A Virtual Reality Four-Square Step Test for Quantifying Dynamic Balance Performance in People with Persistent Postural Perceptual Dizziness

Aharoni, Moshe M.H.; Lubetzky, Anat V.; Wang, Zhu; Goldman, Maya; Krasovsky, Tal

doi:10.1109/icvr46560.2019.9082568

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…Data collection occurred in both sites. Preliminary results from this work were previously presented [31].…”

Section: Methodsmentioning

confidence: 81%

“…Given the prevalence of this condition and its impact on quality of life, this is an important first step in the design of such environments. Our paradigm, of which preliminary results were published [31], was found to be feasible. First, we did not observe major changes in state anxiety, simulator sickness or heart rate.…”

Section: Discussionmentioning

confidence: 86%

“…A detailed description of the procedure was previously published [31]. Participants were asked to fill questionnaires regarding state and trait anxiety (State-Trait Anxiety Inventory; STAI [33]), perceived disability due to dizziness (Dizziness Handicap Inventory, DHI [34]) and balance confidence (Activities-specific Balance Confidence scale; ABC [35]) and perform functional mobility tests including the Timed-Up and Go test (TUG [36]) and the traditional FSST using its original instructions [20].…”

Section: Methodsmentioning

confidence: 99%

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Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

Aharoni

Lubetzky

Arie

et al. 2021

J NeuroEngineering Rehabil

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Background Persistent postural-perceptual dizziness (PPPD) is a condition characterized by chronic subjective dizziness and exacerbated by visual stimuli or upright movement. Typical balance tests do not replicate the environments known to increase symptoms in people with PPPD—crowded places with moving objects. Using a virtual reality system, we quantified dynamic balance in people with PPPD and healthy controls in diverse visual conditions. Methods Twenty-two individuals with PPPD and 29 controls performed a square-shaped fast walking task (Four-Square Step Test Virtual Reality—FSST-VR) using a head-mounted-display (HTC Vive) under 3 visual conditions (empty train platform; people moving; people and trains moving). Head kinematics was used to measure task duration, movement smoothness and anterior–posterior (AP) and medio-lateral (ML) ranges of movement (ROM). Heart rate (HR) was monitored using a chest-band. Participants also completed a functional mobility test (Timed-Up-and-Go; TUG) and questionnaires measuring anxiety (State-Trait Anxiety Inventory; STAI), balance confidence (Activities-Specific Balance Confidence; ABC), perceived disability (Dizziness Handicap Inventory) and simulator sickness (Simulator Sickness Questionnaire). Main effects of visual load and group and associations between performance, functional and self-reported outcomes were examined. Results State anxiety and simulator sickness did not increase following testing. AP-ROM and HR increased with high visual load in both groups (p < 0.05). There were no significant between-group differences in head kinematics. In the high visual load conditions, high trait anxiety and longer TUG duration were moderately associated with reduced AP and ML-ROM in the PPPD group and low ABC and high perceived disability were associated with reduced AP-ROM (|r| = 0.47 to 0.53; p < 0.05). In contrast, in controls high STAI-trait, low ABC and longer TUG duration were associated with increased AP-ROM (|r| = 0.38 to 0.46; p < 0.05) and longer TUG duration was associated with increased ML-ROM (r = 0.53, p < 0.01). Conclusions FSST-VR may shed light on movement strategies in PPPD beyond task duration. While no main effect of group was observed, the distinct associations with self-reported and functional outcomes, identified using spatial head kinematics, suggest that some people with PPPD reduce head degrees of freedom when performing a dynamic balance task. This supports a potential link between spatial perception and PPPD symptomatology.

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“…Data collection occurred in both sites. Preliminary results from this work were previously presented [31].…”

Section: Methodsmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

Aharoni

Lubetzky

Arie

et al. 2021

J NeuroEngineering Rehabil

Self Cite

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“…A recent study on FSST-VR showed that the technology is able to provide additional information about the PPPD patients on spatial and temporal parameters when compared with healthy participants. VR did not exacerbate the symptoms of PPPD, as further studies were ongoing to understand dynamic balance [51]. Therefore, virtual reality could be used along with other therapies for diagnosis and/or treatment purposes.…”

Section: Virtual-reality Environment-enhancement To Conventional Toolsmentioning

confidence: 94%

Persistent Postural-Perceptual Dizziness Interventions—An Embodied Insight on the Use Virtual Reality for Technologists

2022

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Persistent and inconsistent unsteadiness with nonvertiginous dizziness (persistent postural-perceptual dizziness (PPPD)) could negatively impact quality of life. This study highlights that the use of virtual reality (VR) systems offers bimodal benefits to PPPD, such as understanding symptoms and providing a basis for treatment. The aim is to develop an understanding of PPPD and its interventions, including current trends of VR involvement to extrapolate and re-evaluate VR design strategies. Therefore, recent virtual-reality-based research work that progressed in understanding PPPD is identified, collected, and analysed. This study proposes a novel approach to the understanding of PPPD, specifically for VR technologists, and examines the principles of effectively aligning VR development for PPPD interventions.

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“…After that all scenes appeared twice in a randomized order (Static, AP5, AP32 single-task or dual-task). This protocol was part of larger protocol that included also a dynamic postural control task [3], which was Fig. 1.…”

Section: Methodsmentioning

confidence: 99%

People with persistent postural-perceptual dizziness demonstrate altered postural strategies in complex visual and cognitive environments

Lubetzky

Aharoni

Arie

et al. 2021

VES

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BACKGROUND: People with PPPD report imbalance, increase in symptoms and impaired function within complex visual environments, but understanding of the mechanism for these behaviors is still lacking. OBJECTIVE: To investigate postural control in PPPD we compared changes in center of pressure (COP) and head kinematics of people with PPPD (N = 22) and healthy controls (N = 20) in response to different combinations of visual and cognitive perturbations during a challenging balance task. METHODS: Participants stood in a tandem position. Static or moving stars (0.2 Hz, 5 mm or 32 mm amplitude, anterior-posterior direction) were displayed through a head-mounted display (HTC Vive). On half the trials, participants performed a serial-3 subtraction task. We measured medio-lateral and anterior-posterior path and acceleration of COP and head. RESULTS: Controls significantly increased all COP and head parameters with the cognitive task whereas PPPD increased only COP ML path and acceleration. Only controls significantly increased head anterior-posterior & medio-lateral acceleration with moving visual load. Cognitive task performance was similar between groups. CONCLUSIONS: We observed altered postural strategies in people with PPPD, in the form of reduced movement with challenge, particularly around the head segment. The potential of this simple and portable head-mounted display setup for differential diagnosis of vestibular disorders should be further explored.

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A Virtual Reality Four-Square Step Test for Quantifying Dynamic Balance Performance in People with Persistent Postural Perceptual Dizziness

Cited by 8 publications

References 24 publications

Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

Factors associated with dynamic balance in people with Persistent Postural Perceptual Dizziness (PPPD): a cross-sectional study using a virtual-reality Four Square Step Test

Persistent Postural-Perceptual Dizziness Interventions—An Embodied Insight on the Use Virtual Reality for Technologists

People with persistent postural-perceptual dizziness demonstrate altered postural strategies in complex visual and cognitive environments

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