PROJECT SUMMARY/ABSTRACT
Deficits in gaze and postural stability are closely linked with vestibular hypofunction. These deficits result in
dizziness and poor balance, increasing the risk for falls and other poor health outcomes. Vestibular
hypofunction occurs with several conditions and is increasingly prevelant with advancing age. An estimated
85% of people over the age of 80 experience vestibular hypofunction. As with many age-related health
challenges (e.g. sarcopenia, osteoporosis, cardiovascular disease), exercise is widely recommended to
remediate the effects of vestibular hypofunction. Vestibular rehabilitation has demonstrated efficacy at
improving vestibular hypofunction in tightly controlled clinical trials, but the effectiveness in practice is limited
by two major barriers: 1) reduced patient adherence to the exercise program, and 2) inability to precisely
assess vestibular function. These are overlapping challenges; lack of access to vestibular function
assessments impedes effective dosing of rehabilitation as well as monitoring of patient adherence and
progress. Thus, personalization and monitoring—essential ingredients of nearly any health or exercise
regimen—are functionally missing in vestibular rehabilitation practice.
For this proposal, we have developed the Making INformed Decisions in Gaze and Postural Stability
(MINDGAPS) system, which utilizes wearable sensor technology to provide simple, precise measures of gaze
and postural stability, as well as remote monitoring of patient adherence to vestibular exercises. Additionally,
MINDGAPS leverages NIH Toolbox data to display patient status compared to normative values and to
indicate progress over time relative to measurement error. This enables the application of two innovative
behavioral science principles aimed at facilitating patient adherence: 1) social norming; comparison of a patient
to her or his peers, and 2) frequent monitoring of progress and outcomes. This study is designed to examine
the preliminary efficacy of the MINDGAPS system, along with the feasibility, safety, and acceptability of its use
in practice. We will use a single cohort, double-basline design (n=30 older adults with vestibular hypofunction).
Following, the baseline (control) phase, all participants will complete 6 weeks of individualized vestibular
rehabilitation informed by the MINDGAPS system. Preliminary efficacy of the intervention will be examined by
comparing computerized Dynamic Visual Acuity (cDVA) scores during the intervention phase to cDVA scores
during the baseline phase. Other clinical outcomes (e.g., postural stability, video-head impulse testing, patient
reported dizziness) will also be examined. Feasibility and safety of the intervention will be examined relative to
a priori thresholds for recruitment, retention and adherence rates, as well as recording of adverse events.
Finally, the acceptability and remote/telehealth capability of the system will be explored using a mixed methods
analysis, which will inform system refinement in preparation for a future R01 submission (phase II clinical trial).
