Scientific and Technological Transformation in Vestibular Rehabilitation: Neurophysiology-Based, Personalized, and Integrated Approaches

Vollständiger Abstract

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Vestibular rehabilitation therapy (VRT) is undergoing a paradigm shift toward a mechanistically informed, multisensory, and technologically integrated model. This narrative review synthesises current evidence on how this transformation is driven by advances in neurophysiology, diagnostic precision, and immersive technologies such as virtual reality (VR), which collectively enhance personalization and therapeutic efficacy. Traditional approaches that primarily targeted peripheral deficits are now complemented by strategies addressing central processing dysfunctions, cognitive-emotional comorbidities, and maladaptive sensory integration, particularly in conditions like Persistent Postural-Perceptual Dizziness (PPPD) and vestibular migraine. VR-based rehabilitation enables controlled manipulation of sensory inputs and task complexity, facilitating adaptation, habituation, and substitution—key neurophysiological mechanisms underlying vestibular compensation. Objective diagnostic tools, including the Video Head Impulse Test (vHIT) and Computerized Dynamic Posturography (CDP), provide individualized assessments of vestibulo-ocular reflex (VOR) function and sensory reweighting, guiding targeted interventions. Wearable sensors and mobile platforms further extend high-fidelity VRT into home settings, enhancing accessibility and adherence through real-time monitoring and feedback. Randomized controlled trials and meta-analyses support the clinical efficacy of VR-based interventions across peripheral and central vestibular disorders, with several studies reporting outcomes comparable, and in selected populations potentially superior, to conventional methods. Importantly, the management of complex cases increasingly relies on interdisciplinary collaboration among physical therapists, audiologists, neurologists, and mental health professionals. This integrated, patient-centered approach addresses the full spectrum of sensory, motor, cognitive, and psychological dimensions of vestibular dysfunction. As VRT continues to evolve, the synergy of technological innovation and neurophysiological insight offers a robust framework for improving long-term functional outcomes and quality of life in diverse vestibular populations.