Virtual Reality Vestibular Rehabilitation for Vestibular Disorders

(VRVR Trial)

No longer recruiting at 1 trial location

Overseen By Keith Cole, DPT,PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: George Washington University

Must not be taking: Vestibular medications

Disqualifiers: Stroke, Neurologic disease, Pregnancy, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 4

Duration: 4-12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how virtual reality (VR) can improve symptoms for people with vestibular disorders, which often cause dizziness. Researchers aim to determine the optimal amount of exercise by comparing VR exercises (gaze stabilization exercises using a VR device) to standard physical therapy and to healthy participants without dizziness. The VR device controls visual distractions during exercises, making them more comfortable than real-life exercises. This trial may suit those who have experienced dizziness due to vestibular problems or concussions. As an unphased trial, it offers a unique opportunity to contribute to innovative research that could enhance treatment options for vestibular disorders.

Will I have to stop taking my current medications?

The trial excludes participants who are taking medications that affect the vestibular (balance-related) or oculomotor (eye movement-related) system, so you may need to stop taking such medications to participate.

What prior data suggests that this virtual reality vestibular rehabilitation is safe for individuals with vestibular disorders?

Research shows that virtual reality (VR) eye movement exercises can effectively and safely treat balance disorders. Studies have found that performing these VR exercises in a hospital setting improves balance, reduces dizziness, and enhances overall well-being. This indicates they are generally well-received and beneficial.

However, caution is advised. The immersive VR experience might increase the risk of falls or other accidents. Participants should remain aware of their surroundings and take steps to ensure safety when using the VR device.

In summary, while VR exercises seem promising and safe for many, following safety guidelines is crucial to prevent accidents during the exercises. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about using virtual reality (VR) for vestibular rehabilitation because it offers a cutting-edge approach to managing vestibular disorders. Unlike traditional physical therapy exercises, which are typically done in a clinic or at home without technology, the VR-based method immerses patients in a virtual environment that can make gaze stabilization exercises more engaging and potentially more effective. This innovative delivery method could enhance patient motivation and adherence to exercises, leading to better outcomes. Additionally, the use of VR technology allows for precise control and variation of exercise settings, which might lead to more personalized and adaptable rehabilitation programs.

What evidence suggests that this trial's treatments could be effective for vestibular disorders?

Research has shown that virtual reality (VR) can enhance balance training. One study found that VR-based exercises improved balance and quality of life for patients. In this trial, participants in the "Home Exercises Using Virtual Reality Device" arm will incorporate VR into their home exercise program. Other studies have demonstrated that VR can enhance traditional balance training by reducing dizziness and disability. Reviews of multiple studies confirm that VR surpasses conventional methods. In summary, using VR for balance exercises appears more effective in treating dizziness and related issues than standard approaches. ^{2 3 4 6 7}

Who Is on the Research Team?

Karen Goodman, DPT

Principal Investigator

The George Washington University

Are You a Good Fit for This Trial?

This trial is for people with dizziness due to vestibular disorders and healthy volunteers without dizziness. It's not for those with severe obesity, recent concussion, chronic kidney disease, heart issues, stroke history, or on certain medications affecting balance/eye movements.

Inclusion Criteria

I am healthy and do not experience dizziness.

You have a suspected or confirmed problem with your balance or inner ear.

Exclusion Criteria

I am immunocompromised due to a solid organ transplant.

I experience sudden, brief spells of dizziness.

Currently pregnant, or plan to become pregnant during the timeline of the study

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

1 visit (in-person)

Treatment

Participants with Unilateral Vestibular Hypofunction (UVH) undergo a 4-week intervention, while those with Bilateral Vestibular Hypofunction (BVH) or post-concussion undergo a 12-week intervention. The intervention includes physical therapy visits and a home program of vestibular exercises using a virtual reality device.

4-12 weeks

Weekly visits (in-person)

Follow-up

Participants are monitored for safety and effectiveness after treatment, with assessments including vestibulo-ocular assessment, balance, and clinical functional outcome measures.

4 weeks

2 visits (in-person)

Healthy Control Assessment

Healthy control subjects are tested for one day to compare outcomes with those of participants with vestibular disorders.

1 day

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Gaze stabilization Exercises using Virtual Reality Device
• Gaze stabilization non-instrumented

Trial Overview

The study tests how well virtual reality (VR) exercises improve symptoms compared to standard exercises in individuals with vestibular disorders. Participants will use a VR device that controls visual input during exercise to find the right type and dose of therapy.

How Is the Trial Designed?

Group I: Home Exercises Using Virtual Reality Device Experimental Treatment 1 Intervention

Participants in this arm will perform typical PT in the clinic, but will use the virtual reality device as part of their HEP.

Group II: Usual Vestibular Rehabilitation Care Active Control 1 Intervention

Participants in this arm will perform typical PT in the clinic and home environment. They will be asked to keep a log to track their HEP.

Group III: Healthy Control Active Control 1 Intervention

Age-matched healthy control subjects will perform all balance, gait, vestibular, and patient reported outcome measure assessments, including performing 30 seconds of each level of gaze stability exercise for an active comparison to outcomes obtained to those with vestibular disorders. The healthy-control group will only be assessed at baseline (a single visit).

Who Is Running the Clinical Trial?

George Washington University

Lead Sponsor

Trials

263

Recruited

476,000+

Published Research Related to This Trial

A study of 159 patients with vestibular deficits showed that modified VOR X1 exercises focusing on high-velocity head movements significantly improved dizziness and balance, achieving 93-99% of normal scores across multiple outcome measures.

