# Video-oculography: A novel approach towards clinical markers of vestibular function and recovery

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2024 · $693,259

## Abstract

PROJECT SUMMARY
Loss of vestibular function causes visuospatial misperception, imbalance, and decreased visual acuity during
head motion, leading to severe impairment of daily activities. Vestibular rehabilitation therapy is the standard of
care for treating these associated symptoms, but it is not universally effective and there are no objective means
for identifying mechanisms that contribute to the recovery when it is successful. Following loss of vestibular
function, each patient may have a distinct predisposition toward relying on one or another sensory modality (e.g.,
vision or somatosensory inputs), or may adopt a different strategy to cope with the aberrant vestibular information
(e.g., blink during head rotation). These intricate responses can result in different patterns of sensorimotor
reorganization during recovery. Another major constraint rerated to vestibular recovery is the lack of objective
assessments of otolith and semicircular canal function, as the current outcome measures instead rely on the
clinician judgment. Such lack of quantitative measures of the vestibulo-ocular reflex (VOR) and other sensory
substitutions preclude the ability to predict functional outcomes and identify those patients who could benefit
most from rehabilitation. To address this issue, the objective of this project is to examine whether novel video-
oculography (VOG) measures of the VOR can be used as valid markers of functional outcome following
vestibular loss. To this end, we will use the video head impulse test (vHIT) to measure semicircular canal
function. For assessment of the otolith function, we have developed a VOG method based on ocular counter-roll
(vOCR), during which the torsional VOR is quantified with lateral head tilt.
Our preliminary results show recovery in vOCR with vestibular compensation over time, whereas the VOR gain
as measured by vHIT remains abnormal in all stages of recovery following vestibular loss. Some patients
however generate compensatory saccades that conceal their VOR deficit, suggesting a saccade strategy that
may be related to the adequacy of vestibular compensation. In addition, we have found that the difference in
vOCR during en bloc head-and-body tilt versus head-only tilt can be used as a measure of sensory substitution
for vestibular loss during recovery. Based on these findings, our central hypothesis is that vOCR with whole-
body/head-only tilt and compensatory saccades with vHIT can be used as novel markers to (i) measure recovery
and (ii) predict functional outcomes following vestibular loss. We expect that the findings in this project will also
provide the basis for a future grant that investigates customized vestibular rehabilitation using discrete and easy-
to-apply VOG measurements in individual patients rather than applying a fixed treatment protocol in all patients.

## Key facts

- **NIH application ID:** 10980716
- **Project number:** 1R01DC021186-01A1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Amir Kheradmand
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $693,259
- **Award type:** 1
- **Project period:** 2024-09-01 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10980716

## Citation

> US National Institutes of Health, RePORTER application 10980716, Video-oculography: A novel approach towards clinical markers of vestibular function and recovery (1R01DC021186-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10980716. Licensed CC0.

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