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

Jennifer Kelly; Daphna Harel; Santosh Krishnamoorthy; Gene Fu; Brittani Morris; Andrew Medlin; Sarah Mischinati; Zhu Wang; John Sutera; Ken Perlin; Maura Cosetti; Anat V Lubetzky

doi:10.1186/s12984-023-01224-6

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

J Neuroeng Rehabil. 2023 Aug 12;20(1):104. doi: 10.1186/s12984-023-01224-6.

Authors

Jennifer Kelly^{1

2}, Daphna Harel³, Santosh Krishnamoorthy^{1

2}, Gene Fu^{1

2}, Brittani Morris⁴, Andrew Medlin⁴, Sarah Mischinati⁴, Zhu Wang⁵, John Sutera^{1

2

4}, Ken Perlin⁵, Maura Cosetti⁶, Anat V Lubetzky⁴

Affiliations

¹ Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
² Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
³ Department of Applied Statistics, Social Science and Humanities, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA.
⁴ Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA.
⁵ Computer Science Department, New York University, Courant Institute of Mathematical Sciences, New York, NY, USA.
⁶ Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Maura.Cosetti@mountsinai.org.

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.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Dizziness
Humans
Pandemics
Pilot Projects
Postural Balance
Vestibular Diseases* / rehabilitation

Associated data

ClinicalTrials.gov/NCT04268745

Grants and funding

R21 DC018101/DC/NIDCD NIH HHS/United States