Vestibular Rehabilitation Research Articles

Role of nonpharmacological concussion management in children: systematic review of randomized controlled trials.

Concussion is a global public health problem that affects many children worldwide. Most patients present with postconcussion syndrome and normal brain imaging find- ings. Despite the high incidence of concussion in children, published research on nonpharmacological management is lacking and much more often concerns pharmacological interventions. This systematic review aimed to evaluate the role of nonpharmacological interventions in managing concussion based on randomized controlled trials. The PubMed, Scopus, Web of Science, and Cochrane data- bases were extensively searched for articles published between January 2013 and July 2023. A modified patient intervention, comparison, and outcome framework was used to construct the search strategy and eligibility criteria. Risk of bias was assessed using the Risk of Bias-2 tool. A total of 16 studies conducted between January 2013 and July 2023 were analyzed. Three studies were conducted in an acute care setting (<24-hour postinjury) involving rest, computer time, and doing nothing, while the other 13 studies were conducted in a chronic care setting (>24-hour postinjury) and included aerobic exercise, collaborative care intervention, cervical spine rehabilitation, education by physiotherapists, a hyperbaric oxygen therapy protocol, family intervention therapy, virtual reality, traditional occupational therapy, virtual rehabilitation, oculomotor control exercises, vestibular rehabilitation, coordination exercises, and balance exercises. This systematic review highlights the importance of nonpharmacological therapy in pediatric concussion cases. Active rehabilitation may yield promising outcomes. Another interesting approach may be useful in pediatric concussion management. How- ever, this systematic review shows a lack of high-quality literature supporting nonpharmacological pediatric con- cussion treatments.

Constant Dizziness Versus Episodic Vertigo in Ménière's Disease: Health-Related Quality of Life, Cognitive Dissonance, and Postural Problems.

The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière's disease (MD) to allow characterization of the impact of the disease. The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.

The effect of proprioceptive vestibular rehabilitation on sensory-motor symptoms and quality of life.

Peripheral vestibular hypofunction (PVH) is characterized by balance and gait disorders and vestibulo-autonomic findings. The vestibular system and proprioceptive system work together to regulate sensorimotor functions. Vestibular exercises are effective in PVH, but their superiority over each other is still unclear. This study aims to examine the effect of proprioceptive vestibular exercises on patients with PVH. 30 individuals with unilateral PVH were assigned to 3 groups. Group 1 received proprioceptive vestibular rehabilitation, group 2 received standard vestibular rehabilitation. Both groups were given standard vestibular exercises as home exercises. No exercise was applied to the group 3. Patients were evaluated in terms of balance, functional mobility, posture, sensory profile, and quality of life. Although there was a significant intra-group difference in balance, functional mobility, and quality of life results in all groups (p < 0.05), the difference between groups was generally in favor of group 1 (p < 0.05). There was a significant difference between the groups in the posture analysis results (p < 0.05), while there was a significant difference in the 1st group (p < 0.05). There was a significant difference between the groups in the results of sensory sensitivity, sensory avoidance, and low recording (p < 0.05). There was no significant difference between the groups in sensory-seeking results (p > 0.05). There was a significant difference in quality of life between and within groups (p < 0.05). Proprioceptive vestibular rehabilitation is an effective method in PVH. We think that our study will guide clinicians and contribute to the literature. NCT04687371.

Asymmetry and rehabilitation of the subjective visual vertical in unilateral vestibular hypofunction patients.

