Contextual sensory integration training via head mounted display for individuals with vestibular disorders: a feasibility study

Anat V. Lubetzky, Jennifer Kelly, Zhu Wang, Marta Gospodarek, Gene Fu, John Sutera, Bryan D. Hujsak

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Virtual reality (VR) interventions can simulate real-world sensory environments. The purpose of this study was to test the feasibility of a novel VR application (app) developed for a Head Mounted Display (HMD) to target dizziness, imbalance and sensory integration in a functional context for patients with vestibular disorders. Here we describe the design of the app as well as self-reported and functional outcomes in vestibular patients before and after participating in vestibular rehabilitation using the app. Material and methods: Our app includes a virtual street, airport, subway or a park. The clinician controls the visual and auditory load including several levels of direction, amount and speed of virtual pedestrians. Clinicians enrolled 28 patients with central (mild-traumatic brain injury [mTBI] or vestibular migraine) and peripheral vestibular disorders. We recorded the Simulator Sickness Questionnaire, Visual Vertigo Analogue Scale (VVAS), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), 8-foot up and go (8FUG) and Four-Step Square Test (FSST) before and after the intervention. Results: Within the 15 patients who completed the study, 12 with peripheral hypofunction showed significant improvements on the VVAS (p = 0.02), DHI (p = 0.008) and ABC (p = 0.02) and a small significant improvement on the FSST (p = 0.015). Within-session changes in symptoms were minimal. Two patients with mTBI showed important improvements, but one patient with vestibular migraine, did not. Conclusion: HMD training within increasingly complex immersive environments appears to be a promising adjunct modality for vestibular rehabilitation. Future controlled studies are needed to establish effectiveness.IMPLICATIONS FOR REHABILITATION Virtual Reality allows for gradual introduction of complex semi-real visual environments. Within VR training patients can re-learn to maintain balance when presented with a sensory conflict in a safe environment. Head Mounted Display training appears to be a promising adjunct modality for vestibular rehabilitation. Portability and affordability of the hardware and software enhance the potential clinical outreach.

Original languageEnglish (US)
JournalDisability and Rehabilitation: Assistive Technology
DOIs
StateAccepted/In press - 2020

Keywords

  • HMD
  • HTC Vive
  • Vestibular rehabilitation
  • balance
  • sensory integration
  • virtual reality

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine
  • Biomedical Engineering
  • Rehabilitation
  • Speech and Hearing

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