Authors (including presenting author) :
Law CF(1), Wong WL(1), Lau SY(1), Yeung KC(1)
Affiliation :
(1)Physiotherapy Department, Prince of Wales Hospital
Introduction :
Patients with vestibular related problems commonly experience vertigo, instability and their everyday life is affected. Vestibular disorders rehabilitation is a long process. Conventional treatments usually include a list of vestibular adaptation, substitution and habituation exercise in which patients may not have motivation and compliance to perform as home exercise program. Two reformations were conducted in Physiotherapy Department to tackle this problem. Rehabilitation class was formed to enhance group dynamic and Virtual Reality (VR) technology was employed as a form of self exercises. VR has been used for rehabilitation for motor control, gait and balance training. It provides controlled and augmented feedback on motor performance and it offers a pleasant and safe environment for the patients to perform self-vestibular exercises.
Objectives :
To evaluate the treatment outcomes of group vestibular rehabilitation program To explore the possibility of implementation of VR device as alternative of self-exercise.
Methodology :
An observational cohort study of pre-post design was conducted. Subjects were (1) patients with chronic vertigo with diagnosis of vestibular dysfunction (2) Those with diagnosis of Benign Paroxysmal Positional Vertigo were excluded. A group vestibular rehabilitation class was formed with content of vestibular adaptation, substitution, habituation exercise and balance exercise for 7 sessions. Daily home exercise program was prescribed with exercise pamphlet. Portable VR goggles were on loan to patients and patients were educated to download free applications on smartphone as a supplementary home exercise for 20 minutes on daily basis. The feasibility of implementation of VR was deliberated. Outcome measures were categorized as: (1) Numeric Global Rating of Change Scale (NGRCS), (2) Intensity of vertigo with scale of 0-10; (3) Score of Dizziness Handicap Inventory (DHI); (4) Composite score of sensory organization test for postural stability (SOT)
Result & Outcome :
From June 2017 to March 2018, 25 patients with chronic vertigo completed a course of vestibular rehabilitation and 37.5% were male. The mean age was 62.9 years. Mean NGRCS was 67.5%. Mean intensity of vertigo was reported to reduce 57.9% from 5.75 to 2.42. There was 21.1% reduction in mean score of DHI from 45 to 35.5 (p=0.01, paired t-test). There was 10.3% increase in mean SOT from 66.7 to 73.6 (p=0.0001, paired t-test). 10% of patients were able to utilize VR devices for home exercise. They reported to have better motivation for home exercise. Further enhancement of implementation of VR is suggested for arousing patient's interest in VR, improving skill to handle smartphone and availability of smartphone with compatible configuration to operate VR application. Group vestibular rehabilitation program is beneficial to patients with chronic vertigo in terms of both physical and psychological aspects. Implementation of VR device for home exercise is feasible with the above enhancement.
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