An Oculus platform to measure sensory integration for postural control in patients with vestibular dysfunction

Background: We developed a low cost virtual reality [VR] platform using recent substantial advancements in the VR field (namely, Oculus Rift and Vive HTC headsets). Our novel platform comprehensively targets sensory integration for postural control in a manner that is salient and specific to the individual while being affordable, portable and clinically applicable. We aimed to establish the feasibility and test-retest reliability of our platform in adult patients with Vestibular dysfunction. Methods: Seventeen patients with a clinical diagnosis of peripheral vestibular dysfunction completed two testing sessions with our platform, one to four weeks apart. Their postural sway was recorded by a forceplate as they were standing upright on a firm or compliant surface while observing various scenes including three moving spheres scenes and one busy street (`City') scene. In another scene (`Park'), they tried to avoid a virtual ball approaching their head. We calculated Center-of-Pressure displacement, velocity and excursion per scene in the anterior-posterior and medio-lateral directions. We compared these between sessions using Intraclass Correlations (ICCs). Results: Displacement and velocity had good reliability (>0.5, P<;0.001) on all scenes in at least one direction and one surface conditions. ICCs for excursion were poor except for in the medio-lateral direction on the Park scene (ICC between 0.5 to 0.74, P<;0.001). Side effects were minimal and occasionally moderate to severe, but transient. Patients swayed significantly more than healthy young adults (P<;0.001) in both directions and on both surfaces. Conclusion: We designed a novel virtual reality platform via Unity for Oculus Rift to assess sensory integration and visuomotor processing for postural control. With carefully developed abstract and functional scenes, we are tapping into domains that were not accessible in the clinic before and are particularly salient for patients with vestibular dysfunction or other sensory deficits and associated balance problems. We established the feasibility, test-retest reliability and preliminary validity of our platform. We continue to develop our platform into a clinical assessment.