Patients ‘Head over Heels’ for Dizziness Research via Rotating Chair
Problems with the inner ear can push some to their outer limits. Dr. Craig Formby doesn’t take such problems sitting down, but those he assists sometimes do.
Formby’s research interests encompass a groundbreaking invention – a chair that tests portions of the inner ear, which play a crucial role in maintaining balance – and an innovative investigational study of tinnitus, that chronic buzzing or ringing tone in the ear that can drive people to distraction or … even suicide.
First, the chair. The stunning aspect of the machine, which Formby calls the Roto-Tilt Chair, is its capacity to explore why people are dizzy and have balance problems.
“What we can do with it, no one else can do,” says Formby, a distinguished graduate research professor in The University of Alabama’s department of communicative disorders.
Dizziness and lack of balance are no laughing matter. Dysfunction of the vestibular inner ear plays a role in an estimated half of all fall-related injuries and deaths among senior citizens in the United States. Falls are the leading cause of fatal and nonfatal injuries among senior Americans, Formby says, and historical data indicate that at least one-third of all Americans age 65 and older will suffer a fall this year.
“The enormous societal health-care problem and projected future expenses, which are estimated to top $40 billion by 2020, and the fact that most elderly fall injuries and related deaths are preventable, have motivated and intensified national efforts toward an all-out attack on elder falls,” Formby says.
Formby, who, in addition to his College of Arts and Sciences position also has appointments in the College of Engineering and School of Medicine at UA, is a National Institutes of Health-funded investigator.
With the new chair, Formby can evaluate a sitting patient by spinning the chair, by rapidly tilting the chair, or by combining the spinning and tilting actions to achieve specific motions or positions that activate the individual inner ear structures. Researchers can monitor, through the movements of the chair and the eyes, how the patients are dealing with the two basic sensory systems that control their balance: the visual and vestibular systems.
These two systems must work together: The visual system receives input from the eye, while the vestibular system, through the intricate workings of the fluid-filled canals and sensory structures within the inner ear, senses changes in head position that are critical for maintaining balance as the eyes focus on an image.
The question is, when you’re dealing with something as complicated as the inner ear, with its many mechanisms, how do you pinpoint what’s not working properly?
The custom-designed roto-tilt chair can help answer that question. The device, built to Formby’s specifications by Neuro Kinetics Inc. of Pittsburgh, is installed in the AIME Building at UA. Specific motions and positions of the chair can be used to test particular parts of their vestibular system, and visual displays can be presented to assess related eye movement disorders.
“The way the chair is built, the machine can assess all three planes of motion – yaw, roll, and pitch, to use pilot’s terms,” he says. “Yaw is rotating movement like that of the spinning office chair, roll is sideways rotation, and pitch sends you head-over-heels.”
Formby began working on the chair about eight years ago at the University of Maryland School of Medicine. Funding for the machine has come from both the National Institutes of Health and UA. At UA, he’s working with Dr. Keith Williams, associate professor of mechanical engineering, his graduate student David Wilson, and Dr. Tim Haskew, professor of electrical engineering.
As for what the chair can teach, the sky’s the limit.
“We have already visited NASCAR headquarters in Charlotte, N.C. to discuss potential applications of the chair for improving safety of the driver and safety of patients who will be tested in the chair,” Formby says.
“It’s so powerful and flexible that I will end my career and won’t have had enough time to do it justice,” says Formby. “So, we plan to share its use with outside researchers.”
The chair will be a national and even international resource, as UA engineers will work on new applications for it with colleagues from the UA School of Medicine and UAB, where Formby holds an affiliate appointment.
Meanwhile, Formby also is working on an investigational study of a controversial treatment for tinnitus. Tinnitus is a chronic or intermittent sound that sufferers hear coming from their ears or within the head in the absence of any outside signal.
“No one has found a definitive cause or cure for it yet,” Formby says. “Most people can deal with the tinnitus sound, but some can’t.” An estimated 2 million to 5 million people in the U.S. are debilitated by tinnitus for no known reason, Formby says.
While in Maryland, Formby directed an innovative tinnitus treatment program that enjoyed world-wide acclaim for pioneering new techniques to reduce the effects of tinnitus. The founder of this treatment approach, Dr. Pawel Jastreboff, implemented the protocol in two parts. The first prong involves specialized counseling and assurance that the tinnitus condition is not a life-threatening situation for the patient, Formby says.
The second prong uses sound therapy. The patient wears in-the-ear devices that emit soft noise. The noise distracts the sufferer from the tinnitus and minimizes its audibility.
Despite the new treatment program’s promise, controlled clinical trials are needed to prove its efficacy. Formby has designed an investigational trial, which received preliminary NIH funding to support planning and organization of the study. He’s working with the U.S. Armed Services to conduct the clinical trial. The subjects will be Naval, Marine and Air Force personnel who suffer from disabling tinnitus.
“What we’re trying to do is to determine whether the combined counseling and sound therapy protocol really works, and, if so, then is it better than usual and customary care, which in military clinical centers usually involves reassurance,” Formby says. “It is critical to the patient and the clinician to know whether paying thousands of dollars for noise generators provides significant added benefit beyond the effects of the counseling.”
The planned multi-million-dollar clinical trial will be a joint project with the Johns Hopkins School of Public Health.
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