2-dimensional Versus 3-dimensional Virtual Reality Game Training in BPPV
NCT ID: NCT05021939
Last Updated: 2024-02-08
Study Results
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Basic Information
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COMPLETED
NA
42 participants
INTERVENTIONAL
2021-08-28
2023-11-02
Brief Summary
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Detailed Description
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BPPV (Benign Paroxysmal Positional Vertigo) is a condition that affects the inner ear and is caused by semicircular canal dysfunction. Because the otoliths are placed in the semicircular canal and can impair their free movement, the anatomical placement of the canals is critical. BPPV is one of the most frequent peripheral vestibular illnesses with a prevalence of 20-40%. The first pathogenetic element is canalolithiasis, defined as the dissociation of the otoconia from the otolytic membrane and its free movement in the endolymph, which is seen in 80% of the patients. Cupulolithiasis is the occurrence of dizziness (vertigo) and nystagmus specific to the affected canal due to calcium carbonate crystals adhering to the canal. Because of its anatomical location, posterior semicircular canal BPPV is observed 80-90% of the time, lateral semicircular canal BPPV is seen 10-20% of the time, and anterior semicircular canal BPPV is less prevalent. BPPV often is treated with particle repositioning maneuvers once the involved canal is identified. These maneuvers are supposed to move otoconia particles out of the affected canal and back into the vestibule, where they dissolve.
Vestibular rehabilitation is another non-pharmacological intervention for BPPV. Vestibular rehabilitation can enhance general balance function, including gait, gaze, and postural stability, physical mobility, and function with activities of daily living, by integrating proprioceptive, visual, and residual vestibular function. Vestibular rehabilitation utilizes central neuroplasticity mechanisms to improve visuo-vestibular interactions and restore static and dynamic postural stability in situations where sensory input is conflicting. Vestibular rehabilitation includes adaptation, habituation, and substitution exercises. The adaptation exercises are based on the vestibular system's ability to change the magnitude of the vestibulo-ocular reflex (VOR) in response to a specific stimulus (head movement). Habituation exercises, in contrast to adaptation exercises, are based on the notion that frequent exposure to provoking stimuli such as head movements will reduce motion-provoked symptoms. Substitution exercises combine vision and somatosensory cues with vestibular cues to improve gaze and postural stability by enhancing central programming. Maneuvers are shown to be more successful than vestibular rehabilitation in the short term, although combining the two is useful for long-term functional recovery in BPPV. However, there is insufficient evidence to distinguish between different types of vestibular rehabilitation.
The positive impact of vestibular rehabilitation on balance is based on mechanisms related to the central nervous system's neural plasticity, and its goals are to promote visual stabilization, improve vestibular-visual interaction during head movements, thereby improving the standing and dynamic postural stability in conditions that produce conflicting sensory information, and decrease sensitivity to head movements. However, numerous aspects have been identified as having a detrimental impact on the outcome of vestibular rehabilitation, including poor exercise execution, the necessity for active efforts, and the patients' desire. Given the drawbacks associated with the time-consuming, repetitive, monotonous, and non-challenging aspects of vestibular rehabilitation, more efficient and cost-effective types of treatments were proposed as a potential alternative. Currently, virtual reality (VR) applications, can be outfitted with real-time simulations, interactive functions, and game features to allow for more motivated vestibular rehabilitation.
Many studies suggest that engaging virtual reality components can contribute to successful outcomes. It is claimed that it allows visual-vestibular interaction with a large number of visual stimuli, resulting in an optimal environment for better VR performance. It is suggested that this is due to the activation of target-oriented attention and the brain's neural network and that VR applications using eye-tracking algorithms and 'glasses' can be effective. In most of the studies, 2-dimensional systems (e.g. Nintendo Wii, Play station) has been used for the treatment of patients with BPPV. However, due to their proximity to the eye, head-mounted displays (3D VR gaming) may offer high-resolution images which make the users feel like they are a part of the computer-created environment. 3D technologies have been debated about their negative effects such as discomfort, visual fatigue, dizziness, headache, disorientation, motion sickness, which are indicative of VIMS (visually induced motion sickness). The most accepted explanation for VIMS is the classical conflict theory based on the mismatch between the visual, the proprioceptive, and the vestibular stimuli.
