Voxello’s mission directly addresses the communication barriers in the ICU that the Covid19 pandemic has brought to everyone’s attention (www.voxello.com).


Imagine yourself waking up in an intensive care unit and on a ventilator. You feel awful and because you are hooked up to a ventilator you are unable to speak. You are alone as your family and friends are not permitted into the hospital because of  Covid19 precautions. You are surrounded by doctors, nurses and respiratory therapists who are wearing masks and other protective equipment that makes it difficult for you to hear and understand what they are telling you. You have lots of questions about your condition. You want to have a role in critical medical decision making. You want to communicate with your family and know how they are doing. You are scared and not being able to speak and effectively communicate with your healthcare providers is not only stressful but also impacts the care they can provide.


When patients are unable to communicate they are at a heightened risk of experiencing preventable adverse medical outcomes. It is essential that a patient be able to communicate that they are in pain or experiencing a novel symptom if we hope to reduce the risk of ventilator-associated pneumonia, pressure sores, and adverse reactions to medications or blood products. Measures of heart rate, blood pressure, and blood oxygen levels can tell us a lot about a patient’s state, but they cannot necessarily tell us what the source of the patient’s distress is. If a patient is agitated we naturally assume that it is related to the condition that landed them in the ICU.


We had an elderly patient at the University of Iowa Hospitals and Clinics who was intubated and on a ventilator in our ICU and was very agitated about something. The nurses tried to get the patient to write out what was bothering her, but her handwriting was illegible, so they began to ask her a series of yes/no questions. Was she in pain? Was she worried about her condition? This went on for a considerable amount of time and they were not getting any closer to figuring out what was bothering her. By happenstance, they landed up asking the patient some random questions totally unrelated to the condition that brought her to the hospital. It turned out that what she was so worried about was that she had taken some chicken out of the freezer and was worried that it was on her kitchen counter and would spoil. Throughout this whole process, the patient’s anxiety continued to increase to the point that the staff was considering having to sedate the patient. The minute the staff figured out what the patient was worried about and could address that, the patient’s anxiety was alleviated without medical intervention.


Colleagues working with a patient at the University of Wisconsin reported on a patient who was on a ventilator and would need to stay on the ventilator and so would need a tracheostomy. In order to get consent for the procedure, the medical staff was communicating with the patient by asking him yes/no questions. He repeatedly seemed to indicate that he did not want to have a tracheostomy. Luckily a speech-language pathologist was called in and provided the patient with some communication tools that would allow the patient to ask questions. It turned out that the patient definitely did want to be maintained on the ventilator.  What he had been indicating in response to the yes/no questions was that he did not want to be awake during the procedure. Absent the intervention by the speech-language pathologist his initial responses would have been interpreted to mean that he wanted to be withdrawn from life support.


In spite of all the amazing advances in medicine, effective communication between the patient and health care providers remains a key to positive outcomes. We know that patients who are critically ill and in ICUs face significant barriers to communication. Covid19 precautions have only exacerbated the impact of such barriers. Being on mechanical ventilation makes it impossible for patients to speak. Personal protective equipment (PPE) makes it more difficult for patients to hear and understand what their caregivers are saying. It is critical to both diagnosis and to determining the impact of an intervention that a patient be able to communicate about pain and other symptoms. Likewise, it is critical that providers are able to effectively communicate in order to make a patient understand the condition, the intervention being recommended and what actions the patient should take. To make matters worse the current restrictions on visitors have also removed the support that family members and friends can provide. This forces patients to have to cope in isolation and adds to the burdens on their healthcare providers. All of this is even a greater challenge when providing care for patients with limited proficiency in the language spoken by their care providers.


Being in the ICU and on a ventilator produces significant stress and has been identified as a cause of post-ICU stress disorder syndrome akin to the PTSD seen in combat veterans. The stress on nurses and other healthcare providers who are caring for ICU patients has been well documented and has certainly been amplified by the added risks associated with treating patients with COVID19.


Meeting the challenge of overcoming communication barriers in this time of Covid19 is not necessarily going to require complex technology or a new skill set. We can learn from the best practices implemented in hospitals around the world. Speech-language pathologists (SLP) working in hospital settings have for years been providing a range of communication tools and strategies that have enabled critically ill patients to communicate and to more effectively participate in their care and in medical decision making. I have been working with a group of SLPs and other health providers around the country to put together a set of materials that can be freely downloaded and used in the ICUs to support patient-provider communication (www.patientprovidercommunication.org ). Since the Patient Provider Communication site has gone live, it has had over 57,,000-page views by individuals across the U.S. from 107 countries around the world.


No patient hospitalized with Covid19 should be cut off from effectively communicating with their caregivers. Simple communication tools will help patients and their caregivers overcome the physical and psychological stress we are hearing about every day as our healthcare system is severely challenged by the Covid19 pandemic. 

Richard Hurtig, Ph.D.


