The design of Mobili-T’s app was grounded in patient-centered research from the outset (with a bit of a bumpy start). This included in-depth interviews, cultural probes, and extensive secondary research across swallowing therapy, oncology care, and rehabilitation psychology. Across all inputs, a consistent picture emerged: users were often low on energy, cognitively taxed, and navigating complex recovery pathways - yet still expected to perform technical and physically demanding swallowing exercises to restore function.
This experience reinforced a core design principle: the app needed to reflect not only clinical goals, but also the lived reality of fatigue, fragility, and effort. Every interaction was shaped to meet patients where they were - supporting precision without adding burden, and aligning therapeutic intent with human capacity.
Early in development, an external studio was engaged to prototype concepts for grant applications. Based on superficial demographic assumptions (primarily older, male patients), they re-skinned an existing fishing game into a proposed therapy experience called Hook, Line & Swallow.
However, it quickly became clear that the concept was fundamentally inappropriate. It lacked any meaningful connection to the clinical context and overlooked a critical and obvious reality for head and neck cancer patients: water itself is often associated with choking, fear, and anxiety.
For individuals living with head and neck cancer, swallowing is not a neutral act - it is often a negotiation with discomfort, aspiration risk, and psychological distress. Even small sips of water can trigger fear responses, despite being medically necessary due to treatment-related side effects such as dry mouth caused by damaged salivary glands.
This disconnect highlighted a significant gap between generic design and the lived experience of the patient population. The clinical team ultimately placed trust in me to move away from gamification and toward a more grounded, respectful, and clinically aligned experience. This pivot became a turning point in defining the app: shifting from superficial metaphor to meaningful support, rooted in real constraints and real care needs.
Many insights were unlocked through journals and interviews
For many, the experience was less about extended engagement and more about the moment itself. Swallowing therapy was like a short, focused lifting session at the gym, with patients wanting to “get in, do the work, and get out.” They consistently expressed a need for clear, understandable goals and exercises, with minimal cognitive overhead. At the same time, many of the existing clinical interfaces relied on confusing visuals and dense instructional language that added friction rather than clarity.
This led to a deliberate simplification of the experience. Complex clinical instructions were translated into progressively disclosed guidance, allowing users to build understanding over time rather than all at once.
We began by focusing on a foundational question: what prevents patients from continuing therapy at home? Patients needed to understand what to do, whether they were doing it correctly, and what “enough” looked like on any given day. And to create a feedback loop with their clinician.
This became especially important when designing real-time biofeedback. Outside of clinical supervision, patients rely heavily on visual feedback to validate performance. We explored a range of early concepts, from ECG-like signal traces, to more expressive systems where swallowing effort generated animations - such as characters jumping over obstacles or cityscapes forming in response to muscle activity.
While these directions helped test engagement models, they also surfaced important constraints. In one concept, a character navigated obstacles through swallows, but patients were clear: they did not want their character to fail or fall. Recovery is not linear, and neither is strength. Many described variability from day to day, where effort itself could be significantly different depending on fatigue, treatment effects, or pain.
Designing early concepts with colleague Molly McMahon
Low-fidelity concepts were shared through animations and narrated videos, exploring a range of biofeedback approaches
One of the core exercises, the held swallow (Mendelsohn maneuver), illustrates this complexity. Clinically, it is designed to increase hyolaryngeal elevation and improve upper esophageal sphincter opening by holding the larynx at peak swallow for several seconds.
In practice, even performing this movement as a healthy individual revealed how physically demanding and unintuitive it can be - underscoring the challenge for patients living with swallowing impairments, altered anatomy, or the effects of radiation treatment.
What emerged was a preference for honesty over gamification. Patients weren’t looking for performance judgment, they were looking for orientation. What is my goal today? How close am I to reaching it?
This reframed biofeedback from playful representation to grounded measurement: a system that reflects effort accurately, adapts to variability, and supports progress without implying failure.
