Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

Dara Meldrum, Susan Herdman, Roisin Moloney, Deirdre Murray, Douglas Duffy, Kareena Malone, Helen French, Stephen Hone, Ronan Conroy, Rory McConn-Walsh, Dara Meldrum, Susan Herdman, Roisin Moloney, Deirdre Murray, Douglas Duffy, Kareena Malone, Helen French, Stephen Hone, Ronan Conroy, Rory McConn-Walsh

Abstract

Background: Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unknown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus® (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy.

Methods/design: In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months.

Discussion: Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated.

Trial registration: Clinical trials.gov identifier: NCT01442623.

Figures

Figure 1
Figure 1
The Nintendo Wii Fit Plus®.
Figure 2
Figure 2
CONSORT (2010) flow diagram of the trial.

References

    1. Yardley L. et al.Prevalence and presentation of dizziness in a general practice community sample of working age people. The British Journal Of General Practice: The Journal Of The Royal College Of General Practitioners. 1998;48(429):1131–1135.
    1. Herdman S. In: Contemporary perspectives in rehabilitation. 3. Philadelphia: F.A. Davis, editor. 2007. Vestibular rehabilitation; p. 504.
    1. Curthoys IS. Vestibular compensation and substitution. Current opinion in neurology. 2000;13(1):27–30. doi: 10.1097/00019052-200002000-00006.
    1. Strupp M, Brandt T. In: Handbook of clinical neurophysiology. Scott DZE, David SZ.: Elsevier, editor. 2010. Chapter 25 - Vestibular neuritis; pp. 315–332.
    1. Hillier SL, McDonnell M. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane database of systematic reviews. 2011. p. CD005397.
    1. Hansson EE. Vestibular rehabilitation - for whom and how? A systematic review. Advances in Physiotherapy. 2007;9(3):106–116. doi: 10.1080/14038190701526564.
    1. Kammerlind A-SC. et al.Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss-a randomized study. Clinical Rehabilitation. 2005;19(1):54–62. doi: 10.1191/0269215505cr830oa.
    1. Krebs DE. et al.Vestibular rehabilitation: useful but not universally so. Otolaryngology-head and neck surgery: 2003;128(2):240–250. doi: 10.1067/mhn.2003.72.
    1. Bent LR, McFadyen BJ, Inglis JT. Vestibular contributions during human locomotor tasks. Exerc Sport Sci Rev. 2005;33(3):107–113. doi: 10.1097/00003677-200507000-00002.
    1. Teggi R. et al.Rehabilitation after acute vestibular disorders. The Journal Of Laryngology And Otology. 2009;123(4):397–402. doi: 10.1017/S0022215108002983.
    1. Cakrt O. et al.Exercise with visual feedback improves postural stability after vestibular schwannoma surgery. European Archives Of Oto-Rhino-Laryngology. 2010;267(9):1355–1360. doi: 10.1007/s00405-010-1227-x.
    1. Burdea G, Coiffet P. Virtual reality technology. Second. New Jersey: Wiley and Sons; 2003.
    1. Whitney SL. et al.The use of virtual reality for people with balance and vestibular disorders: the Pittsburgh experience. Physical Therapy Reviews. 2009;14:299–306. doi: 10.1179/108331909X12488667117294.
    1. Sveistrup H. Motor rehabilitation using virtual reality. Journal of NeuroEngineering and Rehabilitation. 2004;1(1):10. doi: 10.1186/1743-0003-1-10.
    1. Whitney SL. et al.Responses to a virtual reality grocery store in persons with and without vestibular dysfunction. Cyberpsychology & Behavior: The Impact Of The Internet, Multimedia And Virtual Reality On Behavior And Society. 2006;9(2):152–156.
    1. Nitz JC. et the Wii Fit a new-generation tool for improving balance, health and well-being? A pilot study. Climacteric: The Journal Of The International Menopause Society. 2010;13(5):487–491. doi: 10.3109/13697130903395193.
    1. Young W. et al.Assessing and training standing balance in older adults: a novel approach using the 'Nintendo Wii' balance board. Gait & Posture. 2011;33(2):303–305. doi: 10.1016/j.gaitpost.2010.10.089.
    1. Hain TC. Wii "fit" for balance rehabilitation. 2009.
    1. Clark RA. et al.Validity and reliability of the Nintendo Wii balance board for assessment of standing balance. Gait & Posture. 2010;31(3):307–310. doi: 10.1016/j.gaitpost.2009.11.012.
    1. Meldrum D, Virtual reality rehabilitation of balance: assessment of the usability of the Nintendo WiiFit Plus. Disabil Rehabil Assist Technol. 2011.
    1. Brooke J. In: Usability evaluation in industry, B.T. Jordan PW, Weerdmeester BA, McClelland AL, editor. London: Taylor and Francis; 1996. SUS: a "quick and dirty" usability scale; pp. 189–194.
    1. Moher D. et al.CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c869. doi: 10.1136/bmj.c869.
    1. Shumway-Cook A, Woollacott MH. Motor control: Theory and practical applications. Baltimore, Md. London: Williams & Wilkins; 1995. p. 475.
    1. Shepard NT, Janky K. In: Handbook of Clinical Neurophysiology. D.Z.E. Scott and S.Z. David, editor. Elsevier; 2010. Chapter 19 - Computerized postural control assessment; pp. 238–251.
    1. Morris AE, Lutman ME, Yardley L. Measuring outcome from vestibular rehabilitation, part II: refinement and validation of a new self-report measure. International journal of audiology. 2009;48(1):24–37. doi: 10.1080/14992020802314905.
    1. Morris AE, Lutman ME, Yardley L. Measuring outcome from vestibular rehabilitation, part I: qualitative development of a new self-report measure. International journal of audiology. 2008;47(4):169–177. doi: 10.1080/14992020701843129.
    1. Parry SW. et al.Falls and confidence related quality of life outcome measures in an older British cohort. Postgraduate Medical Journal. 2001;77(904):103–108. doi: 10.1136/pmj.77.904.103.
    1. Herdman S. In: Handbook of Clinical Neurophysiology. D.Z.E. Scott and S.Z. David, editor. Elsevier; 2010. Chapter 14 - Computerized dynamic visual acuity test in the assessment of vestibular deficits; pp. 181–190.
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatrica Scandinavica. 1983;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.
    1. Pocock SJ. Clinical trials; a practical approach. Chichester: John Wiley and Sons; 1983.
    1. Pavlou M. et al.Simulator based rehabilitation in refractory dizziness. Journal of neurology. 2004;251(8):983–995.
    1. Herdman SJ, Hall CD, Delaune W. Variables associated with outcome in patients with unilateral vestibular hypofunction. Neurorehabilitation and neural repair. 2011.
    1. Meldrum D, MCConn Walsh R. In: Neurological Rehabilitation. 3. Stokes M, editor. London: Mosby; 2011. Vestibular Rehabilitation; pp. 413–430.
    1. Heritier SR, Gebski VJ, Keech AC. Inclusion of patients in clinical trial analysis: the intention-to-treat principle. The Medical journal of Australia. 2003;179(8):438–440.
    1. Pocock SJ. et al.Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Statistics in medicine. 2002;21(19):2917–2930. doi: 10.1002/sim.1296.
    1. Schmidt RA, Lee TD. Champaign, Ill. 4. Leeds: Human Kinetics; 2005. Motor control and learning: a behavioral emphasis; p. 537.

Source: PubMed

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