The Development of Vestibular-Perceptual Adaptation Paradigms for Treating Persistent Vertigo & Perceived Disequilibrium

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Vertigo/disequilibrium is a frequent medical complaint for individuals with peripheral vestibular disorders or after concussion, especially individuals with lengthy recovery periods. Concussion and vestibular disease often result in vertigo/disequilibrium, abnormal eye movements, altered self-motion perception, and imbalance. Degraded vestibular perception has recently been linked to balance problems. Despite existing therapies to retrain balance and reflexive eye movements, little is known about the role that self-motion perception plays in the recovery from persistent vertigo/disequilibrium or how to effectively re-train these abnormal perceptions. This career development award will establish Dr. Eric Anson as a clinician scientist with expertise in human vestibular research including basic science ranging from physiology to perception and translational science to enhance the care and quality of life for individuals experiencing chronic dizziness/vertigo. This K23 will ensure Dr. Anson develops expertise in 3 primary domains: 1) Advanced concussion management training; 2) Influence of cognition and emotion on SmP; and 3) statistical methods, perceptual psychophysics, and vestibulo-ocular reflex (VOR) adaptation. Dr. Anson has assembled a multi-disciplinary team of experts in concussion management (Jeffery Bazarian, MD, MPH), cognitive and emotional impacts on balance (Mark Carpenter, PhD; Jeffery Staab, MD), vestibular adaptation (Michael Schubert, PT, PhD), and perceptual psychophysics (Benjamin Crane, MD, PhD; Mark Carpenter, PhD; Jeremy Jamieson, PhD) to facilitate achievement of his goals. Dr. Anson will conduct a series of studies to answer these important questions. He will investigate whether different disease states (concussion and vestibular disease) with similar symptoms lead to differences in self- motion perception (Aim 1). He will determine whether vestibular reflexes and vestibular self-motion perception adapt independently (Aim 2). He will use balance-related anxiety at high heights to investigate the link between emotional regulation, body sway, and self-motion perception (Aim 3). This research plan leverages unique existing resources at the University of Rochester including the CTSI and equipment in the labs of Drs. Anson, Crane, Bazarian, and Jamieson. Dr. Carpenter’s research lab provides access to unique resources for exploring balance-related anxiety as a stressor and training methods to enhance self-motion perception. Dr. Staab’s clinic and research lab provide access to unique resources for training in cognitive behavioral therapy and patients with behavioral variables that contribute to persistent vertigo. The proposed training and mentored research are consistent with the NIDCD strategic plan for research in hearing and balance, specifically addressing current understanding of self-motion perception in health and disease. The proposed training will be the foundation for future R01 applications using self-motion perceptual training to enhance current vestibular rehabilitation, improving quality of life for individuals with vestibular disease or concussion.