Disease or damage of the vestibular sense organs cause a range of distressing symptoms and functional problems that could include loss of balance, gaze instability, disorientation, and dizziness. A novel computer-based rehabilitation system with therapeutic gaming application has been developed. This method allows different gaze and head movement exercises to be coupled to a wide range of inexpensive, commercial computer games. It can be used in standing, and thus graded balance demands using a sponge pad can be incorporated into the program. A case series pre- and postintervention study was conducted of nine adults diagnosed with peripheral vestibular dysfunction who received a 12-week home rehabilitation program. The feasibility and usability of the home computer-based therapeutic program were established. Study findings revealed that using head rotation to interact with computer games, when coupled to demanding balance conditions, resulted in significant improvements in standing balance, dynamic visual acuity, gaze control, and walking performance. Perception of dizziness as measured by the Dizziness Handicap Inventory also decreased significantly. These preliminary findings provide support that a low-cost home game-based exercise program is well suited to train standing balance and gaze control (with active and passive head motion).
Get full access to this article
View all access options for this article.
References
1.
FetterM. Vestibular system disorders. In: HerdmanSJ, ed. Contemporary Perspectives in Rehabilitation: Vestibular Rehabilitation, 3rd ed. Philadelphia: F.A. Davis Co.; 2007: 98–106.
2.
NeuhauserHK, RadtkeA, von BrevernM, et al.Burden of dizziness and vertigo in the community. Arch Intern Med, 2008; 168:2118–2124.
3.
GassmannKG, RupprechtR. Dizziness in an older community dwelling population: A multifactorial syndrome. J Nutr Health Aging, 2009; 13:278–282.
4.
AgrawalY, CareyJP, Della SantinaCC, et al.Disorders of balance and vestibular function in US adults: Data from the National Health and Nutrition Examination Survey. Arch Intern Med, 2009; 169:928–944.
AngelakiDE. Eyes on target: What neurons must do for the vestibuloocular reflex during linear motion. J Neurophysiol, 2004; 92:20–35.
7.
SharpeJA, JohnstonJL. The vestibulo-ocular reflex: Clinical, anatomic, and physiologic correlates. In: SharpeJA, BarberHO, eds. The Vestibulo-Ocular Reflex and Vertigo. New York: Raven Press Ltd.; 1993: 15–39.
8.
HorakFB, NashnerLM, DienerHC. Postural strategies associated with somatosensory and vestibular loss. Exp Brain Res, 1990; 82:167–177.
9.
PeterkaRJ. Sensorimotor integration in human postural control. J Neurophysiol, 2002; 88:1097–1118.
10.
SimmonsRW, RichardsonC, PozosR. Postural stability of diabetic patients with and without cutaneous sensory deficit in the foot. Diabetes Res Clin Pract, 1997; 36:153–160.
11.
Buccello-StoutRR, CromwellRL, BloombergJJ, WhortonEB. Sensorimotor adaptation training's effect on head stabilization in response to a lateral perturbation in older adults. J Aging Phys Act, 2013; 21:272–289.
12.
LacourM, DutheilS, TighiletB, et al.Tell me your vestibular deficit, and I'll tell you how you'll compensate. Ann N Y Acad Sci, 2009; 1164:268–278.
13.
MergnerT, SchweigartG, MaurerC, BlumleA. Human postural responses to motion of real and virtual visual environments under different support base conditions. Exp Brain Res, 2005; 167:535–556.
14.
LacourM, BarthelemyJ, BorelL, et al.Sensory strategies in human postural control before and after unilateral vestibular neurotomy. Exp Brain Res, 1997; 115:300–310.
15.
IgarashiM, LevyJK, O-UchiT, ReschkeMF. Further study of physical exercise and locomotor balance compensation after unilateral labyrinthectomy in squirrel monkeys. Acta Otolaryngol, 1981; 92:101–105.
16.
PaigeGD. Vestibuloocular reflex and its interactions with visual following mechanisms in the squirrel monkey. II. Response characteristics and plasticity following unilateral inactivation of horizontal canal. J Neurophysiol, 1983; 49:152–168.
17.
