Taking Technology Home with
Heather Starmer

How Mobili-T®  is helping patients adhere to their swallowing exercise workouts at home for better results.

About Stanford:

The Head and Neck Speech and Swallowing Rehabilitation Centre at Stanford provides patients with state of the art care following a head and neck cancer diagnosis. 


  • Swallowing exercises work, but patients struggle to complete them
  • Clinicians can teach exercises, but don’t know if patients are exercising with the intensity and frequency needed for the rehabilitation program to be effective. 
  • sEMG biofeedback devices exist but they are large, expensive and inaccessible outside the clinic 
  • Seeking a solution that helped make therapy more accessible, especially from home

Flexibility to provide home therapy and telehealth to reduce barriers to care

Improved patient understanding of swallowing exercises

Better patient adherence to swallowing exercise programs for more positive functional outcomes

More technology options to improve quality of care

Why waste time and valuable resources implementing swallowing exercise programs that are not maximally effective?

Meet Heather

Heather Starmer is an accomplished Speech-Language Pathologist (S-LP). As Director of Stanford’s Head and Neck Cancer Speech and Swallowing Rehabilitation Center, she is well acquainted with the challenges clinicians and patients face in executing an effective swallowing rehabilitation program. After head and neck cancer, 50% of people will experience swallowing difficulties1, also known as dysphagia. Her practice focuses on improving the swallow and helping people regain quality of life that most of us take for granted. 

Heather leads a team of S-LPs providing outpatient therapy. When she heard about Mobili-T, a portable surface electromyography (sEMG) biofeedback system designed to make this effective technology more accessible to clinicians and patients, she quickly came on board. By incorporating Mobili-T into her program’s dysphagia therapy tools, it has become a valuable resource to her and her team in helping their patients. Mobili-T allows patients to adhere to their rehabilitation programs and access care at home, benefits that the S-LPs hope to expand upon and help others adopt.

The Challenge

“One of the areas that I’ve been interested in for more than a decade now is the patient adherence piece. We see the same issues in head and neck cancer that we see throughout our field, but potentially in some cases, to an extreme extent because many of our patients are going through really toxic treatments or having a lot of side effects. Trying to get them engaged with exercises can be particularly challenging just because of everything else that’s going on.”

Heather has always been particularly interested in patient adherence. As she puts it, “How can we help patients do hard things?”. The treatments patients undergo for head and neck cancer are so intense that adhering to a swallowing exercise plan falls to the bottom of the list. This can be the case for many causes of dysphagia. But when prescribed and executed optimally, exercises can work to help patients get back to eating by mouth, enjoy a larger variety of foods and manage their own saliva. These outcomes are incredibly important to quality of life and social participation since so much of gathering revolves around eating. Dysphagia is a big problem and its solutions are imperfect. 

Heather works with many patients who have difficulty maintaining an exercise program and therefore cannot achieve optimal results. She also encounters many who live too far to consistently attend therapy in-clinic or face other barriers to participating in therapy.  Less-than-optimal therapy results in poorer outcomes, frustration and more time and money spent trying to get better results. With the capability to provide more portable tools such as Mobili-T, therapy can take less time and achieve better outcomes both affecting patient satisfaction and the business bottom line.

The Solution

Heather was excited by what a portable sEMG biofeedback device could provide for her patients. She trialed Mobili-T through True Angle’s Innovation Partnership Program where she was loaned a device. She quickly saw the potential and her program purchased eight Mobili-T systems to start their home loaner program. This program enabled the team to train patients to complete swallowing exercises effectively and motivated them to continue the benefits at home. Home can be a comfortable, convenient and less expensive setting for rehabilitation, and with advances in technology, it does not have to come at the cost of quality.

The Benefits

Treatment flexibility for better results

Having Mobili-T in their toolkit has given Heather’s team more flexibility in treatment options creating time and cost savings. Because they are able to send patients home with this technology, therapy can continue without needing as many inconvenient and costly clinic visits. It has also provided a useful tool for integrating more effective telehealth options since the Mobili-T system allows for remote monitoring and hence provides information on what is happening between visits. Mobili-T has provided insight into what patients are doing at home, making it easier to adjust their treatment program and achieve better results.

“It gives us the data points to have realistic conversations about expectations with patients. If you’re not doing what’s recommended, that’s probably going to contribute to why you’re not changing. So I think it helps on both ends. It helps the patients do better quicker, but it also helps us to rope them back into reality if we need to.”

Mobili-T has allowed Heather to know when to go back to basics with patients in terms of proven treatment methods, rather than not knowing why they are not seeing the improvement they would hope for and spending time looking for other solutions. 

Heather has even seen the potential for patients to continue to maintain their progress after discharge by purchasing their own device.

Finding a Partner in Innovation

Heather is no stranger to technology and is quick to see how it can be implemented for the good of her patients, but she has noticed a difference in how True Angle’s clinical roots have been instrumental to the success she has experienced:

“Every concern that I have brought back or every suggestion that I brought back has been integrated. That doesn’t happen in technology, which just speaks to the fact that you’ve got a couple of rehabilitation professionals who are at the helm of this effort…It’s not that there’s anything wrong with programmers and business people, but successful biomedical innovation really requires that clinician piece and I think that’s where True Angle really shines.”

Heather has appreciated True Angle’s customer support model where they are accessible, have met her clinic’s needs by integrating certain functions into the Mobili-T app, and provide education so more people can understand and benefit from the technology. Heather has had such a positive experience with True Angle that it has allowed her to dream big about integrating her own research and work with Mobili-T. Plans for the future!

“The primary goals were to have another tool available that we could use with our patients to enhance adherence and to provide transparency about what’s happening at home as well. We know that sEMG biofeedback or any biofeedback tends to enhance performance, so the tool has offered those things successfully.”

Thank-you to Heather for sharing her experience and expertise with us. We look forward to seeing how her clinic’s commitment to patients and technology continues to revolutionize dysphagia rehabilitation and are thrilled that Mobili-T can be a part of that success.


  1. Cristofaro, M.G., Barca, I., Ferragina, F. et al. The health risks of dysphagia for patients with head and neck cancer: a multicentre prospective observational study. J Transl Med 19, 472 (2021). https://doi.org/10.1186/s12967-021-03144-2

Mobili-T® is a small, portable system that utilizes an under-the-chin sensor and connected mobile application for patients & clinicians to visualize swallowing exercises. Clinicians can use the Mobili-T in the clinic, and send them home with patients for continuity of care. Mobili-T continues to evolve as a result of our high-performing team members, who are all critical thinkers and who thrive on solving real-world problems with input from our patients and clinical users.