This new speed-based approach, combined with balance training for postural realignment, outperformed traditional vestibular rehabilitation techniques, suggesting it could be a more effective method for treating peripheral vestibular hypofunction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A speed-based approach to vestibular rehabilitation for peripheral vestibular hypofunction: A retrospective chart review. Roller, RA., Hall, CD.[2022]

Dynamic visual acuity (DVA) testing in virtual reality (VR) showed similar results to traditional clinical methods, indicating that VR can be a valid platform for vestibular assessments.

The study found that head motion conditions affected DVA scores, balance, and dizziness ratings, with no motion trials yielding the best results, suggesting that VR testing can effectively replicate traditional assessments in healthy individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Leveraging virtual reality for vestibular testing: Clinical outcomes from tests of dynamic visual acuity. Holford, KC., Jagodinsky, AE., Saripalle, R., et al.[2022]

Vestibular rehabilitation therapy (VRT) is an effective exercise-based treatment that helps improve balance, reduce vertigo, and enhance daily activities for individuals with vestibular disorders, regardless of age or the cause of their symptoms.

Key exercises in VRT focus on head-eye movements and balance tasks, and even short, frequent sessions can significantly aid in vestibular recovery by promoting adaptation and substitution mechanisms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Vestibular rehabilitation therapy: review of indications, mechanisms, and key exercises. Han, BI., Song, HS., Kim, JS.[2022]

In patients with unilateral vestibular pathology, the angular vestibular ocular reflex (aVOR) gain does not differ when the head is rotated inward or outward, suggesting that both directions can be used for effective assessment.

The study indicates that head velocity is inversely correlated with aVOR gain for movements towards the affected side, which can inform physical therapists in prescribing gaze stability exercises for rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Acute VOR gain differences for outward vs. inward head impulses. Schubert, MC., Mantokoudis, G., Xie, L., et al.[2015]

In a study of 69 patients with chronic unilateral vestibular hypofunction, vestibular rehabilitation therapy combined with Wii® therapy significantly reduced dizziness handicap, as shown by a decrease in the Dizziness Handicap Inventory score from a median of 40 to 24 (P<.0001).

The therapy also improved balance and visual stability, with the Dynamic Gait Index score increasing from a median of 21 to 23 and dynamic visual acuity improving from a median of 2 to 1, both with statistical significance (P<.0001).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes after vestibular rehabilitation and Wii® therapy in patients with chronic unilateral vestibular hypofunction. Verdecchia, DH., Mendoza, M., Sanguineti, F., et al.[2022]

Adding virtual reality-based home exercises to conventional vestibular rehabilitation significantly improved vestibulo-ocular reflex gain and posturography scores in patients with unilateral vestibular hypofunction, with the mixed-method group showing a gain score of 0.71 compared to 0.64 in the conventional group after one year.

Patients who engaged in virtual reality exercises reported greater improvements in their dizziness-related quality of life, as indicated by a Dizziness Handicap Inventory score of 24.34 versus 35.73 in the conventional group, highlighting the efficacy of this approach in long-term rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial. Viziano, A., Micarelli, A., Augimeri, I., et al.[2019]

Gaze stabilisation exercises are effective in improving the vestibular ocular reflex (VOR) gain, which helps patients with vestibular hypofunction maintain visual clarity during head movements and reduce dizziness and vertigo symptoms.

Recent studies incorporating digital technologies have shown promise in enhancing gaze stabilisation exercises, suggesting potential advancements in vestibular rehabilitation practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Gaze stabilisation exercises in vestibular rehabilitation: review of the evidence and recent clinical advances. Meldrum, D., Jahn, K.[2020]

In a study of 20 patients with unilateral vestibular hypofunction, virtual reality (VR) vestibular rehabilitation was evaluated and compared to conventional therapy, showing promising results in improving symptoms of vertigo.

Both VR and conventional therapy groups reported significant improvements in their symptoms, indicating that VR may be an effective alternative for vestibular rehabilitation, although specific statistical outcomes were not detailed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Virtual Reality Vestibular Rehabilitation in 20 Patients with Vertigo Due to Peripheral Vestibular Dysfunction. Stankiewicz, T., Gujski, M., Niedzielski, A., et al.[2021]

Citations

1.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10390126/

Effectiveness of virtual reality-based vestibular rehabilitation in ...

This study demonstrates that implementing a VR-based VRT protocol may be an efficient option to improve posture stability and the quality of life in patients ...

2.

e-rvs.org

e-rvs.org/journal/view.php?number=985

Clinical application of virtual reality for vestibular ...

SUMMARY. In summary, numerous studies have demonstrated that virtual reality can enhance the effectiveness of vestibular rehabilitation by ...

3.

clinicaltrials.gov

clinicaltrials.gov/study/NCT04851184

Dose of Vestibular Rehabilitation for Vestibular Hypofunction

In this study, the investigators aim to use a commercially available virtual reality device to deliver usual vestibular rehabilitation exercises, while using ...

4.

sciencedirect.com

sciencedirect.com/science/article/pii/S1808869421001725

Effectiveness of conventional versus virtual reality-based ...

Our results revealed that the virtual reality-based vestibular rehabilitation exercises may be an effective treatment in reducing dizziness, disability due to ...

5.

frontiersin.org

frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1519470/full

Virtual reality-based vestibular rehabilitation therapy in ...

Studies have shown VRT using virtual reality (VR) to be effective, with meta-analyses confirming its superiority over conventional methods.

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC10441749/

Vestibular rehabilitation potential of commercially available ...

In hospital VR has been shown to successfully improve stability, reduce dizziness, enhance quality of life, and reduce visual vertigo symptoms ...

7.

jneuroengrehab.biomedcentral.com

jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-025-01623-x

Can virtual reality replace conventional vestibular ...

This study aimed to determine whether a virtual reality (VR)-based rehabilitation program using HMDs is non-inferior to a conventional program.