It is known that brief and sudden positional nystagmus associated with a change in head position relative to gravity may temporarily impair visual stability. The otolithic signal is created in response to the motion, which plays an important role in the perception of orientation and the direction of motion. Compensatory eye movement occurs after linear acceleration of the head, opposite in direction to the head movement, and is generated to stabilize the image of the target in coordination. The impact of dysfunction on the VOR in patients with chronic vestibular problems is associated with the inability to have a clear image of the target on the retina during head movements, resulting in blurred vision. According to these explanations, head movements while playing 3D VR gaming may pose a challenge (sensory mismatch) to the central nervous system, which then attempts to resolve the challenge. Habituation exercises included in the 3D VR gaming task might be beneficial in opposing over-reliance on a sensory modality, desensitizing patients to visual motion and visuo-vestibular conflict, and reducing associated symptoms.
It was proved out that accommodative facility has a tendency to increase after 2D and 3D VR gaming, but particular, the increasing tendency is greater after playing 3D VR gaming. It was explained that while playing a game, eyes are stimulated with stereoscopic images, and brightness change so that pupils remain under persistent stimulation. Therefore, the depth of a focus changes reversely and it results in visual training. In comparison to traditional 2D VR gaming technology, which does not provide depth to objects, 3D VR gaming technology may enable the perception of spatial depth. Additionally, it was proposed that the type of game (action vs. non-action) is important in 3D VR gaming. Especially, action game stimulates the overall parts of a brain, requiring multi-tasking skills and speed.
The research to date covers the VR technologies on the treatment of BPPV. However, to our knowledge, there is no research comparing the effects of 2D and 3D VR gaming technologies with a control group. Therefore, this study aims to examine the effects of different virtual reality applications and vestibular rehabilitation on gait, reaction time, balance functions, activities of daily living, and quality of life in individuals with benign paroxysmal positional vertigo (BPPV) having residual dizziness and balance problems.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
SINGLE
Study Groups
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Control Group
No treatment will be given to the control group. Evaluation will be done at the at the baseline and 8th week.
No interventions assigned to this group
2-Dimensional Group
In the 2-Dimensional Group, 2D VR gaming training in addition to traditional vestibular rehabilitation will be employed. In this group, the 'Verti-Go' game from the Playstation 4 VR gaming device will be played in 2D for 20-25 minutes, as well as vestibular therapy for 20-25 minutes. A total of 45-50 minutes will be given over the course of 8 weeks, 3 sessions per week. The intensity of treatment will rise with each session, depending on how well the patient cooperates. Evaluation will be done at the beginning and in the 8th week.
2-Dimensional Group
In the 2-Dimensional Group, 2D VR gaming training in addition to traditional vestibular rehabilitation will be employed. In this group, the 'Verti-Go' game from the Playstation 4 VR gaming device will be played in 2D for 20-25 minutes, as well as vestibular therapy for 20-25 minutes. A total of 45-50 minutes will be given over the course of 8 weeks, 3 sessions per week. The intensity of treatment will rise with each session, depending on how well the patient cooperates. Evaluation will be done at the beginning and in the 8th week.
3-Dimensional Group
In the 3-Dimensional Group, 3D VR gaming training in addition to traditional vestibular rehabilitation will be employed. In this group, the 'Verti-Go' game from the Playstation 4 VR gaming device with 3D glasses will be played for 20-25 minutes, as well as vestibular therapy for 20-25 minutes. A total of 45-50 minutes will be given over the course of 8 weeks, 3 sessions per week. The intensity of treatment will rise with each session, depending on how well the patient cooperates. Evaluation will be done at the beginning and in the 8th week.
3-Dimensional Group
In the 3-Dimensional Group, 3D VR gaming training in addition to traditional vestibular rehabilitation will be employed. In this group, the 'Verti-Go' game from the Playstation 4 VR gaming device with 3D glasses will be played for 20-25 minutes, as well as vestibular therapy for 20-25 minutes. A total of 45-50 minutes will be given over the course of 8 weeks, 3 sessions per week. The intensity of treatment will rise with each session, depending on how well the patient cooperates. Evaluation will be done at the beginning and in the 8th week.
Interventions
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2-Dimensional Group
In the 2-Dimensional Group, 2D VR gaming training in addition to traditional vestibular rehabilitation will be employed. In this group, the 'Verti-Go' game from the Playstation 4 VR gaming device will be played in 2D for 20-25 minutes, as well as vestibular therapy for 20-25 minutes. A total of 45-50 minutes will be given over the course of 8 weeks, 3 sessions per week. The intensity of treatment will rise with each session, depending on how well the patient cooperates. Evaluation will be done at the beginning and in the 8th week.
