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Lack of funding.
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The effectiveness of convectional vestibular training for balance and dizziness rehabilitation in people with multiple sclerosis has been recently demonstrated in a meta-analysis by this research team (doi: 10.3390/jcm9020590). Furthermore, non-immersive virtual reality-based environments seem to be useful for balance and gait rehabilitation in this population (doi: 10.1177/0269215518768084). However, nothing is known about the feasibility and effectiveness of immersive virtual reality-based rehabilitation in people with multiple sclerosis.
The primary aim of this research is to determine the feasibility, safety and effectiveness of an immersive virtual reality-based vestibular training for dizziness, balance and fatigue rehabilitation, compared to conventional vestibular training.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Immersive virtual reality-based vestibular training. | Experimental | Subjects in this group will receive the same intervention than the other group of study, but they will wear a 3D head mounted display (Oculus Quest glasses) and will receive real-time gaming feedback in terms of visual and audio output while using the training system. Participants will receive a total of 20 sessions (3 sessions of 50 minutes per week, 7 weeks). These sessions will be divided in 10 initial sessions (based on the three first blocks of Cawthorne-Cooksey protocol) and 10 advanced sessions in which vestibular exercises are gradually get more complicated by modifiying the following exercise parameters: base of support width, standing on unstable surface, alternatives single leg support, tandem position, increased velocity of head movements, higher head range motion and coordinated movements with arms and trunk. Same location, tailoring parameters and physical therapist supervision than conventional vestibular training. |
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| Conventional vestibular training. | Active Comparator | Subjects in the control group will receive a total of 20 sessions of 50 minutes (3 sessions per week, 7 weeks). They will receive traditional "Cawthorne-Cooksey" vestibular rehabilitation exercises. This program improves vestibular compensation through a mechanism of neuroplasticity known as adaptation, habituation and substitution. Just like the virtual reality intervention it will be divided in 10 initial sessions and 10 advanced sessions. For the advanced phase of intervention exercises parameters were the same described for the virtual vestibular rehabilitation intervention. A physical therapy with at least two years of expertise in vestibular rehabilitation will adjust the difficulty level. The intervention will be conducted at the Physical Therapy Department of the University of Sevilla (Spain). |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Immersive Virtual-based vestibular rehabilitation | Other | Vestibular rehabilitation based on virtual environment using a head mounted display |
|
| Measure | Description | Time Frame |
|---|---|---|
| Feasibility of virtual reality-based vestibular rehabilitation | Usability of virtual reality device: System Usability Scale (0-100%). Higher Scores means higher usability Participation rate Retention rate Adherence to treatment rate | 7 weeks of intervention |
| Safety of virtual reality-based vestibular rehabilitation | Cybersickness: Scores ranging between 10 and 15 mean significant symptoms and above 20 indicates a simulator problem Falls registry Adverse events registry | 7 weeks of intervention |
| Measure | Description | Time Frame |
|---|---|---|
| Change from baseline dizziness symptoms at 7 weeks | Dizziness Handicap Inventory (0-100 points). Higher scores mean worse dizziness symptoms. | 7 weeks after intervention |
| Change from baseline static balance at 7 weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Maria Jesus Casuso-Holgado | University of Seville | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Universidad de Sevilla | Seville | Sevilla | 41004 | Spain |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 34810187 | Derived | Garcia-Munoz C, Casuso-Holgado MJ, Hernandez-Rodriguez JC, Pinero-Pinto E, Palomo-Carrion R, Cortes-Vega MD. Feasibility and safety of an immersive virtual reality-based vestibular rehabilitation programme in people with multiple sclerosis experiencing vestibular impairment: a protocol for a pilot randomised controlled trial. BMJ Open. 2021 Nov 22;11(11):e051478. doi: 10.1136/bmjopen-2021-051478. |
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| Conventional vestibular rehabilitation protocol | Other | "Cawthorne-Cooksey" vestibular rehabilitation exercises. |
|
Static balance assessed by posturography Dynamic balance assessed by Balance Berg Scale. Higher score better balance.
| 7 weeks after intervention |
| Change from baseline fatigue at 7 weeks | Modified Fatigue Impact Scale (0-84 points). Higher scores mean worse fatigue symptoms. | 7 weeks after intervention |
| Change from baseline quality of life at 7 weeks | Multiple Sclerosis Quality of Life Scale 54 (0-100 points). Higher values indicate better quality of life. | 7 weeks after intervention |
| ID | Term |
|---|---|
| D009103 | Multiple Sclerosis |
| D015837 | Vestibular Diseases |
| D004244 | Dizziness |
| D005221 | Fatigue |
| ID | Term |
|---|---|
| D020278 | Demyelinating Autoimmune Diseases, CNS |
| D020274 | Autoimmune Diseases of the Nervous System |
| D009422 | Nervous System Diseases |
| D003711 | Demyelinating Diseases |
| D001327 | Autoimmune Diseases |
| D007154 | Immune System Diseases |
| D007759 | Labyrinth Diseases |
| D004427 | Ear Diseases |
| D010038 | Otorhinolaryngologic Diseases |
| D012678 | Sensation Disorders |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
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