Balance Cap -- In-Depth Doctor's Interview

What are balance disorders and what causes them?

Dr. Joel Goebel: There are many causes to balance disorders. Sometimes you have an inner ear problem. The inner ear gives us a sense of where we are in space – it helps us fight gravity, like if we’re ready to fall; it helps us stabilize our vision. Other people have muscle problems or neurologic problems that cause them to fall. The elderly have many problems – as we age, many of the systems have trouble. Sometimes, it’s not just one cause.

Why are balance problems and dizziness such a big deal?

Dr. Goebel: It’s a great risk to all of us, and especially to the elderly – breaking a bone, ending up in the hospital, and developing pneumonia – it’s a large source of morbidity and mortality for all of us, but especially the elderly. It causes time off of work and health costs to our system. It is one of the major reasons why people are hospitalized, especially as we get older.

Are diagnosis and treatment difficult to pinpoint?

Dr. Goebel: It can be. Since there are so many factors, whoever is working with people who are falling needs to be aware of all of these factors. That’s why many times we treat these people with a multi-disciplinary team – it’s not just one specialist. Sometimes, it’s an ear, nose and throat doctor who treats dizziness; sometimes it’s a neurologist; sometimes it’s a physical therapist, occupational therapist, or audiologist – many, many different people on the team.

Tell me about what you’re doing here.

Dr. Goebel: We see people in our dizziness and balance center, and some of them we suspect have lost balance function from their inner ears on both sides. That’s very, very devastating. People have lost that inner sense of balance. They’re very reliant on their eyesight; they’re very reliant on the touch on their feet. You can get into circumstances where the lights are dim or it’s dark or the surface under you is unlevel, like walking on the grass or sand, and these people lose their balance because they don’t have an inner ear sense to keep them upright.

What we’re doing is looking at ways to rehabilitate these individuals by giving them an extra queue of where they are in space. That’s based upon the experiments that we’ve been doing with this device worn on the head to give them a queue of which way they’re leaning.

How does the device work?

Dr. Goebel: The device is relatively simple. There’s a small portion of the device which senses which way you’re leaning, and then it sends a signal to four little tappers on your head – one in the front, one in the back and two on the sides. For instance, if I happen to be leaning forward, this device would start the front tapper to just lightly tap me on the forehead and remind me that I’m leaning forward and tell me to correct and lead backwards. If I’m leaning backwards, the same thing would happen on the back tapper and side to side. We’re mainly interested in front to back and side to side leaning, and this device will remind you or tell you that you’re leaning and to adjust.

When you actually tested this with patients, what did you find it did for them?

Dr. Goebel: We took the worst of the worst patients. We first looked at five people who we thought had just absolutely no vestibular function – balance function from their inner ear. They were falling when they were walking in the dark, so we chose for the first experiment people that had very severe problems. We put them on a platform with a harness on them and tested their balance. When we would move the floor underneath them or we would move the screen around them, this would be very bothersome to a person with no inner ear, and they would fall, the vast majority of the time, into the harness. When we put the device on their head and we trained them just for a very short period of time, just a few moments as to what the device does, we could reduce the falls significantly. There were 27 out of 30 falls on the five subjects without the device, and I believe there were only 13 falls out of 30 falls when they had the device on, and that’s after a very short period of treatment. It was highly significant.

What are the implications for this kind of research in terms of how you   might be able to help people with balance problems?

Dr. Goebel: Right now, we’re going into another study where we’re trying to miniaturize the device. The first device was quite a bit of wires and computers and isn’t very user friendly. We’re trying to get it down to literally like wearing a ball cap, like putting a hat on. It could be hidden inside a scarf; it could be hidden inside of any kind of head gear. There is a set of people that probably would have to wear the device all the time in order to get the benefit. They’ve lost so much function, they can’t learn, and then take the device off.  There is probably another subset of people that have some function left, and they just haven’t compensated well. Those people, we might be able to use this as a rehabilitation tool, so they wear it, they practice with it, then they take it off, and even when it’s off, their balance is better.

What kind of a difference would that make to these patients?

Dr. Goebel: Oh, that would bring them back into life again. A lot of these balance patients live in a very narrow world, so being able to give them a sense of balance under certain circumstances won’t bring them back to perfectly normal, but certainly will expand the horizons. They’ll be doing things that they wouldn’t even think of doing before.

Are there other options for treating balance disorders?

Dr. Goebel: If it’s a balance disorder where somebody’s lost some function in their inner ear or their eyesight or the touch on their feet, drugs or surgery don’t really help you because the deficit is there and now your body has to adjust. Rehabilitation is really the main treatment, and balance retraining by a trained physical therapist that specializes in that area is very helpful. There does reach a point, depending upon what the deficit is, that even that type of therapy would need some help, and that’s where this device comes in.

How excited are you about this device?

Dr. Goebel: We are very excited about it because this is filling a gap. There’s nothing that we can really offer to some of these people. We just have to tell them to restrict their activities, and this would give them back some of those activities that they couldn’t do.

We really don’t know where this is going to end up. We’re starting with a certain group of people that have a very bad inner ear deficit. We’re starting to work with some people who maybe only have the problem on one side. We’re starting to work with people who have mild brain injury like car accidents or falls and a head injury. We really don’t know quite which populations will benefit from this, but we think it will probably benefit more than just people who have lost inner ear function on both sides.

Are you recruiting people for the next study?

Dr. Goebel: Yes, we are. We’ve just been funded as of July of this year, and the devices are being produced right now and miniaturized and we’ll be testing subjects probably within the next month or two.

What are the criteria for enrolling in the study?

Dr. Goebel: The criteria are that you come in and get examined. We put you on the platform that tests your balance, and we have a certain level of balance dysfunction that we need to see. You also need to have this balance dysfunction for awhile. We don’t want somebody that’s had a recent balance problem because we know they might recover on their own, so we’re asking people that have a fixed problem probably for a year to come see us and then when we test them, if they have enough problems, we’ll put them in a study.

END OF INTERVIEW

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