Immersive virtual reality in vestibular rehabilitation

Vertigo find dizziness are symptoms very common in popolution.There are no specific drugs for the treatment of these symptoms and there are no specific treatment for the major part of the causes of vertigo and dizziness. Rehabilitation seems to be the most effective tool for therapy of vertigo and dizziness. Although the so-called vestibular rehabilitation, that is a special rehabilitation of motion intolerance and imbalance problem, has only recently gained wide attention, the concept of head, body, and coordinated eye exercises as a treatment for vestibular disorders is actually over 50 years. Cawthorne-Cooksey protocol is based on the concepts of habituation and sensory substitution, These concepts are correct but they are not univoque and, maybe, they are not the most important to explain the therapeutic effects of vestibular rehabilitation. Vertigo and dirtiness are conscious symptoms and the patients' disturbances are not disequilibrium or nystagmus but the consciousness of disequilibrium and nystagmus. Thus, physical rehabilitation must not only be pointed to resolution of objective disorder but it must be also aimed to resolution of subjective consciousness of the disorder itself, Vertigo and dizziness can be considered the effects of an imbalance of a psycho-sensori-motor system. On the basis of this concept we propose to use psycho-cognitive techniques like immersive Virtual Reality in order to improve equilibrium sensori-motor performance. A modified joystick allow to the subject to control the diplacements of virtual movements in virtual environment by the mean of body movements. Appropriate utilization of ankle-hip strategies is necessary in order to explore the virtual environment. We chosen three virtual environments. They were originally designed to evaluate cognitive aspects hire incidental memory attention and categorization. The first environment is a house with different rooms. In each room there are different objects ( a piano, a clock, some pictures,...) The patient has to explore the house and find a selected object. The second environment is an open space coloured in green and blue with a path marked by arrows. The third is a virtual castle constitued by several subsequent rooms. I;or the next room there are different doors. The patient has to choose the appropriate door on the basis of associative criteria. The environment was originally prepared as a virtual reality Wisconsin test. The combination of motor performance ( body control of the joystick) and cognitive involvement (active exploration of the environments) allows to improve the effectiveness of vestibular rehabilitation techniques.