SoundBridge

The onset of the COVID-19 pandemic witnessed a rapid increase in the adoption of virtual approaches to healthcare services, which has proven to be comparable to in-person care in terms of efficacy and scope of application. Virtual healthcare, or telemedicine, has increased accessibility to essential services for patients living in rural areas or with limited mobility. Most hospitals in North America are located in urban and city centers, which presents a challenge for rural communities. People living in rural areas have to take time off work or travel long distances to reach a hospital. This is particularly concerning locally as 15% of Alberta's population consists of senior citizens, and this number is projected to increase to 18.8% by 2040. This group requires reliable healthcare, and their access to it is severely limited by factors such as distance, lack of reliable transportation, limited infrastructure, and healthcare workforce distribution. This issue is not unique to Alberta, as the World Health Organisation (WHO) predicts a doubling of the world’s senior population by 2050, and half of the world already lacks access to essential healthcare services. This highlights the need for addressing the challenge of "Global Health Equity" as an increasingly pressing matter. 

Telemedicine can be implemented synchronously through real-time video-conferencing software. While synchronous modalities can be more effective for certain healthcare services, it has introduced challenges to the efficacy of virtual care. Notably, senior patients may experience intelligibility issues during virtual sessions, despite having near-normal hearing during in-person conversations.  The growing popularity of telehealth has not been accompanied by sufficient attention to the issue of intelligibility limitations inherent in video-conferencing services. This has resulted in a significant gap in our understanding of this matter. Two factors that may contribute to this issue are increased cognitive load for seniors in understanding the clinician's speech due to accent differences or unfamiliar voices, as well as video conferencing platforms intentionally compressing higher frequencies that are easier for seniors to hear due to presbycusis in order to improve signal transmission during a call.

SoundBridge is a software plug-in designed for real-time application during video conferencing sessions or calls made through telemedicine platforms. Unlike most speech-modifying technology that operates on recorded audio, SoundBridge is available for download through video conferencing platforms or the App Store and can be enabled on the user's device during a call. Using a machine learning algorithm, SoundBridge automatically enhances the volume of frequencies in the speech region (1kHz - 5kHz) in real-time. After downloading the app, seniors can customize their settings by taking short audiometric tests. The app will first test hearing loss by administering a 'beep test' and then test speech comprehension to understand which sounds are harder to hear. Then, seniors can select a voice, like that of a spouse, to train the algorithm by repeating simple sentences. This data helps the algorithm adapt the incoming speech signal during calls and convert it into a more familiar voice, reducing cognitive load on the senior patient. This enhancement improves the audibility of specific sounds, like "s," and increases overall signal volume, enhancing speech clarity during calls.

One unique aspect of SoundBridge is its ability to learn from a familiar voice chosen by the user, such as their spouse. The algorithm adapts the incoming signal, such as a doctor's voice during a telemedicine session, to resemble the familiar voice chosen by the user. This adaptation further improves audibility by making the incoming voice sound more familiar and easier to understand. This real-time adaptation based on a familiar voice sets SoundBridge apart from other speech-modifying technologies and enhances its effectiveness in improving speech intelligibility during telemedicine sessions.

The deployment of SoundBridge will have a primary market for seniors with typical age-related hearing loss (presbycusis). This condition often leads to social isolation and low self-esteem as they find it challenging to participate in conversations. In a healthcare setting, missed virtual appointments are common due to difficulties in understanding clinicians.Our solution serves two underserved populations: rural residents and senior citizens. Although 18% of Canadians live in rural areas, the amount of rural located physicians is disproportionately low at only 8% (Tromp, 2020). Studies have shown that rural residents are generally satisfied with telemedicine, but they still prefer in-person care. This preference may stem from the fact that telemedicine is not tailored to their individual needs and circumstances. To engage with remote care, rural residents need to have the necessary resources, skills, and willingness (Rush et al., 2021). SoundBridge aims to address these challenges by providing effective personalised care and does not rely on a one-size-fits-all approach typically associated with telemedicine.

With the help of SoundBridge, seniors can better hear and engage during video calls, allowing them to stay connected with their healthcare providers. Our solution aims to empower seniors with increased independence and autonomy to improve their communication experiences. Furthermore, SoundBridge’s software nature enables it to cater to a broader market, including individuals with mild to moderate hearing loss, extending its reach beyond rural communities to encompass diverse demographics.