Patients with acute unilateral peripheral vestibular hypofunction (AUVP) show postural, ocular motor, and perceptive signs on the diseased side. The subjective visual vertical (SVV) test measures the perceived bias in earth-vertical orientation with a laser line in darkness. This study was aimed at (1) examining whether SVV bias could depend on preset line orientation and angles, and (2) investigating whether vestibular rehabilitation (VR) can improve SVV normalization. To our knowledge, SVV symmetry/asymmetry and impact of VR on SVV normalization have never been documented in the literature. We investigated the SVV bias in a retrospective study (Study 1: n = 42 AUVP patients) comparing the data recorded for line orientation to the ipsilateral and contralateral sides at preset angles of 15° and 30°. We investigated the effects of VR on SVV normalization in a prospective study (Study 2: n = 20 AUPV patients) in which patients were tilted in the roll plane using a support tilted to the hypofunction side with the same amplitude as the SVV bias. This VR protocol was performed twice a week for 4 weeks. Supplementary data on body weight distribution and medio-lateral position of the center of foot pressure (CoP) were obtained using posturography recordings. Study 1 showed asymmetrical values of the SVV bias. On average, the SVV errors were significantly higher for ipsilateral compared to contralateral line orientation (6.98° ± 3.7° vs. 4.95° ± 3.6°; p < 0.0001), and for 30° compared to 15° preset angle (6.76° ± 4.2° vs. 5.66° ± 3.3°; p < 0.0001). Study 2 showed a fast SVV normalization with VR. Non-pathological SVV bias (below ±2°) was found after only 3 to 5 VR sessions while pathological SVV values were still observed at the same time after symptoms onset in patients without VR (1.25° ± 1.46° vs. 4.32° ± 2.81°, respectively; p < 0.0001). A close temporal correlation was observed in the time course of body weight distribution, mediolateral CoP position, and SVV bias over time, suggesting beneficial effects of the VR protocol at both the perceptive and postural levels. We recommend routine assessment of the ipsilateral and contralateral SVV bias separately for a better evaluation of otolith organs imbalance that can trigger chronic instability and dizziness. The SVV bias and the postural impairment caused by the imbalanced otolith inputs after unilateral vestibular loss can be rapidly normalized by tilting the patients in the roll plane, an additional means in the physiotherapist's toolbox. The protocol likely reweights the visual and somatosensory cues involved in the perception of verticality.

Cross-cultural adaptation, reliability, and validity of the vestibular rehabilitation benefit questionnaire in the central Kurdish version

Background and objectives: The vestibular rehabilitation benefit questionnaire is a new patient-reported outcome measures with psychometric properties, to assess the efficacy of vestibular rehabilitation. The present study aims to cross-culturally adapt the questionnaire into the central Kurdish dialect and to examine its psychometric properties. Methods: This is a cross-sectional study conducted in Sulaimani city- Kurdistan Region of Iraq from March to September 2022, on 127 patients diagnosed with vestibular disorders between 18 to 79 years old. The vestibular rehabilitation benefit questionnaire Kurdish version was created through a regulated process of cross-cultural adaptation. The Kurdish participants were responded to the questionnaire, vertigo symptom scale short form and dizziness handicap inventory to assess validity of the questionnaire. The reliability of the questionnaire was assessed by randomly selecting 40 participants to repeat the questionnaire responses over a 24-hour timeline. Results: The results revealed that the ? for subscales of dizziness, anxiety, motion-provoked dizziness, quality of life and the scale of vestibular rehabilitation benefit questionnaire -total were 0.81, 0.82, 0.78, 0.77, and 0.92, respectively. The intra-class correlation coefficient was 0.96 for the questionnaire total scale; 0.97 and 0.93 for symptoms and quality of life subscales, respectively. Spearman rho correlation coefficient revealed a powerfully positive relationship between total the questionnaire and dizziness handicap inventory, and a strong positive relationship between total questionnaire and vertigo symptom scale short form. Conclusion: The vestibular rehabilitation benefit questionnaire Kurdish version is a reliable and validated patient-reported outcome measures that can be utilized for the Kurdish-speaking population.

Balance Impairment in Patients with Rheumatoid Arthritis and Ankylosing Spondylitis.

