Contextual sensory integration training vs. traditional vestibular rehabilitation: a pilot randomized controlled trial

Abstract

Background: We created a clinical virtual reality application for vestibular rehabilitation. Our app targets contextual sensory integration (C.S.I.) where patients are immersed in safe, increasingly challenging environments while practicing various tasks (e.g., turning, walking). The purpose of this pilot study was to establish the feasibility of a randomized controlled trial comparing C.S.I. training to traditional vestibular rehabilitation.

Methods: Thirty patients with vestibular dysfunction completed the Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), Visual Vertigo Analog Scale (VVAS), Functional Gait Assessment (FGA), Timed-Up-and-Go (TUG), and Four-Square Step Test (FSST). Following initial assessment, the patients were randomized into 8 weeks (once per week in clinic + home exercise program) of traditional vestibular rehabilitation or C.S.I. training. Six patients had to stop participation due to the covid-19 pandemic, 6 dropped out for other reasons (3 from each group). Ten patients in the traditional group and 8 in the C.S.I group completed the study. We applied an intention to treat analysis.

Results: Following intervention, we observed a significant main effect of time with no main effect of group or group by time interaction for the DHI (mean difference - 18.703, 95% CI [-28.235, -9.172], p = 0.0002), ABC (8.556, [0.938, 16.174], p = 0.028), VVAS, (-13.603, [-25.634, -1.573], p = 0.027) and the FGA (6.405, [4.474, 8.335], p < 0.0001). No changes were observed for TUG and FSST.

Conclusion: Patients' symptoms and function improved following either vestibular rehabilitation method. C.S.I training appeared comparable but not superior to traditional rehabilitation.

Trial registration: This study (NCT04268745) was registered on clincaltrials.gov and can be found at https://clinicaltrials.gov/ct2/show/NCT04268745 .

Keywords: Balance; HTC Vive; Head mounted Display; Vestibular Rehabilitation.

Fig. 1

Recruitment flow diagram

Fig. 2

Pre and Post estimated marginal mean and their respective 95% confidence intervals for the traditional and C.S.I groups on outcomes that showed a significant change over time in both groups: The Dizziness Handicap Inventory (DHI pre: Traditional 50.8 [41.1, 60.49], C.S.I 53.07 [43.37, 62.76]. post: Traditional 24 [12.11, 35.89], C.S.I 42.4 [29.15, 55.77]); Functional Gait Analysis (FGA pre: Traditional 21.07 [19.05, 23.08], C.S.I 20.43 [18.34, 22.52]. post: Traditional 27.95 [25.5, 30.41], C.S.I 26.35 [23.61,29.1]); Activities Specific Balance Confidence Scale (ABC pre: Traditional 74.21% [64.39, 84.03], C.S.I 71.34% [61.52, 81.16]. post: Traditional 79.78% [68.41, 91.14], C.S.I 82.89% [70.46, 95.31]); Visual Vertigo Analog Scale (VVAS, pre: Traditional 36.84 [24.72, 48.97], C.S.I 43.05 [30.93, 55.17]. post: Traditional 21.41 [6.51, 36.31], C.S.I 31.28 [14.59, 47.97])

Fig. 3

Pre and Post estimated marginal mean and their respective 95% confidence intervals for the for the traditional and C.S.I groups on outcomes that did not change over time in either group: Timed-Up and Go (TUG, pre: Traditional: 7.77 s [6.87, 8.67], C.S.I: 7.97 s [7.02, 8.92], post: Traditional: 8.03 s [7.08, 8.98], C.S.I: 7.93 s [6.88, 8.98]); The Four-Step Square Test (FSST pre: Traditional 9.48 s [7.52, 11.44], C.S.I 11.49 s [9.43, 13.55 ] post: Traditional 9.65 s [7.54, 11.75], C.S.I 10.29 s [7.96, 12.63])