Vestibular rehabilitation in older adults with and without mild cognitive impairment: Effects of virtual reality using a head-mounted display

Purpose: Due to the gap in the knowledge in the field of vestibular rehabilitation the purpose of this randomized study is to highlight the outcomes of head-mounted display (HMD)implementation in older adults and patients with mild cognitive impairment (MCI), suffering from unilateral vestibular hypofunction (UVH). Materials and methods: Vestibulo-ocular reflex (VOR)gain, postural sway examination and dizziness-related and quality of life scores were collected in 12 UVH elderly and 12 UVH subjects suffering from MCI only undergoing vestibular rehabilitation and in 11 UVH elderly and 12 UVH subjects suffering from MCI undergoing a home-based HMD + vestibular rehabilitation protocol. Results: Although the within-subjects analysis found in all groups a significant (p < 0.05)improvement in posturography parameters and dizziness-related and quality of life scores and no changes in VOR gain, implementation of HMD demonstrated a significant (p < 0.05)increase in post-treatment between-group comparisons in the same tests and VOR gain with respect to those older adults and participants with MCI only undergoing vestibular rehabilitation. Positive correlations were discovered between Mini-Mental Score Exam values and pre-/post-treatment differences in (i)power spectra values in the low-frequency interval (r = 0.72)and in (ii)Dynamic Gait Index scores (r = 0.76). Conclusions: This study demonstrates that the implementation of a home-based virtual reality protocol may be a safe option in order to ameliorate VOR, postural control and the quality of life also in the vestibular impaired patients in whom the presence of cognitive decline could hinder the achievement of the goal of rehabilitation.