Vestibular balance

EXTRA INFORMATION

Correcting issues of the vestibular system

WHAT WE KNOW

Our Research

Investigation of factors that modify the vestibulo-ocular reflex (VOR) response to optimize vestibular rehabilitation therapy

The balance system senses head motion via the balance organs and stabilises vision during head movements. Without it, your vision becomes blurry when your head moves and can be severely disabling. This system can self-repair after injury, but that varies between patients. We have developed a rehabilitation technique shown to reliably improve self-repair. This project consists of 13 individual experiments that will help us better understand how the balance system can be trained to improve using our new rehabilitation technique and device.

The effect of enhanced vestibular efferent transmission on plasticity of the mammalian vestibulo-ocular reflex (VOR)

We will address loss of balance, a pressing health-related issue that affects quality of life in up to 5% of the population. Once the balance organ is injured or degrades with age, few treatment options exist. We have identified a nerve-pathway crucial for balance adjustment and self-repair. We will test a mouse type that has this pathway genetically made more sensitive to determine whether stimulation of this pathway is a viable approach to improving recovery after balance loss in humans.

A new mouse model that determines the effects of a unilateral vestibular prosthesis on vestibular plasticity

Much like a cochlear implant restores auditory function, a vestibular prosthesis restores balance function. It is not clear whether the limited results from vestibular prostheses is due the device not stimulating one component (the otoliths) of the vestibular system essential for self-repair. We will test mutant mice that lack otoliths to determine the importance of stimulating the otoliths in restoring function. This work will shape the future direction of prosthesis development.

Development of a take-home rehabilitation device that improves vision and balance in patients with injury to the balance organs

This project will develop a rehabilitation device based on a training technique we invented, which has been shown to significantly normalise the vestibulo-ocular reflex (VOR) response in patients with vestibular organ lesions. Unlike all preceding methods, this technique is practical for vestibular rehabilitation and produces a significant increase in VOR response. We have achieved our first aim of building a rehabilitation device that can withstand the rigours of daily home use. Our current aim is to track VOR function, vision during head movement, standing balance, walking balance and quality of life in two randomised groups of patients with vestibular organ injuries over one week (our short-term clinical trial) and over one year (our long-term clinical trial). In one group, patients will use the rehabilitation device once daily for 15 minutes at home using our new training technique, whereas the other group will undergo the current best practise technique.

Treating dizziness in older people   

Between 10-30% of older community-living population report dizziness often leading to functional disability and psychological distress. The multifactorial aetiology of dizziness combined with a lack of validated diagnostic tests, and a tendency of clinicians to rely on poorly described symptoms and familiar assessments, are significant barriers to objectively establishing a successful diagnosis and implementing effective interventions. Thus, despite effective treatments being available, up to 40% of older people with reported dizziness remain undiagnosed and untreated. A multidisciplinary assessment battery, with new validated assessments of vestibular impairments is required for diagnosing and treating older people with dizziness. This project will therefore aim to conduct a randomised-control trial of a multifaceted dizziness intervention based on a multidisciplinary assessment, and develop a multiple profile assessment of dizziness for use in Specialist Clinics. The sample will comprise 300 people aged 70+ years. Baseline assessments will include self-report items and tests of vestibular, cardiovascular, neuromuscular, balance and psychological functioning. Interventions will be targeting the key underlying causes of dizziness and will be based on the highest level of evidence for each subtype and condition and include: vestibular rehabilitation, medication management, cognitive-behavioural therapy and exercise program. The primary outcome measures will be assessed at baseline and 6-month retest and will capture the four crucial aspects of the trial: reported dizziness, choice-stepping reaction time test (a composite balance measure), gait variability and quality of life. We anticipate that our project will produce a validated assessment tool for providing a differential diagnosis of dizziness and solid evidence that the burden of dizziness in older people can be effectively treated.

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