mVOR: An mHealth Approach to the Clinical Assessment of Gaze Stability and Telerehabilitation of Vestibular Dysfunction

Title: mVOR: An mHealth approach to the clinical assessment of gaze stability and telerehabilitation of
vestibular dysfunction
Abstract: Patients with vestibular dysfunction often suffer from gaze instability and an increased risk of falls.
Current practice guidelines recommend the use of vestibular rehabilitation for vestibular dysfunction. If patients
need to undergo home therapy, additional sensors and instrumentation can pose a challenge in supporting the
use of telehealth to objectively assess the contribution of the vestibulo-ocular reflex (VOR) to gaze stability
objectively. Following head velocity-based parameters for vestibular rehabilitation has been shown to be
effective in patients with dizziness and disequilibrium due to peripheral vestibular loss. However, head
velocity-specific goals can largely be ignored as part of home vestibular physical therapy because there is
no user-friendly way to directly measure head and eye motion without being connected to some form of
external hardware. Although there have been notable attempts to utilize virtual reality and mobile-based
technology to monitor postural balance and head motion, advances in native smartphone-based technology
and computer vision models could provide us the ability to develop a simple, patient-friendly approach to
assessing the VOR. In this project, we aim to develop a mHealth app (mVOR) under the guidance of
expert practitioners who specialize in the care of patients with vestibular dysfunction. mVOR will allow for a
self-administered vestibular dysfunction assessment by approximating the VOR with a well-established
psychophysical test, the gaze stabilization test (GST) protocol. We plan to develop a user-friendly mHealth
app that can provide gaze stability outcomes accessible by patients (mVOR: APP) and clinicians (mVOR:
DMP). mVOR will ultimately provide users with a single clinical outcome measure (GST score): the highest
head velocity (in degrees per second) at which they can maintain their visual acuity. Through the mVOR, the
user's smartphone front camera and microphone will accurately obtain visual acuity data and visual
processing speeds and track head and eye movements acquired by computer vision algorithms and human-
computer interactions. The mVOR: DMP app will graphically summarize results from the mVOR test
protocol, which may aid in further shared decision-making from anywhere. Human subject trials
performed at our partnering research institution (University of Virginia) will ultimately pave the way for
studying the usability, feasibility, and validity of this tool in patients with vestibular dysfunction best served by
home vestibular rehabilitation.

Grant Number: 1R41DC022209-01
NIH Institute/Center: NIH
Principal Investigator: Sheikh Ahamed