Balance weaknesses related to mobility and fall risk in patients with rheumatic diseases are well-known. Vestibular dysfunction could negatively contribute to the balance ability of this patient population. This study aims to investigate the effects of Rheumatoid Arthritis (RA) and Ankylosing Spondylitis (AS), among the most common rheumatic diseases, on postural balance related to vestibular function. Seventy-eight participants were grouped as RA (n=34, 43%), AS (n=24, 30.7%), and the control group consisted of healthy individuals (n=20, 25.6%). Cervical Vestibular Evoked Myogenic Potentials (cVEMP) test, which assesses the vestibular function objectively, Dizziness Handicap Inventory (DHI), which evaluates vertigo subjectively, and Berg Balance Scale (BBS) were performed. Different degrees of VEMP latency prolongations were found in the AS and RA groups. Right, and left ear N1 latencies were significantly longer in the AS group than in RA and control. Right ear P1 latency prolongation was statistically significant in the RA group. Amplitude asymmetry ratio (AAR) was found to be considerably higher in the RA and AS groups than in the control group (p<0.05). The mean BBS score in the AS group was below the fall risk score of 45. A negative statistically significant effect was observed between latency prolongation and BBS in AS groups. The abnormal VEMP findings in individuals with RA and AS shows inner ear vestibular system dysfunction. This vestibular impairment strictly contributes to their postural imbalance and requires a focused vestibular rehabilitation program for balance treatment.

Improvement in Body's Dynamic Adaptation during Walking with Vestibular Rehabilitation Therapy in Patients with Cerebellopontine Angle Tumor Resection.

Our study aimed to investigate the effects of vestibular rehabilitation therapy on functional gait performance in patients with balance disorders. A total of 40 post-operative patients with balance disorders were included in the study. They were divided into two groups and participated in a vestibular rehabilitation program during their hospital stay. After discharge, the intervention group performed vestibular exercises at home, while the control group did not. Balance was assessed using the Functional Gait Assessment Scale at discharge and three months after surgery. The intervention group included 15 women and 5 men with an average age of 45 years, while the control group included 7 women and 13 men with an average age of 50 years. Three months after surgery, the change in Functional Gait Assessment (FGA) scores exceeded the clinically significant threshold of 5 points in 17 patients in the intervention group and 14 in the control group. There was a statistically significant difference in FGA progression between the groups (p = 0.034). After three months post-surgery, 7 patients in the intervention group experienced falls compared to 12 in the control group. Three months after surgery, we observed a significant improvement in the performance of balance tasks while walking and a lower risk of falls in the intervention group.

TBICoE approach to concussion rehabilitation in service members and veterans.

Concussion, also known as mild traumatic brain injury (mTBI), is a condition with unique ties to military service. Service members (SMs) are inherently at a higher risk for concussive injuries due to the intense physical training environment and combat operational tempo required to serve. The Traumatic Brain Injury Center of Excellence (TBICoE) is the US Department of Defense authority on this condition and provides a thorough approach to management of concussion and associated symptom sequela. This article seeks to review the TBICoE approach to the management and rehabilitation of military SMs with mTBI, and highlight resources available to military medical providers. The authors reviewed evidence and TBICoE resources to provide this comprehensive overview of the TBICoE approach to management and rehabilitation of concussion in military SMs. A progressive return to activity protocol in conjunction with symptom-guided management of common post-concussive sequelae, including headache, vestibular and oculomotor issues, sleep dysfunction, cognitive rehabilitation, and behavioral health comorbidities are essential for concussion management in the acute, post-acute and chronic phases of injury. The TBICoE approach to the rehabilitation of military SMs is comprehensive, and includes initial management with a stepwise return to duty protocol and an objective return to duty screening. The mainstays of treatment for SMs with post-acute and chronic post-concussion symptoms are headache management, vestibular and oculomotor rehabilitation, sleep interventions, cognitive rehabilitation, and early intervention for behavioral health comorbidities. These evidence-based strategies may be applied in the treatment of SMs in the US and internationally.

Do we really need this robot? Technology requirements for vestibular rehabilitation: Input from patients and clinicians

