Head Mounted Display Application for Contextual Sensory Integration Training: Design, Implementation, Challenges and Patient Outcomes

Patients with vestibular disorders display difficulty with multisensory integration and complain of dizziness and imbalance in busy and complex visual environments. Patients who experience symptoms or a fall within a certain environment are likely to develop fear of that situation. It has been suggested that multisensory integration should be addressed in conditions as close as possible to real-life situations, but these are often challenging to replicate in the clinical setting. Virtual reality (VR) can provide a non-threatening method for patients to practice multisensory integration in a functional context. Advances in technology make Head Mounted Displays (HMDs) accessible and affordable in the clinic. We developed a VR HMD application that allows patients to practice contextual sensory integration (C.S.I) while sitting, standing, turning or stepping within diverse scenes. This application can become an integral part of vestibular rehabilitation. For successful implementation, usability is critical. In this pilot, usability and preliminary outcomes were tested in a mixed-methods descriptive study. Six physical therapists in a Vestibular Rehabilitation Clinic treated 12 patients with peripheral or central vestibular disorders. Therapists viewed the system as a bridge for a functional carry over from the clinic to the outside world. While they reported challenges in operating the technology within the clinical time constraints, they liked the ability to gradually introduce a challenging sensory stimulus and bring reality to the clinic. Several patients dropped out prior to completing training. Nine out of 12 patients who completed training thus far improved their disability score, 9 improved their visual vertigo and 10 improved their balance confidence following training with the app. Recommendation for future research and clinical implementation are discussed.