The vestibular system is a distributed sensory network involving inner-ear organs, ocular control, postural muscles, brainstem, cerebellum, cortex, and related central pathways. Intact vestibular processing supports posture, gait, the vestibulo-ocular reflex (VOR), and vestibulospinal responses. Dysfunction can cause dizziness, altered perception of body position and motion, impaired ocular motor control, and deficits in posture, gait, and balance. Vestibular disorders arise from varied peripheral and central causes and affect a meaningful fraction of adults.
Vestibular rehabilitation—delivered as progressive, repetitive exercises targeting gaze stability, postural control, and dynamic balance—aims to exploit physiological mechanisms of adaptation, habituation, and substitution to reduce symptoms and restore function. Traditional exercise programs such as the Cawthorne–Cooksey protocol remain a clinical standard, but repetitive tasks can be demotivating and reduce adherence.
Game-based and immersive virtual reality (VR) approaches have been applied to rehabilitation and may enhance habituation, provide adaptive visual feedback for VOR retraining, and offer multisensory substitution. Prior VR implementations vary in specificity to vestibular therapy and sometimes rely on general or commercial environments rather than tailored vestibular exercises. The present study evaluated an immersive system, DizzyVR, specifically developed to support vestibular rehabilitation in a feasibility framework.
This prospective, single-arm feasibility study enrolled ten participants diagnosed with various vestibular disorders. Each participant completed eight weekly training sessions using the DizzyVR system. Feasibility outcomes included session attendance and completion rates.
Usability and satisfaction were measured using standardized instruments: the System Usability Scale and a User Satisfaction Evaluation Questionnaire. Safety and simulator-related adverse effects were monitored with the Simulator Sickness Questionnaire. Clinical outcome measures collected before and after the intervention were the Dizziness Handicap Inventory (DHI), the Timed Up and Go (TUG) test (a measure related to gait speed and mobility), the Activities-specific Balance Confidence (ABC) scale, and the Functional Gait Assessment (FGA).
The study focused on feasibility, acceptability, and safety, with exploratory analyses of pre–post clinical changes. Details on inclusion/exclusion criteria, participant demographics, and exact session protocols were reported in the primary article.
All ten participants completed the eight-session program, producing a high adherence rate of 91.25% across sessions. Usability assessments indicated that participants found DizzyVR easy to use, and satisfaction scores were high on the User Satisfaction Evaluation Questionnaire.
Safety monitoring identified mild adverse events: three participants experienced transient nausea or disorientation related to simulator exposure. These symptoms improved over the course of training and were characterized as mild.
Exploratory pre–post comparisons showed statistically significant improvements in several clinical measures. Gait-related performance measured by the TUG improved (p = 0.002). Self-reported balance confidence on the ABC scale increased (p = 0.007). Gait stability as assessed by the FGA also improved (p = 0.012). Changes in the DHI showed a trend toward reduced dizziness-related handicap but did not reach statistical significance (p = 0.081).
Participants reported feeling safe while using DizzyVR and expressed willingness to recommend or reuse the system as part of rehabilitation.
Findings from this small, single-arm feasibility study indicate that DizzyVR can be delivered with high participant adherence and favorable usability and satisfaction ratings. The occurrence of mild simulator sickness symptoms in a minority of participants underscores the importance of monitoring and suggests symptoms can attenuate with repeated exposure.
Exploratory clinical results demonstrated improvements in mobility, balance confidence, and gait stability. These signals support the hypothesis that an immersive, vestibular-specific VR program can complement conventional vestibular rehabilitation by reinforcing habituation and adaptation mechanisms and enhancing patient engagement. The lack of a statistically significant change in DHI in this cohort suggests either the sample size limited power for that outcome or that perceived handicap requires longer or more intensive intervention to change.
Because this was an uncontrolled feasibility study with a small sample, results must be interpreted cautiously. The study design prioritized feasibility, safety, and acceptability; it was not designed to provide definitive evidence of efficacy. The authors note the need for larger randomized controlled trials with longer follow-up to determine the effect size, optimal dosing, long-term safety, and whether VR-based programs provide benefits beyond standard care.
DizzyVR was feasible to implement, well accepted by participants, and demonstrated good usability in this small cohort of individuals with vestibular disorders. Mild simulator-related adverse effects were reported but improved over time. Exploratory pre–post improvements in TUG, ABC, and FGA suggest potential for benefit in gait and balance outcomes, while DHI change did not reach statistical significance.
The authors recommend further research using larger samples, controlled designs, and extended follow-up to confirm these preliminary observations and to define clinical effectiveness and implementation pathways for VR-supported vestibular rehabilitation.