Vestibular Rehabilitation Using Dynamic Posturography: Functional Stability and Fall Risk Outcomes From a Randomized Trial.

Abstract

To compare computerized vestibular retraining therapy (CVRT) to a home exercise program (HEP) for the treatment of unilateral vestibular deficits. Randomized, unblinded, interventional study with single crossover. This study was performed in a tertiary neurotology clinic. Individuals with a stable unilateral vestibular deficit present for greater than 6 months, confirmed with videonystagmography and vestibular evoked myogenic potential testing and scoring >30 on the dizziness handicap inventory, received either 12 twice-weekly sessions of CVRT or 6 weeks of HEP. Outcome measures were the limits of stability test with submeasures: reaction time; directional control; movement velocity; endpoint and maximum excursion; endpoint and maximum functional stability region. CVRT (n = 18), but not HEP (n = 12), was associated with improvement in all measures and with fewer instances of loss of balance during testing. CVRT was superior to HEP for directional control (24.0; 95% CI 4.4-43.6; P = .01), movement velocity (1.5; 95% CI 0.6-2.3; P < .001), and endpoint excursion (21.1; 95% CI 4.8-37.4; P < .01). Improvements in directional control (23.0; 95% CI 1.1-45.0; P = .046) and movement velocity (1.3; 95% CI 0.4-2.2; P = .04) were greater for HEP/CVRT crossover than for HEP alone. There were no adverse effects of either treatment. CVRT improved postural stability in the limits of stability test. CVRT was associated with greater improvement than HEP in lean angle, accuracy, and speed of volitional leaning. Clinicaltrials.gov NCT05115032 (https://clinicaltrials.gov/study/NCT05115032).