Improving Balance through Virtual Reality and Physical Therapy Integration

Abstract

Background and Purpose: Virtual reality (VR) is an innovative technology that shows promise in the assistance of physical therapy (PT). This case report explores the use of virtual reality with a patient suffering from unilateral vestibular hypofunction (UVH). Case Description: The patient is a 50-year-old male who was referred to physical therapy following a motor vehicle accident. The patient was diagnosed with having an acute left UVH, accompanied by reports of dizziness, imbalance and gait disturbances which impaired him from his work in construction. Intervention: The patient was seen two to three times a week for 40-minute sessions along with an individualized home exercise program. Interventions included vestibular rehabilitation exercises, balance training, gait training, and VR. The goals of VR were to provide taskspecific simulations to improve postural balance, decrease anxiety through exposure therapy, and improve smooth eye pursuits to improve static balance. Outcomes: Outcomes used included subjective questionnaires such as the Activities-Specific Balance Confidence survey and the Dizziness Handicap Inventory (DHI) as well as functional tests like the Sensory Organization Test, Motor Control Test, and the Functional Gait Assessment (FGA). Outcome measures were performed at initial evaluation, at the 10th visit, and again at discharge. Notable improvements were seen on DHI and FGA scores. Conclusion: Dizziness, confidence, balance, and gait improved following vestibular rehabilitation combined with VR. Outcomes of this case suggest that virtual reality in conjunction with vestibular rehabilitation therapy is effective in improving deficits of unilateral vestibular hypofunction. Additionally, the use of VR in this case report suggests this can be an effective tool for intervention to facilitate patient-specific goals.

Step-to-Step Ankle Inversion/Eversion Torque Modulation Can Reduce Effort Associated with Balance

“…Reduced step width can indicate increased balance confidence (Maki, 1997 ; Sheehan et al, 2016 ). An overall reduction in balance-related effort can be indicated by reduced metabolic cost (Donelan et al, 2004 ; IJmker et al, 2013 ) and by the user's subjective assessment (Esguerra and Johnson, 2016 ; Kalron et al, 2016 ), provided that changes in the prosthesis affect only step-to-step mechanics related to balance and not average prosthesis mechanics (Kim and Collins, 2015 ).…”