Episode 85: Tongueometer: Measuring Maximum Lingual Strength and Endurance with Elizabeth Lipton

Quick Disclaimer all information, content and material of this podcast are the opinions of the speakers and is for the informational purpose only and not intended to serve as a substitute for the consultation, diagnosis and or medical treatment of a qualified healthcare provider. Hi and welcome to episode 85 of the Untethered Podcast. Today we have Elizabeth Lipton Daily and Ed Steger joining us. Elizabeth is a speech language pathologist. She received her Master's in Communication Sciences and Disorders from the University of Wisconsin. As the EDP for E2 Scientific Corp. She guides the clinical practices, documentation and education process for Tongometer to the SLP and patient communities. In addition to working in acute care, Elizabeth is also the Executive Director for the national foundation of Swallowing Disorders. Ed Steger is a five time head and neck cancer survivor. The effects of surgery, radiation and years of toxic chemotherapy resulted in his diagnosis of severe dysphagia in 2007. His last normal meal was in 2006. Mr. Sager was elected President of the national foundation of swallowing disorders in 2012. He has worked tirelessly to raise dysphagia awareness, advance swallowing disorder education, promote research and provide patient support. He designed the product and had a major role in prototype production using the latest technologies. Prior to his head and neck cancer diagnosis in 2005, Ed spent almost 30 years in industry as a management consultant. He has a Master's degree from Carnegie Mellon University. Ed and Elizabeth, thank you so much for joining me on the podcast today. I'm really excited to have you here.

Thank you so much for the opportunity to join you. We're looking forward to this discussion and I as well.

So thank you for inviting us.

Absolutely.

So we're going to talk all about the tongue Ometer today, which is your baby, your invention. First, let's just start with having you tell us what, what is the Tongueometer?

So, Haley, the Tongueometer, it's a handheld device that measures tongue strength and tongue endurance. It pairs with a free downloadable app that can show exercise feedback. It stores that data and then users can also send that from their device. So it works with Apple devices, so iPhone, iPads, and also Android devices. We have two different models of our device. One pairs directly with your phone, where you use a cable to plug it in to your phone or tablet. The new version that we have that works with both Apple and Android is a Bluetooth version.

Oh, nice. Yeah.

And the version that is Wired is Android only.

Okay, good to know. Very good to know. And so how did you come up with this concept? You know, what, what brought it to your mind in the first place.

So it's an interesting story. Elizabeth and I were both attending the Dysphagia Research Society conference in Tucson about five years ago. I'm a head and neck cancer survivor and I was visiting the different exhibit tables I visited with IOPI and I thought, this is a great device. And. Then the price.

Yeah.

We left their conference and a few months later, oh well, at the conference Elizabeth said, I don't understand why someone hasn't developed an app based version of this device. And so that kind of percolated in my mind and I started to for around with how to make the hardware that would pair with an app and draw on and leverage all the products that are already on the market to come up with a similar device that was affordable. So that's kind of the backstory behind the device. Four or six months later, Elizabeth and I put our heads back together and we began the road through prototyping, through fda, through the FCC compliance, through the Bluetooth registration. I mean it is a long, long process.

It sounds like it.

So, so although we've been at this for four and a half to five years and that may seem very rapid in the medical device introductory time frame, for us it feels like a lifetime.

I can only imagine because I'm on the other side of it here going, wow, you guys brought this to market fast. And you're like, this was a labor, a labor of love. I mean I can only imagine. And I've birthed some things, but my things have all been like online courses, not products. So there's so many more obstacles. Like you mentioned the FCC and just all the different things that you've had. I didn't even know you had to register things for Bluetooth. So I just learned something new.

So about that, Haley, not only do you have to register, but there's almost a five figure fee to do that registration.

Everything has a price tag, you know.

My goodness.

