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Warchoł J, Tetych A, Tomaszewski R, Kowalczyk B, Olchowik G. Virtual Reality-Induced Modification of Vestibulo-Ocular Reflex Gain in Posturography Tests. J Clin Med 2024; 13:2742. [PMID: 38792284 PMCID: PMC11122614 DOI: 10.3390/jcm13102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The aim of the study was to demonstrate the influence of virtual reality (VR) exposure on postural stability and determine the mechanism of this influence. Methods: Twenty-six male participants aged 21-23 years were included, who underwent postural stability assessment twice before and after a few minute of single VR exposure. The VR projection was a computer-generated simulation of the surrounding scenery. Postural stability was assessed using the Sensory Organization Test (SOT), using Computerized Dynamic Posturography (CDP). Results: The findings indicated that VR exposure affects the visual and vestibular systems. Significant differences (p < 0.05) in results before and after VR exposure were observed in tests on an unstable surface. It was confirmed that VR exposure has a positive influence on postural stability, attributed to an increase in the sensory weight of the vestibular system. Partial evidence suggested that the reduction in vestibulo-ocular reflex (VOR) reinforcement may result in an adaptive shift to the optokinetic reflex (OKR). Conclusions: By modifying the process of environmental perception through artificial sensory simulation, the influence of VR on postural stability has been demonstrated. The validity of this type of research is determined by the effectiveness of VR techniques in the field of vestibular rehabilitation.
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Affiliation(s)
- Jan Warchoł
- Department of Biophysics, Medical University of Lublin, K. Jaczewskiego 4, 20-090 Lublin, Poland; (A.T.); (B.K.); (G.O.)
| | - Anna Tetych
- Department of Biophysics, Medical University of Lublin, K. Jaczewskiego 4, 20-090 Lublin, Poland; (A.T.); (B.K.); (G.O.)
| | - Robert Tomaszewski
- Department of Computer Science, University of Applied Sciences in Biala Podlaska, Sidorska 95/97, 21-500 Biala Podlaska, Poland;
| | - Bartłomiej Kowalczyk
- Department of Biophysics, Medical University of Lublin, K. Jaczewskiego 4, 20-090 Lublin, Poland; (A.T.); (B.K.); (G.O.)
| | - Grażyna Olchowik
- Department of Biophysics, Medical University of Lublin, K. Jaczewskiego 4, 20-090 Lublin, Poland; (A.T.); (B.K.); (G.O.)
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Kelly JL, Cosetti M, Lubetzky AV. Can head sway patterns differentiate between patients with Meniere's disease vs. peripheral vestibular hypofunction? Front Neurol 2024; 15:1347335. [PMID: 38487324 PMCID: PMC10937734 DOI: 10.3389/fneur.2024.1347335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
Background Meniere's disease (MD) is defined by episodic vertigo, unilateral sensorineural hearing loss and fluctuating aural symptoms. Due to the variable clinical presentation, objective tests of MD may have significant diagnostic utility. Head kinematics derived from a head-mounted display (HMD) have demonstrated to be sensitive to vestibular dysfunction. The purpose of this pilot study was to investigate whether head sway can differentiate between patients with MD, vestibular hypofunction (VH) and healthy controls. Materials/methods 80 adults (30 healthy controls, 32 with VH, and 18 with MD) were recruited from a tertiary vestibular clinic. All underwent a postural control assessment using the HTC Vive Pro Eye HMD that recorded head sway in the anterior-posterior (AP), medio-lateral (ML), pitch, yaw and roll direction. Participants were tested with 2 levels of visual load: a static versus oscillating star display. Each scene lasted 60 s and was repeated twice. Sway in each direction was quantified using root mean square velocity (VRMS) for the first 20 s and full 60 s of each scene. Results Static visual: participants with VH showed significantly larger head VRMS than controls in the AP (60 s and 20 s) and pitch (20 s) directions. Dynamic visual: participants with VH showed significantly larger head VRMS than controls all directions for both the 60 and 20 s analysis. Participants with MD did not differ significantly from the control or the VH group. Conclusion While limited in numbers, Patients with MD had a high variability in head sway in all directions, and their average head sway was between controls and those with VH. A larger sample as well as patients with worse symptoms at time of testing could elucidate whether head sway via HMD could become a viable test in this population. A similar finding between 20- and 60-s scene and the full portability of the system with an in-clinic testing setup could help these future endeavors. Head sway derived from HMD is sensitive to VH and can be clinically useful as an outcome measure to evaluate sensory integration for postural control.
