Decrease in head sway as a measure of sensory integration following vestibular rehabilitation: A randomized controlled trial

Article type: Research Article

Authors: Lubetzky, Anat V.^{a; *} | Harel, Daphna^b | Krishnamoorthy, Santosh^{c; d} | Fu, Gene^{c; d} | Morris, Brittani^a | Medlin, Andrew^a | Wang, Zhu^e | Perlin, Ken^e | Roginska, Agnieszka^f | Cosetti, Maura^d | Kelly, Jennifer^{c; d}

Affiliations: [a] Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA | [b] Department of Applied Statistics, Social Science and Humanities, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA | [c] Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA | [d] Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA | [e] Computer Science Department, Courant Institute of Mathematical Sciences, New York University, New York, NY, USA | [f] Department of Music and Performing Arts Professions, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA

Correspondence: [*] Corresponding author: Anat V. Lubetzky, 380 2nd Avenue, 4th floor, New York, NY 10010, USA. Tel.: +1 212 998 9195; E-mail: anat@nyu.edu.

Abstract: Objective:The purpose of this study was to determine the extent to which sensory integration strategies via head sway, derived from a Head-Mounted Display (HMD), change in people with vestibular disorders following vestibular rehabilitation. Design:Randomized Controlled Trial Setting:Vestibular Rehabilitation Clinic Participants:Thirty participants with vestibular dysfunction and 21 age-matched controls. Main Outcome Measures:Participants experienced two levels of visual surround (static or moving ‘stars’, front to back at 0.2 Hz, 32 mm) and white noise (none or rhythmic) while their head sway was recorded via the HTC Vive. We quantified head sway via Directional Path (DP) and Root Mean Square Velocity (RMSV) in 5 directions: anterior-posterior, medio-lateral, pitch, yaw, and roll and Power Spectral Density in low (PSD 1), medium (PSD 2) and high (PSD 3) frequencies in the anterior-posterior direction. Interventions:Participants performed the assessment prior to being randomized into 8-weeks of contextual sensory integration training in virtual reality or traditional vestibular rehabilitation and once again following completion of the intervention. Controls performed the assessment once. Twelve participants dropped out, half due to covid lock-down. We applied an intention to treat analysis. Results:We observed significant increases in AP DP, RMSV and all PSDs with change in visual level. Both intervention groups significantly decreased medio-lateral, pitch and roll DP and RMSV and anterior-posterior PSD 2 with no group differences. Vestibular participants were significantly higher than controls on all outcomes pre rehabilitation. Post rehabilitation they were only significantly higher on PSD 2. Sound was not a significant predictor of head sway in this protocol. Conclusions:Head sway decreased following vestibular rehabilitation regardless of visual load or type of intervention applied. This change was measured via head kinematics derived from a portable HMD which can serve as a sensitive in-clinic assessment for tracking improvement over time

Keywords: Balance, postural control, head kinematics, dizziness, virtual reality

DOI: 10.3233/VES-220107

Journal: Journal of Vestibular Research, vol. 33, no. 3, pp. 213-226, 2023