So I mean it's pretty cool though that you, that you did this and that you had the means to do so and you guys were able to come together and bring it to market. What feels like you guys, you know, to took a lifetime but really for the consumer pretty quickly because I know that I've attended courses and conferences and I've seen the IOP and I always go, wow, that's so cool. And then I go, but like you said, the price tag is so high and okay, we can maybe justify it. But then when you start to learn, well, I really need these to go home with my patients. I can't really have one in my office, then it really becomes unreachable for almost every speech language pathology practice out there. Just because, you know, our families are not going to pay for it, insurance is not going to cover it. So I think that, you know, creating a tool in your price range is definitely more affordable and more realistic for families to afford and. Or clinics who lend out, you know, I don't know how yours works specifically yet, but how does that, how does that work for you all? Is it something that families purchase individually? Do clinics purchase it and lend it out? Can it be done either or what does that look like?

It could be done either way. So when we were developing this, our idea, our thinking was that each individual would purchase their own device. Thinking about assessment, that's not realistic, right? If you wanted to use this device to assess a patient's tongue strength and it turns out it's fine, you don't need it, you don't want to purchase a device and dedicate it for that, for one use, and then you don't need it. So when we were building it, we designed the product so that the bulb is replaceable. You can use the device with multiple patients. So if you were using it in a clinic for assessment, you can use the same device, see if the patient would benefit from a tonometer for home practice. If so, then either the clinic could purchase a bunch and then lend them out as loaner devices for their treatment program, or if patients were able to, they could purchase it directly and they can do that from our website directly. Or, you know, depending on the clinic, we have institutions that buy them in bulk and then send them to patients and have patients pay for them that way, or they direct patients to our website to purchase them for their home practice.

That's fantastic. I think that's, you know, it makes it so much more accessible. And I love tools that give feedback, right. I love tools that. I think patients really thrive on that. I've used different things in my practice, both as a feeding specialist and a myofunctional therapist that, you know, maybe it's not something that's commonly used amongst everybody, but it was really impactful for my patients to see a number change. Right. Even from one session to the next, and especially from the initial session to when they graduate. I also think it helps insurance to see numbers. They like numbers. They don't care where the numbers come from half the time, but they like numbers. So if you can show some improvement in something, I think that that also speaks volume and I think that if it is something that has some research behind it as well, obviously that strengthens it. So let's talk about who the device is appropriate for. Who was it created for, and where have you seen it used thus far?

When we were creating it, we were focusing mostly on head and neck cancer patients, stroke patients. There's research using tongue strengthening devices in lots of different populations. TBI patients, stroke, dementia, als. And so adults were kind of our focus. But recently we've been hearing from dentists, orthodontists, speech language pathologists that work with children who are also incorporating this type of device. And they're looking to us for some of the research. And there's just not a whole lot available, which is actually how I connected with you. We were looking to the specialist to see. To get input from your area on how this device could be used in that population.

Yeah, and I can kind of add a little bit on there. So, yes, there's absolutely more research needed. That's an ongoing conversation in our space, especially the pediatric feeding space and the myofunctional therapy space. And we work with both pediatrics and we do see adults for myofunctional therapy as well. And so, you know, as we were chatting and I was going on Google Scholar and seeing, like, what I could find and pull up, you know, there were definitely some articles out there, different levels of evidence, you know, but I think a lot of it tends to fall back in our space. It tends to be more level three, level four type of evidence. And so which is, you know, I think personally, for me, that's great because I want to know functionally how it's helping patients. And that tells me more than a level one study sometimes, at least in my personal practice. So, you know, I found one pilot study, for example, from the European Journal of Orthodontics, that spoke about how myofunctional therapy does, you know, increase tongue strength, especially as it relates to elevation of the tongue to the palate. Right. For our tongue to spot, as we, many of us call it, which is what we need for our oral rest, posture. You know, I also saw where it helps with lingual elevation for creating that. That lingual palatal steel to swallow a prepared bolus back. So, you know, there's definitely something here to be said for the ability to use a tool like this, you know, across different types of therapy that, you know, it all comes back to function. And we need strength, we need endurance, we need, you know, range of motion. There's all these things that, again, are just not looked at or studied. So I mean, I would love to see somebody, one of our listeners, maybe, you know, team up with you and do some pediatric studies in the pediatric feeding world or the myofunctional therapy world using this device. Because I think I really. I have to wonder if it would actually make things progress faster when they're working towards a goal and they're getting that like, biofeedback that really says, hey, like, wow, you just went from point A to point C. Let's try to go, you know, let's go from A to D now. Because that's the type of feedback that really gets my patients, especially my little pediatric ones, like, they get excited and then the adults and the teens, they just get really competitive with themselves. So it really can be really effective.