About Dr. Hurtig

Richard Hurtig, Ph.D. is a Professor Emeritus in the department of Communication Sciences & Disorders at The University of Iowa and is a Fellow of the American Speech & Hearing Association. He directs the UI Assistive Devices Laboratory and is also a founder and the Chief Scientific Officer of Voxello. His research over a period of 30 years has included the development of assistive technologies for individuals with complex communication needs and the development of strategies to facilitate patient-provider communication for patients in acute care and for persons with ALS.  His current efforts have been focused on the development of the noddle® and the noddle-chat communictaion app. This work has been supported in part by the National Institute of Nursing Research under Awards R43NR016406 and R44NR016406.

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When it’s hard to breathe, it can be hard to speak! In light of COVID-related respiratory illness, a greater number of people need breathing tubes or ventilator support, which takes away the ability to speak. Hospitals and healthcare workers need resources to support communication in alternative ways.

Voxello is committed to ensuring that all patients in critical care are able to effectively communicate with their caregivers and participate in their care.  Richard Hurtig, Voxello’s Chief Scientific Officer has been working with a team of clinicians across the country to put together a set of low-tech tools that can be easily deployed in ICUs treating patients with COVID.

As a public service, the Patient-Provider Communication Forum, with support from the United States Society of Augmentative and Alternative Communication (USSAAC), is providing a FREE bank of communication tools for you to download and print, created in response to this COVID crisis. 

Visit: patientprovidercommunication.org

Download FREE Communication Boards


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Voxello has been invited to present at the NACD 2019 Global Board Leaders Summit as a Dancing With the Start-Ups finalist. Dancing With the Start-Ups features some of the most innovative and promising companies in an array of industries defending their ideas to a panel of judges and an audience. This fun and exciting competition format provides a platform for directors to see firsthand some of the leading-edge ideas and technologies that Voxello is using to shape and disrupt in the field of medtech.  

We are honored and excited to be taking part in this event! 

Attending? The presentation will be at 1:45pm in Liberty I-L (M4) on September 23. Learn more at the Summit website by clicking here. Hope to see you there!

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Voxello was selected by NIH to exhibit and present at the Bio 2019 conference in Philadelphia, PA June 3-6, 2019. Attendees and exhibitors span from the largest tech and pharma companies to smaller start-up organizations. Over 16,000 attendees spanning the globe will be gathering at the conference to learn and network in a collaborative environment. Dr. Richard Hurtig, Voxello’s Chief Scientific Officer, will be presenting one of the over 500 scheduled educational sessions by special invitation.

You can catch Dr. Hurtig’s presentation on June 5th at 4:45pm in Theater 3, Level 200. 

Bio2019’s theme of “It Starts with One” closely aligns with Voxello’s goal of impacting the individual patients and families that the Noddle system serves, and of the thought that one idea can create a global impact on patient care. 

Voxello will exhibit in the Innovation Zone at IZ-63. If you are attending, please stop by and introduce yourself, and we look forward to seeing you in Philadelphia!

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In healthcare, innovative and lifesaving technology is unavoidable—it’s seemingly everywhere. Patient-provider technology is rapidly evolving into a seamless communication stream that connects patient with caregiver, establishing unrelenting ‘big data’ for clinical decision support.  EHR systems such as Cerner and Epic, robots that perform surgery, smart and wireless IV pumps and even robots roaming the hallways of our hospitals delivering food and supplies! How could there possibly be a patient, or even worse still, a group of the most vulnerable patients in our hospitals that are not well-served by technology? How is it possible that a group of patients is completely let down and shunned by lack of innovation? Why were these patients and the caregivers that provide for them left behind in the technological revolution designed to improve entire healthcare populations?

Let’s take a minute to examine the details and the scope of this seemingly unbelievable situation. In our nation’s hospitals, roughly 3.9 million patients per year end up in our ICU’s in a non-verbal, non-mobile state1. These patients cannot summon a caregiver, and even if they could – they couldn’t communicate with their caregiver to explain why they’re reaching out to them. These non-verbal patients are at a three times greater risk of a preventable adverse event than patients that can communicate with their caregivers2. This issue costs our hospitals nearly $29 billion per year. Several studies examining patient-provider communication have indicated that the quality of the communication played a significant role in medical outcomes and in both patient and caregiver satisfaction3-6.

Current hospital-based solutions used to communicate with non-verbal, non-mobile patients is straight out of the 18th century. However, there is no one to blame here–this is not hospital leadership’s fault. Why? Because hospital providers are using what is most readily available to them: lip-reading, patient scribbling, laminated paper-based communications boards, etc. Technology born of last century.

If patient empowerment is truly the future of healthcare—how do we include the non-verbal, non-communicative patient in this promising future if current standard communication protocols in our nation’s hospitals leave them feeling frustrated, forgotten and without a voice? Voxello has a solution that brings these patients into the 21st century of patient empowerment and communication directly impacting patient outcomes and provider stress with the noddle® technology that literally gives these patients a voice and empowers them to be active participants in their own care.  

