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

Jennifer Kelly, Daphna Harel, Santosh Krishnamoorthy, Gene Fu, Brittani Morris, Andrew Medlin, Sarah Mischinati, Zhu Wang, John Sutera, Ken Perlin, Maura Cosetti, Anat V. Lubetzky

Research output: Contribution to journalArticlepeer-review


Background: We created a clinical virtual reality application for vestibular rehabilitation. Our app targets contextual sensory integration (C.S.I.) where patients are immersed in safe, increasingly challenging environments while practicing various tasks (e.g., turning, walking). The purpose of this pilot study was to establish the feasibility of a randomized controlled trial comparing C.S.I. training to traditional vestibular rehabilitation. Methods: Thirty patients with vestibular dysfunction completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), Visual Vertigo Analog Scale (VVAS), Functional Gait Assessment (FGA), Timed-Up-and-Go (TUG), and Four-Square Step Test (FSST). Following initial assessment, the patients were randomized into 8 weeks (once per week in clinic + home exercise program) of traditional vestibular rehabilitation or C.S.I. training. Six patients had to stop participation due to the covid-19 pandemic, 6 dropped out for other reasons (3 from each group). Ten patients in the traditional group and 8 in the C.S.I group completed the study. We applied an intention to treat analysis. Results: Following intervention, we observed a significant main effect of time with no main effect of group or group by time interaction for the DHI (mean difference − 18.703, 95% CI [-28.235, -9.172], p = 0.0002), ABC (8.556, [0.938, 16.174], p = 0.028), VVAS, (-13.603, [-25.634, -1.573], p = 0.027) and the FGA (6.405, [4.474, 8.335], p < 0.0001). No changes were observed for TUG and FSST. Conclusion: Patients’ symptoms and function improved following either vestibular rehabilitation method. C.S.I training appeared comparable but not superior to traditional rehabilitation. Trial registration: This study (NCT04268745) was registered on and can be found at .

Original languageEnglish (US)
Article number104
JournalJournal of NeuroEngineering and Rehabilitation
Issue number1
StatePublished - Dec 2023


  • Balance
  • HTC Vive
  • Head mounted Display
  • Vestibular Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Health Informatics


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