Abstract
To determine the effect of customized vestibular exercise (VE) and optokinetic stimulation (OS) using a virtual reality system in patients with persistent postural-perceptual dizziness (PPPD). Patients diagnosed with PPPD were randomly assigned to the VE group or VE with OS group. All participants received VE for 20 min using a virtual reality system with a head mount display once a week for 4 weeks. The patients in the VE with OS group additionally received OS for 9 min. We analysed the questionnaires, timed up-to-go (TUG) test, and posturography scores at baseline and after 4 weeks. A total of 28 patients (median age = 74.5, IQR 66–78, men = 12) completed the intervention. From baseline to 4 weeks, the dizziness handicap inventory, activities of daily living (ADL), visual vertigo analogue scale, and TUG improved in the VE group, but only ADL and TUG improved in the VE with OS group. Patients with severe visual vertigo improved more on their symptoms than patients with lesser visual vertigo (Pearson’s p = 0.716, p < 0.001). Our VE program can improve dizziness, quality of life, and gait function in PPPD; however, additional optokinetic stimuli should be applied for individuals with visual vertigo symptoms.
Highlights
Session 1: Adaptation with stable backgroundVestibulo-ocular reflex exercise: the patients rotate their head 10 times 15° around the target* on the centre along the pitch and yaw axisStatic environment: a living room Dynamic environment: under the sea, with fishSession 2: Adaptation with habituative backgroundVisual guided vestibulo-ocular reflex exercise: the patients follow the head AND eye to the target*
We developed VE and OS with a virtual reality system and applied a patent collaborating the manufacturer (JCS Co., Ltd.)
VRT has been proven to improve subjective symptoms and posturographic results in chronic subjective d izziness, which type of exercise is effective for PPPD has not been clarified
Summary
Session 1: Adaptation with stable backgroundVestibulo-ocular reflex exercise: the patients rotate their head 10 times 15° around the target* on the centre along the pitch and yaw axisStatic environment: a living room Dynamic environment: under the sea, with fishSession 2: Adaptation with habituative backgroundVisual guided vestibulo-ocular reflex exercise: the patients follow the head AND eye to the target*. Vestibulo-ocular reflex exercise: the patients rotate their head 10 times 15° around the target* on the centre along the pitch and yaw axis. Visual guided vestibulo-ocular reflex exercise: the patients follow the head AND eye to the target*. The target* moves 15° horizontally and vertically. Active head and eye exercise: the patients rotate their head and shift their gaze rapidly to catch-up to the target (space- The night sky (black space) craft), which randomly appears every 10 s and moves around within a 270° visual field. Optokinetic stimulation: Additional habituation in the night sky, which rotate counter-clockwise along the pitch, yaw, and roll axis of their head.
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