Production of a device to obtain continuous ambulatory vestibular assessment (CAVA)

In England and Wales, 8 out of every 1,000 patients are likely to consult their GP complaining of dizziness every year. Dizziness is the most common reason for a doctor to visit a patient over the age of 75 years old, and one-third of adults over the age of 65 years experiences at least one fall each year. This is particularly important as the cost of falls to the NHS and social services in people over 60 years old in 1999 was £981 million. However, we are currently significantly restricted with respect to what specialist tests are available for assessing patients with dizziness, because there are no tests available to evaluate a patient during an actual dizziness attack in the community. If this were possible, an accurate diagnosis could be made there and then, rather than speculating as to what the cause of the dizziness attack was days or weeks after the event when the patient has recovered. The US National Institutes of Health reports that the average number of doctors that a patient with dizziness visits before receiving a correct diagnosis is 4.5, and a similar finding is reported from specialist balance centers in the UK. We have developed and successfully tested a prototype body worn device to diagnose the cause of dizziness in the community, and are applying to the Medical Research Council to fund the next stage of device development. Once fully developed and tested in clinical studies, it is hoped that our device will be made available at the point of initial referral to a doctor or nurse to avoid delay in diagnosis and ensure cost-effective use of appropriate resources.

Our current prototype device is only partly developed, and as such currently requires the involvement of a large, bulky and uncomfortable to wear module; as it has been constructed using unrefined electronics and off the shelf materials to prove that it is a viable concept. Our application to the Medical Research Council is to fund the development of a complete bespoke device that would be a lightweight, durable, body worn monitoring device that could be worn day and night. In addition to this, funding from the Medical Research Council would support the development of specialist computer software to analyse the data produced by our refined device.

Dizziness is a common condition that is responsible for a significant degree of material morbidity and burden on our health service. There are multiple causes of dizziness, and these originate from pathologies affecting a large variety of different organ systems. Dizziness is usually episodic and short-lived, so when a patient presents to their health care provider, examination is often normal. As such, diagnosis is challenging and patients often experience significant delay in receiving a diagnosis. We have developed a prototype device for monitoring dizziness and have tested it in a small group of volunteers. The results showed that our device is capable of accurately, precisely and reliably identifying periods of dizziness over a short period of time. Independent market research has confirmed that our device could meet the required clinical need, would be desired by clinicians, and that there is no equivalent solution currently available. We seek funds to trial our device in a large cohort of healthy volunteers and a large cohort of patients with a defined dizziness syndrome. We will then be positioned well to test our device in a more diverse patient population. Once validated, developed and brought to market, the device would provide early diagnosis and accurate treatment for a significant proportion of the patient population. This would save the NHS money by reducing multiple visits to GP clinics, reducing referrals to multiple specialist clinics, and reducing treatment required from falls and other conditions associated with dizziness.

This research will benefit patients, clinicians, healthcare systems (NHS) and researchers who are interested in gaining greater insight into the causes and mechanisms responsible for many balance disorders and types of dizziness conditions. Patients will benefit from a quicker and more accurate definition of the cause of their symptoms. Clinicians will benefit from having a clearer understanding of the cause of their patient's symptoms earlier on in the diagnostic process. Healthcare systems will save money by reducing the number of patient consultations required before a diagnosis is made, and avoid the use of unnecessary expensive specialist tests. Governments would be able to implement amended patient pathways allowing a greater transition from hospital-centered care to a more cost-effective community-based concept of care.

Dizziness is the most common reason for a physician to visit a patient over the age of 75 years old, and one-third of adults over the age of 65 years experiences at least one fall each year. There is great potential in improving the direct health of patients with dizziness, but also indirectly improve the health of patients be reducing the risk of falling, particularly in the elderly. The cost of falls to the NHS and social services in people over 60 years old in 1999 was £981 million. In addition to this, balance disorders are responsible for work absence, early retirement and a significant reduction in quality of like. The development of this device will contribute to the nation's health culture by promoting diagnostic investigations to be performed outside the hospital or surgery environment.

Other beneficiaries include, private health care companies, technology companies and UK businesses that may be involved in the various roles associated with the manufacture, marketing and promotion of this device. As a new diagnostic tool, a whole new field of balance medicine may be created, allowing further research into balance disorders from a perspective never appreciated before. This will promote further research into balance disorders that have been derived from the primary outcomes of our initial research performed using this device.

This application is for a key stage in the development of our device, for use and testing in healthy individuals and in patients with a specific dizziness syndrome. The timescale for some of the benefits of this device will be realised by the end of duration of this grant (36 months), and a full working device would be available for further clinical trials in an undiagnosed population of patients. The full benefits of this device is likely to be fully realised in 3 to 5 years.

The research associate employed on this project will develop skills in both research and other professional areas. In research, he or she will learn how to plan and execute a research project, from reviewing literature to posing research questions to formulating experiments and interpreting results. In doing the research, he or she will develop their knowledge of machine-learning and pattern recognition theory and techniques, and also strengthen and expand their programming skills. In the latter stages of the project, he or she will develop their understanding and knowledge of app programming for mobile devices, which is a skill that is currently sought after in many different areas of industry. Overall, he or she will also learn how to participate in a project team as a technical member and how to contribute to the development of a project as a leader, managing a variety of individual project components.