Abstract
(1) Background: Current vestibular rehabilitation therapy is an exercise-based approach aimed at promoting gaze stability, habituating symptoms, and improving balance and walking in patients with mild traumatic brain injury (mTBI). A major component of these exercises is the adaptation of the vestibulo-ocular reflex (VOR) and habituation training. Due to acute injury, the gain of the VOR is usually reduced, resulting in eye movement velocity that is less than head movement velocity. There is a higher chance for the success of the therapy program if the patient (a) understands the exercise procedure, (b) performs the exercises according to the prescribed regimen, (c) reports pre- and post-exercise symptoms and perceived difficulty, and (d) gets feedback on performance. (2) Methods: The development and laboratory evaluation of VestAid, an innovative, low-cost, tablet-based system that helps patients perform vestibulo-ocular reflex (VORx1) exercises correctly at home without therapist guidance, is presented. VestAid uses the tablet camera to automatically assess patient performance and compliance with exercise parameters. The system provides physical therapists (PTs) with near real-time, objective (head speed and gaze fixation compliance), and subjective (perceived difficulty and pre- and post- exercise symptoms) metrics through a web-based provider portal. The accuracy of the head-angle and eye-gaze compliance metrics was evaluated. The accuracy of estimated head angles calculated via VestAid’s low-complexity algorithms was compared to the state-of-the-art deep-learning method on a public dataset. The accuracy of VestAid’s metric evaluation during the VORx1 exercises was assessed in comparison to the output of an inertial measurement unit (IMU)-based system. (3) Results: There are low mean interpeak time errors (consistently below 0.1 s) across all speeds of the VORx1 exercise, as well as consistently matching numbers of identified peaks. The spatial comparison (after adjusting for the lag measured with the cross-correlation) between the VestAid and IMU-based systems also shows good matching, as shown by the low mean absolute head angle error, in which for all speeds, the mean is less than 10 degrees. (4) Conclusions: The accuracy of the system is sufficient to provide therapists with a good assessment of patient performance. While the VestAid system’s head pose evaluation model may not be perfectly accurate as a result of the occluded facial features when the head moves further towards an extreme in pitch and yaw, the head speed measurements and associated compliance measures are sufficiently accurate for monitoring patients’ VORx1 exercise compliance and general performance.
Highlights
Introduction conditions of the Creative CommonsAn estimated 35.4% of adults in the United States have some kind of vestibular dysfunction requiring medical attention [1,2]
We describe lab-testing of the feasibility of the VestAid system by: (1) Testing the accuracy of the VestAid head-angle estimation algorithm by comparing its performance against HopeNet [11], a state-of-the-art deep-learning method that requires too much computational load for use in the tablet-based app; (2) testing the accuracy of the VestAid head-turn frequency determination method by comparing its performance to an inertial measurement unit (IMU) affixed to the back of the head during the conduct of the exercises; and (3) evaluating the eye-gaze compliance algorithm using a publicly available dataset
Once we established that the algorithms perform well on static face figures from the public dataset, we conducted the second evaluation, i.e., the evaluation of the head-speed compliance metric resulting from the implementation of the algorithms in the app
Summary
An estimated 35.4% of adults in the United States have some kind of vestibular dysfunction requiring medical attention [1,2]. This dysfunction usually results in dizziness and vertigo, which can impact daily life and is a major risk factor for falls. The most common exercises provided for persons with complaints of dizziness and concussion are gaze stabilization or VORx1 adaptation exercises. In these exercises, patients perform active eye and head movements in a lighted room while focusing on a target. These exercises recalibrate the VOR through the concept of retinal slip [5]
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