A Pilot Study of Virtual Reality‐Vestibular Physical Therapy for Refractory Dizziness

Abstract Objective To assess the tolerability and efficacy of Virtual Reality‐Vestibular Physical Therapy (VR‐VPT) in individuals with refractory symptoms after conventional vestibular rehabilitation. Study Design Prospective cohort study. Setting Single institution tertiary care practice. Methods Participants were offered VR‐VPT if they (1) still had symptoms after conventional vestibular physical therapy or (2) were considered to have a specific problem suited to VR‐VPT. Treatment consisted of approximately 8 45‐minute sessions, each directed by a physical therapist. Differences in baseline and posttreatment surveys, provider‐based assessments, and presession and postsession Simulator Sickness Questionnaire (SSQ) scores were analyzed. Results Among our cohort of 18 participants, there were 10 individuals with vestibular loss (VL), 6 with vestibular migraine (VM), and 4 with Persistent Postural‐Perceptual Dizziness (PPPD), with some participants having more than 1 diagnosis. Significant improvements were seen posttreatment in the Dizziness Handicap Inventory (n = 15, mean difference: −11.7, 95% CI: −18.2, −5.2, P = .002) and the Functional Gait Assessment (n = 17, mean difference: 2.3, 95% CI: 0.8, 3.8, P = .005). Video head impulse testing and dynamic visual acuity improved in a subset of VL participants who underwent both baseline and posttreatment testing. VR‐VPT sessions did not significantly provoke symptoms captured in SSQ responses, such as nausea (average difference: 0.32 ± 0.68) or general discomfort (average difference: 0.14 ± 0.68). Conclusion This pilot study suggests that VR‐VPT can be tolerated and may benefit many patients with refractory symptoms, with additional benefits in vestibular function observed in individuals with vestibular loss.