BackgroundA main challenge in many types of physical rehabilitation is patient adherence to recommended exercises. Vestibular rehabilitation is the most effective treatment for the symptoms of dizziness, vertigo, imbalance, and nausea caused by vestibular disorders, but adherence levels are particularly low as the rehabilitation program calls for many short exercise sets during the day, which can worsen symptoms and impair balance in the short term. Technological tools have the potential to increase adherence, but to date, there has been no comprehensive analysis, in the context of vestibular rehabilitation, of the specific needs from technology, of its limitations, and of concerns regarding its use. ObjectiveThe aim of the study is to identify the main features required from technology for vestibular rehabilitation, as perceived by patients with vestibular disorders and by vestibular physical therapists, using a socially assistive robot as a test case. We seek here to provide practical information for the development of future vestibular rehabilitation technologies which are based on human-computer interaction (HCI) and human-robot interaction (HRI). MethodsWe conducted a qualitative study with six focus groups (N = 39). Three groups of patients with vestibular disorders (N = 18) and three groups of physical therapists (N = 21) participated in this study. The participants answered structured questions on technologies for vestibular rehabilitation, watched a presentation of two videos of a socially assistive robot (SAR), and completed an online survey. Thematic analysis with a mixed deductive and inductive approach was used to analyze the data. ResultsParticipants preferred phone applications or virtual/augmented reality platforms over an embodied robotic platform. They wanted technology to be adaptive to the different stages of rehabilitation, gamified, easy to use, safe, reliable, portable, and accessible remotely by the therapist. They reported that the technology should provide feedback on the quality and quantity of exercise performance and monitor these factors while considering the tolerability of the ensuing disruptive symptoms. Participants expected that using technology as part of the rehabilitation process would shorten exercise sessions and improve clinical outcomes compared to standard care. SARs for vestibular rehabilitation were perceived as useful mostly for children and patients with chronic vestibular disorders, and their potential use for rehabilitation raised concerns regarding safety, ethics, and technical complexity. ConclusionsAlthough SARs can potentially be used to increase exercise adherence, a phone application appears to be a more suitable medium for this purpose, raising fewer notable concerns from users. We provide a summary of perceived advantages and disadvantages of technology for vestibular rehabilitation, as well as a set of specific requirements from it, which may inform the future development of specific supportive technologies. In addition, the focus group methodology employed demonstrates the importance of participatory design in the development of rehabilitation-supportive technology as participants were able to identify the likely inappropriateness of SARs for the specific case of vestibular rehabilitation.

Clinical efficacy of vestibular assessment and rehabilitation training in peripheral vestibular vertigo.

To evaluate the clinical efficacy of vestibular assessment and rehabilitation training in patients with peripheral vestibular vertigo. This was a retrospective study. A total of 169 patients diagnosed with peripheral vestibular vertigo, admitted to Cangzhou People's Hospital between January 2020 and January 2023 were divided into control group (83 cases) and observation group (86 cases). The control group received medication-based treatment, while the observation group was provided with combined treatment of medication and vestibular rehabilitation training. Assessment of recovery included the Dizziness Handicap Inventory (DHI), Vestibular Symptom Index (VSI), and Activities-specific Balance Confidence (ABC) scale before and at two, four, and eight weeks post-treatment. Psychological status, sleep quality, and life quality were evaluated. Both groups underwent the Fukuda stepping test and timed balance test. At two, four, and eight weeks post-treatment, both groups exhibited significantly lower DHI-P, DHI-F, DHI-E, VSI, and ABC scores compared to pre-treatment (p<0.05). The observation group showed significantly lower DHI-P, DHI-F, DHI-E, VSI, and ABC scores than the control group at two and four weeks post-treatment (p<0.05). After treatment, both groups demonstrated reduced body deviation angles and increased time without falling in the Fukuda stepping test (p<0.05). Notably, the observation group had significantly better outcomes (p<0.05). In comparison to medication-based treatment alone, a combined approach involving medication treatment and vestibular rehabilitation training may demonstrate early improvements in vertigo symptoms, enhance balance capabilities, and ameliorate psychological well-being, sleep quality, and overall quality of life for patients.

Proximal auditory AR rehabilitation: system integration and wellness applications-from hearing support up toward vestibular rehabilitation.

