The Use of Virtual Reality in Rehabilitation in Patients After Vestibular Schwannoma Surgery.

Summary

Resection of the vestibular schwannoma leads to acute peripheral or combined vestibular loss caused by a surgical lesion to the branches of the vestibular nerve and, less frequently also the lesion of the cerebellum. The lesion presents in patients with postural instability, vertigo, oscillopsia, and vegetative symptoms that may accompany it. The organism reacts to this state with the process of central compensation with the significant role of the cerebellum. The goal of the rehabilitation is to support this process and thus to make recovery faster and more efficient since not all patients are capable of complete restoration of the vestibular function. Up to date, rehabilitation includes, apart from the specific vestibular exercise, also the possibility of modern techniques using virtual reality space and prehabituation. Thanks to prehabituation, i.e., chemical labyrinthectomy with intratympanically installed gentamicin, the timing of the origin of the acute vestibular loss and the surgical procedure is separated. Therefore, there is a chance of achieving vestibular compensation before vestibular schwannoma removal. In the last decade, due to the advances in technology in the field of computer games and the applications for smartphones, the tools for virtual reality have become less expensive and more available in common praxis. Virtual reality is a technique for generating an environment that can strengthen three-dimensional optokinetic stimulation, subsequently the process of central compensation. Overall, it may shorten the time of recovery after the surgery and improve patients' quality of life.

Conditions

• Acute Peripheral Vestibulopathy Following Surgical Procedure

Interventions

PROCEDURE

Prehabituation

chemical labyrinthectomy with intratympanically installed gentamicin

PROCEDURE

3D optokinetic stimulation in virtual reality space

3D optokinetic stimulation via virtual reality goggles with the software designed by Pro-Zeta comp.

PROCEDURE

Vestibular training

vestibular training program adopted for patients with acute vestibular loss under the supervision of a physical therapist. The program includes gaze stability exercises, smooth pursuit, and saccadic eye movements, and postural exercises to improve balance control and gait stability. Each session lasts around 30 minutes and happened daily for the 7 postoperative days.

Sponsors & Collaborators

• Charles University, Czech Republic

  lead OTHER

Principal Investigators

• Markéta Bonaventurová · Department of ENT and Head and Neck Surgery, Charles University in Prague and Motol University Hospital

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2020-01-01

Primary Completion

2026-06-30

Completion

2026-06-30

Countries

• Czechia

Study Locations