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Case Series Volume 10 Issue 1
Assessing the effectiveness of head-held virtual reality vestibular physical therapy: a case series
Alexander Au Dien,
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Gann E, Gardi A, Sharon J
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Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, USA
Correspondence: Alexander Au Dien, Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, USA
Received: April 26, 2025 | Published: June 4, 2025
Citation: Dien AA, Gann E, Gardi A, et al. Assessing the effectiveness of head-held virtual reality vestibular physical therapy: a case series. Int Phys Med Rehab J . 2025;10(1):29. DOI: 10.15406/ipmrj.2025.10.00394
Introduction
Traditional vestibular physical therapy (VPT) can ameliorate symptoms associated with numerous vestibular disorders. However, some patients fail to improve with VPT. Virtual reality vestibular physical therapy (VRVPT) has the potential to offer alternative, individualized modules tailored to address specific impairments that have previously been unresponsive to VPT, such as visual motion sensitivity or visual vertigo.1,2 The use of head-held virtual reality devices may augment VPT by providing an immersive condition where the user can experience sensory inputs emulating their real environment. Therefore, the purpose of this interventional case series was to 1) describe an individualized, head-held VRVPT intervention and 2) to examine changes in self-reported and performance-based measures prior to and after treatment.
Case description
Twelve participants (age 61±19 years; 6 female) diagnosed with vestibular loss (VL) (participants 1-6) or vestibular migraine (VM) (participants 7-12) completed the study. All participants had previously completed traditional VPT and returned due to continued deficits. Participants completed 8, 45-minute sessions consisting of VRVPT using the Virtualis head-held system over a 12-week period. The VRVPT intervention was completed for at least 25 minutes during each clinic session and supplemented with a home exercise program. The VRVPT targeted impairments such as gaze stability, sensory orientation, and visual motion sensitivity. Each session was monitored by a physical therapist and specific virtual reality modules were selected based on each participant’s functional impairments. At baseline and 12 weeks the Dizziness Handicap Inventory (DHI) to assess restriction of activities due to dizziness, Functional Gait Assessment (FGA) to assess dynamic balance, Visual Vertigo Analogue Scale (VVAS) to assess visual motion sensitivity and Sea Simulator Sickness Questionnaire (SSQ) to assess tolerance to the VPT.3
Outcomes
All (100%) VRVPT sessions were completed and well-tolerated without adverse events (e.g., simulator sickness). Changes Post-vs Pre intervention were (mean [SD]): DHI = 13.7 (8.5); FGA = 3.3 (3.3); VVAS = 23.9 (3.42). Improvements on the DHI and FGA did not exceed minimal detectable change (MDC) of 18 points and 6 points, respectively. No MDC for VVAS has been established. There were no differences in improvements between participants with VL and VM.4
Discussion
The use of VRVPT was safe, well-tolerated and resulted in measurable improvements in self-reported and performance-based measures.5 While there were improvements on the VVAS, our ability to draw conclusions about these changes are limited due to the paucity of research on this measure. Individualized VRVPT appears to hold promise for improving visual vertigo in patients with VL and VM who failed to improve with VPT. Further research is warranted to determine which vestibular conditions benefit most from the use of VRVPT, and to establish MDC values for the VVAS.
Acknowledgments
None.
Conflicts of interest
The authors declare that there are no conflicts of interest.
References
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- Xie M, Zhou K, Patro N, et al. Virtual reality for vestibular rehabilitation: a systematic review. Otol Neurotol. 2021;42(7):967–977.
- Rosiak O, Szczepanik M, Woszczak M, et al. Effectiveness of vestibular rehabilitation in patients with vestibular dysfunction. Med Pr. 2019;70(5):545–553.
- Dannenbaum E, Chilingarian G, Fung J. Validity and responsiveness of the visual vertigo analogue scale. J Neurol Phys Ther. 2019;43(2):117–121.
- Rosiak O, Krajewski K, Woszczak M, et al. Evaluation of the effectiveness of a virtual reality-based exercise program for unilateral peripheral vestibular deficit. J Vestib Res. 2018;28(5-6):409–415.
©2025 Dien, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.