Effect of vestibular exercise and optokinetic stimulation using virtual reality in persistent postural-perceptual dizziness

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.

Figure 1

Consort diagram.

Figure 2

Dizziness handicap inventory (DHI, A), vestibular activities of daily living (ADL, B), visual vertigo analogue scale (VVAS, C), and time of timed up-to-go test (TUG, D) before and after treatment. All questionnaires and TUG time scores were significantly improved in the vestibular exercise (VE) group (green); however, only ADL and TUG time were improved in the VE with optokinetic stimulation (OS) group (purple). Every dot is each score or time of patient. The green or purple bars indicate the interquartile range, and the horizontal black bars identify the median value of each group. All p values were assessed with the Wilcoxon signed rank test.

Figure 3

The change in VVAS after the 4-week program (ΔVVAS = VVAS at baseline—after 4 weeks, a negative value indicates aggravated visual vertigo) was correlated with VVAS at baseline in the VE group (blue dots, Spearman’s ρ = 0.881, p < 0.001) and the VE + OS group (red dots, Spearman’s ρ = 0.544, p = 0.036). The change in the VVAS score of all participants was correlated with the initial visual vertigo symptom (Pearson’s ρ = 0.716, p < 0.001, R² = 0.513).