We heard a story recently from somebody who was using the tongueometer over the course, I think, of four weeks, who had changed their tongue strength from the mid teens all the way into the high 40s in just a matter of weeks. They were so motivated because by using the device, they were able to get their own tablet, which they could use outside of therapy too. But that was the motivating factor. They got to get their own tablet. I love it, but hey, it never works, right? Exactly.

Elizabeth, is that the same person whose mother called the therapist and said, my son is talking in full sentences for the first time in their life?

A different person. But some of the feedback we get, it's so inspiring to hear these stories directly from consumers, from users of our device. But yeah, we also received some feedback where after a child had gone through their therapy quickly, the mother said that the child was speaking in full sentences, their speech was much clearer. And it's just great to hear stories like that.

Yeah. And I think that really speaks to. And I feel like I get some hate from the speech pathology community for this one. But I often will say, traditional articulation therapy really is not effective unless we're dealing with the surrounding structures, because if we can't move the tongue properly, we're just compensating. And so I was guilty of doing this way back before I got into the myofunctional therapy world. I would do articulation therapy and I would say, oh, it sounds good sound.

So check.

We met that sound without actually realizing that what the tongue was doing was completely compensatory, not functional. And then it impacts the quality of speech, especially when we co articulate. And so I was also working with these kiddos who had severe speech sound.

Disorders.

Oftentimes when they have speech sound disorders. They also don't have great oral motor feeding skills. Even if they eat everything under the sun, it doesn't mean they're always doing it well. And so we really had started to look at what's going on inside the mouth, under the tongue, look at the palate, look in the back of the throat. Like, we really need to do not just a full blown oral motor exam, but an orofacial myofunctional exam. Like, okay, we see what everything looks like. Is it functional? Are they able to function without, like, a lot of compensation? Because that's fatiguing. Right. And so I think that what a device like this, I'm thinking, personally, just this is how my brain's operating at the moment. A device like this would help us to gain more function in a way that helps us, you know, move away from using compensations. Right. If we can gain tongue strength and the tongue can become more independent, if you will, you know, then that also supports the surrounding structures, and then that supports speech, and that supports, you know, our feeding skills. And so that's where I'm guessing that if we're seeing it speed up some therapy or we're seeing some kids with some really great results who maybe weren't speaking so much before, I think a lot of us don't look into how fatiguing it can be to talk when you don't have the right supports in place. And so, yeah, I mean, I think this would be really cool to test out in Mayo. So let's also talk about, are there any other devices out there or is the IOP the main device? Are you familiar with any others?

There was a device out there, swallow strong, and it uses a little bit different sensor system inside the oral cavity. They stopped selling that device about a year or year and a half ago, but recently in the last month or two, have reintroduced it to the market. A year and a half or so ago, that device was priced at around 3,500 to $4,000. So again, probably a terrific device, but it's not in the reach of the consumer. So good for assessment, not so good for making it available to those that would benefit on an ongoing basis.

