Virtual Reality for Vestibular Rehabilitation: A Modern Approach
- Ana Souto
- Jul 9
- 5 min read
Updated: Jul 10
Vestibular disorders—such as unilateral vestibular hypofunction (UVH), benign paroxysmal positional vertigo (BPPV), and persistent postural-perceptual dizziness (PPPD)—can seriously disrupt daily life. These conditions often cause symptoms like dizziness, vertigo, and unsteadiness, which can lead to reduced mobility, a higher risk of falls, and a noticeable decline in quality of life.
But the challenges don’t stop there. Many individuals also develop visual dependence, relying too heavily on their vision to maintain balance. This can make visually complex environments—like supermarkets or crowded streets—feel overwhelming. Others experience motion hypersensitivity, where even small movements or visual motion can trigger discomfort or dizziness. And for many, these symptoms are accompanied by a growing fear of falling, which can lead to avoidance behaviors, increased anxiety, social withdrawal, and a loss of independence. That’s why effective, engaging, and personalized rehabilitation is so important.
Why Virtual Reality Matters in Vestibular Rehabilitation
This is where Virtual Reality steps in as a game-changer. Virtual Reality brings a fresh, engaging twist to vestibular rehabilitation by offering immersive, interactive environments that can be tailored to each patient’s specific needs and tolerance levels. Therapists can adjust the complexity of tasks and the type of sensory input, making therapy not only more effective but also more motivating and enjoyable.
What makes Virtual Reality especially powerful is its ability to provide progressive exposure to visual and motion stimuli in a safe, controlled setting. This gradual stimulation helps the brain adapt more efficiently, accelerating vestibular compensation—the brain’s natural process of adjusting to inner ear dysfunction. As a result, patients often experience improvements in gaze stability, postural control, and overall functional balance.
Studies show that Virtual Reality-based therapy can:
Improve vestibulo-ocular reflex (VOR) gain
Reduce dizziness-related disability
Enhance postural stability, even in chronic cases
What Are We Trying to Achieve?
With Virtual Reality in vestibular rehabilitation, the main goals are:
1. Reduce symptoms like dizziness and vertigo
2. Improve gaze stabilization
3. Enhance postural stability and balance
How Does Virtual Reality Help?
• Adaptation: Virtual Reality helps retrain the brain to stabilize vision during head movements. Games like 'Seek and Find' and 'WHACK 'EM ALL' challenge patients to move their heads, scan environments, and even shift their weight to find objects.
• Habituation: By exposing patients to busy or complex virtual environments—like a supermarket or a crowded street—Virtual Reality helps reduce sensitivity to motion and visual stimuli.
• Substitution: Virtual Reality encourages the use of other senses like vision and proprioception to compensate for vestibular deficits. Exercises often involve coordinating eye and head movements in dynamic settings.
Real-World Applications
Libra VR, for example, includes a posturography assessment tool. This lets clinicians measure how different virtual environments affect a patient’s balance. It’s especially useful for conditions like visual dependence and PPPD.
• For UVH: Virtual Reality improves VOR gain, balance, and confidence.
• For BVH: Though research is still growing, Virtual Reality shows promise in improving dynamic visual acuity and stability.
• For PPPD: Virtual Reality helps patients gradually get used to motion and visual complexity, reducing their symptoms over time.
Therapeutic Games That Make a Difference
Libra VR includes fun and effective games like:
• Car Smash
• Coin Collector
• Maze Master
These games are designed to be both engaging and therapeutic, targeting specific rehabilitation goals such as enhancing balance control, improving gaze stability, and expanding the patient’s limits of stability.
Things to Keep in Mind
While Virtual Reality is generally safe, it’s not for everyone. It may not be suitable for:
People in an acute Ménière’s attack
Those with significant cognitive impairments
Individuals who experience persistent discomfort (cybersickness) after using Virtual Reality - Symptoms can include nausea, dizziness, and visual disturbances.
That said, most patients tolerate Virtual Reality well, especially when sessions are introduced gradually and tailored to their tolerance levels. Starting with shorter, simpler exposures and progressively increasing complexity can help minimize discomfort and build confidence.
Key Takeaways
• Virtual Reality adds variety and realism to vestibular rehab.
• It supports hybrid exercises that combine physical and cognitive challenges.
• It’s engaging, customizable, and backed by research.
• When used appropriately, it can significantly enhance rehab outcomes
Want to know how to implement this in your clinic?
Ana Souto
Meet Ana, a physiotherapist with a
master's degree in human physiology and certified by the American Institute of Balance.
