About this trial
This research project aims to measure how balance is affected by special visual stimulation. Dizziness caused by complex moving visual patterns, known as optokinetic stimulation, is usually called visually induced dizziness (VID).
The study includes patients with persistent symptoms after a concussion and those with non-traumatic dizziness. Healthy participants serve as a control group for the comparison of balance and symptom responses.
The optokinetic stimulation is done using either a physical rotating disk or a virtual reality (VR) headset. The visual effects are created by bright moving dots. During the stimulation, these patterns move in a specific manner and directions while the subject's balance is recorded. Symptoms such as dizziness, headache, and nausea are also documented.
The goal of this project is to improve objective diagnosis of VID. By comparing patients and healthy subjects, the study aim to assess the severity of the disorder. It is also assumed that using different visual stimuli during the balance assessment will offer more sensitive and accurate results.
In the long term, this innovative assessment method shall support clinicians to establish the diagnosis of VID, and improve the treatment and management of patients with VID.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
Age between 18 and 60 years
Binocular vision
Recent concussion/mTBI within 4 weeks to 18 months post-injury for concussed patients
Diagnosis related to dizziness or VID within 4 weeks to 18 months for non-concussed dizzy patients (including vestibular migraine)
Disqualifiers
BMI greater than 30
Acute vestibular syndrome lasting at least 24 hours
Severe non-correctable visual impairment
Neurological conditions (e.g., migraine)
Trial design
Crossover
Treatments tested in this trial
Postural Response upon physical optokinetic stimulation
Diagnostic testThe physical optokinetic stimulation consists of rotating stimulation in either direction using a physical disc (de Vestel, et al., 2022; Guerraz et al., 2001; van Ombergen et al., 2016). The assessment is conducted in complete dark, unless the fluorescent dots (approx. 11% covered of the disc area.). The disc has a diameter of 1 m. Stimulation time per trial will be 30 s.
Postural Response upon virtual optokinetic stimulation
Diagnostic testThe virtual optokinetic stimulation is implemented in virtual reality goggles (Meta Quest 3, Meta Platforms, Menlo Park, CA, USA) applying oscillating and rotating stimulation in frontal and vertical axis with coherent or incoherent stimuli. The assessment in the virtual environment will be as similar as possible compared the physical stimulation. Hence, the virtual environment simulation complete dark, unless the fluorescent dots (approx. 15% covered of the disc area.). In addition to the rotating condition, the virtual dots are able to oscillate on the horizontal or vertical axis to create a more sensitive evaluation method than the physical one (Laurens et al., 2011). Stimulation time per trial will be 30 s.
Treatment groups
Trial outcomes
Primary outcomes
Sensitivity of Postural Response to Optokinetic Stimulation
To identify visually induced dizziness through the balance assessment, cutoff values based on calculated balance parameters will be evaluated to differentiate balance responses between concussed patients, non-concussed dizzy patients, and healthy controls. The reference will be the VID assessment performed during the clinical examination. Measurement Tool: * 6D sensor system (accelerometer and gyroscope) placed on the lower back and head. * acceleration in m/s\^2 * gyroscope in deg/s) Unit of Measure: Calculations on the balance responses from each measuring site and sensor type (accelerometer, gyroscope) include temporal and spectral parameters such as: * 95% area of motion (m\^2/s\^4, deg\^2/s\^2) * RMS, SD, Mean (m/s\^2, deg/s) * Power Spectral Density (PSD) between 0.1-2 Hz ((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) * Power Spectral Density (PSD) at stimulation frequency of 1/3 Hz((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) Comparison: * Balance parameters among the investigated groups
Secondary outcomes
Identification of Different Postural Characteristics Response to Optokinetic Stimulation
It is hypothesized that patients with different diagnoses will exhibit distinct postural response patterns, which can be quantified and categorised. Based on the diagnosis, specific characteristics from the determined parameters shall be analysed. Measurement Tool: * 6D sensor system (accelerometer and gyroscope) placed on the lower back and head. * acceleration in m/s\^2 * gyroscope in deg/s) Unit of Measure: Calculations on the balance responses from each measuring site and sensor type (accelerometer, gyroscope) include temporal and spectral parameters such as: * 95% area of motion (m\^2/s\^4, deg\^2/s\^2) * RMS, SD, Mean (m/s\^2, deg/s) * Power Spectral Density (PSD) between 0.1-2 Hz ((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) * Power Spectral Density (PSD) at stimulation frequency of 1/3 Hz((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) Comparison: * Differences and rates of change in determined parameters are clustered across these groups
Severity of Visually Induced Dizziness
The balance assessment outcome shall be used to categorise the severity of visually induced dizziness based on calculated balance parameters. Measurement Tool: * 6D sensor system (accelerometer and gyroscope) placed on the lower back and head. * acceleration in m/s\^2 * gyroscope in deg/s) Unit of Measure: Calculations on the balance responses from each measuring site and sensor type (accelerometer, gyroscope) include temporal and spectral parameters such as: * 95% area of motion (m\^2/s\^4, deg\^2/s\^2) * RMS, SD, Mean (m/s\^2, deg/s) * Power Spectral Density (PSD) between 0.1-2 Hz ((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) * Power Spectral Density (PSD) at stimulation frequency of 1/3 Hz((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) Comparison: * Balance parameters will be classified into clusters, such as normal, borderline, and abnormal balance behaviour.
Other outcomes
Comparison of virtual and physical optokinetic stimulation in healthy subjects
Balance responses will be compared between the two arms of healthy subjects who complete both types of balance assessments (virtual and physical optokinetic stimulation). Measurement Tool: * 6D sensor system (accelerometer and gyroscope) placed on the lower back and head. * acceleration in m/s\^2 * gyroscope in deg/s) Unit of Measure: Calculations on the balance responses from each measuring site and sensor type (accelerometer, gyroscope) include temporal and spectral parameters such as: * 95% area of motion (m\^2/s\^4, deg\^2/s\^2) * RMS, SD, Mean (m/s\^2, deg/s) * Power Spectral Density (PSD) between 0.1-2 Hz ((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) * Power Spectral Density (PSD) at stimulation frequency of 1/3 Hz((m\^2/s\^4)/Hz, (deg\^2 /s\^2)/Hz) Comparison: * Balance parameters among healthy controls.
Sponsors and contacts
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Dominik Straumann
Lead sponsor
University of Zurich
Sponsor institution
University Hospital, Zürich
Collaborator
BrainCare Medical Group
Collaborator