Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial

Abstract

IntroductionVestibular system damage in patients with multiple sclerosis (MS) may have a central and/or peripheral origin. Subsequent vestibular impairments may contribute to dizziness, balance disorders and fatigue in this population. Vestibular rehabilitation targeting vestibular impairments may improve these symptoms. Furthermore, as a successful tool in neurological rehabilitation, immersive virtual reality (VRi) could also be implemented within a vestibular rehabilitation intervention.Methods and analysisThis protocol describes a parallel-arm, pilot randomised controlled trial, with blinded assessments, in 30 patients with MS with vestibular impairment (Dizziness Handicap Inventory ≥16). The experimental group will receive a VRi vestibular rehabilitation intervention based on the conventional Cawthorne-Cooksey protocol; the control group will perform the conventional protocol. The duration of the intervention in both groups will be 7 weeks (20 sessions, 3 sessions/week). The primary outcomes are the feasibility and safety of the vestibular VRi intervention in patients with MS. Secondary outcome measures are dizziness symptoms, balance performance, fatigue and quality of life. Quantitative assessment will be carried out at baseline (T0), immediately after intervention (T1), and after a follow-up period of 3 and 6 months (T2 and T3). Additionally, in order to further examine the feasibility of the intervention, a qualitative assessment will be performed at T1.Ethics and disseminationThe study was approved by the Andalusian Review Board and Ethics Committee, Virgen Macarena-Virgen del Rocio Hospitals (ID 2148-N-19, 25 March 2020). Informed consent will be collected from participants who wish to participate in the research. The results of this research will be disseminated by publication in peer-reviewed scientific journals.Trial registration numberNCT04497025.

Virtual Reality–Based Neurorehabilitation Support Tool for People With Cognitive Impairments Resulting From an Acquired Brain Injury: Usability and Feasibility Study

“…By applying this methodology, we have demonstrated the potential of integrating VR into clinical practice. This supports recent literature findings that also describe detailed customized VR rehabilitation tools and have conducted large-quality studies obtaining promising results [36,[39][40][41]63,64]. All participants from the multiple proof-of-concept study completed the session without experiencing adverse effects or encountering major issues.…”

Peripheral Vestibular System Involvement in Multiple Sclerosis and Associations with the Disease Severity

“…The EDSS scores range from 0 (normal neurological status) to 10 (death due to MS). Balance problems become more common as the EDSS scores increase [2]. The EDSS uses an ordinal scoring scale with increments of 0.5, between 0 (normal neurological status) and 10 (MS-related death).…”

Effect of Caw Thorne Cooksey Exercise in Patient with Multiple Sclerosis: An Evidence Based Review

“…Multiple sclerosis is a chronic auto-immune mediated neurodegenerative disorder characterised by the development of lesions along the central nervous system resulting in neurological impairment. [1,2] Multiple Sclerosis (MS) is among the present century diseases with a large outbreak in Iran and worldwide. It isan extremely expensive disease with socioeconomic consequences.…”

“…Specifically, patients with brainstem involvement, as identified using the Expanded Disability Status Scale (EDSS) could be showing signs of imbalance, vestibular disorders and greater disability. [2] Gait impairment results from the mix common multiple symptoms and deficits as fatigue, weakness, spasticity, ataxia, vertigo and balance problem, vestibular rehabilitation can reduce vertigo and decrease impact of it on gait parameters. [5] Prevalence of MS in India of 3/100,000, in this a nation of 1.2 billion people, there are probably more than 30,000 people with MS. [6] In the 1940s, British otolaryngolog Terence Caw Thorne observedthat some patients showed faster recovery with sequentialand rapid head movements, and developed the eye rehabilitationprotocol Caw Thorne and Cooksey together with physiotherapistCooksey.…”

“…[3] Caw Thorne-Cookseyvestibulartraining is considered the gold standard protocol.Based on mechanismsof substitution, adaptation and habituation,vestibularrehabilitation can be effective in peripheraland central vestibular impairments. [2] A vestibular rehabilitationprogram may include exercises designed to improve vestibulo-ocular reflex, vestibulospinal reflex,somatosensory retraining, balance and gait.Although it is recommended that vestibular rehabilitation is considered for people with multipleSclerosis. [4] Caw-Thorne Cooksey exercises is traditional physical therapy program for each session in form of:…”