FetterM, ZeeDS. Recovery from unilateral labyrinthectomy in rhesus monkey. J Neurophysiol, 1988; 59:370–393.
18.
CookseyFS. Rehabilitation in vestibular injuries. Proc R Soc Lond B Biol Sci, 1946; 39:273–278.
19.
CawthorneT. The physiological basis for head exercises. J Chart Soc Physiother, 1944:106–107.
20.
NorreME. Rationale of rehabilitation treatment for vertigo. Am J Otolaryngol, 1987; 8:31–35.
21.
NorréME, BeckersAM. Vestibular habituation training. Specificity of adequate exercise. Arch Otolaryngol Head Neck Surg, 1988; 114:883–886.
SzturmT, IrelandDJ, Lessing-TurnerM. Comparison of different exercise programs in the rehabilitation of patients with chronic peripheral vestibular dysfunction. J Vestib Res, 1994; 4:461–479.
24.
HerdmanSJ, SchubertMC, DasVE, TusaRJ. Recovery of dynamic visual acuity in unilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg, 2003; 129:819–824.
25.
HerdmanSJ, HallCD, SchubertMC, et al.Recovery of dynamic visual acuity in bilateral vestibular hypofunction. Arch Otolaryngol Head Neck Surg, 2007; 133:383–389.
26.
SchubertMC, MigliaccioAA, ClendanielRA, et al.Mechanism of dynamic visual acuity recovery with vestibular rehabilitation. Arch Phys Med Rehabil, 2008; 89:500–507.
27.
SchubertMC, Della SantinaCC, ShelhamerM. Incremental angular vestibulo-ocular reflex adaptation to active head rotation. Exp Brain Res, 2008; 191:435–446.
28.
Shumway-CookA, HorakFB. Assessing the influence of sensory interaction of balance. Suggestion from the field. Phys Ther, 1986; 66:1548–1550.
29.
VitteE, SemontA, BerthozA. Repeated optokinetic stimulation in conditions of active standing facilitates recovery from vestibular deficits. Exp Brain Res, 1994; 102:141–148.
30.
LoaderB, GrutherW, MuellerCA, et al.Improved postural control after computerized optokinetic therapy based on stochastic visual stimulation in patients with vestibular dysfunction. J Vestib Res, 2007; 17:131–136.
31.
OhyamaS, NishiikeS, WatanabeH, et al.Effects of optokinetic stimulation induced by virtual reality on locomotion: A preliminary study. Acta Otolaryngol, 2008; 128:1211–1214.
32.
PavlouM. The use of optokinetic stimulation in vestibular rehabilitation. J Neurol Phys Ther, 2010; 34:105–110.
33.
ChangCP, HainTC. A theory for treating dizziness due to optical flow (visual vertigo). Cyberpsychol Behav, 2008; 11:495–498.
34.
YoungW, FergusonS, BraultS, CraigC. Assessing and training standing balance in older adults: A novel approach using the ‘Nintendo Wii’ balance board. Gait Posture, 2011; 33:303–305.
35.
RendonAA, LohmanEB, ThorpeD, et al.The effect of virtual reality gaming on dynamic balance in older adults. Age Ageing, 2012; 41:549–552.
36.
González-FernándezM, Gil-GómezJA, AlcañizM, et al.eBaViR, easy balance virtual rehabilitation system: A study with patients. Stud Health Technol Inform, 2010; 154:61–66.
37.
SzturmT, BetkerAL, MoussaviZ, et al.Effects of an interactive computer game exercise regimen on balance impairment in frail community-dwelling older adults: A randomized controlled trial. Phys Ther, 2011; 91:1449–1462.
38.
BetkerAL, SzturmT, MoussaviZMK. Staying in tune. IEEE Eng Med Biol Mag, 2008; 27(5):91–98.
39.
BetkerAL, SzturmT, MoussaviZK, NettC. Video game-based exercises for balance rehabilitation: A single-subject design. Arch Phys Med Rehabil, 2007; 87:1141–1149.
40.
ChenP-Y, HsiehW-L, WeiS-H, KaoC-L. Interactive Wiimote gaze stabilization exercise training system for patients with vestibular hypofunction. J Neuroeng Rehabil, 2012; 9:77.