A goal is set based on that day's calibration, which measures muscle activity/capability. Repetitions are represented by cube building blocks. Each cube represents how they performed that rep in relation to the goal effort.
Each swallow is represented by a coloured cube, corresponding to different exercise types
Each rep of a swallowing exercise has an outcome: goal reached, goal attempted and nothing detected
A dotted goal line is generated during calibration. This becomes the goal during exercise. Different exercises have different time or intensity goals.
Considerations for colour blindness were considered, with colleague Abygail Berg running simulations
The Regular swallow is like a warm-up - used to calibrate the goal for other exercises.
The Effortful swallow involves squeezing neck and throat muscles as hard as possible
The Held swallow involves holding the larynx (Adam’s apple) at its highest point for 3-5 seconds during a swallow
The cubes acted as building blocks for an exercise routine being created. Different patients have different needs, resulting in different swallowing therapy prescriptions. One person might only focus on Held swallows, while another might require 9 regular swallows to warm-up before attempting a limited number of Effortful swallows.
Green means ‘Go’ and the regular swallow is the starting point and cornerstone of the therapy, as it is used in both calibration and as the warmup for more difficult exercises.
Although it has many negative connotations (blood, danger), red is associated with energy, strength and power. It is an intense colour, which matches the intent of the effortful swallow - to swallow as hard as possible and far exceed the calibration goal line.
Blue represents tranquility and calmness, and was chosen as an appropriate colour for what will likely be the most difficult exercise for most patients, requiring the most concentration and control of swallowing muscles. It's hard. Give it a try.
During onboarding, where anatomical imagery is required to support instruction, I designed a softened, an abstracted human form to keep focus on the intent of the guidance rather than anatomical realism. This approach allowed attention to remain on key actions - such as device placement, alignment, and preparing the site for adhesion - without introducing unnecessary clinical detail or visual intensity.
The result is a neutral, legible representation of the human body that supports instruction. In head and neck cancer care, anatomical variation is significant across individuals, shaped by surgery, treatment, and recovery. This approach helped establish a tone for onboarding that is clear, clinically grounded, and emotionally considerate - supporting understanding while avoiding visual assumptions about the patient’s condition.
Onboarding instructions needed to be respectful, instructional and considerate of elderly users. Written, visual and narrated instructions (by Dr. Gabriela Constantinescu) were used to facilitate device placement.
Through a series of interviews with clinicians - both experienced Mobili-T users and those new to the platform - a consistent insight emerged: face-to-face interaction remains essential. Clinicians emphasized the importance of observing patients in real time, outside of structured exercises, to better understand their capabilities and guide treatment.
This led to the development of Core - initially conceived as a standalone offering, and later integrated into the main app across multiple SaaS tiers. With the ability to zoom, pause, and guide patients through open-ended movements, clinicians can facilitate more natural, conversational sessions.
By extending biofeedback beyond rigid exercise flows, Core supports the kind of in-person insight clinicians value
Core is a sandbox-style biofeedback interface that allows clinicians to live stream muscle activity from Mobili-T’s sensors
Core enhances in-clinic utility and strengthens the transition to structured therapy at home.
Patients can see can insights through in-app tracking
Clinicians have access to insights on their Clinician Portal
Changes to the workout can be made in the Portal and patients will be notified of alterations
A centralized view of patient progress - highlighting trends, performance data, and opportunities for timely intervention
The Clinician Portal was designed to support both individual practitioners and larger clinics - providing a centralized way to manage patient care at scale. Clinicians can access patient profiles, review performance data, and quickly identify patterns of progress or areas where additional support may be needed. And it shares a similar visual language to the patient app for continuity of communication.
Workouts can be adjusted remotely, allowing care plans to evolve alongside the patient’s progress. Updates are communicated directly through the app, with clinician notes providing context and guidance. This helps maintain continuity between in-clinic sessions and at-home therapy.
The result is a system that extends the clinician’s reach, enabling more responsive, personalized care while reducing friction in day-to-day management.
Read about my collaborations with Mobili-T's sales and marketing teams