Smart tech to treat debilitating balance disorders

Last year, TV doctor Michael Mosley took the participants in his Channel 4 weight -loss programme by surprise when he asked them to close their eyes and stand on one leg. Dr Mosley wasn't playing games.

He was highlighting the results of a study by the UK's Medical Research Council that linked three measures of physical capability – balance, grip, and chair-rise speed – with life expectancy. Of the three strengths tested, poor standing balance was identified as more strongly associated with mortality.

A healthy adult aged 40 or under should be able to balance on one leg with their eyes closed for at least 20 seconds. Those over 40 will find 10 seconds a challenge and staying power declines with age.

Watching Mosley’s participants flail and wobble made for good TV, but there was a serious undercurrent. Various studies over the past 20 years have identified an association between balance and heart and brain health. Japanese research, published in the Stroke journal in 2014, found that postural instability was “associated with early pathological changes in the brain and functional decline, even in apparently healthy subjects”.

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Those unable to remain upright on one leg for 20 seconds showed a higher rate of reduced cognitive function, micro bleeding in the brain and a type of stroke known as a small lacunar infarction. In short, there is ample evidence to suggest that balance has significant implications for health outcomes.

Loss of balance can happen at any age and is a deeply unpleasant sensation that can cause nausea and vomiting as well as unsteadiness. Balance disorders affect an estimated 35 per cent of adults worldwide and are of particular concern in older people as vertigo (where one’s surroundings spin) and dizziness (where one feels light-headed and unbalanced) increase the risk of falling 12-fold, often with life-limiting consequences.

Normally, our brains use information from the complex vestibular system in our ears, eyes and proprioceptor sensors in our muscles and joints to keep us balanced. However, infection, injury, medication, ageing and conditions such as arthritis can disrupt this delicate mechanism. Approximately 1.8 million people in Ireland, the UK, Australia and the US visit their doctor each year with vertigo and those experiencing a serious and ongoing loss of balance will need rehabilitative exercises to recover.

For over two decades, physiotherapist Dr Dara Meldrum has specialised in treating those with balance problems. However, she has always felt the standard treatment of giving patients photocopied exercises to do at home was inadequate. Progress is monitored with pen and paper, repeat visits to a therapist are required and it's easy for motivation to flag if patients are not sure they're doing their exercises correctly.

Meldrum describes the existing treatment model as “completely outdated and ripe for disruption”, and in 2011 she began looking at how she could combine her interest in technology with her clinical expertise to develop a better treatment for vestibular rehabilitation.

Meldrum was working on her PhD at the Royal College of Surgeons when by chance she saw children playing a video fitness game that gave them feedback about their balance via a foot board. This set her mind whirring and between 2011 and 2014 she conducted a randomised control trial to assess the accuracy of this type of balance tracking.

Positive results convinced Meldrum she was on to something and she has since developed Vertigenius, a medical device that uses smart technology to assess balance, dynamic visual acuity and gait speed to rehabilitate patients with balance disorders more effectively.

Vertigenius is a sea change in how vestibular rehabilitation is managed. It takes treatment out of the dark ages of printed handouts and manual in-person monitoring and replaces it with a wearable sensor, a patient app and a clinician’s dashboard that can monitor and tweak a patient’s treatment remotely if required.

At the heart of Vertigenius’ solution is a sensor that looks like a conventional hearing aid and is worn by the patient during their exercise session. The sensor is paired via Bluetooth to a smartphone app and its key role is to give clinicians accurate feedback on head movement – a crucial parameter for successful treatment.

People with balance problems commonly find that moving their heads makes them feel worse so they avoid doing so. However, moving the head in a gentle and methodical way is vital if the brain is to learn to compensate for the balance disorder.

Vertigenius records the patient’s head movement in real time and uses an algorithm to crunch the velocity, frequency, angle and plane of movement to get an indication of how rapidly and severely their symptoms are provoked by head movement. This helps the clinician decide what type of exercises to prescribe and the intensity and frequency with which they should be done.

“This knowledge is critical for motor learning and to ensure that patients don’t do too much or too little, or move too slowly or too fast. In a nutshell, Vertigenius automates every step in the rehabilitative process and allows an individual’s rehabilitation to be progressed a lot more sensitively and scientifically,” Meldrum says.

“The patient app can deliver exercises from a library of over 250 movements specific to vestibular rehabilitation and it guides patients through their exercises, coaches them to follow their prescription and records their compliance and symptom burden.”

Dr Deirdre Murray, a clinical specialist in vestibular rehabilitation at Beaumont Hospital, has been piloting Vertigenius with a group of 15 patients since last September. "The system completely came into its own with Covid as we were trying to minimise face-to-face consultations and Vertigenius allowed us to remotely monitor patients and adjust their programme with no break in treatment," she says.

“The system will speed up how quickly patients can be treated and it is a highly-structured approach that really keeps people on track. Vestibular rehabilitation exercises are a bit weird, for want of a better word, and it’s important that the exercises are done correctly, so having the video guidance on Vertigenius is a big help. The app will also open up the availability of treatment as currently people have to travel for this specialist service.”

Balance rehabilitation software is already available but not at a price or in a way that makes it widely accessible. “Basically, there is no low-cost sensor-enabled technology for balance and vestibular rehabilitation and this is what has been developed over the last five years with the input of my very capable team,” Meldrum says.

“Our solution is a win-win for the patient and the practitioner. It makes doing the exercises easier which will improve compliance and ultimately treatment outcomes. From the practitioner’s side, preparing individual exercise sheets is time consuming and our portal will let them complete the process in two minutes and send the programme directly to a patient’s phone.”

Meldrum teamed up with software developer and healthtech expert Richard Skinner to bring the Vertigenius platform to life and Skinner has subsequently become her business partner. Vertigenius will be spun-out from Trinity College (where Meldrum is currently a senior research fellow in the academic unit of neurology) in April.

The project has been funded by Enterprise Ireland under its commercialisation programme and the next step is a fundraising round of €750,000 to progress to key milestones such as regulatory approval for the device with a view to launching it on the market later this year.