Kristal Mills Riska completed a dual degree program in audiology leading to a clinical doctorate in Audiology (Au.D) and a doctor of philosophy (Ph.D) in July 2011 at East Carolina University. She currently holds clinical certification from the American Speech, Language, Hearing Association and the state of NC. She has over 5 years of research experience working primarily in the NIH/NIDCD funded research laboratory of Sherri M. Jones, Ph.D. During that time, she has studied the functional outcomes of animal models with inner ear deficits due to genetic mutations. Her dissertation evaluated ocular motor and vestibular function in military personnel following blast exposure. Her primary research interests are in assessment and management of vestibular disorders. She currently is funded by the Auditory and Vestibular Research Enhancement Area Program (REAP) award in a temporary research position at the Mountain Home VAMC as she works towards establishing her own grant funding. The CDA-1 award would provide Dr. Riska with the opportunity to develop new research skills and mentoring needed to expand her research interests and to become an independent VA investigator. There are four mentors for this proposal: (1) Faith Akin, Ph.D, who is a VA-funded investigator(two RR&D Merit Reviews),Director of the Vestibular Laboratory at the VA Medical Center, Mountain Home, Tennessee, and Associate Professor in Audiology and Speech Pathology at East Tennessee State University (ETSU), (2) Courtney D. Hall, Ph.D., who is a VA-funded investigator(RR&D Merit Review, RR&D Pilot Merit) at the VA Medical Center, Mountain Home, TN., and Associate Professor in Physical Therapy at ETSU, (3) Sherri M. Jones, PhD., who is a NIH/NIDCD funded vestibular researcher, professor and the chair of the Department of Special Education. & Communication Disorders at the University of Nebraska-Lincoln, and (4) Beth Bailey, Ph.D., a funded investigator (NIH, March of Dimes, DHHS), Associate Professor in Family Medicine at ETSU. Dr. Riska has proposed a rigorous training plan including coursework, webinars related to VA research, and travel to conferences for continued professional development and education. The research plan will be conducted at the James Quillen VAMC in Mountain Home, TN. This VAMC is a research rich environment and houses a renowned vestibular and balance research program with state-of the-art facilities. The broad long-term programmatic goals of this project are to address the challenges in evaluating and rehabilitating Veterans with dizziness by improving and refining clinical pathways for vestibular assessment and management. The short term goals of the proposed research are as follows: 1) to determine the incidence of dizziness and to characterize Veterans with dizziness/vertigo; and 2) to determine the proportion of individuals referred for clinical vestibular assessment and the incidence of vestibular dysfunction and 3) to evaluate the proportion of specific vestibular end-organ dysfunction in Veterans referred for vestibular testing at Mountain Home VAMC. To achieve objective 1, a VA-wide evaluation of clinical data will be performed using a natural language processing (NLP), ICD-9 codes and capture recapture methodology. For objective 2, a two-prong approach will be utilized in which we will explore both national VA-wide data and local VA data from Mountain Home VAMC. First, all patients who were identified as part of objective 1 will be analyzed to determine if they underwent clinical vestibular testing. Second, we will determine the incidence of Veterans with vestibular dysfunction among those clinically evaluated. Lastly, we will determine the proportion of specific vestibular end-organ dysfunction.
Approximately 40% of Americans will experience dizziness requiring medical attention during their lifetime (NIDCD). Dizziness can be caused by many medical conditions. A higher incidence of dizziness/vertigo are reported in older adults, individuals with traumatic brain injury, and individuals with psychiatric disorders (Barin & Dodson, 2011; Terrio et al., 2009; Lin & Bhattacharyya, 2012; Kraus et al, 2005; Scherer & Schubert, 2009; Staab, 2006). Each of these are key military and Veteran populations. National studies evaluating dizziness have specifically excluded military and VA hospitals (Kerber et al., 2008; Burt and Shappart, 2004). Therefore, we have an incomplete understanding of dizziness in Veterans. It is imperative that we evaluate dizziness within VA healthcare and develop an vestibular screening instrument to identify patients with possible inner ear abnormalities leading to dizziness and vertigo.
