Quantifying What Patients Still Feel: Wearable Gait Analysis and Residual Dizziness in BPPV
- Goran Latif Omer
- Jan 23
- 3 min read
An EurAsia Group Scientific Initiative
Benign Paroxysmal Positional Vertigo (BPPV) is widely regarded as one of the most treatable vestibular disorders. In daily clinical practice, canalith repositioning procedures often resolve positional vertigo rapidly and effectively. Yet a familiar clinical paradox remains. A substantial proportion of patients continue to report imbalance, unsteadiness, or vague dizziness despite apparent clinical recovery. This phenomenon, commonly referred to as residual dizziness, is real, functionally relevant, and frequently underestimated. Traditional bedside examinations and routine vestibular tests often fail to capture it. The question is no longer whether residual dizziness exists, but how it can be objectively measured. As part of an EurAsia Group initiative, a multidisciplinary team spanning otolaryngology, vestibular medicine, and biomedical engineering addressed this gap using wearable sensor technology and advanced gait analytics. The results were recently published in the journal Life, marking a significant step toward objective, digital biomarkers in vestibular care .
Why Gait Matters in Vestibular Disorders
Walking is not a simple motor act. It is a dynamic process that depends on continuous integration of vestibular, visual, and proprioceptive inputs. Even subtle vestibular dysfunction can disrupt this integration, leading to changes in rhythm, symmetry, and stability long before overt imbalance is visible on clinical examination. Residual dizziness after BPPV treatment is believed to reflect delayed or incomplete sensory reweighting rather than persistent otoconial pathology. Capturing this process requires tools that assess dynamic balance in real-world conditions, not static snapshots. Wearable inertial sensors provide such an opportunity. They allow high-resolution analysis of gait during natural walking, offering quantitative insight into how the nervous system organizes movement after vestibular disturbance.
The φ-Bonacci Framework: From Mathematics to Medicine
In this study, patients with BPPV and age-matched healthy controls underwent standardized walking tasks while wearing inertial measurement units. Gait was analyzed using the φ-bonacci framework, a novel mathematical model grounded in self-similarity, symmetry, and consistency of movement.
Rather than relying on basic spatiotemporal parameters, the analysis focused on three physiologically interpretable components:
Self-similarity (A1), reflecting gait harmonicity and automaticity
Swing symmetry (A2), reflecting bilateral coordination
Double-support consistency (A4), reflecting stability strategies during stance transitions
These parameters were assessed before treatment, after canalith repositioning, and under both eyes-open and eyes-closed conditions to probe sensory dependence.
What the Study Showed
Several clinically relevant findings emerged. Before treatment, patients with BPPV demonstrated disrupted gait self-similarity compared with healthy controls, even during straightforward walking tasks. After successful repositioning maneuvers, this parameter normalized, indicating recovery of gait automaticity. However, the most revealing insight came from patients who reported residual dizziness despite complete clinical resolution of positional vertigo. In these individuals, double-support consistency remained abnormal, particularly when visual input was removed. This pattern suggests ongoing reliance on compensatory stabilization strategies and incomplete vestibular sensory reweighting .In other words, although the vertigo was gone, the nervous system had not fully recalibrated how it controls balance during movement.
Why This Matters Clinically
Residual dizziness is often dismissed as benign or self-limiting. Yet for patients, it affects confidence, mobility, and quality of life. Objectively identifying those at risk has direct implications for care. This EurAsia initiative demonstrates that wearable-derived gait metrics can reveal clinically meaningful abnormalities that are invisible to standard examinations. Such measures can:
Objectively confirm residual functional impairment
Identify patients who may benefit from targeted vestibular rehabilitation
Provide quantitative endpoints for treatment response and follow-up
Support development of data-driven, personalized vestibular care
Importantly, the testing protocol is brief, non-invasive, and compatible with routine clinical workflows.
EurAsia Group and Translational Vestibular Research
This work reflects EurAsia Group’s broader mission to bridge clinical medicine, engineering, and data science across institutions and regions. By integrating advanced analytical frameworks with real-world clinical problems, EurAsia initiatives aim to move beyond symptom-based assessment toward objective, functional biomarkers. The φ-bonacci gait framework represents one such bridge, translating complex mathematical principles into clinically interpretable insights that matter to patients and clinicians alike.
Looking Ahead
While exploratory, these findings lay the groundwork for larger, multicenter studies and future integration with machine-learning approaches. As wearable technologies continue to evolve, their role in vestibular medicine is likely to expand from research tools to routine clinical instruments. Residual dizziness should no longer be considered an intangible complaint. With the right tools, it can be measured, understood, and addressed.
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