Yeah, and I think that's. I love the point you made there. So it's great to have these tools for assessment. But how functional is it if we can't use it throughout the therapeutic process? You know, I think that's really where it comes into full function for the patient and, you know, being able, like we talked about having that baseline measurement Having that measurement to graduation, like, that's great, but can we get some measurements along the way? Can we integrate it into the therapeutic process? And so that's where I feel like Tongometer, you guys have really captured that market. So yay. I'm excited. I'm excited. And I know that I don't. Do you guys have research in the works? I think there was some discussion about that. So tell us a little bit about that.

Yes. So there is research that's ongoing using the Tongometer device. As of this podcast. There's no current publications that are using the device right now. There's studies that are looking at the norms in healthy adults to compare that to the IOB norms, because that's important too. Even though we know that or we expect that there will be similar results. Using an air filled bulb to press against the palate with the tongue, we anticipate that will increase tongue strength. But just showing what the norms are so that you can decide whether this is an appropriate device for a patient to use. We anticipate that those will be similar to iops because of our bulb shape is the same design. It's an air filled bulb. We both measure using kilopascals, but until that research is available, we can't say for sure or this is the equivalent. So that's important to have. Right now there's a few other studies that are looking at changes in tongue strength over time. So hopefully Covid has kind of put a damper on all research right now. A lot of that's been suspended, which for good reason, but hopefully we'll have that available. 2021, 2020, 2020 22. So look, looking forward to that. Yeah.

As you're sitting here talking, I'm thinking about how a lot of our sensory kiddos who don't love food in their mouth. Right. To begin with, here we are in our assessments. We're going, hey, can you eat a cracker and swallow so we can observe like what that looks like? And can you eat a carrot and swallow and chew it up and show us what that looks like?

Hey, now swallow.

Now show me your tongue again. You know, we're taking them through all these different steps. And while I think that's very good information for us to still gather, sometimes we just have kids where they just don't have a great relationship with food right now. And for good reason. They have a hard time chewing it and swallowing it. It's not enjoyable. And so this also gives us a great way to avoid extra food in treatments because here we're trying to teach them to get their tongue up to the palate and we have some kids who really struggle with that. And so then you go, well, what can we do? Well, we could put a Cheerio between the tip of the tongue and the.

Top of the mouth.

Or we could put a, you know, break a cracker and put a piece and have them smash that cracker against the top of their mouth. But I mean, look, saliva will break it down, it will, you know, kind of melt. But it doesn't feel good to push these things up against your palate. It really doesn't. And so that's where I feel like, you know, an air filled bulb is a really great opportunity to achieve and even maybe I think it has multifunction for all intents and purposes, like teaching the skill while also gaining strength. Obviously we need strength, we need endurance. But even just teaching that skill, the awareness of, hey, do you feel that thing touching your tongue? And you feel that thing touching your palate? Let's smash it together. Can you bring them smash it together, make it flat. Because I think for a young child that is kind of like a game now. It's a game now it's fun versus going, hey, smash that cracker into the top of your mouth. And they're like, you want me to do what?

And in line with that, the visual feedback when that happens is instantaneous. And so the effort they're putting in, they can actually see immediately.

Yeah, and that's pretty cool. I mean, that's cool. I feel like a lot of our kids these days are also so wired to, you know, look at devices and they understand that visual feedback so well that it's, it's a beautiful reward in and of itself to be able to see that they don't really need anything beyond that because it's like, whoa, look.

What I just did.

So yeah, I mean, I know it was created for adults, but I think you have a huge opportunity totally with the little ones, you know, both in feeding therapy and myofunctional therapy and arguably in speech therapy as well, you know, especially when we're trying to get that tongue working independent of the rest of the articulators. So that's pretty cool.

Sorry, go ahead.

There is one other research team from a top tier university who has made the tonometer part of their telehealth kit. So they, they have put a kit together of various tools, whether that's blood pressure or oxygen reading, possibly an EMST type device for a neurodegenerative disease population. So we're very excited about that work. And they have, They have included our device with appropriate patients in that clinical trial.

