Virtual reality-based interventions for the rehabilitation of vestibular and balance impairments post-concussion: a scoping review

Abstract

Background Concussions and mild traumatic brain injuries are the most common causes of physical and cognitive disability worldwide. Concussion can result in post-injury vestibular and balance impairments that can present up to five years post initial concussion event, ultimately affecting many daily and functional activities. While current clinical treatment aims to reduce symptoms, the developing use of technology in everyday life has seen the emergence of virtual reality. Current literature has failed to identify substantial evidence regarding the use of virtual reality in rehabilitation. The primary aim of this scoping review is to identify, synthesise, and assess the quality of studies reporting on the effectiveness of virtual reality for the rehabilitation of vestibular and balance impairments post-concussion. Additionally, this review aims to summarise the volume of scientific literature and identify the knowledge gaps in current research pertaining to this topic. Methods A scoping review of six databases (PubMed, Embase, CINAHL, ProQuest, SportDiscus, Scopus) and a grey literature (Google Scholar) was conducted using three key concepts (virtual reality, vestibular symptoms, and post-concussion). Data was charted from studies and outcomes were categorised into one of three categories: (1) balance; (2) gait; or (3) functional outcome measures. Critical appraisal of each study was conducted using the Joanna Briggs Institute checklists. A critical appraisal of each outcome measure was also completed utilising a modified GRADE appraisal tool to summarise the quality of evidence. Effectiveness was assessed using calculations of change in performance and change per exposure time. Results Three randomised controlled trials, three quasi-experimental studies, three case studies, and one retrospective cohort study were ultimately included, using a thorough eligibility criteria. All studies were inclusive of different virtual reality interventions. The ten studies had a 10-year range and identified 19 different outcome measures. Conclusion The findings from this review suggests that virtual reality is an effective tool for the rehabilitation of vestibular and balance impairments post-concussion. Current literature shows sufficient but low level of evidence, and more research is necessary to develop a quantitative standard and to better understand appropriate dosage of virtual reality intervention.

Contextual sensory integration training vs. traditional vestibular rehabilitation: a pilot randomized controlled trial

“…Specifically on the FGA both groups began on average at fall risk (below 22) and came closer to maximal score (on average 28 or 26 points out of 30) following the intervention. These changes of a little over 20% are similar to the ones reported in a recent systematic review [ 11 ]. There was a strong theoretical rationale to believe that an individualized, context-specific approach that allows for immersive training in standing and stepping would provide greater benefits for patients with vestibular dysfunction than off-the-shelf games.…”

“…Technology ranging from off-the-shelf games to laboratory large screens has been used for many years in vestibular rehabilitation and has been shown to be effective with regards to physical outcomes and for facilitating sensorimotor relearning for balance [ 7 ] though not necessarily better than traditional rehabilitation [ 8 , 9 ]. Recent systematic reviews observed potential clinical benefits of virtual reality technology for vestibular rehabilitation compared with conventional vestibular rehabilitation based on low level of evidence [ 10 , 11 ]. Yet they noted a gap in the literature related to utility of newer portable headsets and the efficacy of an individualized, context specific approach that can be used to train balance when the patient is standing and moving [ 10 , 11 ].…”

“…Recent systematic reviews observed potential clinical benefits of virtual reality technology for vestibular rehabilitation compared with conventional vestibular rehabilitation based on low level of evidence [ 10 , 11 ]. Yet they noted a gap in the literature related to utility of newer portable headsets and the efficacy of an individualized, context specific approach that can be used to train balance when the patient is standing and moving [ 10 , 11 ].…”