Prototype app for voice therapy: a peer review

Lavaissiéri, Paula; Melo, Paulo Eduardo Damasceno

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Sumário

Original Article • CoDAS 29 (1) • 2017 • https://doi.org/10.1590/2317-1782/20172015300 copy

Prototype app for voice therapy: a peer review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose

Voice speech therapy promotes changes in patients’ voice-related habits and rehabilitation. Speech-language therapists use a host of materials ranging from pictures to electronic resources and computer tools as aids in this process. Mobile technology is attractive, interactive and a nearly constant feature in the daily routine of a large part of the population and has a growing application in healthcare. To develop a prototype application for voice therapy, submit it to peer assessment, and to improve the initial prototype based on these assessments.

Methods

a prototype of the Q-Voz application was developed based on Apple's Human Interface Guidelines. The prototype was analyzed by seven speech therapists who work in the voice area. Improvements to the product were made based on these assessments.

Results

all features of the application were considered satisfactory by most evaluators. All evaluators found the application very useful; evaluators reported that patients would find it easier to make changes in voice behavior with the application than without it; the evaluators stated they would use this application with their patients with dysphonia and in the process of rehabilitation and that the application offers useful tools for voice self-management. Based on the suggestions provided, six improvements were made to the prototype.

Conclusion

the prototype Q-Voz Application was developed and evaluated by seven judges and subsequently improved. All evaluators stated they would use the application with their patients undergoing rehabilitation, indicating that the Q-Voz Application for mobile devices can be considered an auxiliary tool for voice speech therapy.

Keywords
Speech, Language and Hearing Sciences; Speech Therapy; Voice; Voice Training; Software; Cell Phones

