Visual vertigo is characterized by unsettling dizziness and disequilibrium in situations and environments with high levels of visual stimulation. People with visual vertigo tend to become symptomatic when shopping in grocery stores, driving or riding in a car, walking down a busy sidewalk, or walking over a busy carpet or tile floor.
Visual vertigo can become debilitating when it leads to avoidance of triggering environments and can be associated with anxiety and depression. One of the treatments for visual vertigo is habituation of symptoms through progressive exposure training. With progressive exposure, a treatment plan is devised to slowly and systematically spend increasing amounts of time in progressively more triggering environments, usually using a symptom ceiling to guide time spent and at what level of exposure. A symptom ceiling is a previously decided upon rating of symptoms from 0-10 that indicate when continued exposure to the environment may only serve to make an individual more symptomatic and may no longer be therapeutic. Habituation and progressive exposure treatments can be beneficial in reducing symptoms and improving quality of life, but they can also be challenging to schedule and too overwhelming in the early stages of treatment. This is where virtual reality (VR) can come in handy!
VR is a term used to describe the computer-generated simulation of a three-dimensional image or environment that can be interacted with in a seemingly real or physical way. In the treatment of visual vertigo, VR can be used in the clinic to mimic visually stimulating environments. Using VR goggles and apps like VR Tube, Roller Coaster Simulator, and InMind VR, among countless other options, patients can experience visually stimulating, 360 degree environments safely and comfortably in the clinic. When the simulation becomes too provoking, the goggles are simply removed to allow symptoms to return to baseline. Overtime, patients are able to tolerate longer amounts of time in the VR simulation with fewer and shorter rest breaks needed. Other progressions to this treatment include moving from sitting, to standing, to standing or marching in place on a compliant surface like a foam pad, to walking while in the VR simulation. Once a patient is able to tolerate the VR simulation of their specific triggering environment with minimal increase in symptoms, they usually find it much easier to tolerate that environment in real life and their visual vertigo becomes more manageable.
VR is just one of the many treatments used at Mainstay PT to help resolve dizziness, but it may be the treatment that is the most fun!