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Meldrum D, Kearney H, Hutchinson S, McCarthy S, Quinn G. Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1406926. [PMID: 39050817 PMCID: PMC11267627 DOI: 10.3389/fresc.2024.1406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/05/2024] [Indexed: 07/27/2024]
Abstract
Introduction Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. Methods This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Results Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. Discussion This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.
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Affiliation(s)
- D. Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - H. Kearney
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. Hutchinson
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- MS Unit, Department of Neurology, St. James’s Hospital, Dublin, Ireland
| | - S. McCarthy
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
| | - G. Quinn
- Physiotherapy Department, St. James’s Hospital, Dublin, Ireland
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Grove CR, Loyd BJ, Dibble LE, Schubert MC. Evidence for the differential efficacy of yaw and pitch gaze stabilization mechanisms in people with multiple sclerosis. Exp Brain Res 2024; 242:1797-1806. [PMID: 38839617 DOI: 10.1007/s00221-024-06864-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
People with multiple sclerosis (PwMS) who report dizziness often have gaze instability due to vestibulo-ocular reflex (VOR) deficiencies and compensatory saccade (CS) abnormalities. Herein, we aimed to describe and compare the gaze stabilization mechanisms for yaw and pitch head movements in PwMS. Thirty-seven PwMS (27 female, mean ± SD age = 53.4 ± 12.4 years old, median [IQR] Expanded Disability Status Scale Score = 3.5, [1.0]. We analyzed video head impulse test results for VOR gain, CS frequency, CS latency, gaze position error (GPE) at impulse end, and GPE at 400 ms after impulse start. Discrepancies were found for median [IQR] VOR gain in yaw (0.92 [0.14]) versus pitch-up (0.71 [0.44], p < 0.001) and pitch-down (0.81 [0.44], p = 0.014]), CS latency in yaw (258.13 [76.8]) ms versus pitch-up (208.78 [65.97]) ms, p = 0.001] and pitch-down (132.17 [97.56] ms, p = 0.006), GPE at impulse end in yaw (1.15 [1.85] degs versus pitch-up (2.71 [3.9] degs, p < 0.001), and GPE at 400 ms in yaw (-0.25 [0.98] degs) versus pitch-up (1.53 [1.07] degs, p < 0.001) and pitch-down (1.12 [1.82] degs, p = 0.001). Compared with yaw (0.91 [0.75]), CS frequency was similar for pitch-up (1.03 [0.93], p = 0.999) but lower for pitch-down (0.65 [0.64], p = 0.023). GPE at 400 ms was similar for yaw and pitch-down (1.88 [2.76] degs, p = 0.400). We postulate that MS may have preferentially damaged the vertical VOR and saccade pathways in this cohort.
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Affiliation(s)
- Colin R Grove
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
- Division of Physical Therapy, Department of Rehabilitation Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
- Applied Vestibular Physiology Laboratory, Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, 1441 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, College of Health, University of Montana, Missoula, MT, USA
- School of Integrative Physiology and Athletic Training, College of Health, University of Montana, Missoula, MT, USA
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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Hall CD, Flynn S, Clendaniel RA, Roberts DC, Stressman KD, Pu W, Mershon D, Schubert MC. Remote assessment and management of patients with dizziness: development, validation, and feasibility of a gamified vestibular rehabilitation therapy platform. Front Neurol 2024; 15:1367582. [PMID: 38872821 PMCID: PMC11169667 DOI: 10.3389/fneur.2024.1367582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Dizziness is a growing public health concern with as many as 95 million adults in Europe and the United States experiencing vestibular hypofunction, which is associated with reduced quality of life, poorer health, and falls. Vestibular rehabilitation therapy (VRT) is effective in reducing symptoms and improving balance; however, limited access to qualified clinicians and poor patient adherence impedes optimal delivery. The goal of this study was to develop and evaluate the feasibility of a remote therapeutic monitoring VRT Platform application (APP) for the assessment and treatment of vestibular dysfunction. Methods User-centered iterative design process was used to gather and integrate the needs of users (clinicians and patients) into the design at each stage of development. Commonly used vestibular patient-reported outcome measures (PROs) were integrated into the APP and adults with chronic dizziness were enrolled to evaluate validity and reliability of the APP compared to standard clinical measures (CLIN). Gaze stabilization exercises were gamified to provide an engaging experience and an off-the-shelf sensor captured eye and head movement to provide feedback on accuracy of performance. A prospective, pilot study design with pre-and post-treatment assessment assessed feasibility of the APP compared to standard VRT (CLIN). Results Participants with dizziness wanted a summary rehabilitation report shared with their clinicians, felt that an app could help with accountability, and believed that a gaming format might help with exercise adherence. Clinicians felt that the app should include features to record and track eye and head movement, monitor symptoms, score accuracy of task performance, and measure adherence. Validity and reliability of the digital PROs (APP) were compared to scores from CLIN across two sessions and found to have good validity, good to excellent test-retest reliability, and excellent usability (≥88%ile). The pilot study demonstrated feasibility for use of the APP compared to CLIN for treatment of vestibular hypofunction. The mean standard system usability score of the APP was 82.5 indicating excellent usability. Discussion Both adult patients with chronic dizziness and VRT clinicians were receptive to the use of technology for VRT. The HiM-V APP is a feasible alternative to clinical management of adults with chronic peripheral vestibular hypofunction.