We present a new rehabilitation system based on novel principles, which consists of an auditory augmented reality (AR) headset we originated. The auditory AR headset, which does not cover both ears, allows users to hear both Real and Virtual environmental sounds at the same time. It can also be used in combination with Hearing Aids. We have studied a system to support hearing-impaired people and conducted a test evaluation. The system was able to provide convenience akin to "reading glasses for sound" to those who had mild hearing disabilities. Furthermore, by combining the system with surrounding speakers, a completely novel virtual auditory illusion was created in which the sound image jumps into the ear and runs away. We name this "proximal auditory AR (PAAR)" system. This system directly affects the unconscious level of reflexes for maintaining a standing position and can generate very subtle body motion disturbance. Using this system, we can modulate the standing posture and observe the autonomic nerve system's ability to subliminally compensate for the disturbance, using a stabilometer that measures body sways by center of pressure (COP). We observed a significant difference in the declination of COP only when using the PAAR, which is combined with array speakers and the auditory AR headphone, compared using a conventional closed-type and a bone-conduction headphone. By analyzing such big data of physical movement through machine learning, we expect to realize new systems for diagnosis, rehabilitation, function maintenance, and fall prevention.

Telerehabilitation: Vestibular Physiotherapy vs. Multicomponent Exercise for Functional Improvement in Older Adults: Randomized Clinical Trial.

The loss of vestibular and motor function can occur naturally with aging. Vestibular physiotherapy exercises (VE) specifically address vestibular rehabilitation to reduce imbalances and improve physical condition, like therapeutic exercise (TE). During COVID-19, technology was used with the elderly for implementation. Objective: to determine if vestibular exercises are as effective as multicomponent exercises in improving functional capacity using technological tools. Methods: A randomized clinical trial compared two intervention groups of 21 subjects with functional limitations and frailty (average age 76.11 years). The intervention involved multicomponent exercise for the control group (Vivifrail protocol) and vestibular exercises for the experimental group (Cawthorne and Cooksey exercises) for 6 weeks with five sessions per week both groups. Two professionals implemented the exercises, and participants received tailored exercise videos. Primary outcomes were gait speed, dynamic balance, and physical capacity. Results: Both groups showed significant improvements. For physical function measured by SPPB (0-12 points), the multicomponent exercise group improved by 1.97 (0.91; 3.03), p < 0.001, and the vestibular exercise group improved by 1.63 (0.65; 2.60), p = 0.002. For dynamic balance measured by the Timed Up and Go (TUG) test, the multicomponent exercise group improved by -0.88 (-1.33; -0.42), p < 0.001, and the vestibular exercise group improved by -0.79 (-1.21; -0.37), p < 0.001. There were no significant differences between groups. Finally, regarding gait speed, there were no differences in either group between pretest and post-test (p > 0.05). Conclusions: Both multicomponent exercise and vestibular exercises improve functional capacities via telerehabilitation as measured by the SPPB, although vestibular physiotherapy does not show superior outcomes compared to the control group.

Customized Vestibular Rehabilitation for Vestibular Schwannoma Excision via Translabyrinthine Approach: A Single-Center Experience.

Objectives: To evaluate the effectiveness of intensive customized vestibular rehabilitation after vestibular schwannoma (VS) excision. Methods: 52 patients who underwent VS removal via a translabyrinthine approach from 2020 to 2022 were involved in this study. Bedside examination, video head impulse test (vHIT), functional head impulse test (fHIT), and the dizziness handicap inventory (DHI) were performed before and after the rehabilitation, which consisted of 10 sessions of specifically designed vestibular, visual, and physical integrated training. Results: After rehabilitation, the vHIT showed overall unchanged values on the affected and healthy side. In contrast, the scores of fHIT, which explores the higher connection of the vestibular system with visual and cerebellar pathways, improved on both the pathological and healthy sides after training (p-value 0.004 and 0.000, respectively). The effectiveness of the rehabilitation was reinforced by the DHI scores, which were considerably lower after training. Conclusions: To our knowledge, this is the first study to explore fHIT outcomes after removal of VS, estimating the impact of rehabilitation on the overall compensation process. The outcomes support the role of extensive postsurgical rehabilitation in the compensatory process, even just a few days after surgery.

Vestibular Rehabilitation Using Dynamic Posturography: Objective and Patient-Reported Outcomes from a Randomized Trial.

