VestAid: A Tablet-Based Technology for Objective Exercise Monitoring in Vestibular Rehabilitation

Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction

The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.

Remote assessment and management of patients with dizziness: development, validation, and feasibility of a gamified vestibular rehabilitation therapy platform

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.

Effectiveness of Telerehabilitation in Dizziness: A Systematic Review with Meta-Analysis

Dizziness can be a debilitating condition with various causes, with at least one episode reported in 17% to 30% of the international adult population. Given the effectiveness of rehabilitation in treating dizziness and the recent advancements in telerehabilitation, this systematic review aims to investigate the effectiveness of telerehabilitation in the treatment of this disorder. The search, conducted across Medline, Cochrane Central Register of Controlled Trials, and PEDro databases, included randomized controlled trials assessing the efficacy of telerehabilitation interventions, delivered synchronously, asynchronously, or via tele-support/monitoring. Primary outcomes focused on dizziness frequency/severity and disability, with secondary outcomes assessing anxiety and depression measures. Seven articles met the eligibility criteria, whereas five articles contributed to the meta-analysis. Significant findings were observed regarding the frequency and severity of dizziness (mean difference of 3.01, p < 0.001), disability (mean difference of -4.25, p < 0.001), and anxiety (standardized mean difference of -0.16, p = 0.02), favoring telerehabilitation. Telerehabilitation shows promise as a treatment for dizziness, aligning with the positive outcomes seen in traditional rehabilitation studies. However, the effectiveness of different telerehabilitation approaches requires further investigation, given the moderate methodological quality and the varied nature of existing methods and programs.

A gaming app developed for vestibular rehabilitation improves the accuracy of performance and engagement with exercises

Introduction

Vestibular hypofunction is associated with dizziness, imbalance, and blurred vision with head movement. Vestibular rehabilitation is the gold standard recommendation to decrease symptoms and improve postural stability. The Clinical Practice Guidelines for vestibular hypofunction suggest home exercises 3-5 times daily, but patient adherence is a problem, with compliance rates often below 50%.

Methods

An app was developed to increase engagement with home exercises by providing exercises as games. This study compared the accuracy of exercise performance in a one-time session using the app versus no-app and gathered participant feedback on using the app for vestibulo-ocular reflex (VOR) and balance exercises. The app was tested with 40 adults (20 women), mean age of 67 ± 5.7 years, with symptomatic unilateral or bilateral vestibular hypofunction. Participants completed VOR exercises in pitch and yaw planes, weight-shift, and single-leg balance exercises using an inertial motion unit to move the character on the tablet screen. Participants were randomly assigned to begin the exercises with or without the app.

Results

Results show that during VOR exercises, participants achieved the prescribed frequency of head motion for the yaw plane (p ≤ 0.001) and reduced variability of head movement frequency in both the yaw (p ≤ 0.001) and pitch plane (p ≤ 0.001) in the app compared to the no-app condition. During weight-shifting exercises, a larger range of body motion was noted in the anteroposterior and mediolateral directions in the app compared to the no-app condition (p < 0.05). During single-leg balance exercises, pelvic motion was lower in the app versus no-app condition (p = 0.02). Participants modified their exercise performance and corrected their mistakes to a greater extent when they used the app during the VOR exercises. Participants agreed that they felt motivated while playing the games (97%) and felt motivated by the trophies (92%). They agreed that the app would help them perform the exercises at home (95%), improve their rehab performance (95%) and that it was fun to do the exercises using the app (93%).

Discussion

The results of this study show that technology that is interactive and provides feedback can be used to increase accuracy and engagement with exercises.

Vestibular rehabilitation in cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS)- A case report

Background and purpose

Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) is a neurodegenerative disease of the cerebellum. The disease progression is slow, with up to 25% of people diagnosed needing to use a wheelchair after 15 years from diagnosis. Vestibular symptoms arise from centrally-mediated ocular movement degradation and the reduced vestibular-ocular reflex functioning bilaterally. To date, no report has shown an improvement in VOR gain or gait outcome measures in someone with CANVAS after a course of vestibular physical therapy.

Case description

A 65-year-old male, Patient X, first noticed symptoms in his fourth decade of life and was diagnosed with (CANVAS) in his seventh decade. Patient X reported numbness and tingling in his hands and feet, decreased ability to perform daily activities, and several falls.

Intervention

Patient X completed a four-month course of vestibular physical therapy, including vestibular ocular reflex exercises, balance training, gait training, and the VestAid application for eye gaze compliance monitoring. The Vestaid application uses eyes and facial recognition software to record the percentage of time that the patient kept their eyes on the target.

Outcomes

After vestibular therapy, Patient X had a clinically meaningful improvement in gait speed: from 1.02 m/s to 1.13 m/s and in the Functional Gait Assessment from 20/30 to 27/30. Patient X's eye gaze compliance improved from a median of 43% (range 25-68%) to a median of 67% (58-83%).

Discussion

This case study demonstrates that vestibular rehabilitation improved eye gaze compliance and functional outcomes in a person living with CANVAS.

