Clinical Research Directory

Virtual Reality and Biofeedback for Adolescents With Chronic Dizziness

Both persistent postural-perceptual dizziness (PPPD) and vestibular migraine (VM) are common diagnoses in patients presenting to physicians for evaluation of vestibular symptoms such as dizziness and vertigo. Although they are most often described in the adult population, they are also common in children and adolescents with dizziness. Chronic dizziness profoundly affects quality of life, often keeping children out of school and inhibiting their participation in the normal activities of childhood and adolescence. Overall, chronic dizziness is suspected to be due in large part to a "rewiring" of the brain that alters how cues related to balance and orientation are processed, with overreliance on visual inputs to maintain balance and equilibrium being a common development. Thus, chronic dizziness, especially that which is due to PPPD, is often caused by visual triggers. A multi-modal approach is often taken to treat chronic dizziness, attempting to recalibrate this maladaptive "rewiring" and return the sensory system to normal function. Given the role that visual inputs play in developing and perpetuating chronic dizziness, habituation to visual stimuli should be a significant component to treatment. Treatments often include cognitive behavioral therapy (CBT), systematic desensitization exposure response prevention (SDERP), and biofeedback therapy (BFB). However, these visually provoked symptoms are often resistant to treatment. One reason for this may be that visual stimuli are difficult to replicate in the clinic or office. One way to address this gap in treatment is through virtual reality (VR) technology, which immerses patients in realistic visual environments. VR has not been explicitly described in the treatment of PPPD or chronic dizziness, but it has been piloted, and shown to be effective, in the rehabilitation of peripheral vestibular dysfunction. This study aims to integrate VR into the current PPPD/chronic dizziness techniques of CBT, SDERP, and BFB. The investigators will use a commercially available VR headset, which enables the use of VR in the office setting in a relatively low-cost form of VR technology. This study will evaluate the feasibility and effectiveness of VR in conjunction with CBT, SDERP, and BFB to investigate if VR technology enhances previously established effective treatments to reduce chronic dizziness and PPPD.

A Study Of Auricular Transcutaneous Vagus Nerve Stimulation In Chronic Dizziness

The purpose of this study is to measure the change in dizziness, as measured by change in Dizziness Handicap Inventory (DHI) score, following a 4-week treatment period with aurical transcutaneous vagus nerve stimulation (aTVNS).

Comparison Between Traditional Vestibular Rehabilitation Therapy And Virtual Reality In Management Of Patients With Chronic Dizziness

Chronic dizziness is a common and often debilitating condition, especially among older adults. It typically presents as a persistent sensation of unsteadiness, spinning, or motion lasting weeks or months. Most cases stem from vestibular system disorders, such as vestibular neuritis, benign paroxysmal positional vertigo (BPPV), Menière's disease, and bilateral vestibulopathy \[1,2\]. Symptoms may persist beyond the acute phase due to the brain's incomplete adaptation or maladaptive behaviors, like avoiding movement. Psychological factors, such as anxiety and stress, can worsen or prolong symptoms \[3\]. While many vestibular disorders resolve over time, some patients experience chronic symptoms due to poor central compensation or fear-based movement avoidance \[2\]. Chronic dizziness significantly impacts daily life-leading to imbalance, increased fall risk, reduced mobility, and emotional distress. Proper management is crucial to improving safety, independence, and quality of life \[4\]. Initial treatments may include medications or maneuvers like the Epley technique for BPPV. If symptoms persist, Vestibular Rehabilitation Therapy (VRT) is often recommended. VRT is a personalized exercise program aimed at enhancing the brain's ability to adapt, habituate, or compensate through substitution \[6-8\]. Recently, Virtual Reality (VR) has emerged as an innovative tool in vestibular rehab. It provides engaging, interactive environments for practicing balance and visual-vestibular tasks. Studies suggest that VR is feasible, well-tolerated, and effective, particularly for patients with persistent or visually-induced dizziness \[9,10\].

Repetitive Transcranial Magnetic Stimulation Paired with Augmented Reality to Alter Concussion Symptoms

This study aims to determine whether the delivery of brain stimulation paired with a balance training task can improve symptoms of dizziness for individuals experiencing these symptoms due to concussion. The main questions it aims to answer are: * Does repetitive transcranial magnetic stimulation (rTMS) paired with balance training improve the symptoms of dizziness in individuals with persistent dizziness due to concussion? * Is the proposed rTMS and balance training protocol feasible in this population? Researchers will compare results from a sham rTMS group with those from a real rTMS group to see if any observed changes are from the placebo effect rather than the expected effects of real rTMS. Participants will receive pulses of rTMS to the area of the brain responsible for control of movement and then be asked to interact with digital objects using augmented reality glasses for 14 days over 3 weeks.