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Customised vestibular rehabilitation with the addition of virtual reality based therapy in the management of persistent postural-perceptual dizziness

Published online by Cambridge University Press:  10 August 2021

E Mempouo*
Affiliation:
Department of Neuro-otology, Sheffield Teaching Hospital, Sheffield, UK
K Lau
Affiliation:
Department of Neuro-otology, Sheffield Teaching Hospital, Sheffield, UK
F Green
Affiliation:
Department of Neuro-otology, Sheffield Teaching Hospital, Sheffield, UK
C Bowes
Affiliation:
Department of Audiology, Sheffield Teaching Hospital, Sheffield, UK
J Ray
Affiliation:
Department of Neuro-otology, Sheffield Teaching Hospital, Sheffield, UK
*
Author for correspondence: Miss Eugenie Mempouo, 94 Mulehouse Road, SheffieldS10 1TB, UK E-mail: [email protected]

Abstract

Objective

Visual-vestibular mismatch patients experience persistent postural and perceptual dizziness. Previous studies have shown the benefit of vestibular rehabilitation for visual desensitisation using gaze stabilisation exercises and optokinetic stimulation. This study assessed the benefit of customised vestibular rehabilitation with visual desensitisation and virtual reality based therapy rehabilitation in the management of patients with persistent postural-perceptual dizziness.

Methods

This retrospective study included 100 patients with Situational Characteristic Questionnaire scores of more than 0.9. All patients received virtual reality based therapy along with usual vestibular rehabilitation using gaze stabilisation exercises with a plain background followed by graded visual stimulation and optokinetic digital video disc stimulation. Patients’ symptoms were assessed before and after vestibular rehabilitation using the Situational Characteristic Questionnaire, Generalised Anxiety Disorder Assessment-7, Nijmegen Questionnaire and Dizziness Handicap Inventory.

Results

There were statistically significant improvements in Situational Characteristic Questionnaire scores, Nijmegen Questionnaire scores and Dizziness Handicap Inventory total score. However, there was a statistically insignificant difference in Generalised Anxiety Disorder Assessment-7 scores. There was a significant positive correlation between post-rehabilitation Situational Characteristic Questionnaire scores and other questionnaire results.

Conclusion

Incorporating virtual reality based therapy with customised vestibular rehabilitation exercises results in significant improvement in persistent postural-perceptual dizziness related symptoms.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Miss E Mempouo takes responsibility for the integrity of the content of the paper

References

Staab, JP, Eckhardt-Henn, A, Horii, A, Strupp, M, Brandt, T, Bronstein, A et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J Vestib Res 2017;27:191208CrossRefGoogle Scholar
McCabe, BF. Diseases of the end organ and vestibular nerve. In: Naunton, RF (ed). The Vestibular System. New York: Academic Press, 1975;299302CrossRefGoogle Scholar
Bronstein, AM. Visual vertigo syndrome: clinical and posturography findings. J Neurol Neurosurg Psychiatry 1995;59:472–6CrossRefGoogle ScholarPubMed
Staab, JP, Ruckenstein, MJ. Expanding the differential diagnosis of chronic dizziness. Arch Otolaryngol Head Neck Surg 2007;133:170–6CrossRefGoogle ScholarPubMed
Jacob, RG, Lilienfeld, SO, Furman, JMR, Durrant, JD, Turner, SM. Panic disorder with vestibular dysfunction: further clinical observations and description of space and motion phobic stimuli. J Anxiety Disord 1989;3:117–30CrossRefGoogle Scholar
Brandt, TH, Dieterich, M. Phobic attack vertigo, a new syndrome? [in German] Münch Med Wochenschr 1986;128:247–50Google Scholar
Powell, G, Derry-Sumner, H, Rajenderkumar, D, Rushton, SK, Sumner, P. Persistent postural perceptual dizziness is on a spectrum in the general population. Neurology 2020;94:e1929–38CrossRefGoogle ScholarPubMed
Bergeron, M, Lortie, CL, Guitton, MJ. Use of virtual reality tools for vestibular disorders rehabilitation: a comprehensive analysis. Adv Med 2015;2015:916735CrossRefGoogle ScholarPubMed
Pavlou, M, Lingeswaran, A, Davies, RA, Gresty, MA, Bronstein, AM. Simulator based rehabilitation in refractory dizziness. J Neurol 2004;251:983–95CrossRefGoogle ScholarPubMed
Pavlou, M, Kanegaonkar, RG, Swapp, D, Bamiou, DE, Slater, M, Luxon, LM. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study. J Vestib Res 2012;22:273–81CrossRefGoogle ScholarPubMed
Moaty, AS, Mahallawi, THEL, Dimitriadis, PA, Allam, A, Bowes, C, Ray, J et al. The role of customized vestibular rehabilitation with visual desensitization in the management of visual vertigo syndrome. Hear Balance Commun 2017;15:127–32CrossRefGoogle Scholar
Rizzo, AA, Cohen, I, Weiss, PL, Kim, JG, Yeh, SC, Zaii, B et al. Design and development of virtual reality based perceptual-motor rehabilitation scenarios. Conf Proc IEEE Eng Med Biol Soc 2004;2004:4852–5Google ScholarPubMed
Guerraz, M, Yardley, L, Bertholon, P, Pollak, L, Rudge, P, Gresty, MA et al. Visual vertigo: symptom assessment, spatial orientation and postural control. Brain 2001;124:1646–56CrossRefGoogle ScholarPubMed
Pavlou, M, Davies, RA, Bronstein, AM. The assessment of increased sensitivity to visual stimuli in patients with chronic dizziness. J Vestib Res 2006;16:223–31CrossRefGoogle ScholarPubMed
van Dixhoorn, J, Duivenvoorden, HJ. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res 1985;29:199206CrossRefGoogle ScholarPubMed
Jacobson, GP, Newman, CW. The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 1990;116:424–7CrossRefGoogle ScholarPubMed
Spitzer, RL, Kroenke, K, Williams, JBW, Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092–7CrossRefGoogle ScholarPubMed
Mallinson, AI. Visual vestibular mismatch: a poorly understood presentation of balance system disease [PhD thesis]. Maastricht: Maastricht University, 2011Google Scholar
Meldrum, D, Herdman, S, Vance, R, Murray, D, Malone, K, Duffy, D et al. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil 2015;96:1319–28CrossRefGoogle ScholarPubMed
Alahmari, KA, Sparto, PJ, Marchetti, GF, Redfern, MS, Furman, JM, Whitney, SL. Comparison of virtual reality based therapy with customized vestibular physical therapy for the treatment of vestibular disorders. IEEE Trans Neural Syst Rehabil Eng 2013;22:389–99CrossRefGoogle Scholar
Humphriss, RL, Baguley, DM, Andersson, G, Wagstaff, S. Hyperventilation in the vestibular clinic: use of the Nijmegen Questionnaire. Clin Otolaryngol Allied Sci 2004;29:232–7CrossRefGoogle ScholarPubMed
Bance, ML, O'Driscoll, M, Patel, N, Ramsden, RT. Vestibular disease unmasked by hyperventilation. Laryngoscope 1998;108:610–14CrossRefGoogle ScholarPubMed
Sakellari, V, Bronstein, AM, Corna, S, Hammon, CA, Jones, S, Wolsley, CJ. The effects of hyperventilation on postural control mechanisms. Brain 1997;120:1659–73CrossRefGoogle ScholarPubMed