Smartphone-Assisted Medical Care for Vestibular Dysfunction as a Telehealth Strategy for Digital Therapy Beyond COVID-19: Scoping Review

BACKGROUND

Dizziness and vertigo can be caused by various factors, such as peripheral vestibular and central disorders. Although consultations with specialists are advisable when necessary, patients with severe vertigo symptoms may have limited mobility, which may interfere with hospital visits. The spread of COVID-19 has further limited the number of hospital visits for patients with dizziness; therefore, a method of medical care that enables more accurate treatment under time and geographical constraints is needed. Telemedicine has become widespread, owing to the popularity of smartphone and tablet devices in recent years, and the use of devices and systems has made it possible to provide efficient medical care. However, no previous scoping review has mapped existing studies on telemedicine for vertigo and dizziness, and no recommendations have been made regarding which devices and systems should be used for specific diseases.

OBJECTIVE

The aim of this review was to map and assess previous studies on the use of information communications technology, smartphones, and apps for treating patients with vertigo and discuss the added value of introducing telemedicine to improve the quality of medical care and create an environment that builds security and trust among patients.

METHODS

A scoping review was conducted with the methodological framework of Arksey and O'Malley and in accordance with the of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. The PubMed, MEDLINE, and Cochrane Library databases were searched to retrieve previous reports on smartphone-assisted telemedicine treatment for vertigo published between January 2000 and May 2023. Two authors independently assessed eligibility and extracted data.

RESULTS

This review included 20 papers that reported devices or systems for telemedicine for vestibular dysfunction. Among studies that reported the use of a device or app, 2 were related to anamnesis and subjective symptoms, 12 were related to objective examination, 7 were related to remote diagnosis, and 7 were related to treatment and rehabilitation.

CONCLUSIONS

With the advancement of technology, the use of telemedicine in patients with dizziness may be feasible. In the future, it will be necessary to consider how telemedicine can be used in dizziness treatment and develop an effective treatment system combining in-person medical care and the effective use of devices for the management of severe vertigo and related diseases. The smooth introduction of telemedicine in vertigo treatment is expected to improve the quality of treatment, increase opportunities for patients to receive medical care, and reduce time and travel costs, leading to a sense of security and trust among patients.

Utility of VestAid to Detect Eye-Gaze Accuracy in a Participant Exposed to Directed Energy

INTRODUCTION

The VestAid is a tablet-based application that provides feedback about a patient's eye/head movements during exercise after concussion. The goal of this case series was to determine if VestAid could be used to detect eye-gaze accuracy in a participant exposed to directed energy (DE).

MATERIALS AND METHODS

The VestAid results of a participant with DE were compared to an age- and gender-matched healthy control, a participant post-concussion, and a participant with vestibular neuritis. A tablet with VestAid software was utilized to record eye-gaze accuracy and head speed during VORx1 exercises using eye and facial recognition as participants were exposed to 12 visual scenes.

RESULTS

The participant with DE consistently had difficulty with eye-gaze accuracy when the head was rotated towards the right for all trials. The participant with DE had poor eye-gaze accuracy during all phases of the head turn cycle compared to the control participant (mean 47.91%, [SD = 7.32%] for the DE participant versus mean 94.28%, [SD = 5.87%] for the control participant). Post-exercise dizziness and perceived difficulty in the 12 exercises completed by the participant with DE were strongly related (Spearman's rho = 0.7372, P = .0062). The participant with DE had the lowest scores on 10 of the 12 head movement trials.

CONCLUSIONS

VestAid provided unique information about eye-gaze accuracy that detected eye movement abnormalities in the participants with DE exposure, concussion, and vestibular neuritis. The objective metrics of eye-gaze stability correlate with participants' symptoms and perceived difficulty of the eye/head movements.

Development of an Automatic Pill Image Data Generation System

OBJECTIVES

Since the easiest way to identify pills and obtain information about them is to distinguish them visually, many studies on image processing technology exist. However, no automatic system for generating pill image data has yet been developed. Therefore, we propose a system for automatically generating image data by taking pictures of pills from various angles. This system is referred to as the pill filming system in this paper.

METHODS

We designed the pill filming system to have three components: structure, controller, and a graphical user interface (GUI). This system was manufactured with black polylactic acid using a 3D printer for lightweight and easy manufacturing. The mainboard controls data storage, and the entire process is managed through the GUI. After one reciprocating movement of the seesaw, the web camera at the top shoots the target pill on the stage. This image is then saved in a specific directory on the mainboard.

RESULTS

The pill filming system completes its workflow after generating 300 pill images. The total time to collect data per pill takes 21 minutes and 25 seconds. The generated image size is 1280 × 960 pixels, the horizontal and vertical resolutions are both 96 DPI (dot per inch), and the file extension is .jpg.

CONCLUSIONS

This paper proposes a system that can automatically generate pill image data from various angles. The pill observation data from various angles include many cases. In addition, the data collected in the same controlled environment have a uniform background, making it easy to process the images. Large quantities of high-quality data from the pill filming system can contribute to various studies using pill images.