QUESTIONS AND RESPECTIVE RESPONSES

Are the schedule alerts satisfactory for the purpose?
“Yes. Need to be adapted to the patient profile. many tasks proposed and/or not concluded may generate anxiety.”
Is the information on Vocal Care satisfactory for the purpose?
“Fairly satisfactory. The information could be more concise – I thought it was very long, a lot of information to be assimilated.”
“Fairly satisfactory. Suggestion: emphasize the “strategies” heading to highlight the change from concept to practice. Perhaps figures could help remembering the concepts.”
Is the app a useful tool for voice therapy?
Very useful. Because it is motivational and helps organize patients´ everyday routine, but the patient needs to be motivated.”
Do you believe that patients will be able to make voice behavior changes more easily with the app than without it? Justify your answer.
“Yes. It will be a further instrument available for use. However, provided they are previously or minimally motivated and aware.”
“Yes. With the work routine and daily tasks, it can alert about the need to practice the exercises, remind about how to perform the technique, the function of each technique and the importance and function of each voice care or habit.”
“Yes because the use of mobiles is now increasingly accessible, the device has been used for many different things. I believe that proposing an App as an aid in voice therapy will contextualize voice training within the patient´s routine.”
“Yes. Because it will be like a daily contact with the responsibility of “Being Accountable.”
“Yes. The app helps in the maintenance of the exercises and clarifies any doubts about voice care and habits.”
“Yes, because this app facilitates exposure to highly relevant information about habits. Patients do not need to search for the information, when they can often be erroneously referred to information sources. In the app, this information is scientifically based.”
“Yes. Perhaps...it depends on the profile of the patient and the level of awareness about the problem and degree of self-knowledge and openness to change.”
Would you use this app for your patients with dysphonia undergoing rehabilitation?
“Yes. If it was accessible to the patient and they were adept app users.”
“Yes. For the same reasons as item 11 (preceding question) and the practicality of interaction between therapist and patient.”
“Yes. Certainly, to extend and emphasize the guidance on voice care and techniques beyond the therapeutic setting.”
“Yes. The schedule, voice care, and reminders on times to practice take out the “I forgot” element. As it can be used as an alarm and to set times.”
“Yes. Because the maintenance and frequency of the exercises is of extreme importance in therapy, and by using the app the patient has more control over the execution and timing of these.”
“Yes. It is an excellent reminder for all aspects of therapy. The patient is informed and also reminded about when, how many times and how the exercises should be performed.”
“Yes. I think that in medicine today, technological resources should be increasingly used. It allows closer monitoring of training between patient and therapist. Notes are easier to store and carry. It transfers the ‘memory’ function over to the device. It motivates using graphics. It organizes homebased work into time x purpose. It allows models to be recorded and registers training for future correction. It allows progress to be registered. It aids patient x therapist x otolaryngologist communication.”
Does the app have useful tools voice self-management?
“Yes. Because it allows the inclusion of items that are required for each patient.”
“Yes, because patients are aware of which techniques to practice, their applications and functions, it shows whether the frequency and practice are done effectively, the voice quality in the assessment can be compared with earlier assessments to check whether there has been improvement or not.”
“Yes, because the user (patient) has access to the graphs and reports produced containing information on the frequency of exercises performed, besides reminders and remarks about the proper care concerning diet and voice.”
“Yes. I think the possibility of patients being able to record, listen to and compare their voice is stimulating for behavior change.”
“Yes. Same as 12.” (preceding question)
“Yes. It provides the means for patients to create a certain independence when performing exercises, since they all have models of how they should be performed, and become aware of voice habits, because they all have explanations.”
¨Yes. Same as 12.” (preceding question)
Write remarks or recommendations for the prototype app:
“I believe it´s necessary to have a start page with general and specific instructions on how to use the app, this would aid initial and immediate use. The HELP topic holds this information but it is necessary to read the whole item – perhaps something condensed like a tutorial. Summarize the “Theories” part of the information on the ‘Voice care’ screen – a lot of information for patients who are not good readers. There could be a suggestion on how therapists can make best use of the app – in as far as optimizing and broadening its use to encompass all the app can offer. It is a really well produced and functional tool.”
“Correction in the ‘tongue.g' vibration technique. Screens are clear and easy to understand. In the schedule, the ability to view techniques, or habits or care performed on other days.”
“Suggestions: - Only the therapist has permission to delete the techniques outlined. - Upon clicking ‘no’ for the alarm reminding to perform the techniques, patient put a brief reason to serve as a reminder when explaining to the therapist. - Change title on the ‘tools’ menu given the association with colors and general appearance settings of the app. - Correct ‘cn’ to ‘can’ on the ‘help’ menu. - Correct the words 'stores' to 'stored' in the 'help -> notes’ menu. - put the term ‘tension’ in the topic on the ‘help -> voice care’ menu. Positive feedback: I thought the idea of the app was excellent. It´s going to help voice therapy generally, it´s going to help both patient and therapist by encompassing all the important aspects that should be addressed in therapy, besides extending and reinforcing the care and guidance on techniques beyond the therapeutic setting.”
“Caution required to ensure patients do not think that use of the app replaces face-to-face therapy. Recommended for high socioeconomic level. Useful for patients willing to change that have a busy daily routine. Must not use the app as an excuse for non-adherence. If the person forgets to charge the mobile for example, they need to know that they cannot become reliant on the app.”
“Recommendations: If possible, integration in the app whereby the therapist can access the patient´s therapeutic information without necessarily depending on the sending of the report. Another suggestion would be the part selected by the patient to perform the training of the exercise – when clicking on Yes the patient must perform the training - if the training is not performed, the option automatically returns to no! Correction: Help-> Points/graphs -> Display scores and graphs -> daily scores (‘daily’)”
“I suggest that an option be created allowing an explanation to be exited (each item of voice and care habits) at the end of it (an ‘x’, for example), not having to go back page by page through this explanation to return to the main menu. The app is highly explanatory and complements the advice given to patients during therapy.”
“I liked the font. Is the idea to produce the least number of pages? If so, fair enough. If not, could the font be a little larger? Highlight titles to stand out more. Add figures for the voice care concepts. Well done! Nice job.”

COMMENTS OF EVALUATORS

Regarding accessibility of the app:
“Recommended for high socioeconomic level.”
(Question “Would you user this app for your patients with dysphonia undergoing rehabilitation?”)
“Yes. If it was accessible to the patient and they were adept app users.”
Regarding replacing therapy with the app:
“Caution required to ensure patients do not think that use of the app replaces face-to-face therapy.”
Regarding patient motivation
“It will be a further instrument available for use. However, provided they are previously or minimally motivated and aware.”
“It depends on the profile of the patient and the level of awareness about the problem and degree of self-knowledge and openness to change.”
“Useful for patients willing to change that have a busy daily routine.”
Regarding reliance on the app:
“If the person forgets to charge the mobile for example, they need to know that they cannot become reliant on the app.”

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[1] Conflict of interests: nothing to declare.