We are deliberately designing the technology to be used as a consumer product - an accessory to video conferencing systems (Zoom, Meet, FaceTime etc.) accessible for business or personal usage. With a growing trend of remote work, businesses commonly use videoconferencing platforms, which means SoundBridge, can serve multiple communities for various reasons. Additionally, our software can be useful for corporate and healthcare industries where many seniors are still working. This has the added benefit of being able to extend the application of our software into everyday use. Thus, SoundBridge serves as a vital tool in overcoming healthcare disparities and fostering equitable access to care for rural populations across North America. 

References: 

Rush, K. L., Seaton, C., Li, E., Oelke, N. D., & Pesut, B. (2021). Rural use of Health Service and telemedicine during COVID-19: The role of access and eHealth Literacy. Health Informatics Journal, 27(2), 146045822110200. https://doi-org.ezproxyberklee.flo.org/10.1177/146045... 

Tromp, M. (2021). Using wisely: Our health workforce is our most valuable resource. Canadian Journal of Rural Medicine, 26(1), 3. https://doi-org.ezproxyberklee.flo.org/10.4103/cjrm.c...

The Rehabilitation Robotics Lab is currently conducting the Tele-Rehab 2.0 study, which is a technology and process innovation launched in 2015. The project aims to develop and adopt virtual health technologies to support patients who require complex assessments, while staying in rural communities or assisted living facilities. Rural communities lack access to the same expert care as urban communities, and about a quarter of Alberta's population lives in such settings. Non-physician experts are primarily concentrated in urban centres, leading to an unacceptable level of inequality in our healthcare system. The residents of rural communities face significant challenges in accessing necessary specialized appointments, including taking time off work, being separated from support systems, arranging childcare, and covering travel costs. Moreover, Alberta's harsh winter conditions pose a risk to their safety while travelling. These challenges prevent rural community residents from receiving the care they need as often as they need, which can worsen their conditions or cause other issues like chronic pain or loss of function. It is clear that a better system is needed.

Through Tele-Rehab 2.0, we are striving to provide rural communities with the same or better quality of care as urban communities, thereby closing the gap and creating equality in healthcare services, no matter where you live. We have been working with clinicians and clients in rural communities since July 2020 and have received great feedback. The COVID-19 pandemic highlighted the need for virtual care, and provided our project an opportunity to demonstrate why virtual health is here to stay as the new normal. Connecting with clinicians virtually means more of us can access the care we need and deserve. We collaborate closely with Alberta Health Services (Alberta Health Services (AHS) is Canada's largest integrated health system, delivering health services to over 4.5 million people in Alberta) and a local hospital, incorporating feedback from patients and clinicians to continuously improve our solution. Tele-Rehab 2.0 is in close collaboration with rural care facilities as well as 4 community care programs and 11 more through AHS.

We are actively utilizing our connections with local healthcare services and running our Tele-Rehab 2.0 project, which allows us to virtually assist 10-20 seniors per week. This helps us to understand their opinions on virtual healthcare, and to what extent they experience audibility problems that are not related to WiFi. Additionally, we are investigating if the concept of SoundBridge is attractive to the demographic we are targeting towards. Currently, we are in the process of exploring the extent of impact of high-frequency amplification and familiar voices on auditory clarity, as part of our research into SoundBridge. Our initial investigations involve conducting pilot studies with participants aged 65 and over, who are accompanied by a familiar voice partner (such as a friend, spouse, or relative) for both in-person and Zoom-based sentence retell tasks and an audiology test. This allows us to examine any differences in intelligibility and better understand the role of these factors in auditory enhancement before developing our algorithm. In March 2024, we took steps to safeguard our invention by submitting a disclosure through our lab's affiliated University, the University of Alberta. This was in response to Zoom Communication Inc.'s patent application in September 2023, which focuses on a "signal out of noise and distortion" claim rather than the use of machine learning to enhance audibility based on voice familiarity.

We are applying to Solve because its platform aligns with our need to address the specific barriers that are hindering the advancement of our healthcare solution. We are particularly interested in joining the Solver Program, which connects Solver teams with partners who can provide monetary and non-monetary support that aligns with our goal – to promote equity and accessibility in healthcare by enhancing auditory comprehension for seniors and other individuals with hearing impairments during virtual communication, particularly in telemedicine context. Our existing virtual healthcare program, Tele-Rehab 2.0, has made a significant impact, and we aim to further enhance the quality of patient experiences and accessibility to healthcare services through SoundBridge. 

In addition to the financial support, the program will provide valuable networking opportunities, enabling us to connect with like-minded individuals, potential collaborators, and investors crucial for navigating the complex landscape of healthcare innovation, globally. While seed funding is important, our motivation for applying to Solve goes beyond monetary support; we seek to leverage Solve's resources, expertise, and mentorship to refine our solution, validate its feasibility, and accelerate its implementation. The SoundBridge Team also includes  a partnership with a start-up called Reverb Robotics, which specializes in AI speech technology. Our plan is to develop a machine learning algorithm and then sell it through their platform. Although we have some of the necessary resources to build and market this product, we recognize the value of working with Solve, whose expertise will help us create a solution that can reach a wider range of customers and developers. 

