Three‐Dimensional, Virtual Reality Vestibular Rehabilitation for Ménière's Disease‐Induced Chronic Imbalance Problem

Abstract

Objectives: Patients with Ménière’s disease (MD) may suffer from chronic imbalance problem that cannot be cured by surgery or medication. For these patients, vestibular rehabilitation is another treatment option. Three-dimensional (3D), virtual reality (VR) technology may be applied to facilitate rehabilitation exercise. In this study we report outcomes of 3D, VR rehabilitation for patients with MD-related chronic vestibular dysfunction. Methods: A VR-based rehabilitation system was developed. The system consists of the Kinect Xbox for full-body interaction, 3D-ready projector with shutter-glasses for stereo imaging, Wii Fit pressure pad (for tracing the center of gravity sway and statokinesigrams [SKG], in cm2), and Unity game engine for leveled-difficulty design. The modified Cawthorne-Cooksey exercises (MCCE) was adapted into this system; the MCCE scores were compared following intervention. 50 MD patients with chronic balance were recruited for this prospective, longitudinal, uncontrolled clinical study. Patients followed the instructions of MCCE to complete at least 6 sessions of vestibular rehabilitation within a 4-week period. Results: All patients experienced improvement of balance function performing daily activities and were overall positive about the training protocol. After intervention, the fast components of postural sway and SKG ( P < 0.05) were reduced. The MCCE scores significantly improved (66.6 to 74.6, P < 0.05). We found age (Î2 = -0.52, P < 0.05) and number of training sessions (Î2 = 2.53X, P < 0.05) were significant predictors for clinical improvement. Conclusions: Vestibular rehabilitation can assist MD patients who cannot benefit from medication and surgery. The data support the applicability of 3D, VR technology in the field of vestibular rehabilitation.