Balance deficits are common and debilitating. Standard treatments have limitations in addressing symptoms and restoring dynamic balance function. This study compares a rehabilitative computerized dynamic posturography (CDP) protocol, computerized vestibular retraining therapy (CVRT), with a home exercise program (HEP) for patients with objectively confirmed unilateral vestibular deficits (UVDs). Single-center, randomized, interventional trial, with 1-sided crossover. A tertiary neurotology clinic. Patients with UVDs and Dizziness Handicap Inventory (DHI) score >30 were randomized to receive either CVRT or HEP. After completion of treatment, the HEP group was crossed over to CVRT. Outcome measures were the sensory organization test (SOT) and 3 participants reported dizziness disability measures: the DHI, Activity-Specific Balance Confidence Scale (ABC) scale, and Falls Efficacy Score-International (FES-I). We enrolled 37 patients: 18 participants completed CVRT and 12 completed HEP, 11 of whom completed the crossover. Seven participants withdrew. The CVRT group demonstrated a greater improvement in SOT composite score than the HEP group (P = .04). Both groups demonstrated improvement in participant-reported measures but there were no differences between groups (DHI: P = .2604; ABC: P = .3627; FES-I: P = .96). Following crossover to CVRT after HEP, SOT composite (P = .002), DHI (P = .03), and ABC (P = .006) improved compared to HEP alone. CVRT and HEP were both associated with improved participant-reported disability outcomes. CVRT was associated with greater improvement in objective balance than HEP. Adding CVRT after HEP was superior to HEP alone. Multimodal CDP-based interventions, such as CVRT, should be considered as an adjunct to vestibular physiotherapy for patients with UVD.

Three-dimensional exergaming conjunction with vestibular rehabilitation in individuals with Benign Paroxysmal Positional Vertigo: A feasibility randomized controlled study.

To examine the effectiveness of 3D (dimensional)-vestibular rehabilitation therapy (VRT) on gait, balance problems, processing time speed and subjective complaints in patients with Benign Paroxysmal Positional Vertigo (BPPV) compared to a control group (CG). This study aimed to test the feasibility of virtual reality-based 3D exergaming conjunction with vestibular rehabilitation. Twenty-two patients with BPPV (negative DixHallpike/Roll test results, existing dizziness/balance complaints) were randomly allocated to the study group (SG, n:11 3D-VRT) or Control group (CG n:11, no exercise-rehabilitation) for 8 week. The SG performed 3D-VRT for 45 to 50 min/d, 3 times/wk, and the CG did receive only Canalith Repositioning Maneuver (CRM). CRM was applied in both groups before the study. Outcome measures included 10-Meter-Walk-Test (10-MWT) (with/without head turns), Dynamic Gait Index (DGI), Choice-Stepping-Reaction-Time-ped (CSRT-MAT), Fullerton Advanced Balance Scale (FAB), and Visual Analog Scale (VAS). The SG showed significantly improvement in 10-MWT without (p5 = 0.00,η2 = 0.49), with horizontal (p5 = 0.00,η2 = 0.57),vertical (p5 = 0.01,η2 = 0.48) head turns, DGI (p5 = 0.00,η2 = 0.74), CSRT-MAT, FAB (p5 = 0.00,η2 = 0.78) and VAS-dizziness (p5 = 0.00,η2 = 0.65), VAS-balance problem (p5 = 0.00,η2 = 0.43), VAS-fear of falling (p5 = 0.00,η2 = 0.42) compared to the CG. The 3D-VRT were effective in improving gait, balance, processing speed and resolving the subjective complaints in BPPV. The 3D-VRT method is feasible for patients who suffer from residual dizziness or balance complaints after CRM. Furthermore, the 3D-VRT is more accessible and less expensive than other virtual reality applications, which may facilitate further research or clinical use.