Ana currently serves as the clinical specialist at PhysioSensing, a cutting-edge Balance Assessment and training device. Her approach is firmly rooted in the latest scientific findings, ensuring that PhysioSensing users receive the most effective and up-to-date care. In addition to her role in designing tailored programs, Ana plays a pivotal role in guiding new clients through the learning process of using PhysioSensing. She also provides advanced training and support to existing customers seeking to further deepen their clinical practice knowledge and stay on top of the latest scientific advancements.
References
Choi, S., et al. (2021). Effect of vestibular exercise and optokinetic stimulation using virtual reality system on chronic postural perceptual dizziness. Scientific Reports, 11, 13745. https://doi.org/10.1038/s41598-021-93214-7
Duque, G., et al. (2013). Effects of balance training using a virtual-reality system in older fallers. Clinical Interventions in Aging, 8, 257–263. https://doi.org/10.2147/CIA.S39722
Fujitani, R., Noguchi, S., & Jiroumaru, T. (2025). Single exposure to optokinetic stimulation through virtual reality decreases reliance on visual inputs for posture control. Journal of Physical Therapy Science, 37, 199–203.
Garcia, A. P., et al. (2013). Vestibular rehabilitation with virtual reality in Ménière’s disease. Brazilian Journal of Otorhinolaryngology, 79(3), 366–374. https://doi.org/10.5935/1808-8694.20130066
Hall, C. D., et al. (2022). Vestibular rehabilitation for peripheral vestibular hypofunction: An updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy, 46(2), 118–177. https://digitalcommons.wustl.edu/open_access_pubs/11826
Heffernan, A., Abdelmalek, M., & Nunez, D. A. (2021). Virtual and augmented reality in the vestibular rehabilitation of peripheral vestibular disorders. Scientific Reports, 11, 19207. https://doi.org/10.1038/s41598-021-98774-z
Holten, V., van der Smagt, M. J., Verstraten, F. A. J., & Donker, S. F. (2016). Interaction effects of visual stimulus speed and contrast on postural sway. Experimental Brain Research, 234(1), 113–124. https://doi.org/10.1007/s00221-015-4438-y
Hong, S. K. (2024). Clinical application of virtual reality for vestibular rehabilitation. Korean Journal of Otorhinolaryngology-Head and Neck Surgery, 67(1), 5–12.
Horiuchi, K., Ishihara, M., & Imanaka, K. (2017). The essential role of optical flow in the peripheral visual field for stable quiet standing: Evidence from the use of a head-mounted display. PLoS ONE, 12(10), e0184552. https://doi.org/10.1371/journal.pone.0184552
Kaliuzhna, M., et al. (2018). Optimal visuo-vestibular integration for self-motion perception in patients with unilateral vestibular loss. Neuropsychologia, 111, 145–154. https://doi.org/10.1016/j.neuropsychologia.2018.01.033
Luo, H., et al. (2018). The effect of visual stimuli on stability and complexity of postural control. Frontiers in Neurology, 9, 48. https://doi.org/10.3389/fneur.2018.00048
Mandour, A. E.-S., et al. (2022). Virtual reality versus optokinetic stimulation in visual vertigo rehabilitation. European Archives of Oto-Rhino-Laryngology, 279(3), 1121–1126. https://doi.org/10.1007/s00405-021-07091-y
Micarelli, A., et al. (2017). Three-dimensional head-mounted gaming task procedure maximizes effects of vestibular rehabilitation in unilateral vestibular hypofunction: a randomized controlled pilot trial. International Journal of Rehabilitation Research, 40(4), 325–332. https://doi.org/10.1097/MRR.0000000000000247
Obrero-Gaitán, E., et al. (2024). Optokinetic stimulation for the treatment of vestibular and balance disorders: a systematic review with meta-analysis. European Archives of Oto-Rhino-Laryngology, 281, 4473–4484. https://doi.org/10.1007/s00405-024-08604-1
Tsutsumi, T., et al. (2010). Postural stability during visual stimulation and the effect of vestibular dysfunction. Acta Oto-Laryngologica, 130(4), 464–471. https://doi.org/10.3109/00016480903365922
Älmqvist Nae, J., Nyström, A., Luccini, F., Magnusson, M., & Ekvall Hansson, E. (2024). Video exposure through virtual reality can improve older people’s ability to manage postural instability: A repeated measures experimental study. PLoS ONE, 19(7), e0306834. https://doi.org/10.1371/journal.pone.0306834
Viziano, A., et al. (2019). Long-term effects of vestibular rehabilitation and head-mounted gaming task procedure in unilateral vestibular hypofunction: a 12-month follow-up of a randomized controlled trial. Clinical Rehabilitation, 33(1), 24–33. https://doi.org/10.1177/0269215518788598
Whitney, S. L., et al. (2006). Responses to a virtual reality grocery store in persons with and without vestibular dysfunction. CyberPsychology & Behavior, 9(2), 152–156. https://doi.org/10.1089/cpb.2006.9.152