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Affiliation(s)
- Courtney D. Hall
- Mountain Home Hearing and Balance Research Program, James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN, United States
- Physical Therapy Program, College of Clinical and Rehabilitative Health Sciences, East Tennessee State University, Johnson City, TN, United States
| | | | - Richard A. Clendaniel
- Department of Orthopedic Surgery, Physical Therapy Division, Duke University Medical Center, Durham, NC, United States
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, United States
| | - Dale C. Roberts
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Kara D. Stressman
- Mountain Home Hearing and Balance Research Program, James H. Quillen Veterans Affairs Medical Center, Mountain Home, TN, United States
| | - William Pu
- Blue Marble Health, Altadena, CA, United States
| | | | - Michael C. Schubert
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
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Weston AR, Dibble LE, Hoppes CW, Loyd BJ. People with multiple sclerosis and unilateral peripheral vestibular loss demonstrate similar alterations in head and trunk turning kinematics compared to healthy controls. Gait Posture 2023; 105:132-138. [PMID: 37562112 DOI: 10.1016/j.gaitpost.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Individuals with peripheral vestibulopathy are known to have difficulty with volitional head turns. This leads to differences in head and body turning kinematics, compared to those without vestibular dysfunction. Multiple sclerosis (MS), a neuro-inflammatory disease affecting the central nervous system, can cause vestibular dysfunction (dizziness, unsteadiness, gaze instability). However, head and trunk turning kinematics in people with MS (PwMS) have not been assessed. RESEARCH QUESTION Will PwMS, demonstrate head and body kinematics alterations similar to individuals with a peripheral dysfunction compared to vestibular healthy individuals? METHODS Eleven individuals with a recent vestibular schwannoma resection (VSR), fourteen PwMS, and 10 healthy control (HC) participants were fitted with head and trunk worn inertial measurement units (IMUs) and performed walking and turning tasks. Head and trunk peak turning speed and amplitude were extracted. Regression models controlling for gait speed were fit per outcome with post hoc corrections applied to significant models. RESULTS Yaw plane head turn speed and amplitude were significantly less in the VSR group compared to HC. Pitch plane head turn amplitude was significantly smaller in PwMS compared to HC (p = 0.04), however pitch plane speed did not differ between the groups. There was no difference between PwMS and the VSR group in yaw or pitch plane speed and amplitude. Both PwMS and the VSR group turned significantly slower than HC during the 180d body turn as measured at the head and trunk (head speed model p = 0.009 and <0.001; trunk speed model p < 0.001 for both groups) however the MS and VSR groups did not differ from each other. SIGNIFICANCE Turning kinematics while walking in PwMS are altered compared to HC and are similar to individuals with unilateral vestibular hypofunction. Centrally mediated vestibular dysfunction in PwMS may alter movement kinematics and should be considered during examination and treatment.
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Affiliation(s)
- Angela R Weston
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA; Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, 78234 USA.
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, 78234 USA.
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, 32 Campus Dr., Missoula, MT 59812, USA.
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Grove CR, Wagner A, Yang VB, Loyd BJ, Dibble LE, Schubert MC. Greater Disability Is Associated with Worse Vestibular and Compensatory Oculomotor Functions in People Living with Multiple Sclerosis. Brain Sci 2022; 12:1519. [PMID: 36358444 PMCID: PMC9688247 DOI: 10.3390/brainsci12111519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 08/15/2023] Open
Abstract
Globally, there are nearly three million people living with multiple sclerosis (PLW-MS). Many PLW-MS experience vertigo and have signs of vestibular dysfunction, e.g., low vestibulo-ocular reflex (VOR) gains or the presence of compensatory saccades (CSs), on video head impulse testing (vHIT). We examined whether the vestibular function and compensatory oculomotor behaviors in PLW-MS differed based on the level of MS-related disability. The VOR gain, CS frequency and latency, and gaze position error (GPE) were calculated from the individual traces obtained during six-canal vHIT for 37 PLW-MS (mean age 53.4 ± 12.4 years-old, 28 females) with vertigo and/or an imbalance. The subjects were grouped by their Expanded Disability Status Scale (EDSS) scores: PLW-min-MS (EDSS = 1.0-2.5, n = 8), PLW-mild-MS (EDSS = 3.0-4.5, n = 23), and PLW-moderate-MS (EDSS = 5.0-6.0, n = 6). The between-group differences were assessed with Kruskal-Wallis tests. The VOR gains for most of the canals were higher for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. CS occurred less often in PLW-min-MS versus PLW-mild- and mod-MS, respectively. No clear trend in CS latency was found. The GPE was often lower for PLW-min-MS compared to PLW-mild- and mod-MS, respectively. Thus, our data demonstrate that worse VOR and compensatory oculomotor functions are associated with a greater MS-related disability. PLW-MS may benefit from personalized vestibular physical therapy.
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Affiliation(s)
- Colin R. Grove
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Andrew Wagner
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH 43212, USA
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH 43212, USA
| | - Victor B. Yang
- School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Brian J. Loyd
- School of Physical Therapy and Rehabilitation Sciences, University of Montana, Missoula, MT 59812, USA
| | - Leland E. Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT 84108, USA
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD 21287, USA
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