Effects of Virtual Reality Assisted Vestibular Rehabilitation Versus Conventional Vestibular Rehabilitation on Dizziness, Balance, and Gait in Patients With Benign Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common peripheral vestibular disorders, caused by the displacement of otoconia within the semicircular canals of the inner ear. It is characterized by brief but intense episodes of vertigo triggered by head movements, often accompanied by dizziness, postural instability, and gait disturbances. These symptoms can significantly impair functional mobility, increase the risk of falls, and reduce overall quality of life. Vestibular Rehabilitation Therapy (VRT) is a well-established treatment approach that uses specific exercises to promote central nervous system compensation for vestibular dysfunction. Conventional VRT includes gaze stabilization exercises, balance training, and habituation exercises. While effective, some patients experience residual symptoms or limited engagement, which has led to the exploration of more innovative rehabilitation methods such as Virtual Reality (VR). This study focuses on evaluating the comparative effects of Virtual Reality-assisted Vestibular Rehabilitation and Conventional Vestibular Rehabilitation on dizziness, balance, and gait in patients with BPPV. VR-based rehabilitation offers an interactive, multisensory environment that can simulate real-life scenarios, enhance patient engagement, and promote neuroplasticity. By providing controlled visual and vestibular stimuli, VR may accelerate recovery and improve functional outcomes. Intervention Strategies: Virtual Reality-assisted Vestibular Rehabilitation: This approach utilizes VR technology to create immersive environments where patients perform balance and gaze stabilization exercises. The visual feedback provided through VR enhances sensory integration and promotes vestibular adaptation. VR training may improve motivation, adherence, and functional performance by making rehabilitation more engaging and task-oriented. Conventional Vestibular Rehabilitation: This approach includes traditional vestibular rehabilitation exercises such as gaze stabilization, habituation exercises, and balance training. These exercises aim to reduce dizziness, improve postural control, and enhance gait performance by promoting central compensation mechanisms. Study Design and Groups: This randomized controlled trial will include patients diagnosed with BPPV who meet the inclusion criteria. Participants will be randomly assigned into two groups: Group 1 (Experimental Group): Virtual Reality-assisted vestibular rehabilitation combined with routine physical therapy. Group 2 (Control Group): Conventional vestibular rehabilitation combined with routine physical therapy. The interventions will be conducted several times per week over a defined intervention period (e.g., 4-8 weeks). Each session will include structured rehabilitation exercises supervised by trained physiotherapists. Outcome Measures: The primary outcome of the study will be the reduction in dizziness severity, measured using the Dizziness Handicap Inventory (DHI), Balance assessment using the Berg Balance Scale (BBS), Gait performance using the Dynamic Gait Index (DIG) test, Functional mobility and risk of falls. Assessments will be conducted at baseline, mid-intervention (if applicable), and post-intervention to evaluate both immediate and progressive effects. Data Collection and Analysis: Data will be collected at multiple time points to evaluate changes in dizziness, balance, and gait performance. Statistical analysis will be performed using appropriate methods such as repeated measures ANOVA or mixed-model ANOVA to compare within-group and between-group differences. Post hoc analysis will be conducted to determine the effectiveness of each intervention over time. Safety and Ethics: This study will be conducted following approval from the institutional ethical review board. Informed consent will be obtained from all participants prior to inclusion in the study. All interventions will be supervised by qualified healthcare professionals to ensure participant safety. Potential risks are minimal and may include temporary dizziness, fatigue, or mild discomfort during exercises. Participants will be monitored throughout the sessions, and any adverse effects will be managed promptly. Confidentiality of participant data will be strictly maintained, and all personal information will be anonymized. Participation will be voluntary, and participants may withdraw at any time without consequences. Significance and Potential Impact: This study has the potential to contribute significantly to the field of vestibular rehabilitation by providing evidence on the comparative effectiveness of Virtual Reality-assisted and Conventional rehabilitation approaches. If VR-assisted therapy proves more effective, it may offer a more engaging, innovative, and efficient treatment option for patients with BPPV. Given the increasing interest in technology-based rehabilitation, this research may support the integration of VR into clinical practice, especially in improving patient adherence and outcomes. It may also provide a foundation for future research in vestibular disorders and neurorehabilitation. Conclusion: By comparing Virtual Reality-assisted Vestibular Rehabilitation with Conventional Vestibular Rehabilitation, this study aims to identify the most effective approach for reducing dizziness and improving balance and gait in patients with BPPV. The findings may enhance clinical decision-making and support the development of more effective, evidence-based rehabilitation strategies for vestibular disorders.

Inclusion criteria

• Participants of both genders.
• Adults aged 18-40 years.
• Clinically diagnosed with posterior canal Benign Paroxysmal Positional Vertigo (BPPV) confirmed by a positive Dix-Hallpike test, with a duration of at least one month since diagnosis.
• Individuals who have undergone canalith repositioning maneuvers and demonstrate resolution of positional nystagmus.
• Presence of residual dizziness and/or balance impairment persisting after repositioning treatment.
• Ability to ambulate independently and safely participate in balance-related exercises.
• Willingness to participate in the study and provide written informed consent.

Exclusion criteria

• Central vestibular disorders
• Cervical spine instability or severe neck pain
• History of recent head trauma (<3 months)
• Neurological disorders affecting balance
• Severe visual or cognitive impairment preventing VR use
• Patients of Vertebrobasilar insufficiency (VBI)