A Study Protocol to Evaluate the Effects of Vestibular Training on the Postural Control of Healthy Adults Using Virtual Reality

Postural instability is a common symptom of vestibular dysfunction due to an insult to the vestibular system. Vestibular rehabilitation is effective in decreasing dizziness and visual symptoms, and improving postural control through several mechanisms, including sensory reweighting. As part of the sensory reweighting mechanisms, vestibular activation training with headshake activities influences vestibular reflexes. However, combining challenging vestibular and postural tasks to facilitate more effective rehabilitation outcomes is underutilized. Our research goal is to develop a virtual reality vestibular rehabilitation method for vestibular-postural control in neurological populations with vestibular and/or sensorimotor control impairment. The NeuroCom (R) SMART Balance Master (Natus Medical Inc., Pleasanton, CA, USA), which was used in a prior study, is expensive and bulky. Hence, a novel study protocol is established in this paper with the detailed objectives and pre-/post-intervention data analysis pipeline (ANOVA, t-test, post hoc analysis, etc.) involving modern off-the-shelf sensors and custom instrumentation (electromyography, electrooculography, video head impulse testing, force plates, and virtual reality headsets). It is expected that the training will significantly decrease vestibuloocular reflex gains and eye movement variability, as well as reweight the somatosensory ratio, finetune postural muscle activation, and consequently improve postural flexibility and produce a faster automatic postural response. The findings may have implications for the future development of vestibular rehabilitation protocols.