Effects of neurofeedback training with a wearable mandibular vibrotactile device on refractory dizziness and postural instability in unilateral vestibular loss

Abstract

Background Some patients with unilateral vestibular loss remain with persistent symptoms and posture and gait instability despite standard vestibular rehabilitation. This exploratory study examined the effects of neurofeedback training using a wearable mandibular vibrotactile device in patients with unilateral vestibular loss who had persistent symptoms and postural instability despite standard vestibular rehabilitation. Methods Twelve patients who did not respond to standard vestibular rehabilitation underwent neurofeedback training using a wearable mandibular vibrotactile device providing real-time body tilt information in the roll plane via mandibular vibratory stimulation for 3 months. The Dizziness Handicap Inventory (DHI), posturography, and gait analysis were assessed before and after training without wearing the device. Results After neurofeedback training, the mean DHI score significantly decreased from 61.3 to 47.2 ( p < 0.01). The total COP velocity with eyes closed significantly decreased from 3.79 to 3.08 cm/s ( p < 0.05). The mediolateral COP velocity with eyes open and eyes closed significantly decreased from 1.25 to 0.96 cm/s and from 2.09 to 1.62 cm/s, respectively ( p < 0.05). Gait stride length significantly increased from 1.11 to 1.21 m ( p < 0.05), and gait speed significantly increased from 1.04 to 1.17 m/s ( p < 0.05). The mediolateral center-of-mass path length during gait significantly decreased from 235.0 to 178.1 mm ( p < 0.05). Conclusions In this exploratory study, neurofeedback training using a wearable mandibular vibrotactile device was associated with improved dizziness and postural instability in patients with unilateral vestibular loss who had persistent symptoms despite standard vestibular rehabilitation.