Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial

Abstract

Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes.

Postural and vestibular changes related to CPAP treatment in moderate-to-severe OSA patients: a 12-month longitudinal study

“…In particular, CPAP treatment significantly reduced the postural parameters which have been found to be more related to vestibular discharge, especially during blind vision (closed eyes condition) and challenging situations (i.e., upright position on FC). These assumptions are confirmed by the fact that body sways within low frequency intervals and surface are mainly under vestibular control [23,28,29], and patients suffering from peripheral vestibular impairments (i.e., vestibular neuritis, Meniere's disease) as well as moderate-to-severe OSA had more increased values than normal subjects [13]. Furthermore, post-treatment OSA patients demonstrated a PS reduction in those blind vision and challenging conditions involving middle and high frequency interval related to somatosensory, proprioceptive, and central nervous systems discharge [23,30] (Fig.…”

Exergaming in a Moving Virtual World to Train Vestibular Functions and Gait; a Proof-of-Concept-Study With Older Adults

“…The successful use of exergaming in vestibular rehabilitation has been implemented previously ( Bergeron et al, 2015 ; Micarelli et al, 2017 ). Micarelli et al (2017) found a non-significant improvement in the VOR gain in patients with unilateral vestibular hypofunction by using a self-assessed gaming procedure with a head-mounted device ( Micarelli et al, 2017 ). The patients with Ménière’s disease in this study showed a decreasing trend in their center of gravity sway after three-dimensional VR vestibular rehabilitation ( Hsu et al, 2017 ).…”

Role of head-mounted displays in enhancing vestibular rehabilitation effects, comment on: “Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit”

“…In the field of VR-based vestibular rehabilitation, recent evidence advocated for the use of headmounted displays (HMD) in a home-based gaming program coupled with conventional adaptation, habituation and substitution exercises [5]. Unilateral vestibular hypofunction patients demonstrated a significant improvement in posturography parameters and self-report measures such as the Dizziness Handicap Inventory; interestingly, also VOR gain was significantly increased in patients undergoing VRbased gameplay, with respect to their peers treated with conventional rehabilitation alone [5]. The use of HMD-based exercises has the advantage of delivering images as the highest possible resolution, while following the user's movements [3].…”

“…The use of HMD-based exercises has the advantage of delivering images as the highest possible resolution, while following the user's movements [3]. Visual information can be altered, asking patients to perform tasks in visually enriched environments, and vestibular stimulation can be added by incorporating head movements [1], facilitating central pre-programmed eye movements during active tasks which may contribute to gaze stability [5]. The enhancing effects of [2].…”

“…The use of HMD has drawn some criticism due to movement restrictions, limited visual field and the possible onset of nausea and sickness [3]. However, those limitations in VR technology were assessed in the clinical field by means of the Simulator Sickness Questionnaire and did not represent an obstacle in completing the rehabilitation program, with significant reduction in sickness scores along the treatment, reflecting habituation to VR stimuli, which seems to occur regardless of the technique used [1,5,6].…”