That's very exciting. That's really, I can't wait to hear what comes of that. But, you know, and that's, that's the really cool thing too is, you know, you bring up a great point. Even though we're in the middle of a pandemic still, therapy goes on. People need therapy. We have to figure out, you know, if you can't be in person, how do we make this work? And because it is accessible and it can be used as a tool at home, we can definitely do this over teletherapy. You know, it can definitely be used very successfully in teletherapy sessions and then with the patient on their own between sessions. So I love that.

One of the neat things about having an app based program here, so when you have the app running, if you were doing teletherapy, you can share your screen from your tablet or your phone so the therapist can actually see in real time how you're doing your exercises too, and adjust the exercise parameters as appropriate with that, which is kind of neat. I was going to jump back for just one second here when we were talking about sensory input with bulb. It's similar shape to the iopi, but we made it a little bit different in two ways. One difference with our bulb is that there's a texture to it and that just gives a little extra sensory feedback. And the goal of that too was also so that there wasn't so much slippage of the bulb in the mouth to keep it in one place. The other thing too, when we were designing our device, some of the feedback from clinicians that use similar devices was that placement of the bulb in the mouth wasn't consistent, so they weren't sure how far should they be putting it in their mouth. And so we designed this lip guard that's on the top. You thread the bulb through there and then you can adjust the length so it stays in place so that you're consistently putting the bulb on the same spot of the tongue each time. And it stays in place. You have to really pull hard to move it from the position that it's in. So that's just another feature of the tongueometer that's different compared to the iopi and designed that way for a reason.

No, but that's great, especially for patients who are using it at home who may not be using it with you because it leaves less room for error. So I think that's great. So we actually know that the tongue really is truly strengthening and it's in the same place each time. It's not slipping around. I love it. That's awesome.

That's awesome.

So you were talking about the dashboard. Is that basically what you would screen share? So if you were in a teletherapy session, the patient could share that with the therapist or what does that look like?

Yeah. So on the app, in the app there's four different exercise modules. There's two that assess maximums, so there's one that assesses your maximum strength, and then there's one that assesses your maximum endurance. And then there's two exercise ones. Ones. One that's looking at repetitive strength. So you would set the exercise parameters, let's say, you know, I want you to target between 10 and 20 kilopascals and do 15 repetitions, whatever's appropriate for that. And then one where you can set the settings for how hard you want the person to press and then how long you want them to hold it there. So looking more at endurance, the app, it counts all of your repetitions, it stores all your exercise data, and then there's an option to view your data in a patient friendly format so that the patient can see how well they're doing. And then there's the option to send the report to the clinician. And this is where you get more detailed information that may be more beneficial to the clinician compared to the the patient. And I'll let Ed talk a little bit more about the dashboard that he created that you can download from the website because this is a really nice feature for documentation, but also for seeing progress, both for the patient, but also the clinician. So Ed, if you want to talk a little bit about the dashboard report that you've built.

Sure. So it's a one page report it's generating by Excel. It has all four modules on shows over time what your settings, what your range settings were. So if your range setting was 7 to 15 when you started and then moved to 10 to 20 as your tongue strength increased, it will show that along with the number of reps you did per day over a month, two months, year, period, however long you want to see that. There's a regression line on the TON strength module, so you can kind of see the direction your tongue strength is headed in. And it's all included within the base price of the tonometer. There's no extra fee for that.

That's fantastic. I love it. I mean, and it's also really nice to generate A report and be able to compare a timeline. Right. So that's, I mean, that is, that's priceless. You could have upcharged a lot of money for that. But that's really nice that you decided to include it. That's fantastic.

Go ahead. Yeah.

Just to add on to that, we felt it might help therapists in their insurance billing to be able to have a piece of paper that says, you know, I started here after a month, we were here after two months, we were here. We're still seeing progress. And that was another kind of drive behind why we thought this was important.

