Computerized game-based vestibular rehabilitation: assessment of feasibility and motor learning

前庭系统的损伤是一个常见的问题，往往会导致严重的残疾。在大多数情况下， 没有有效的药物来恢复前庭功能。相反，治疗的主体是前庭 康复，以促进中枢运动学习，这将增强受损的前庭反射和补偿 治疗前庭功能障碍前庭治疗包括一个在家里进行的锻炼计划， 在一位训练有素的前庭治疗师的监督下进行。注视稳定性练习针对前庭眼 反射和改善视力在头部运动;平衡练习有助于恢复良好的姿势控制。 虽然前庭治疗是有效的，但目前实践中存在几个关键限制。一是 运动的难度不能精确地校准到每个患者的具体损伤水平。第二、 不能容易地监测对治疗的依从性。最后，标准练习可能不足以 鼓励继续实践。本项目的目的是测试定制的可行性， 交互式前庭游戏，用于凝视稳定性练习。这个游戏是基于一个视觉辨别任务， 测试头部旋转时的视力。任务的难度可以自定义和调整 根据患者的初始功能水平和治疗随时间的进展，逐渐增加。 这项试点研究有两个目的。第一个目标将测试游戏诱导可塑性的能力， 前庭功能正常的健康个体的前庭眼反射。该方法将基于 前庭适应的先前研究，其中前庭（头部运动）和视觉（ 正在观看的场景）输入导致前庭眼反射的增益的变化。同一组 受试者，VOR增益的变化由视觉前庭功能障碍程度的递增引起， 失配将与由更传统的单步自适应方法引起的失配进行比较。的 一种假设是，游戏将导致前庭-眼反射增益的变化，并且这种变化将 更大的增量战略。 第二个目的是测试前庭游戏的可行性和玩一组的经验， 周围前庭功能减退的退伍军人，正在接受或最近完成了标准 前庭康复治疗每个病人都会玩这个游戏，并提供他们的经验反馈。 我们还将记录相同的生理数据（前庭眼反射增益之前和之后玩），以评估 短期运动反应。患者将每周玩一次游戏，每次四次;这将提供 随着时间的推移，我们获得了关于凝视稳定性改善的初步数据。这一目标的数据将支持 一个未来的应用程序，用于我们的游戏与传统疗法相比的多阶段临床试验。

Damage to the vestibular system is a common problem that often leads to substantial disability. For most cases, there is no effective medication to restore vestibular function. Instead, the mainstay of treatment is vestibular rehabilitation to promote central motor learning that will enhance impaired vestibular reflexes and compensate for the vestibular deficit. Vestibular therapy consists of a program of exercises that are performed at home and in the clinic, supervised by a trained vestibular therapist. Gaze stability exercises target the vestibulo-ocular reflex and improve vision during head movement; balance exercises help to restore good postural control. Although vestibular therapy is effective, there are several key limitations as it is currently practiced. First, the difficulty of exercises cannot be precisely calibrated to each patient's specific level of impairment. Second, compliance with therapy cannot be easily monitored. Finally, standard exercises may not be sufficiently engaging to encourage continued practice. The objective of this project is to test the feasibility of a customized interactive vestibular game for gaze stability exercises. The game is based on a visual discrimination task that tests visual acuity during rotations of the head. The difficulty of the task can be customized and adjusted incrementally based on the patient's initial level of function and progress over time with treatment. There are two aims of this pilot study. The first aim will test the ability of the game to induce plasticity in the vestibulo-ocular reflex in healthy individuals with normal vestibular function. The approach will be based on prior studies of vestibular adaptation, in which a mismatch of vestibular (head motion) and visual (motion of the scene being viewed) inputs leads to a change in the gain of the vestibulo-ocular reflex. In the same group of subjects, the change in VOR gain provoked by an incremental increase in the degree of visual-vestibular mismatch will be compared to that induced by the more traditional approach of single-step adaptation. The hypothesis is that the game will lead to a change in vestibulo-ocular reflex gain, and that this change will be larger with the incremental strategy. The second aim will be to test the feasibility and playing experience of the vestibular game in a group of veterans with peripheral vestibular hypofunction, who are undergoing or who have recently completed standard vestibular rehabilitation therapy. Each patient will play the game and will provide feedback of their experience. We will also record the same physiological data (vestibulo-ocular reflex gain before and after playing) to assess short term motor response. The patients will play the game once a week for four sessions each; this will provide us with preliminary data regarding improvements in gaze stability over time. The data from this aim will support a future application for a multisession clinical trial of our game in comparison to conventional therapy.