iswallow: Maximizing technology to improve compliance in dysphagia therapy The University of California, Davis

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1 iswallow: Maximizing technology to improve compliance in dysphagia therapy The University of California, Davis

2 Disclosure I/UC Davis have no financial interest in this product The model for the video clips did not have hair and make up people.

3 2007 Time Magazine s Invention of the YEar UCDavis

4 Over 45,000,000 sold between October 2007 and December 2009 UCDavis

5 Over 1,000,000,000 Apps Downloaded UCDavis

6 Match Made in heaven UCDavis

7 Smartphones will transform Health Industry Telemedicine Virtual visits will reduce ER visits Patients can monitor their own disease Monitor weight, glucose, blood pressure, serum chemistry, mental health Can be used as microscopes and stethescopes UCDavis

8 Why iswallow Dysphagia is prevalent 16.5 million Americans in 2010 Most common symptom following CVA IN 59% after XRT for HNCA UCDavis

9 Why iswallow Access to care is a problem Aging population presents a growing number of patients in need of services Some data suggest an SLP shortage UCDavis

10 Why iswallow Dysphagia exercise works Can prevent disability and dysfunction in people undergoing ChemoRT Can assist as a starting point for those intolerant of saliva UCDavis

11 Why iswallow Compliance is a major hurdle to successful therapy Traditional swallowing instructions are on paper somewhere in the house? UCDavis

12 Compliance with SLP Dietary Recommendations Stroke Ward Geriatric Ward Medicine Ward Surgical Ward Overall Rosenvinge SK, Starke ID. Improving care for patients with dysphagia. Age Ageing Nov;34(6): UCDavis

13 Shaker Exercise Isometric 50 Isokinetic 70 Attain Exercise Goal Easterling et al. Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise. Dysphagia. Volume 20, Number 2, , DOI: /s

14 Shaker Exercise Easterling et al. Attaining and Maintaining Isometric and Isokinetic Goals of the Shaker Exercise. Dysphagia. Volume 20, Number 2, , DOI: /s

15 iswallow-what it is Adjunct to therapy Used under the supervision of a clinician Compatible with ipad, ipod2, iphone (not Mac computer) UCDavis

16 iswallow-what it is not A blanket set of OM or swallowing ex given to each patient To be used in place of functional swallowing therapy To be used without periodic re-assessment and adjustments UCDavis

17 iswallow Primary Goals - Improve access to care - Enhance dysphagia education - Improve exercise compliance - Improve exercise technique UCDavis

18 Getting Started

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22 Setup patient exercises Click on the Exercise Setup tab to setup the personalized exercise program for your patient. UCDavis

23 Choose from the exercise menu Choose the exercises from the menu that you want the patient to perform. In this example lets choose the Massako Maneuver. Click on the Massako Maneuver tab to turn on the exercise. UCDavis

24 Enable the exercise Click the ON button to enable this exercise and then click the Next tab to continue. UCDavis

25 Enter the number of repetitions Enter the number of repetitions that you want the patient to perform the exercise. The default number of repetitions is 3. Click the Save tab to continue. UCDavis

26 Add the Time Add the time that you would like the patient to perform the exercise. Click on the Add Time tab. In this example, lets choose 8am, 12pm, 4pm, and 8pm. UCDavis

27 Choose the 1st time Scroll the time to 800am and then click the Save tab. UCDavis

28 Add the 2nd time Add the 2nd time that you would like the patient to perform the exercise. Click on the Add Time tab. UCDavis

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31 The Exercise Menu You will see the iswallow Exercise screen showing the exercises that your clinician has prescribed for you. The exercises that are overdue have a red bar next to them. The exercises that are scheduled, but not yet due have a green bar next to them

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34 QuickTime and a DV/DVCPRO - NTSC decompressor are needed to see this picture. UCDavis

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47 Case studies/sample exercise protocol 74 yo man with h/o BOT CA, 10 years ago treated primarily with XRT. Total oral eater. Recent hospital admission with pneumonia, determined to be aspiration PNA Dynamic Swallow Study findings included reduced pharyngeal constriction, reduced PES opening, reduced hyolaryngeal excursion

48 QuickTime and a H.264 decompressor are needed to see this picture.

49 Choose the Exercises from the exercise menu

50 Theme: Swallow for Life!

51 Case studies/sample exercise protocol 52 yo female laryngeal transplant patient Bilateral tvf paralysis, closed position with trach, PEG tube Intolerant of secretions, periodically expectorates secretions, by occluding trach or suctioning through trach, unable to tolerate

52 QuickTime and a H.264 decompressor are needed to see this picture.

53 Choose the Exercises from the exercise menu

54 Case studies/sample exercise protocol 68 yo man with h/o C-spine + injury, s/p fusion and instrumentation Trach, PEG tube dependent for 6 months Periodically expectorates secretions, tolerates speaking valve 3x/day for 30 min-1hr

55 Theme: Your Tongue is the Super Hero!

56 XXXXX QuickTime and a decompressor are needed to see this picture. Mr. Snickers

57 Case studies/sample exercise protocol Dynamic Swallowing Study findings included: Gross silent aspiration of small amounts 1cc, 3cc of thick and thin liquids both during and after the swallow, poor pharyngeal constriction

58 Choose the Exercises from the exercise menu

59 Theme: Swallow Swallow Swallow! or No Snickers for YOU!

60 Summary Smartphones will transform the health industry Compliance is a problem Shortage of clinicians iswallow may help bridge the gap and improve outcomes? UCDavis