Yeah, well, and I can tell you as a private practice owner who's out of network, we provide super bills to our patients. We give them a note every time we treat them so that they have documentation that they can submit to insurance whenever insurance asks for that clinical documentation. And it's so important to have that information. And so I think it is key whether you're in network, out of network. We know insurance is going to request it at some point in time. Most likely they want to see some kind of data. So it's really helpful to have that. Beautiful. Even if, you know, a one page report that talks about where they started, where they are now and demonstrates progress, you know, that's what insurance wants to see. They want to know that it's medically necessary. They want to see that you're demonstrating progress in therapy toward the end goal. They want to know they're not going to be paying for this forever. So, you know, I think that that's fantastic that you, that you're providing this because I'm sure a lot went into creating that. I'm sure that wasn't a cheap process to generate the technology to create this type of a, you know, all embedded report. But from a therapist side, like I super appreciative of features like that.

I'd like to build on two other things Elizabeth said earlier about some of the differences. The first is feedback we're setting is that the device is user friendly and just so intuitive to use. And they're making that comparison to other tools on the market. And I'm sorry, but I forgot myself a point.

No worries.

I knew I would do that.

I'm over here downloading the app right now because I'm like, let me look at this while you're talking about it. I mean, it's so easy to go to the Apple App Store and just say I put it in. It came right up. It was the only one. And it's currently downloading yes.

The app is free. You can download it. You don't need to purchase a device first. So if you just want to experience explore the app and see what it can offer, anybody can do that. So also, if you were using this in a clinic and you have multiple clients coming in, they can download it on their own device that they bring in. Right. Who doesn't come to clinic without their own phone or tablet these days, download it. And that way all the exercise data are stored on their own device, so it's not on yours. And you're having to keep track of whose data is whose. Keeps it simple.

And now I remember the second point.

We'Ll come back to.

Thank you, Elizabeth. The second point is there's a reset all button. So if you're using the same device among different patients and you want to intermix the data, you can reset it all so that you can basically separate data by patient. Yeah. And that is partly a manual process on your side to separate what patient use the device during that session. But we thought it was important for those devices that were in clinics and hospitals to reset all the data with the push of a button.

That is very cool. I'm over here playing with the app. I mean, it is very intuitive, right. You open it up and you can swipe just to get from 1 to 1 through 4. You mentioned there were the four different modules. And so is that what you, what you're referencing when you talk about modules? These four. Okay, perfect. Okay. Yeah. So those come right up, starting with repetitive strength. And then, you know, I see at the bottom also where you can just click a button to connect it with your tongueometer. So would you like, would you click that then if a patient brings their own device and connect to theirs? Or I guess you would just use their phone. Right. If they're bringing their phone with them to therapy, you don't need to use your device.

So.

That is correct.

Very cool. Yeah. I mean, it seems very intuitive. It doesn't seem complicated at all. I see the little, the little Bluetooth, you know, little Bluetooth guy so that you can make sure it's connected to Bluetooth. I see where you can get the stats, you know, on total reps and isometric, max repetitions, max strength, max endurance. And then there's the reset down at the bottom. And then there's the email button. Share my report. Yeah, I mean, it's all very, very simple. Apps can be so complex these days. So kudos to you guys for making like a really simple, functional, really usable app. Because this is beautiful.

Hey. A shout out to our app developers. They are awesome. So I won't name them, but they have been terrific.

Nice. It's nice to have a team that functions together and can actually bring to life what you envision. Because I'm sure that you. I mean, I know me, half the time I'm like, well, I'm thinking about this, this, and this and this. And I have no clue what that's actually gonna look like in the end. And then, like, my team helps me actually bring it to life. And I'm like, wow, this looks great. You guys are awesome. So if it's anything like that, I get it.

Hallie, since you have the app up, if you go to the first exercise, you can then change the KPA targeted range by the slider bar. I see that it's just very easy to perform all of the exercises and assessments.