3-Dimensional Group
In the 3-Dimensional Group, 3D VR gaming training in addition to traditional vestibular rehabilitation will be employed. In this group, the 'Verti-Go' game from the Playstation 4 VR gaming device with 3D glasses will be played for 20-25 minutes, as well as vestibular therapy for 20-25 minutes. A total of 45-50 minutes will be given over the course of 8 weeks, 3 sessions per week. The intensity of treatment will rise with each session, depending on how well the patient cooperates. Evaluation will be done at the beginning and in the 8th week.
Eligibility Criteria
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Inclusion Criteria
2. Dix hallpike test negative (inactive BPPV),
3. Recurrent and persistent dizziness,
4. Balance problems,
5. Age 25-65 years old individuals will be included in the study.
Exclusion Criteria
2. Anterior semicircular canal BPPV or multi-canal BPPV,
3. Coexisting vestibular disorders, including Meniere disease, vestibular neuritis, labyrinthitis and peripheral vestibular loss
4. Other neurological diagnoses (e.g., peripheral neuropathy, stroke, Parkinson's, central brain lesion)
5. Dizziness due to postural hypotension,
6. Using vestibulosuppressants, antihistamines or ototoxic medications within the previous 3 months will not be included in the study.
25 Years
65 Years
ALL
No
Sponsors
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Eastern Mediterranean University
OTHER
Responsible Party
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Aytül Özdil
Research Assistant
Principal Investigators
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Aytül Özdil, PT
Role: PRINCIPAL_INVESTIGATOR
Eastern Mediterranean University
Gözde İyigün, PhD
Role: STUDY_DIRECTOR
Eastern Mediterranean University
Locations
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Eastern Mediterranean University
Famagusta, Eyalet/Yerleşke, Cyprus
Countries
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References
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Iyigun G, Kirmizigil B, Angin E, Oksuz S, Can F, Eker L, Rose DJ. The reliability and validity of the Turkish version of Fullerton Advanced Balance (FAB-T) scale. Arch Gerontol Geriatr. 2018 Sep-Oct;78:38-44. doi: 10.1016/j.archger.2018.05.022. Epub 2018 Jun 4.
Meldrum D, Herdman S, Vance R, Murray D, Malone K, Duffy D, Glennon A, McConn-Walsh R. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial. Arch Phys Med Rehabil. 2015 Jul;96(7):1319-1328.e1. doi: 10.1016/j.apmr.2015.02.032. Epub 2015 Apr 2.
Nada EH, Ibraheem OA, Hassaan MR. Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness. Ann Otol Rhinol Laryngol. 2019 Apr;128(4):323-329. doi: 10.1177/0003489418823017. Epub 2019 Jan 4.
Rosiak O, Krajewski K, Woszczak M, Jozefowicz-Korczynska M. Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit. J Vestib Res. 2018;28(5-6):409-415. doi: 10.3233/VES-180647.
Yeh SC, Chen S, Wang PC, Su MC, Chang CH, Tsai PY. Interactive 3-dimensional virtual reality rehabilitation for patients with chronic imbalance and vestibular dysfunction. Technol Health Care. 2014;22(6):915-21. doi: 10.3233/THC-140855.
Micarelli A, Viziano A, Augimeri I, Micarelli D, Alessandrini M. Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial. Int J Rehabil Res. 2017 Dec;40(4):325-332. doi: 10.1097/MRR.0000000000000244.
Roettl J, Terlutter R. The same video game in 2D, 3D or virtual reality - How does technology impact game evaluation and brand placements? PLoS One. 2018 Jul 20;13(7):e0200724. doi: 10.1371/journal.pone.0200724. eCollection 2018.
Hsu SY, Fang TY, Yeh SC, Su MC, Wang PC, Wang VY. Three-dimensional, virtual reality vestibular rehabilitation for chronic imbalance problem caused by Meniere's disease: a pilot study<sup/> Disabil Rehabil. 2017 Aug;39(16):1601-1606. doi: 10.1080/09638288.2016.1203027. Epub 2016 Jul 15.
Ozaldemir I, Iyigun G, Malkoc M. Comparison of processing speed, balance, mobility and fear of falling between hypertensive and normotensive individuals. Braz J Phys Ther. 2020 Nov-Dec;24(6):503-511. doi: 10.1016/j.bjpt.2019.09.002. Epub 2019 Sep 23.
Other Identifiers
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2420-0107
Identifier Type: -
Identifier Source: org_study_id
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