile health (mHealth) systems (e.g., apps and hardware for mobile technologies) hold potential to address long-standing gaps in access to healthcare. However, the design and usability of mHealth technologies are central to ensuring uptake and adherence for patients. The work in this dissertation constitutes a systematic and documented approach to the design and development of an mHealth system for patients in need of swallowing therapy.
  In the first study, we compared the signal to noise ratio (SNR) from two surface sensors, surface electromyography (sEMG) and mechanomyography, in healthy participants and in patients with a history of head and neck cancer, to determine which sensor would be used in the mHealth device. Following this study, sEMG sensors were recommended for the device as they yielded better SNR and test-retest reliability.
  In the second study, patients were interviewed to identify themes on facilitators and barriers to home-based rehabilitation therapy without a device. Then, through a second set of interviews, preferences for design concepts of biofeedback visuals in the application (app) were also sought. Simple, straightforward visuals were recommended to represent swallowing biofeedback during exercise trials.
  Next, an automated swallow-detection algorithm was developed by the development team, using signals collected from healthy participants. This algorithm was central to the app as it ensures that signals arising from swallow or swallow-like exercises are reinforced for patients, while non-swallow movements are ignored. In the third study, we evaluated this automated swallow-detection algorithm in healthy and head and neck cancer participants. The performance of the algorithm was robust even with head and neck cancer patients and hence no modifications to it were recommended before incorporating it in the app. In the final research paper we tested the usability of the mHealth system with head and neck cancer patients. This work identified additional information and development needs to be addressed before sending patients home with the system.
  The dissertation concludes with a viewpoint paper that offers perspectives on the development of mobile health technologies within an academic context. In this dissertation we have developed and evaluated this mHealth system and readied it for validation on patients. We hope that the studies herein serve as examples to other researchers, clinicians, and industry wishing to develop mHealth solutions for their patients.

• Subjects / Keywords

  • deglutition
  • surface electromyography
  • mobile health
  • mHealth
  • dysphagia
  • visual biofeedback
  • deglutition disorders
  • head and neck cancer

• Graduation date

  Fall 2018

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3QJ78D83

• License

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