KU School of Health Professions researcher is helping turn tedious physical therapy exercises into a game

Dizziness and vision problems caused by vestibular dysfunction disrupt people’s lives and can put them at higher risk for falls.

There’s a sub-category of physical therapy that can treat these issues, called vestibular rehabilitation. But many patients fail to improve simply because they don’t complete their assigned exercises at home.

“Those exercises are super boring,” admitted Linda D’Silva, Ph.D., PT, NCS, assistant professor in the department of Physical Therapy, Rehabilitation Science and Athletic Training in the University of Kansas School of Health Professions, and an expert in this field. Not only are these patients dizzy to start with, but gaze stability exercises are tricky to do correctly without direction, and they’re supposed to be done multiple times per day.

“We know that people don’t do their exercises,” D’Silva said. “They themselves say so — they confess.”

D’Silva’s research team is collaborating on an innovative solution: a video game app that makes these notoriously tedious exercises fun — complete with a cute dolphin character and trophies.

The vestibular system, a cluster of small organs in the inner ear, helps control balance and eye movements. Vestibular damage can result in dizziness, vertigo and eye-tracking problems. Causes may include concussions, certain infections or simply getting older.

Certain vestibular conditions are treated with gaze stability and balance exercises, such as focusing on a single letter on an eye chart while moving the head side to side.

Research and development

Alabama-based CFD Research Corp. created and developed an app, called VestRX, with National Institutes of Health funding. The company needed a vestibular rehabilitation expert and enlisted D’Silva, who teaches neuro-rehabilitation courses and directs the Vestibular and Balance Rehabilitation Laboratory, known as the STABILITI Lab, at KU Medical Center.

VestRX aims to replicate these exercises in a way that motivates people to actually complete them at home. The app requires a tablet and wearable equipment to track head and body movements and give feedback to ensure users are doing the exercises correctly.

The concept is reminiscent of Pac-Man. But instead of using a joystick to control a chomping yellow circle, people use body movements to guide a dolphin around the screen.

In one game, people use their face and eyes to move the dolphin horizontally then vertically, making it swim around rocks jutting into its path. Another game has users shift weight from side to side to move coconuts into a basket.

D’Silva led research to confirm the app followed clinical practice guidelines and to demonstrate its clinical relevance. Specifically, her team investigated whether using the app increased the accuracy of exercise performance and whether the app increased engagement with exercises. Their work included a pilot study of 40 older adults with vestibular hypofunction. Resulting articles have been published in Frontiers in Neurology and Frontiers in Medicine.

Participants overwhelmingly thought the app was fun, felt more motivated to do their home exercises and significantly improved their dizziness symptoms, D’Silva said. One participant even took the app on a trip to Hawaii.

“Linda’s clinical insights have been instrumental in developing VestRX, and her enthusiasm for VestRX has been instrumental in getting the first older adults to use the app successfully at home,” said Paulien Roos, Ph.D., director and division chief of the biotechnology and life sciences division at CFD Research Corp.

Next, D’Silva and CFD Research hope to collaborate on a larger clinical trial. Also, Roos said, the company is tailoring a version of the app specifically to help military service members recover from vestibular conditions and return to duty. Another goal is adapting the app for musculoskeletal injuries.

In-demand expertise

Certified vestibular therapy specialists can be hard to find. It’s a “niche” field but has seen growing awareness, D’Silva said.

At KU, neuro-rehabilitation courses, including units on vestibular therapy, are required for students completing a Doctor of Physical Therapy degree.

Many sports-focused physical therapy students are surprised by the neurological content, D’Silva said. “The concepts are very difficult, and the brain is not easy to understand,” she said. “But it’s been really interesting how much they enjoy it.”

Patricia Kluding, Ph.D., chair of the KU department of Physical Therapy, Rehabilitation Science, and Athletic Training, called VestRX “an exciting and innovative approach to a real-world problem.” It’s an example of how faculty with this kind of cutting-edge experience such as D’Silva are an asset to KU students.

“It is really beneficial for our students to learn about this treatment approach from an expert who is doing the research to inform clinical practice,” Kluding said.