Our solution addresses concerns raised by seniors, and by participating in Solve, we aim to refine it based on feedback from seniors and other stakeholders within the healthcare and engineering industries. We have established relationships with local continuing care providers and aim to expand our impact globally through Solve's extensive network and reach. While we have made significant progress in terms of ethics, scientific validation, and assembling a team of leading academics, the translation of SoundBridge into practice remains a critical piece of the puzzle. Solve's emphasis on actionable solutions and implementation support will be instrumental in overcoming this challenge.

SoundBridge aims to address the challenge of speech intelligibility in telemedicine, especially for senior patients experiencing hearing impairments. We have combined insights from cognitive psychology, audiology, and telecommunication to develop a study protocol that investigates the effectiveness of familiar voices and high-frequency region amplification in enhancing speech intelligibility during telemedicine sessions. Our multidisciplinary approach sets our solution apart, as it bridges the gap between cognitive science, audiology, and telemedicine, providing actionable insights for improving communication outcomes in virtual care but also has marketing potential for business or personal use. Most importantly, SoundBridge works in real-time, adapting the incoming signal while preserving audio and video quality, ensuring no lag during a call. Our app is flexible to use with different videoconferencing platforms and can adjust the settings as the senior ages and degenerative hearing loss progresses.

SoundBridge would make remote healthcare services more patient-oriented and tailored to individual needs. This means that patients can receive personalized medical care from the comfort of their own homes, without compromising on the quality of the service. This approach has revolutionized the healthcare industry, making it more accessible and convenient for everyone. Our research findings can produce broader positive impacts by informing best practices and guidelines for enhancing speech intelligibility in telehealth, driving innovation in the market landscape and promoting the adoption of accessible and inclusive communication solutions.

• Activities: Implementation of the SoundBridge software utilizes machine learning algorithms to enhance high-frequency sounds and modulate incoming audio to replicate a familiar voice pattern. This technology is specifically designed to tackle the challenges identified in seniors with cognitive and hearing impairments, as demonstrated by research indicating a close link between cognitive decline and hearing impairment (Bisogno et al., 2021).

• Immediate outputs: Our activities are expected to yield immediate outputs such as enhanced speech clarity and reduced listening effort during telemedicine interactions. These outputs will be measured and validated through research findings and process evaluations involving senior patients.

• Short to medium-term outcomes: With the deployment of SoundBridge, expected improvements include increased patient engagement and satisfaction during telemedicine sessions. This improvement stems from the reduced cognitive load facilitated by familiar voice recognition (Holmes et al., 2018) and the enhancement of speech intelligibility through high-frequency amplification, addressing presbycusis commonly found in the senior population (Gates & Mills, 2005).

• Long-term outcomes: The ultimate goal is to improve healthcare delivery and patient outcomes for seniors. This includes reducing rates of medical misunderstandings or misdiagnoses, promoting greater independence, and fostering inclusivity in digital health platforms.

To substantiate the connections between these steps, our approach incorporates evidence and methodologies from cognitive psychology, audiology, and telecommunication studies. Our ongoing pilot study will provide us with reliable data to drive the creation of our technology in a feasible, patient focused direction. Further, our solution aligns with feedback and insights from our targetted, equity deserving population, ensuring that the SoundBridge not only addresses their needs effectively but also integrates seamlessly into their routine healthcare interactions.

References: 

Bisogno, A., Scarpa, A., Di Girolamo, S., De Luca, P., Cassandro, C., Viola, P., Ricciardiello, F., Greco, A., De Vincentiis, M., Ralli, M., & Di Stadio, A. (2021). Hearing loss and Cognitive impairment: Epidemiology, common pathophysiological findings, and treatment considerations. Life, 11(10), 1102.

Gates, G. A., & Mills, J. H. (2005). Presbycusis. TheLancett, 366(9491), 1111-1120. Holmes, E., Domingo, Y., & Johnsrude, I. S. (2018). Familiar voices are more intelligible, even if they are not recognized as familiar. Psychological Science, 29(10), 1575–1583.

Our impact goals for our solution are designed to ensure a transformational effect on senior’s lives while also assessing its scalability and sustainability. Our first impact goal revolves around ensuring that our solution effectively addresses the identified healthcare challenges. To measure progress towards this goal, we are tracking specific indicators related to the efficacy of our solution. These indicators include:

•  Creating a patient-focused solution: Regular feedback from seniors, including patients, caregivers, and healthcare providers, helps us assess the effectiveness of our solution in meeting their needs and expectations. 

