2014 BC Balance and Dizziness Disorders Society Awards
A total of $10,000 in grants for research into improving treatment of balance and dizziness disorders was awarded in the third year of our awards program. To a research group at Vancouver General Hospital (VGH) led by Dr. Nicole Acerra went $5000; an equal amount was awarded to a second group at VGH led by Dr. Emily Kershner.
Read about the 2014 projects:
- Comparison of standard vestibular rehabilitation with a specialized rehabilitation program based on specific patient symptoms
- Using virtual reality as a tool in vestibular rehabilitation
Comparison of standard vestibular rehabilitation with a specialized rehabilitation program based on specific patient symptoms
Led by Dr. Nicole Acerra, vestibular physiotherapist at VGH, Department of Physical Medicine.
Summary of project: Two years ago a research project by members of our group studied results of two tests of balance; posturography (which measures body balance) and “VEMPs” (which measures head and neck balance). Results from this research showed that there is no association between the two, which suggested to us that these two systems may operate independently.
Traditional vestibular physiotherapy treatments have been aimed at training these two systems to work together, but we aim to try a new approach. We will divide patients into two groups based on test results, and aim to compare traditional therapy methods with a new “eyes closed” method in patients who have measured “body balance” abnormalities. We need funding for an experienced vestibular physiotherapist. We hope this “tailoring” of therapy will assist those patients who have not benefited a great deal from traditional therapy.
Significance of research: There are two different reflexes which are driven by a normally functioning balance system, (or even a damaged system which has been effectively compensated for). Vestibular patients often suffer spinning but often are also off balance and also feel disoriented when they move their head at all. It is well recognized (but poorly understood) that in some patients, these symptoms do not recover despite management with therapy from competent professionals. These symptoms can often persist and can severely affect everyday life.
Past research (in astronauts for instance) has shown that both these symptoms are from the vestibular system and some recent evidence of ours has suggested these two chores (stabilizing the body and stabilizing the head) may be driven by two different vestibular pathways. In our lab, we are able to report which tests are abnormal and suggest which pathway might be affected, and we feel that this process might lead to an ability to recommend a more “focused” form of rehabilitation for patients. We propose to use this grant money to fund an appropriate professional in order to develop our new “tailoring” process which is aimed at a patient’s specific complaints.
Led by Dr. Emily Keshner, VGH and Temple University, Philadelphia
Summary of project: So-called “traditional” complaints of dizziness (e.g., spinning) are often accompanied by extreme nausea and also newly developed motion sickness. Past work has shown this to be the result of otolithic pathology (structures in the inner ear which are poorly understood). Often these patients are also nauseated by extreme visual stimuli such as crowds or busy shopping malls. These symptoms are generated by an inappropriate reliance on visual cues (because there is something wrong with the balance system). Patients are sometimes debilitated on a long term basis.
A renowned researcher who studies this problem by exposing patients to virtual reality environments has expressed a wish to work with dizzy and imbalanced patients in Vancouver. She would like to work with us to develop a new rehabilitation technique with virtual reality goggles. This research would require involvement by a vestibular physiotherapist to evaluate success of virtual reality compared to standard vestibular physiotherapy.
Significance of research: The concept of compensation for balance system damage is a process of recovery where the brain learns to use other environmental signals to assist in keeping balance (from the feet, trunk and eyes). The effectiveness of this process is often enhanced by vestibular rehabilitation in an effort to maximize the use of this alternative information. Many patients recover by making effective use of these alternate inputs. There are some patients who do not have actual imbalance but instead they develop an abnormal hypersensitivity to certain environmental movement or patterns, and for some reason, these stimuli generate unpleasant nausea and anxiety. Why some patients develop this is poorly understood, and there is some suggestion that, this sensitivity could possibly be minimized by “virtually reality” environments which might teach patients to appropriately ignore the disagreement between the incoming signals. Work done in a highly regarded lab in the United States has developed some new virtual reality techniques, and we have wondered (because there is a group of patients who still have symptoms for years) if these patients might benefit from the new virtual reality techniques rather than traditional therapy. We hope to work with our visiting researcher to develop these techniques.