Immersive Virtual Reality Rehabilitation For Residual Dizziness And Balance Impairment In BPPV: A Randomized Controlled Trial

Abstract

Background: Benign paroxysmal positional vertigo (BPPV) is commonly treated successfully with canalith repositioning
maneuvers; however, some individuals continue to experience residual dizziness and balance impairment after resolution of
positional vertigo. Vestibular rehabilitation may help address these persistent functional symptoms, and immersive virtual
reality (VR) provides an interactive environment for balance and movement-based training.
Objective: To compare the effects of immersive VR-based vestibular rehabilitation and conventional vestibular rehabilitation
on residual dizziness and functional balance in individuals with BPPV following successful canalith repositioning.
Methods: A randomized controlled study was conducted on 30 adults with residual dizziness and/or balance impairment
following successful treatment of BPPV. Participants were randomly allocated into two groups of 15 each. Group A received
immersive VR-based vestibular rehabilitation using a PlayStation VR2 system with Synth Riders, while Group B received
conventional vestibular rehabilitation. Both groups received 12 supervised sessions over 4 weeks, with three sessions per
week. Dizziness-related disability was assessed using the Dizziness Handicap Inventory (DHI), and functional balance was
assessed using the Berg Balance Scale (BBS). Assessments were performed before and after the intervention.
Results: Both groups demonstrated significant improvement following the intervention. In Group A, DHI scores decreased
from 41.07 ± 7.10 to 24.27 ± 7.28, with a mean reduction of 16.80 ± 2.65 points (p < 0.001). In Group B, DHI scores
decreased from 44.13 ± 5.83 to 32.07 ± 6.94, with a mean reduction of 12.07 ± 4.40 points (p < 0.001). The between-group
difference in DHI change was 4.73 points (p = 0.001). BBS scores improved by 5.53 ± 1.60 points in Group A and 3.67 ± 1.80
points in Group B (p < 0.001 for both groups), with a between-group difference of 1.87 points (p = 0.006).
Conclusion: Both immersive VR-based and conventional vestibular rehabilitation were associated with significant
improvements in dizziness-related disability and functional balance following successful BPPV treatment. The immersive VR
group demonstrated greater improvement in both DHI and BBS scores. Immersive VR-based vestibular rehabilitation may
therefore be a useful approach for managing residual symptoms following successful canalith repositioning.