• Clinical outcomes: We assess the effectiveness of our solution by evaluating if rural residents and elderly patients attend follow-up appointments after addressing any audibility issues.

• System integration: Integration with existing healthcare systems and workflows is crucial for the scalability and sustainability of our solution. We track the level of integration achieved and the resulting efficiencies gained.

Our second impact goal focuses on assessing the adoption potential and scalability of our solution. To measure progress towards this goal, we are monitoring the following indicators:

• User adoption rates: We track the number of users interested in adopting our solution over time, including both individual users and healthcare institutions implementing our solution within their systems.

• Geographic expansion: We aim to expand the reach of our solution to new regions and communities. Tracking the geographic distribution of clinics that implement telemedicine and implementation sites helps us gauge our progress in achieving this goal.

• Partnerships and collaborations: Engaging with strategic partners and stakeholders is essential for scaling our solution. We measure our success in forming partnerships with healthcare organizations, technology providers, and other relevant entities.

Our third impact goal focuses on assessing the financial sustainability of our solution. To measure progress towards this goal, we are monitoring the following indicators:

• Revenue generation: We track revenue streams generated through the sale or licensing of our solution, subscription fees, or other monetization strategies.

• Cost-effectiveness: Assessing the cost-effectiveness of our solution compared to traditional healthcare approaches helps us demonstrate its value proposition to stakeholders.

•  Funding and investment: We monitor our ability to attract funding and investment to support ongoing development, implementation, and scaling efforts.

To effectively track progress towards our impact goals and ensure successful project management, we have designated project management capability within our team. This includes assigning specific roles and responsibilities, implementing project management tools and methodologies, and regularly reviewing and adjusting our strategies based on progress and feedback. Our impact goals are centered on delivering effective solutions, achieving widespread adoption, and ensuring financial sustainability, with designated project management capability playing a crucial role in driving progress towards these goals.

SoundBridge is an innovative system that employs a sophisticated machine learning algorithm to help seniors with presbycusis, which is a common age-related hearing loss, to better comprehend high-frequency components of speech. Typically, voiceless consonants (such as p, k, f, s, and ch) are more challenging for seniors with presbycusis to hear, and this often leads to communication difficulties, especially in a healthcare setting. 

The system works by amplifying the higher frequencies in the incoming signal, such as the clinician's voice, making it easier for the patient to understand. This is similar to how hearing aids amplify sound. Additionally, the system converts the incoming signal into a voice that is familiar to the patient, such as that of their spouse or a loved one. This familiarization strategy is designed to make it easier for seniors to comprehend the speech components in the signal.

To train the algorithm, patients will be asked to familiarize the software with testing sentences that encompass multiple components of speech. This will enable the algorithm to learn more about the patient's hearing needs and preferences, and improve the accuracy of the amplification and voice conversion features. However, unlike modern applications of AI speech technology, SoundBridge will be implementing these adjustments to the incoming signal in real-time. Our software will have the capability to adapt the signal while also preserving other vital features of videoconferencing such as synchronization of audio and video.

The SoundBridge Team consists of nine members. Our start-up company partner, Reverb Robotics, has three contracted employees working on the solution. Additionally, there are five full-time employees and one part-time employee who are administrative staff, research assistants, audiologists, and university co-investigators at the University of Alberta.

Our team has been working on SoundBridge for one year. We received ethics approval in October 2023 and started pilot testing in January 2024.

The Rehabilitation Robotics Lab is deeply committed to fostering diversity, equity, and inclusivity across all facets of our operations. We recognize the inherent value of cultivating a team comprised of individuals with diverse educational backgrounds, varied research experiences, and unique perspectives. Our inclusive approach to team composition ensures that we harness the full spectrum of human creativity and innovation, drawing from insights across disciplines ranging from the Arts to STEM fields.

Central to our values is a strict adherence to the University of Alberta’s zero-tolerance policy on harassment, which guides our interactions and practices within the lab. We prioritize creating a supportive and respectful environment where every team member feels valued, heard, and empowered to contribute their unique perspectives to our collective endeavours.

In addition to upholding ethical standards in our conduct, the SoundBridge team undergoes rigorous training and certification in research ethics. Our certification with the Course on Research Ethics, based on the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2: CORE 2022), underscores our commitment to conducting research with integrity and care. This certification ensures that our research practices adhere to the highest ethical standards, promoting transparency, accountability, and the well-being of all individuals involved in our studies.

