Customised vestibular rehabilitation with the addition of virtual reality based therapy in the management of persistent postural-perceptual dizziness

Abstract

Objective Visual-vestibular mismatch patients experience persistent postural and perceptual dizziness. Previous studies have shown the benefit of vestibular rehabilitation for visual desensitisation using gaze stabilisation exercises and optokinetic stimulation. This study assessed the benefit of customised vestibular rehabilitation with visual desensitisation and virtual reality based therapy rehabilitation in the management of patients with persistent postural-perceptual dizziness. Methods This retrospective study included 100 patients with Situational Characteristic Questionnaire scores of more than 0.9. All patients received virtual reality based therapy along with usual vestibular rehabilitation using gaze stabilisation exercises with a plain background followed by graded visual stimulation and optokinetic digital video disc stimulation. Patients’ symptoms were assessed before and after vestibular rehabilitation using the Situational Characteristic Questionnaire, Generalised Anxiety Disorder Assessment-7, Nijmegen Questionnaire and Dizziness Handicap Inventory. Results There were statistically significant improvements in Situational Characteristic Questionnaire scores, Nijmegen Questionnaire scores and Dizziness Handicap Inventory total score. However, there was a statistically insignificant difference in Generalised Anxiety Disorder Assessment-7 scores. There was a significant positive correlation between post-rehabilitation Situational Characteristic Questionnaire scores and other questionnaire results. Conclusion Incorporating virtual reality based therapy with customised vestibular rehabilitation exercises results in significant improvement in persistent postural-perceptual dizziness related symptoms.

The effect of self‐management vestibular rehabilitation on persistent postural‐perceptual dizziness

“…In PPPD patients, improvement of subjective symptoms by VR has been previously reported 7–11 . Among them, one study using web‐based VR, which is not conducted in a medical institution, reported an improvement in the subjective symptoms of PPPD 7 .…”

“…However, vestibular rehabilitation (VR), along with selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs), and cognitive‐behavioral therapy (CBT), has recently been advocated as a promising treatment method 1 . Its efficacy has been reported in various clinical studies 7–11 …”

“…1 Its efficacy has been reported in various clinical studies. [7][8][9][10][11] In general, VR can be performed in a medical institution or at home. Although home-based methods basically require patient selfmanagement, self-management rehabilitation seems to be important in situations where access to medical resources is difficult for patients.…”

Validity and reliability of the Niigata PPPD Questionnaire in a Western population

“…Within therapeutic management, multimodal approaches have shown efficacy in the medium term, such as the combination of serotonergic medication, cognitive–behavioural psychotherapy and physiotherapy [ 7 , 8 ]. With regard to the approach through physiotherapy, the protocols are based on desensitization models through neurosensory stimulation of increasing intensity [ 9 , 10 ]. Due to the lack of well-defined procedures and doses, the protocols are dependent on each work team [ 9 , 10 ].…”

Eye tracking by Virtual Reality Head Mounted Display provides biofeedback for gaze stabilisation exercises and enables on-the-fly measurement of Vestibulo-Ocular Reflex gain

“…Modern VR-HMDs are uniquely equipped to serve as a base as personalised vestibular rehabilitation tools. Rehabilitation systems utilising interaction with 3D space through augmented reality [18], immersive projection theatres [19,20], and VR-HMDs using exposure to motion [21,22], or gaming tasks [23,24] have already been proven to help in recovery from vertigo and imbalance, increasing overall stability and gait [5]. Currently available consumer grade VR devices shift from being an accessory requiring a computer with dedicated room-wide tracking systems to all-in-one units that can be used independently from other devices, with minimal setup (such as Oculus Quest 2™, Vive Focus 2™) and some equipped with eye tracking hardware (Pico Neo 2™, Playstation VR2™).…”