That's really cool. Yeah, I looked at that at the bottom, I was like, what does that do? That's so simple. It makes sense. You can set your minimum and your maximum, and it looks like you can do that for three of the four. The maximum strength is just its own without a. We're going for max strength, so that makes sense. So we don't need a range there. We want to know max strength, but very cool.

And on maximum strength. And actually, across all the modules, the meter goes up from or is from 0 to 60 kPa kilopascals. But we're actually capturing data for 0 to 100. But our thought was a norm for a healthy adult is around 60. So why have a meter that goes up to 100 when the target for this is really people that have compromised anatomy? Why make them? Let's show them the progress they're making in the range that they're most likely to be part of.

Mm, yeah. And that plays into human psychology and how we respond to things. So I think that's brilliant because, you know, if we feel like we're succeeding, we're going to keep going. And if we feel like this is not working, we're going to feel pretty defeated and most likely not, you know, not actually do our exercises. So I think that was very smart in having that as the threshold for the point of the app visualization for what we can see on here. That's great. That makes a lot of sense to me. Is there anything else that you want to share about the app or the Tongueometer that we haven't covered? I know we've talked about a lot, and I know we kind of jumped all over the place. And I definitely feel like there are many different ways, as I've mentioned, that we can implement this across the board into both pediatric and adult, you know, speech feeding, myofunctional therapy. You know, you guys mentioned the populations that you created it for that was initially intended for. But I'm excited that, you know, it is so accessible and that it is a tool that clinics can both afford to purchase and lend out. And families may also be able to afford to purchase for their own personal use at home. So I know if it's anything like some of the therapy that I do, we might have families going. I had to buy two because both kids needed one so they could have competitions. And who has the stronger tongue? Hopefully they'll just share one. But you never know. This day and age, I have families come in and they're like, we bought two. And I'm like, why? Why did you buy both kids? Well, both kids had help. Okay, I get it. I've got a three and a five year old. Okay, two and a half and a five year old. And it's like, it's just easier sometimes to have two of something than to get between their fights. But, yeah, I know this is. I think this is very, very cool. One other thing I'll add is, you know, we. We use these, like, buttons on a string for lip strength and myofunctional therapy and working on correct, you know, or not correct, correct, oral rest, posture, but just we get a lot of tension around the lips. And so we actually try to create more tension to then release the muscles so that the lips will sit, you know, together and they won't sit so far apart. And so we have these little battle buttons where, you know, they might actually, like, do it with a buddy, whether it's a parent or a sibling. And they try to see, like, who can hold it the longest while putting some tension on it. And that's where I was. My brain was going with this. I was like, I can see some, like, little, you know, battles happening with the tongama between siblings, like, who's got a stronger tongue? Like, no, my tongue is stronger. No, my tongue is stronger. So I think this could be a lot of fun in pediatric therapy.

Helen, you mentioned that there wasn't a lot of research in your specific discipline, but there is a ton of research on tongue strengthening and a safe swallow. And on our website, on the frequently asked questions page, we've collected about a dozen of the top articles on what the research says about tons spread to.

The.

So one can use that as a data point for knowing or thinking about how this might help them.

