It's hard to imagine a better blend of high tech and low tech than an iPhone stuck to the bottom of a plastic bucket. But that combination is exactly what the diagnosis of vestibular conditions in children calls for, according to physicians at Boston Children's Hospital, who recently validated the technique in a paper published in the International Journal of Pediatric Otorhinolaryngology.

Vestibular conditions affect children's sense of balance, according to a post on Vector, Boston Children's innovation blog, but similar symptoms can be caused by the heart, the brain, the eyes, or the inner ear.

“One of the toughest things to figure out is, is it a problem with the vestibular system, or is it part of something else, a heart problem or an eye problem?” Dr. Jacob Brodsky, director of the Balance and Vestibular Program at Boston Children’s Hospital, told Vector. “Then, the next challenging part is determining whether it is an inner ear problem or a central vestibular disorder — a problem with the brain.”
The traditional test to pinpoint inner ear problems requires putting the patient in a darkened room, to shut out all outside stimuli, and showing them a not-quite-straight line. The patient is given a remote and asked to adjust the line until it's straight.

The bucket system, developed by Australian clinician Matthew Holmes, ports the line test to a smartphone and replaces the darkened room with a bucket held up to the patient's face. The test uses the phone's gyroscope, so the patient doesn't have to be able to reach the phone's touchscreen to adjust the line -- they just rotate the bucket. The set up makes the test more portable, allowing pediatricians, neurologists and otolaryngologists to have it on hand, rather than needing to refer the patient to a specialist for testing. Holmes' company, Clear Health Media, sells the app for $18.

In the study, 39 children with balance problems were evaluated using the bucket test. It correctly identified the six patients with inner ear vestibular problems.

Other pediatric vestibular programs are now evaluating the app for additional use cases, like testing balance in children with concussions.