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Affiliation(s)
- Jennifer L. Kelly
- Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Maura Cosetti
- Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Anat V. Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, United States
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Kulkarni CA, Wadhokar OC. Virtual reality a technological miracle transforming physical rehabilitation: A scoping review. J Family Med Prim Care 2023; 12:1257-1260. [PMID: 37649752 PMCID: PMC10465040 DOI: 10.4103/jfmpc.jfmpc_1216_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/26/2022] [Accepted: 02/14/2023] [Indexed: 09/01/2023] Open
Abstract
Physical rehabilitation is evolving day by day. In the same way, simulation in rehabilitation is increasing and has now become a cornerstone for rehabilitation programs. Increase in the number of new protocols, clinical methods, and treatment standardization, virtual reality is appearing as a new medium to deliver the simulation. Virtual reality gives the benefits of forming standardized treatment protocols on demand for various conditions repetitively with a cost-effective delivery system. This was an observational retrospective study. The PubMed database was used to obtain the available material related to virtual reality and rehabilitation and was searched using the same keywords. The articles were then sorted as the subject to the recent decade. The basic information was then obtained, which included timespan, sources of the document, average years of publication, document types we collected, and average citation per year per document. Analysis of the literature that was available online related to virtual reality and rehabilitation between 2011 and 2021 generated a list of 813 documents from 275 sources, of which 810 were from journal articles and 3 were book chapters with an average year of publication of 2.16. The highest number of publications was 480 in 2020, followed by 150 in 2019, 95 in 2018, and 28 in 2017. The annual growth rate percentage of scientific publications was 26.1%. Therefore, more studies should be performed on virtual reality.
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Affiliation(s)
- Chaitanya A. Kulkarni
- Phd Scholar, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- Assistant Professor, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pune, India
| | - Om C. Wadhokar
- Phd Scholar, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India
- Assistant Professor, Dr. D.Y. Patil College of Physiotherapy, Dr. D.Y. Patil Vidyapeeth, Pune, India
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Lubetzky AV, Harel D, Krishnamoorthy S, Fu G, Morris B, Medlin A, Wang Z, Perlin K, Roginska A, Cosetti M, Kelly J. Decrease in head sway as a measure of sensory integration following vestibular rehabilitation: A randomized controlled trial. J Vestib Res 2023; 33:213-226. [PMID: 36911951 PMCID: PMC10405044 DOI: 10.3233/ves-220107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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 TrialSetting:Vestibular Rehabilitation ClinicParticipants: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.
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Affiliation(s)
- Anat V. Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Daphna Harel
- New York University, Department of Applied Statistics, Social Science and Humanities, Steinhardt School of Culture Education and Human Development
| | - Santosh Krishnamoorthy
- Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gene Fu
- Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brittani Morris
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Andrew Medlin
- Department of Physical Therapy, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Zhu Wang
- New York University, Computer Science Department, Courant Institute of Mathematical Sciences, New York, NY, USA
| | - Ken Perlin
- New York University, Computer Science Department, Courant Institute of Mathematical Sciences, New York, NY, USA
| | - Agnieszka Roginska
- Department of Music and Performing Arts Professions, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Maura Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer Kelly
- Vestibular Rehabilitation, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Al-Sharif DS, Tucker CA, Coffman DL, Keshner EA. The effects of visual context on visual-vestibular mismatch revealed by electrodermal and postural response measures. J Neuroeng Rehabil 2022; 19:113. [PMID: 36266687 PMCID: PMC9584264 DOI: 10.1186/s12984-022-01093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND No objective criteria exist for diagnosis and treatment of visual-vestibular mismatch (VVM). OBJECTIVE To determine whether measures of electrodermal activity (EDA) and trunk acceleration will identify VVM when exposed to visual-vestibular conflict. METHODS A modified VVM questionnaire identified the presence of VVM (+ VVM) in 13 of 23 young adults (34 ± 8 years) diagnosed with vestibular migraine. Rod and frame tests and outcome measures for dizziness and mobility were administered. Participants stood on foam while viewing two immersive virtual environments. Trunk acceleration in three planes and electrodermal activity (EDA) were assessed with wearable sensors. Linear mixed effect (LME) models were used to examine magnitude and smoothness of trunk acceleration and tonic and phasic EDA. Welch's t-test and associations between measures were assessed with a Pearson Correlation Coefficient. Effect sizes of group mean differences were calculated. RESULTS Greater than 80% of all participants were visually dependent. Outcome measures were significantly poorer in the + VVM group: tonic EDA was lower (p < 0.001) and phasic EDA higher (p < 0.001). Postural accelerations varied across groups; LME models indicated a relationship between visual context, postural, and ANS responses in the + VVM group. CONCLUSIONS Lower tonic EDA with + VVM suggests canal-otolith dysfunction. The positive association between vertical acceleration, tonic EDA, and visual dependence suggests that increased vertical segmental adjustments are used to compensate. Visual context of the spatial environment emerged as an important control variable when testing or treating VVM.
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Affiliation(s)
- Doaa S Al-Sharif
- Department of Health and Rehabilitation Sciences, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA, 19122, USA
| | - Carole A Tucker
- Department of Health and Rehabilitation Sciences, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA, 19122, USA
- Department of Physical Therapy, University of Texas Medical Branch, Galveston, TX, 77555, USA
| | - Donna L Coffman
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, 19140, USA
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA
| | - Emily A Keshner
- Department of Health and Rehabilitation Sciences, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA, 19122, USA.
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