The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: A pilot study

Abstract

Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot study compared the responses of sixteen patients with unilateral peripheral vestibular disorder randomly allocated to a VR regime incorporating exposure to a static (Group S) or dynamic (Group D) VR environment. Participants practiced vestibular exercises, twice weekly for four weeks, inside a static (Group S) or dynamic (Group D) virtual crowded square environment, presented in an immersive projection theatre (IPT), and received a vestibular exercise program to practice on days not attending clinic. A third Group D1 completed both the static and dynamic VR training. Treatment response was assessed with the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. At final assessment, significant betweengroup differences were noted between Groups D (p = 0.001) and D1 (p = 0.03) compared to Group S for VV symptoms with the former two showing a significant 59.2% and 25.8% improvement respectively compared to 1.6% for the latter. Depression scores improved only for Group S (p = 0.01) while a trend towards significance was noted for Group D regarding anxiety scores (p = 0.07). Conclusion: Exposure to dynamic VR environments should be considered as a useful adjunct to vestibular rehabilitation programs for patients with peripheral vestibular disorders and VV symptoms.

The Effectiveness of Vestibular Rehabilitation Interventions in Treating Unilateral Peripheral Vestibular Disorders: A Systematic Review

“…Risk of bias assessment with the PEDro scale resulted in the following: one study scored 2/10 (Clendaniel, 2010), two scored a 4/10 ( Cohen and Kimball, 2004;Teggi et al, 2009), three scored a 5/10 (Giray et al, 2009;Pavlou et al, 2012;Marioni et al, 2013) and one article scored a 7/10 (Herdman et al, 2003). All of the studies (100%) complied with random allocation.…”

“…The classification of the intervention types used within the seven chosen articles (Table 1) is of particular interest. According to the vestibular rehabilitation strategies utilized within the intervention groups in each study, the studies clustered into one of three groups: 1) adaptation and habituation compared with substitution (Cohen and Kimball, 2004), 2) adaptation and substitution compared with habituation and substitution (Herdman et al, 2003;Clendaniel, 2010;Marioni et al, 2013 and 3) adaptation, substitution and habituation compared with a control (Giray et al, 2009;Teggi et al, 2009;Pavlou et al, 2012). Outcome measures used in the included studies can be found in Tables 2 and 3.…”

“…In three articles of poor quality as assessed by the PEDro scale, the authors used combined programmes of adaptation, habituation and substitution (Giray et al, 2009;Teggi et al, 2009;Pavlou et al, 2012). Tables 2 and 3 list the outcome measures utilized in these studies.…”

“…Although effect sizes could not be calculated for the study of Giray et al (2009), the intervention group was found to have a significant decrease in DHI total (p = 0.001), while the control group had no significant decrease in DHI total (p = 0.53). Two studies reported improvements on the dynamic gait index (DGI) (Teggi et al, 2009;Pavlou et al, 2012). Large effect sizes were demonstrated by Teggi et al (2009) for both the control and intervention groups with a large difference between groups (favouring the intervention group), and a large effect size was reported for intervention group 3 by Pavlou et al (2012).…”

Framing visual roll-motion affects postural sway and the subjective visual vertical

“…The idea behind this approach is that repeated exposure to visual motion can reduce the severity of disturbances caused by visual motion in certain vestibular patients (Guerraz et al, 2001; Pavlou, Bronstein, & Davies, 2013; Pavlou, Lingeswaran, Davies, Gresty, & Bronstein, 2004; Pavlou, 2010; Riecke & Schulte-pelkum, 2013). This kind of therapeutic intervention can be facilitated by using electronic screens instead of previously used mechanical devices (Pavlou, 2010; Pavlou et al, 2012, 2013; Roberts, Bronstein, & Seemungal, 2013; Vitte, Sémont, & Berthoz, 1994). …”