By placing diversity, equity, and inclusivity at the forefront of our mission, we aspire to create a workplace culture that celebrates differences and leverages them as strengths. Our commitment to these values not only enriches our research endeavors but also fosters a more vibrant and dynamic community within the field of rehabilitation robotics. We firmly believe that by embracing diversity and inclusivity, we can drive meaningful innovation and make a positive impact in advancing the boundaries of knowledge and improving outcomes in rehabilitation robotics.

SoundBridge operates under a hybrid business model that strategically combines impact-driven service with robust revenue generation tactics to ensure both social benefit and financial sustainability. Our core offering, SoundBridge, is a cutting-edge software plug-in designed specifically to enhance telemedicine communication for seniors. This product addresses crucial auditory challenges faced by this demographic by amplifying high-frequency sounds and personalizing audio outputs to mimic familiar voices, thus making digital healthcare interactions more accessible and effective.

Our business model is designed to cater to two main channels: direct-to-consumer (B2C) and business-to-business (B2B). In the B2C segment, we target seniors suffering from hearing impairments—a market that has shown a 7% annual growth[1] as telemedicine becomes increasingly prevalent in healthcare routines. We offer SoundBridge directly to this consumer base through downloadable software available on various digital platforms, making it easy for individuals to enhance their communication devices at home.

In the B2B sector, our strategy involves forming partnerships with telemedicine service providers and healthcare institutions. These entities use SoundBridge to upgrade their communication platforms, thereby enhancing the quality of service they provide to patients. This not only improves patient satisfaction but also reduces the rate of miscommunication in treatment, a significant issue that accounts for approximately 30% of malpractice claims in telehealth[2].

Revenue streams include:

Direct Sales: Selling software licenses to individual users with options for volume discounts for group or family purchases.

Subscription Models: Offering a premium subscription per month, which includes continuous updates, advanced customization features, and premium customer support.

B2B Licensing: Charging an integration fee to telemedicine platforms, alongside a recurring annual license renewal cost. We also explore revenue-sharing models based on usage. Partnerships: Collaborating with hearing aid manufacturers to integrate SoundBridge technology directly into their devices, which opens a new revenue channel and broadens our market impact.

[1]https://www.grandviewresearch....

[2]https://openloophealth.com/blo...

As SoundBridge navigates its early concept development stage, we are implementing a multifaceted financial sustainability plan to secure the necessary funding and partnerships to move from concept to commercialization effectively.

Grants and Public Funding: We are actively applying for a mix of provincial and federal grants available in Canada, which are designed to support health technology innovations. Additionally, we are exploring international grants that focus on advancing global health technology solutions. These grants not only provide essential funding but also validate our innovative approach in the eyes of the global healthcare community. We have currently received $4200 from the Glenrose Hospital Foundation.

Commercial Partnerships and Early Engagements: Even in the concept stage, forming early relationships with potential commercial partners and telemedicine platforms is crucial. By engaging with these platforms from the outset, we can tailor our development to meet industry needs, thereby securing early adoption and potential funding through collaborative development agreements. These partnerships could provide both financial resources and critical market insights that shape the final product.

Venture Capital and Angel Investors: We are planning to engage with angel investors and participate in health technology incubators that offer seed funding specifically for labs like ours. This early-stage capital is vital for transitioning from concept to prototype development, allowing us to build and test SoundBridge with real user data.

Transition to Commercialization: As we progress beyond the prototype validation phase, our strategy will focus on establishing a robust commercial presence:

Formalizing Commercial Partnerships: We plan to solidify our early engagements with telemedicine platforms and healthcare providers into formal partnerships. These agreements will include licensing our technology, which will provide a steady stream of revenue as we continue to enhance and adapt our product to meet broader market needs.

Direct Sales and Licensing: Once validated, SoundBridge will be marketed directly to healthcare providers and may also be offered through various software distribution platforms. Licensing our technology to other health tech companies will open additional revenue streams, supporting long-term financial stability.

Expansion through Further Investments: With a validated prototype and established market interest, we will seek additional funding through venture capital and beyond. This capital will be crucial for scaling our operations, expanding our reach into new markets, and continuously improving our technology.

Building a Sustainable Revenue Model: Our long-term financial strategy includes developing a subscription model for ongoing service and support, which will ensure a continuous revenue flow. We also plan to explore revenue-sharing models with our telemedicine partners, aligning our success with the usage and efficacy of our technology in real-world settings.

This comprehensive approach ensures that SoundBridge not only secures the necessary funding to move from concept to market but also establishes a sustainable business model that supports long-term growth and innovation in the healthcare technology sector.