None listed
Conditions
Brief summary
Dizziness is one of the most common and disabling symptoms after an acquired brain injury (ABI), such as concussion or traumatic brain injury. Many people begin to avoid movements, places and activities that bring on their dizziness, which can slow recovery, increase the risk of falls, and affect mood, work and quality of life. Standard vestibular (balance) rehabilitation gradually exposes people to movements and environments that provoke symptoms, but is usually delivered using simple 2D videos that lack real-world realism. This study will recruit participants to take part in a virtual reality (VR) program delivered by trained clinicians during their usual outpatient rehabilitation sessions at the Brain Injury Rehabilitation Service (BIRS) Day Hospital or Concussion Clinic at the Princess Alexandra Hospital. Participants will wear a VR headset and be gradually exposed to virtual environments that vary in visual busyness and movement, chosen and progressed by their treating clinician based on their individual symptoms and goals. The sessions will last for about 30 minutes. Questionnaires and balance assessments will be completed before and after the program, and some participants and clinicians will be invited to a short interview about their experience. It is hoped this study will show that VR-based graded exposure is practical, safe and acceptable in outpatient brain injury rehabilitation. The study will also be used to provide early evidence about its effects on dizziness, avoidance of activity, anxiety and everyday function. The findings will inform a future larger controlled trial.
Interventions
The intervention: a single-arm feasibility pilot study of a virtual reality (VR)-based graded exposure program for persistent dizziness following acquired brain injury.
Who delivers it: Experienced, trained clinicians including physiotherapists of the multidisciplinary brain injury rehabilitation team.
Materials: A commercially available head-mounted VR display presenting a set of immersive footage of real-world environments that vary in visual complexity, motion, and sensory load (e.g., quiet
The intervention: a single-arm feasibility pilot study of a virtual reality (VR)-based graded exposure program for persistent dizziness following acquired brain injury. Who delivers it: Experienced, trained clinicians including physiotherapists of the multidisciplinary brain injury rehabilitation team. Materials: A commercially available head-mounted VR display presenting a set of immersive footage of real-world environments that vary in visual complexity, motion, and sensory load (e.g., quiet vs busy environments, movement-based scenes). The VR content was co-produced by the clinical and research team prior to study commencement (co-production is not part of the research procedures). Procedures: The intervention is based on graded exposure principles consistent with optokinetic stimulation and habituation approaches used in vestibular rehabilitation. Environments are not individually created for each participant; the treating clinician selects and progresses environments from the predefined set based on individual symptom triggers, tolerance, symptom severity, response to previous exposures, and rehabilitation goals. Progression occurs through graded increases in visual complexity, motion, and duration of exposure. Participants can pause or cease the VR experience at any time. How is it delivered: Face-to-face, individual sessions are integrated within routine outpatient rehabilitation sessions at the Metro South Health Brain Injury Rehabilitation Service (BIRS) Day Hospital and Concussion Clinic, Princess Alexandra Hospital, Brisbane. The VR intervention is not part of standard care and is delivered as part of this research study. Study sessions: Individual VR sessions run for approximately 30 minutes, inclusive of equipment set-up and symptom monitoring. Session frequency will vary according to patient presentation, symptoms and stage of rehabilitation. This may occur weekly or fortnightly, reflecting real-world service delivery. Videos will be 1- 5 minute duration and occur over a 30-minute rehabilitation session. The intervention period spans from approximately 2 weeks to 6 weeks of rehabilitation. This will be dependent on patient symptom severity and clinician clinical reasoning. Selection and progression of the VR program are tailored by the treating clinician. Adherence: Adherence is recorded via therapist session logs (session attendance, duration of VR exposure). Simulator sickness is monitored pre- and post-session using the Simulator Sickness Questionnaire; sessions are modified, paused or discontinued if symptoms exceed tolerable levels. Exploratory data: Where supported by the headset and consented to, basic de-identified eye-tracking metrics (e.g., gaze direction, fixation duration, visual exploration patterns) may be recorded during VR exposure for exploratory, descriptive purposes.
Sponsors
Griffith University
Study design
Allocation
Non-randomised trial
Primary purpose
Treatment
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
- Adults aged 18 to 70 years. - Diagnosis of acquired brain injury (ABI), including concussion and mild, moderate or severe traumatic brain injury. - Clinically significant dizziness, defined as a Dizziness Handicap Inventory (DHI) score greater than or equal to 16. - Dizziness or motion sensitivity that persists despite initial vestibular management or is considered appropriate for graded exposure-based rehabilitation. - Receiving rehabilitation at the BIRS Day Hospital Service or Concussion Clinic, Princess Alexandra Hospital. - Able to participate in supervised VR-based activities - Capacity to provide informed consent, assessed clinically or via a formal capacity assessment (University of California Brief Assessment of Capacity to Consent) if required.
Exclusion criteria
- Unstable or severe medical conditions that contraindicate VR use (e.g. uncontrolled seizures, acute migraine). - Cognitive impairment that prevents informed consent or participation, where capacity assessment indicates inability to consent. - Significant history or ongoing pattern of substance or alcohol use that impairs the ability to safely participate and engage in the intervention. - Significant psychiatric history or comorbidity (e.g., psychosis, acute psychiatric instability) that may interfere with the ability to engage safely or consistently in the intervention. - Isolated benign paroxysmal positional vertigo (BPPV) that has resolved following repositioning manoeuvres and does not require further vestibular rehabilitation.
Outcome results
None listed