41.
SzturmT, MaharjanP, MarottaJJ, et al.The interacting effect of cognitive and motor task demands on performance of gait, balance and cognition in young adults. Gait Posture, 2013; 38:596–603.
42.
SzturmT, MarottaJ, WuQ, NayakA. Technology-assisted and motivational programme for a blended approach to manage balance, gaze, mobility and cognitive decline with age. OA Evid Based Med, 2013; 1(1):4.
43.
FrenchB, ThomasL, LeathleyM, et al.Does repetitive task training improve functional activity after stroke? A Cochrane systematic review and meta-analysis. Rehabil Med, 2010; 42:9–15.
44.
CramerSC, SurM, DobkinBH, et al.Harnessing neuroplasticity for clinical applications. Brain, 2011; 34:1591–1609.
45.
WolfSL, WinsteinCJ, MillerJ, et al.Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: The Excite randomized clinical trial. JAMA, 2006; 296:2095–2104.
46.
HornbyTG. Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke. Top Stroke Rehabil, 2011; 18:293–307.
47.
SchubertMC, HerdmanSJ, TusaRJ. Functional measure of gaze stability in patients with vestibular hypofunction. Ann N Y Acad Sci, 2001; 942:490–491.
48.
VenutaPJ, OrlandoFL. Inter-rater reliability of the clinical dynamic visual acuity test. Presented at the Scientific Meeting and Exposition of the American Physical Therapy Association, June 6, 1998, Orlando, FL.
49.
BraswellJ. A clinical test of dynamic visual acuity for children. Int J Pediatr Otorhinolaryngol, 2003; 67:1195–1201.
50.
JacobsonGP, NewmanCW. The development of the dizziness handicap inventory. Arch Otolaryngol Head Neck Surg, 1990; 116:424–427.
51.
DesaiA, GoodmanV, KapadiaN, et al.Relationship between dynamic balance measures and functional performance in community-dwelling elderly people. Phys Ther, 2010; 90:748–760.
52.
BetkerAL, MoussaviZMK, SzturmT. On modeling center of foot pressure distortion through a medium. IEEE Trans Biomed Eng, 2005; 52:345–352.
53.
LoughranS, GatehouseS, KishoreA, SwanIRC. Does patient-perceived handicap correspond to the modified clinical test for the sensory interaction on balance?. Otol Neurotol, 2006; 27:86–91.
54.
GrossmanGE, LeighRJ. Instability of gaze during locomotion in patients with deficient vestibular function. Ann Neurol, 1990; 27:528–532.
55.
YuwonoM. Gait cycle spectrogram analysis using a torso-attached inertial sensor. Conf Proc IEEE Eng Med Biol Soc, 2012; 2012:6539–6542.
56.
CohenJ. Statistical Power Analysis for the Behavioral Sciences, 2nd ed. New York: Routledge Academic; 1988.
57.
SchererM, MigliaccioAA, SchubertMC. Effect of vestibular rehabilitation on passive dynamic visual acuity. J Vestib Res, 2008; 18:147–157.
58.
HillmanEJ, BloombergJJ, Vernon McDonaldP, CohenHS. Dynamic visual acuity while walking in normals and labyrinthine-deficient patients. J Vestib Res, 1999; 9:49–54.
59.
LambertS, SigristA, DelaspreO, et al.Measurement of dynamic visual acuity in patients with vestibular areflexia. Acta Otolaryngol, 2010; 130:820–823.
60.
BlackFO, WallC, NashnerLM. Effects of visual and support surface orientation references upon postural control in vestibular deficient subjects. Acta Otolaryngol, 1983; 95:199–201.
61.
PangMYC, LamFM, WongGH, et al.Balance performance in head-shake computerized dynamic posturography: Aging effects and test-retest reliability. Phys Ther, 2011; 91:246–253.
62.
DuysensJ, DuysensJP, BastiaanseCM, et al.How trunk turns affect locomotion when you are not looking where you go. Hum Move Sci, 2008; 27:759–770.
63.
KavanaghJJ. Lower trunk motion and speed-dependence during walking. J Neuroeng Rehabil, 2009; 6:9–15.