Efficacy of Virtual Reality as Vestibular Rehabilitative Therapy in Peripheral Vestibular Dysfunction: A Systematic Review and Meta-Analysis

Abstract Background Vestibular rehabilitation therapy is a safe, effective and non-invasive treatment for the uncompensated peripheral vestibular lesions. Virtual reality can be utilized in vestibular rehabilitation. There are no standardized guidelines settled in the literature involving virtual reality settings for the treatment of the peripheral vestibular lesions. Aim of the Work To study the efficacy of virtual reality (VR) interventions in vestibular rehabilitation in patients with peripheral vestibular disorders. Methods The following databases were examined: PubMed, Google scholar andEmbase. The following search terms were utilized: (Virtual reality – video games – Vestibular rehabilitation – peripheral vestibular dysfunction). Results Based on the inclusion and exclusion criteria, four studies were selected for inclusion in this study. Statistical analysis was done using outcome measures as Dizziness Handicap Inventory (DHI) and Activities-specific Balance Confidence questionnaire (ABC). This study found that virtual reality interventions can improve balance function in patients with peripheral vestibular disorders. Conclusions This study suggests that virtual reality has potential clinical benefit for vestibular rehabilitation in peripheral vestibular dysfunction compared with conventional vestibular rehabilitation.

Advances in vestibular function and rehabilitation of large vestibular aqueduct syndrome

Large vestibular aqueduct syndrome（LVAS） is a common recessive hereditary hearing loss disease, and some patients may also experience vestibular dysfunction. With the wide application of cochlear implant（CI） and the development of vestibular medicine, the pathophysiological mechanism of LVAS and the influence mechanism of CI on vestibular function are gradually elucidated. Consequently, the evaluation and rehabilitation of vestibular dysfunction function have also become research hotspots. This article reviews studies on vestibular function and related rehabilitation in patients with large vestibular aqueduct syndrome.

Effects of Vestibular vs. Somatosensory Rehabilitation on Balance and Quality of Life of Sub-acute Stroke Patients with Vestibular Syndrome

Background: Stroke is one of the most common causes of disability worldwide, affecting millions of people per year, and it has a large burden on health care systems. In the early subacute phase, patients who survive a stroke usually show impairments in balance, often due to sensory and vestibular deficits; this influences their quality of life. Methods: A double-blind, randomized controlled trial was conducted to assess the effectiveness of vestibular and somatosensory interventions on balance and quality of life in early subacute stroke patients with vestibular syndrome. Fifty-two patients were randomly divided into a vestibular or somatosensory rehabilitation group or a control group receiving usual care. The trial was completed by 49 patients who were evaluated onon the Berg Balance Scale and the Vestibular Quality of Life Questionnaire at baseline and 12 weeks post-intervention. Results: The study found that both vestibular and somatosensory rehabilitation interventions led to significant improvements in balance, as indicated by the Berg Balance Scale scores, and quality of life, based on vestibular Quality of Life Questionnaire scores, compared to the control group (p&lt;0.05). There was no significant difference between the two intervention groups in terms of their impact on either balance or quality of life outcomes. Conclusion: Vestibular and somatosensory rehabilitation interventions represent effective strategies for improving balance and quality of life in early subacute stroke patients with vestibular syndrome. These findings underline the importance of including targeted rehabilitation approaches within stroke care protocols to achieve optimal functional outcomes and long-term recovery. Keywords: Balance, Stroke, Quality of Life, Vestibular Symptoms.

Comparative Study of Vestibular Rehabilitation and Dual Task Training on Balance and Quality of Life in Young Stroke Patients

Question: Is there any impact of vestibular rehabilitation and dual task training alongside conventional therapy on balance and quality of life in young stroke patients.  Design: Quasi-experimental study with treatment duration of 8 weeks. Simple random sampling was used to divide patients into 3 groups.  Participants: 30 subjects in the age group 18-45 years both males and females with diagnoses of unilateral hemiplegia within the previous six months.  Intervention: Group A received vestibular rehabilitation along with conventional therapy; Group B received dual task training alongside conventional therapy and Group C received only conventional therapy. Outcome measures: Assessment using Berg Balance Scale and Stroke Specific Quality of Life was conducted pre- and post-treatment.  Results: The results revealed a significant improvement (p&lt;0.05) in balance and quality of life scores in Group A as compared to Groups B and Group C.  Conclusion: Hence, it was concluded that vestibular rehabilitation along with conventional therapy is more effective in enhancing balance among young stroke patients compared to dual task training along with conventional therapy or conventional therapy alone.  Registration: BFUHS/2K23p-TH/11527.

Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction.

The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.