A Pilot Study of Virtual Reality-Vestibular Physical Therapy for Refractory Dizziness.

Abstract

To assess the tolerability and efficacy of Virtual Reality-Vestibular Physical Therapy (VR-VPT) in individuals with refractory symptoms after conventional vestibular rehabilitation. Prospective cohort study. Single institution tertiary care practice. Participants were offered VR-VPT if they (1) still had symptoms after conventional vestibular physical therapy or (2) were considered to have a specific problem suited to VR-VPT. Treatment consisted of approximately 8 45-minute sessions, each directed by a physical therapist. Differences in baseline and posttreatment surveys, provider-based assessments, and presession and postsession Simulator Sickness Questionnaire (SSQ) scores were analyzed. Among our cohort of 18 participants, there were 10 individuals with vestibular loss (VL), 6 with vestibular migraine (VM), and 4 with Persistent Postural-Perceptual Dizziness (PPPD), with some participants having more than 1 diagnosis. Significant improvements were seen posttreatment in the Dizziness Handicap Inventory (n = 15, mean difference: -11.7, 95% CI: [-18.2, -5.2], P = .002) and the Functional Gait Assessment (n = 17, mean difference: 2.3, 95% CI: [0.8, 3.8], P = .005). Video head impulse testing and dynamic visual acuity improved in a subset of VL participants who underwent both baseline and posttreatment testing. VR-VPT sessions did not significantly provoke symptoms captured in SSQ responses, such as nausea (average difference: 0.32 ± 0.68) or general discomfort (average difference: 0.14 ± 0.68). This pilot study suggests that VR-VPT can be tolerated and may benefit many patients with refractory symptoms, with additional benefits in vestibular function observed in individuals with vestibular loss.