Comparison of Virtual Reality Based Therapy With Customized Vestibular Physical Therapy for the Treatment of Vestibular Disorders

Abstract

We examined outcomes in persons with vestibular disorders after receiving virtual reality based therapy (VRBT) or customized vestibular physical therapy (PT) as an intervention for habituation of dizziness symptoms. Twenty subjects with vestibular disorders received VRBT and 18 received PT. During the VRBT intervention, subjects walked on a treadmill within an immersive virtual grocery store environment, for 6 sessions approximately one week apart. The PT intervention consisted of gaze stabilization, standing balance and walking exercises individually tailored to each subject. Before, one week after, and at 6-months after the intervention, subjects completed self-report and balance performance measures. Before and after each VRBT session, subjects also reported symptoms of nausea, headache, dizziness, and visual blurring. In both groups, significant improvements were noted on the majority of self-report and performance measures one week after the intervention. Subjects maintained improvements on self report and performance measures at 6 months follow up. There were not between group differences. Nausea, headache, dizziness and visual blurring increased significantly during the VRBT sessions, but overall symptoms were reduced at the end of the six-week intervention. While this study did not find a difference in outcomes between PT and VRBT, the mechanism by which subjects with chronic dizziness demonstrated improvement in dizziness and balance function may be different.

Persistent Postural-Perceptual Dizziness

“…54 The most sophisticated plans included stimulation in virtual reality and were developed to treat patients with visually induced dizziness that complicated structural vestibular lesions. 55,56 As for PPPD specifically, one retrospective study reported that most patients with PPPD found a physical therapy consultation to be helpful, and a majority experienced clinically significant improvements in symptoms with home-based exercises, though benefits for symptoms related to self-motion were greater than for those related to visual motion in the environment. 51 ►Table 4 lists several physical therapy and cognitive-behavioral therapy strategies that may be used to treat specific symptoms of PPPD and its behavioral complications.…”

Specific Organ Targeted Vestibular Physiotherapy: The Pivot in the Contemporary Management of Vertigo and Imbalance

“…The common practice of doctors giving some tear-away sheets of the CawthroneCooksey exercises to patients (circulated by some pharmaceutical companies with the names of some anti-vertigo products advertised therein) is farcical and defeats, if not makes a joke of the purpose of these exercises. These [10] is also being used to restore stability in balance disorder patients and is instrumental in improving the plight of balance challenged patients in a big way. Virtual reality programs especially made for balance disorder patients entails presenting to the patient's senses a computer generated virtual environment that isn't really there, but from the patient's perspective is perceived as real.…”

Resultados y seguimiento de la rehabilitación vestibular

“…Los estudios que comparan los ejercicios clásicos de RV con la rehabilitación más instrumentalizada, determinan que ambos tipos de tratamiento conducen a una mejora del equilibrio y de la estabilidad de la mirada [24], no pudiéndose [ 110 ] Rev. ORL, 2020, 11, 1, 107-114 demostrar que una terapia sea mejor que la otra [25][26], aunque el entrenamiento con determinados equipos (realidad virtual, sistema Wii con plataforma de equilibrio, uso de estímulos OKN) puede resultar más estimulante, ofreciendo un feedback de la progresión obtenida [25]. Las ayudas sensoriales (mediante estímulos vibrotactiles) son útiles en pacientes con desequilibrio y balanceo, mejorando la estabilidad postural y el riesgo de caídas [21,27].…”