Virtual Reality & Vestibular Rehabilitation: Will A New Technology Improve Outcomes?

Vestibular Rehabilitation Therapy (VRT) has long been recognized as the gold standard in the non-medical management of patients with chronic non-compensated vestibulopathy. The functional manifestations may be comprised of one or more of the following symptoms:

  1. Oscillopsia- blurred vision with active head movement at specific frequencies and direction.
  2. Vestibular recruitment- hypersensitivity, sense of exaggerated motion or after-motion at specific frequencies and direction of movement.
  3. Dependence on the vision and/or surface sensory modalities to maintain proper management of center of gravity (COG) over base of support (BOS).

Diagnosis Based Strategies, first described by this author in 1996, is a prescriptive therapy curriculum developed to meet the specific needs of the patient based on their symptoms and compensation status. Patients will vary in their compensation timeline based on their neural plasticity, compliance, and other medical co-morbidities. We understand that the more complex and challenging the therapeutic activities, the better and faster the progress. Traditional VRT however, can only be made so complex within the therapy setting. Furthermore, the patient’s home-based supplemental work between clinic sessions cannot be too aggressive and safely performed. It is often difficult, if not impossible to replicate the challenges visually of a dynamic and fast-paced world, whether that is due to changes in height, speed or optokinetic movement of the external world.

Virtual Reality has recently emerged as a technology which may be incorporated into VRT to “turbo-charge” and better approximate the challenges that a patient encounters in the real world, particularly with enhanced visual stimulation. This may be further strengthened by introducing dynamic surfaces, just as would be done with substitution-based protocols.

The AIB has introduced the use of Virtual Reality in both its clinical protocols with patients as well as in the VR Certification Workshops. There are also several AIB Partner in Balance facilities that are set to acquire the VR Technology and a multi-center investigation of VRT outcomes with VR Technology will be forthcoming over the next 9-12 months.

The accompanying video demonstrates the VR Technology with attending Physical Therapists and Audiologists during an AIB Workshop.

References:

  1. Gans, R., Vestibular Rehabilitation: Protocols and Programs, Singular Publishing, 1996
  2. Gans, R. Vestibular Rehabilitation Therapy, Eds. Dispenza, F. and De Stefano, A. In Textbook of Vertigo: Diagnosis and Jaypee Brothers Medical Publishers, 2014
  3. Gans, R., Vestibular Rehabilitative Therapy, Eds. Katz, J. et al In Handbook of Clinical Audiology, Wolters Kluwer, 2015
  4. Hall, CD et al, Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION, Journal of Neurologic Physical Therapy: April 2016 – Volume 40 – Issue 2 – p 124–155, 2016