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Vestibular telemedicine and rehabilitation. Applications for virtual reality.

This paper will discuss the use of Virtual Reality (VR) technologies in the rehabilitation of patients with vestibular disorders and in the provision of remote medical consultations for those patients. Patients with a vestibular problem are very common (vertigo is the second most common neurological complaint after headache) and yet there are very few vestibular neurotologists: specialists in their diagnosis and treatment. New treatments for various disorders causing vertigo now exist. This means that appropriate diagnosis can significantly improve patients' well-being. Remote medical diagnosis and treatment facilities could make the few vestibular disorder specialists much more available to patients. An analysis of the technological and economic factors influencing the provision of this service is necessary. The main long term effect of many vestibular disorders is damage to the sensing apparatus of the inner ear. The damage can lead to inappropriate interaction between visually driven orientation sensing and sensing of orientation by the inner ear. The consequence for the patient is vertigo (a sensation of turning), motion sickness and imbalance. Current rehabilitation efforts are intended to drive the nervous system to adapt to the disordered vestibular input. Adaptation appears to occur slowly in many subjects, even those within rehabilitation programs. An appropriately designed VR experience could greatly increase the rate of adaptation in these patients.