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Virtual Reality-Based Vestibular Rehabilitation Improves Patient Disability and Outcomes

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Complaints of dizziness and vertigo affect over 20% of the world’s population at any given time.

Vestibular Rehabilitation Therapy (VRT) is the most effective treatment option for individuals experiencing dizziness and vertigo cause by a unilateral peripheral vestibulopathy [1; 3].

The established treatment categories used in VRT include [1; 2; 4]:

  • Postural Stability & Balance Re-training
  • Gaze Stabilization
  • Habituation of self-motion and/or visual environment triggers

A systematic review and meta-analysis published in 2021 found that virtual reality-based VRT interventions reduced patient disability, as noted on the Dizziness Handicap Inventory (DHI), significantly more than traditional vestibular rehabilitation alone in adults with unilateral peripheral vestibulopathy [3]. Another systematic review performed in the same year found that patients who performed virtual reality-based VRT had significantly greater increases in Vestibulo-Ocular Reflex (VOR) gain and had significantly less motion sickness compared to patients who performed traditional vestibular rehabilitation [4].

Virtual Reality (VR) is generally described as any computer-generated environment meant to simulate the real world [2]. The illusion of being in a virtual environment, defined as presence, is created by a combination of high-quality software with immersive head-mounted display (HMD) hardware that stimulates multiple sensorimotor systems. Therapeutic VR systems, engage patients in high-presence environments that are customizable, critical when providing VRT for patients with symptoms of dizziness and vertigo.

Of course, VRT is not provided randomly or by following a specific protocol of exercises, rather, is a customized approach to treatment which is based first on examination and identification of functional impairments, activity limitations, and participation restrictions [2]. In order to identify the right treatment category of exercise, vestibular rehabilitation specialists must first choose outcome measures to assess vestibular function. Once a functional impairment and treatment category is noted, the vestibular rehabilitation specialist must choose a virtual reality module to use for intervention, then adjust the level of intensity and duration of exercise to the patient’s ability to meet the rehabilitation goal.

Another finding of the Heffernan, et al 2021 systematic review and meta-analysis was that patients who performed virtual reality-based VRT in-clinic were found to have better and longer-lasting outcomes than home-based rehabilitation [3].

Author: Jennifer Stoskus, PT, DPT, NCS (Board-Certified Clinical Specialist in Neurologic Physical Therapy)

[1] Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, Furman JM, Getchius TS, Goebel JA, Shepard NT, Woodhouse SN. Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther. 2016 Apr;40(2):124-55. doi: 10.1097/NPT.0000000000000120. PMID: 26913496; PMCID: PMC4795094.
[2] Hall, Courtney D. PT, PhD; Herdman, Susan J. PT, PhD, FAPTA; Whitney, Susan L. DPT, PhD, NCS, ATC, FAPTA; Anson, Eric R. PT, PhD; Carender, Wendy J. PT, MPT, NCS; Hoppes, Carrie W. PT, PhD, NCS, OCS, ATC; Cass, Stephen P. MD, MPH; Christy, Jennifer B. PT, PhD; Cohen, Helen S. OTR, EdD, FAOTA; Fife, Terry D. MD, FAAN, FANS; Furman, Joseph M. MD, PhD; Shepard, Neil T. PhD; Clendaniel, Richard A. PT, PhD; Dishman, J. Donald DC, MSc, FIACN, FIBE; Goebel, Joel A. MD, FACS, FRCS; Meldrum, Dara MSc, PhD; Ryan, Cynthia MBA; Wallace, Richard L. MSLS, EdD, AHIP; Woodward, Nakia J. MSIS Vestibular Rehabilitation for Peripheral Vestibular Hypofunction, Journal of Neurologic Physical Therapy: December 03, 2021 – Volume – Issue – doi: 10.1097/NPT.0000000000000382
[3] Heffernan A, Abdelmalek M, Nunez DA. Virtual and augmented reality in the vestibular rehabilitation of peripheral vestibular disorders: systematic review and meta-analysis. Sci Rep. 2021 Sep 8;11(1):17843. doi: 10.1038/s41598-021-97370-9. PMID: 34497323; PMCID: PMC8426502.
[4] Xie M, Zhou K, Patro N, Chan T, Levin M, Gupta MK, Archibald J. Virtual Reality for Vestibular Rehabilitation: A Systematic Review. Otol Neurotol. 2021 Aug 1;42(7):967-977. doi: 10.1097/MAO.0000000000003155. PMID: 33782257.


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