Efficacy of Incremental Vestibular Ocular Reflex Adaptation Training on Gait, Balance, and Quality of Life in Individuals With Chronic Peripheral Vestibular Hypofunction: A Randomized Controlled Trial.

OBJECTIVE: To compare gait, balance, and subjective measures of dizziness outcomes in patients with vestibular hypofunction completing either a novel, incremental vestibular ocular reflex (VOR) adaptation program or traditional vestibular rehabilitation. DESIGN: Randomized, double-blinded, crossover-controlled trial including a 6-month follow-up. SETTING: Tertiary care, outpatient physical therapy. PARTICIPANTS: N=24 individuals with chronic peripheral vestibular hypofunction. INTERVENTIONS: Group A first completed incremental VOR adaptation training using the novel, head-mounted StableEyes device, while group B completed traditional gaze stability exercises considered standard of care in vestibular rehabilitation. After 3 weeks, participants entered a 3-week washout period before crossing over to the opposing gaze stability training intervention and starting balance and gait training. MAIN OUTCOME MEASURES: The magnitude of the vestibulo-ocular reflex was the primary outcome measure of the clinical trial; this paper reports results for the secondary outcome measures of gait, balance, and subjective experience, which are of primary concern to patients with vestibular disorders. Demographic, balance, gait, and subjective symptom differences between the groups were analyzed using a linear mixed model with a random intercept and, when appropriate, paired t tests, following the intent-to-treat principle. RESULTS: At baseline, group A had lower subjective balance confidence scores (P=.016) and fewer neurobehavioral symptoms (P=.029) than those allocated to group B. However, we found no difference between the groups in the change of any clinical outcome (gait, balance, or subjective symptoms) after completion of either/both types of gaze stability training. Regardless of cohort placement, individuals improved their gait, balance confidence, and global impression of change, yet these improvements were not retained at 6 months. CONCLUSIONS: The novel incremental VOR adaptation method for gaze stability training offers advantages similar to those of traditional vestibular rehabilitation in improving gait, balance, and subjective symptoms, though these improvements are lost at 6 months.