  1. Zubow and Hurtig, 2013
  2. Bartlett, et al 2008
  3. Hoffman et al., 2005
  4. Balandin et al., 2007
  5. Hemsley et al, 2007
  6. Hemsley et al., 2011
  7. Cohen et al., 2005
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On average every year hospitalized patients in the US experience almost 3 million preventable adverse events such as adverse drug reactions, falls, pressure ulcers and ventilator-associated pneumonia. The total cost to the US health system of treating these adverse events is in excess of $29 billion. Due to the regulatory shift towards quality and accountability, these are costs that hospitals must absorb. Hospital barriers to communication and poor patient-provider communication put individuals at increased risk of experiencing preventable adverse medical outcomes and unnecessary additional staff and patient stress.


To address the communication needs of the widest range of patients, Voxello continues to develop technology to support patients who face both physical and cognitive barriers to effective communication. Individuals who have limited physical abilities are often unable to effectively summon help and communicate with caregivers. How do you communicate a potential adverse reaction to a medication if you cannot speak or move? Voxello addresses these communication barriers and by doing so hospitals can potentially save capital dollars by reducing their adverse event rates. Effective patient-provider communication reduces both patient and staff stress and can significantly move the needle on patient satisfaction. Improving patient-provider communication is at the core of the Voxello mission.


See our recently published analysis of the cost of communication barriers (Perspectives of the ASHA Special Interest Groups,  SIG 12, Vol. 3(Part 3), 2018).

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It’s no secret that patients who are cognitively impaired or who have Alzheimer’s or Alzheimer’s related dementias have a great deal of difficulty communicating with caregivers. They have difficulty in understanding what they are being told and may also be unable to effectively let caregivers know how they are feeling and what their needs are.

Hospitalizations can be very challenging for patients with dementia because of the change in environment as well as the change in daily activity schedule due to the medical interventions. These patients’ chronic difficulties with word finding, short-term memory and attention, that impact their ability to speak and to comprehend can become significantly greater as a function of increased stress and disorientation associated with their hospitalization. This makes it more difficult for them to effectively communicate with their nurses and other healthcare providers, rendering them more susceptible to preventable adverse events and delirium. Their inability to effectively communicate about their needs also contributes to their increased agitation and non-compliant behaviors, which in turn requires increased use of sedation and increased risk of delirium.


Voxello has received an additional grant from the National Institute of Nursing Research (NIH) to expand their noddle-chat platform (communication software that enables patients with significant communication barriers the ability to actively engage with a  provider) so that it can also be used to support the communication needs of patients with Alzheimer’s Dementia and other patients who are cognitively impaired.

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Voxello and its clinical partners will be at ATIA in 2019 and will have two presentations on the docket.

The first will highlight Voxello’s newest sensor, the min-mo (patent pending). Voxello, with support from the NIH-NINR, has developed the min-mo sensor that uses motion-sensing technology to detect a wide range of small intentional gestures (e.g. head nod, shoulder shrug, wrist roll). It can be used in a plug-and-play mode or can learn to recognize a patient’s particular gesture. The sensor is designed to be directly mounted to the patient so that patients can, regardless of their position in bed, be able to use the noddle to activate the nurse call system and control the noddle-chat communication tablet with speech generation. With the addition of this sensor, Voxello has expanded the range of patients that can more effectively summon their nurses providing greatly enhanced communication and participation in their care.


The second presentation showcases a series of case studies at the University of Wisconsin Hospitals and Clinics following implementation of the noddle® and the noddle-chat communication device for patients with complex communication needs.  While the use of augmentative and alternative communication (AAC) strategies with outpatient populations is well established, it is not yet the standard of care for patients facing acute barriers to communication during a hospitalization. The presentation will describe the system barriers that must be overcome to incorporate AAC technology into clinical practice.  The presented cases will highlight the need for interprofessional practice and describe the implementation strategies and ongoing problem-solving needed to meet the communication needs of hospitalized patients.


You can also see the latest Voxello technology at the ATIA conference

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 Voxello’s first publication indicating the economic impact of communication barriers in hospitals has been accepted by the American Speech and Hearing Association (ASHA). The publication emphasizes the importance of creating effective communication channels for patients that cannot speak or use common nurse call systems due to their conditions. The results of creating effective communications paths for this vulnerable patient population leading to profound outcomes on reducing preventable adverse events and creating cost savings for hospitals of $6.8 billion each year in the United States. You can read the abstract here. 

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Voxello Case Studies

Voxello has released two new case studies highlighting the clinical and operational impact the noddle system is having at the University of Iowa Hospitals and Clinics (UIHC), a Level 1, 811-bed hospital. These case studies highlight the experiences of Matthew Howard, MD, Chair and DEO or Neurosurgery and Jolyn Schneider, BSN, RN PCCN, Intensive and Specialty Services, Burn/Trauma Center at UIHC. 

“The noddle helps us to provide a higher standard of care. It decreases the patient’s frustration with not being able to communicate with us effectively. I believe use of the noddle makes a patient feel that UIHC is doing the best it can to provide them quality care,” says Jolyn.

You can find both Dr. Howard and Jolyn’s case studies by clicking here.

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