That's fantastic. And we will definitely. I've got your website here that we will link to. We're going to link to that Frequently Asked Questions page as well, because I know you've got some different resources on there to share with our listeners. And you know, and yes, there we know that in the world of feeding in general, there is research out there to support. I think what it comes down to is it's the pediatric feeding. It's like our infant and toddlers that we really lack a lot of research in that area, and rightly so. You know, we have infants we don't want to mess around with. Well, one gets the therapy and one doesn't. And so I think it also sometimes comes down to the IRB board, like, what's, what can we ethically do with this population? So, you know, I think that's, that's a discussion that I hear a lot in our, in our space. But what we do know is, like you said, there is a body of research and so we'll definitely link to the Frequently Asked Questions page. I think that what everybody looks for, and I think I mentioned, I don't know if I mentioned this on the recording now or if it was before when we were chatting, before I hit record. But the research that is even out there and supporting myofunctional therapy and supporting other things in that space, they tend to fall in journals outside of the speech pathology world. They tend to be in orthodontic journals, dental journals. And so we really, if you know where to look, you can often find supporting research, but the words orofacial myofunctional therapy are often not found in a lot of those, those research journals. And so you have to get creative with really understanding and maybe not so creative, but you really have to have a good appreciation for and a good understanding of like, what muscles are we targeting? Why are we targeting these muscles? You know, what is our end goal? What is where, you know, where is the patient presenting versus where we want the patient to be functionally and when you know that, like you said, there is a body of research out there and there is, there's growing research to support it. But again, everybody discounts it. It, it doesn't say orofacial myofunctional or orofacial myofunctional therapy or disorder. So, you know, I should take back what I said because there's a ton of research. It's just you have to piecemeal it together yourself. It's not just, you know, all included in one beautiful, fancy article for you. So thank you for that. And we will link to that information. And even on that front, you know, the International association of Orofacial Myology has this like 30 page, like list of different research articles and papers that are out there that do talk about all the different things. But again, it's all piecemeal. It's, you know, you have to really read it and put it together for yourself. So it's out there. But then again, there is the omd, OMT world itself with actual verbiage is what's lacking. So we're working on it. It's not me specifically, but the community as a whole. So.

Yeah.

So thank you. Is there anything else in terms of like, if somebody wanted to see how this works, you know, is there. I know we mentioned there's a video. Where could they go to see that?

They can go to our website to see some videos. I'll get you the link for that. And then if anybody ever wants an in service or just a live demo of that, we are always happy to set up a time to do that. We can connect via Zoom, show them how the device works, have them download the app at home so that they can follow along with us. But just have them reach out to us. You can reach us at email. It's info2Scientific.com we can give that to you to share as well with your community. Perfect.

And then, Ed, were you going to add anything on that front?

No. We love showing the device off to both patients, therapists and the feedback we have is very positive. So those interchanges help shape the future direction of the product.

Absolutely. And thank you guys for doing that, for creating this, for being so open to teaching our community throwing things here. And I know that, you know, you had also said that you had a $10 discount code for our listeners and so we'll make sure that's also in the show notes. If you guys are listening, it's untethered. Now, does that need to be all capitalized or does it not? Doesn't matter. Doesn't matter. Untethered, capped or not. Doesn't matter. But untethered for a $10 off code. And the website is e2Scientific.com right. And they'll go to shop to find. Okay, perfect. Again, we will include that link, you guys, with the show notes. We'll also put that up on Apple podcasts so that when they see the episode, the link is there for them to get to the product as well. Is there anything else you want to share with us today that we haven't covered?

I don't think so. Thank you so much.

It's been a blast. Yeah, thank you guys so much for coming on the podcast. Thank you. It's been an absolute pleasure having you join me.

This has been so enjoyable. It's so nice to see you face to face. So mature listeners won't be able to do, but we appreciate it.

Absolutely.

Well, and just so all of our listeners know, we also put all of these up on YouTube so if you do want to watch the episodes, instead of listening to the episodes, they are available for you to watch as well and we'll link that as well. So thank you guys again. This has been an absolute pleasure having you on the podcast.

Thank you.

Thanks for listening to this podcast. If you want to hear more of these Myo Tots, Airway and Feeding related episodes, be sure to leave a review on Apple Podcasts or pledge a small amount on patreon.com the Untethered podcast. If you found value, others you know in this space will too. So be sure to share this episode on your social media platforms and join us over on Facebook, on my Facebook page at Halibalkin Biz, on Instagram at Ali Balkan. And you can head over to theuntetheredpodcast.com to grab a copy of the Show Notes where you can also subscribe to be kept up to date on the latest podcast episodes.