Evidence for Vestibular Sensory Reweighting and Improvement in Dynamic Posturography after Computerized Vestibular Retraining for Stable Unilateral Vestibular Deficit

Balance deficits increase the risk of falls and compromise quality of life. This single group, interventional study assesses a computerized vestibular retraining protocol in patients with objectively determined unilateral peripheral vestibular deficits. Participants received twelve twice-weekly sessions of vestibular retraining guided by an interactive display. Objective posturography tests and questionnaires were administered before and after retraining. We enrolled 13 participants (5 females and 8 males) with a median age of 51 years (range 18 to 67). After retraining, the median change in sensory organization test (SOT) composite scores was 8.8 (95% CI, 0.6 to 19.1). The SOT visual (median change of 0.12 [-0.09 to 0.30]) and vestibular (0.10 [-0.06 to 0.25]) ratios improved but there was no change in the somatosensory or visual preference ratios. Participants with moderate-to-severe disability at baseline (n=7), as measured by Dizziness Handicap Inventory, had a larger magnitude of improvement (SOT composite 14.6 [7.0 to 36.9]; visual ratio 0.16 [0.09 to 0.39]; vestibular ratio 0.12 [0.08 to 0.28]). We found that computerized vestibular retraining is associated with improvement in dynamic balance performance for individuals with stable unilateral vestibular deficits, consistent with sensory substitution to vestibular organs. Posturography improvements correlated with reduced perceived fall risk. Clinicaltrials.gov registration NCT04875013; 06/05/2021