UCLH to start clinical trials to improve diagnosis of balance disorders 

03/03/2014 00:00 
Clinical trials will start at UCLH in May 2015 to help diagnose and treat a range of balance disorders, such as vertigo, Ménière's Disease  and migraine-related dizziness.

UCLH is looking to recruit patients for the EMBalance project.  As one of the partners involved in the project, we are asking GPs, Ear, Nose and Throat (ENT) specialists and neurologists to refer people who suffer with any form of dizziness to the study. 

They will be assessed by two doctors and receive a diagnosis.  One of the doctors will use the new computer-based EMBalance system the other wont be using the system.  If the doctors do not arrive at the same conclusions, a highly specialist audio-vestibular physician will confirm the patient's diagnosis and management plan resulting in an expert level of care.  

The main aim is for ENT doctors and GPs to be equipped with a new, online information system to help diagnose and treat balance disorders themselves. The research has been made possible with 3.5m European Union funding.

Balance is crucial for mobility, says Dr Doris-Eva Bamiou, Honorary Consultant at UCLH & primary investigator for the EMBalance project at the UCL Ear Institute. When balance deteriorates it hampers peoples independence and can often lead to falls and injuries, especially in the elderly.

In addition to the serious risk of injury, there is also a large socioeconomic cost associated with these conditions.  The majority of people with chronic balance disorders experience a range of psychological disorders. Older adults in particular may become isolated, while a quarter of working age adults affected by balance disorders will take time off work while they wait to receive the correct diagnosis and treatment.

Through EMBalance we aim to produce a computer-based information system that will support clinical decision-making. This should enable accurate and early diagnosis of balance disorders and ensure patients receive a prompt and efficient treatment plan.
Balance disorders affect more than a third of the UK population at some point in their lives and falls are the most common cause of accidental death in those aged 75 and over. However, diagnosis is rarely straightforward and can often take months, or even years.

The human balance control system is incredibly complex, relying on the brain to join a range of information from the eyes, the joints/muscles, and the vestibular system (motion, equilibrium, spatial orientation). This coupled with the fact that there are few balance disorder specialists in the primary and secondary healthcare systems, means that receiving a correct diagnosis can often be a long, drawn-out process for patients.

Therefore the trial will assess the effectiveness of the EMBalance tool in producing the correct diagnosis and management plan by non-experts.  The three-year project will be coordinated by UCL and involve researchers from UCLH and ten different partners, spread across seven European countries. The aim at the end of the project is for the EMBalance system to be made available over the internet and equip non-experts with a powerful diagnostic tool.

Clinical trials are expected to commence at UCLH in May 2015 for clinical validation of the EMBalance tool. At the end of the three year project, the EMBalance system will be made available via web-services to ensure that it is both widely accessible and accepted. It will stand as a powerful web-based platform for primary and secondary care physicians across specialties, levels of training and geographical boundaries towards the early diagnostic evaluation, disease course prediction and effective management planning of balance problems. 

Clinical trials of novel therapies is a major objective of the National Institute for Health Research University College London Hospitals Biomedical Research Centre which supports experimental medicine research at UCLH and UCL.

The EMBalance project will involve four clinical academic institution partners across Europe:

UCL (University College London) is the project coordinator, dissemination manager and clinical trial lead partner.

Universitaetsklinikum Freiburg, Germany, provides existing motion capture data of patients suffering from stance and gait disorders and model-based interpretations of several balancing problems in various diseases. It utilises a humanoid robot (PostuRob) to provide model tests of human normal and abnormal balancing and participates in the clinical validation activities and small scale trials.

The National & Kapodistrian University of Athens leads the small scale trials for diagnosis, follow up actions and treatment planning and will participate in clinical proof of concept/clinical validation activities, user requirements elicitation and retrospective data collection.

Antwerp University Research Center for Equilibrium and Aerospace will contribute to the project with existing data from aerospace and aeronautics of over 300. It will lead towards the proof of concept and the verification of the EMBalance system in microgravity conditions using aerospace data.

The EMBalance project will involve six technical partners across Europe:

Institute of Communication and Computer Systems (ICCS) in Greece leads the development of the advanced Decision Support System (DSS), incorporating validated multi-scale and patient-specific balance models, and undertakes the technical management of the project.

Technische Universiteit Delft will lead the extension of the modelling activities of the balance system in order to deliver the multi-scale and patient-specific EMBalance model and will participate in the technical validation and verification of the model.

City University London will lead the human-computer interaction design of the EMBalance platform and participate in the platform development and system integration, the decision support system development, and the proof of concept and clinical evaluation of the platform from a usability perspective. It will also undertake responsibility for the overall quality management of the project.

Universiteit Twente, Holland, contributes to the clinical validation of the EMBalance clinical partners by comparing model responses with human responses in well-defined patient categories.

Engineering Ingegneria Informatica S.p.A., Italy, will be involved in the design, architecture and management of the integrated platform.

BioIRC Ltd, Bioengineering R&D Center, Kragujevac (Serbia) will develop a computer model of the semi-circular canal and will develop EMBalance platform integration with 3D visualisation tool to assist clinicians in determining how different pathologies may affect the dynamic behaviour of the semi-circular canal model.

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