Balance Rehabilitation by Virtual Grocery Shopping

Visit any video arcade and you'll find virtual reality games that challenge your sense of balance and equilibrium. You can race motocross, navigate a supercharged waverunner through stormy seas, or avoid near-misses with planets and alien attackers while riding futuristic spacecraft at light speed. Virtual reality describes interaction with a computer-generated simulation of reality that includes visual, physical, and sometimes tactile sensations. A new project at University of Pittsburgh Medical Center (UPMC) has harnessed virtual reality technology as a potential therapy for the balance disorders and chronic dizziness that affect millions of Americans.

With a grant from the National Institute on Deafness and Other Communication Disorders, UPMC researchers have established a Medical Virtual Reality Center featuring a virtual grocery store to study how people maintain balance and to identify new potential therapies for balance problems. Their studies are advancing the understanding of balance, including components of good balance and factors that lead to poor balance.

The Center's virtual reality grocery store tests a new model for balance rehabilitation. A custom-built treadmill and four computer-controlled projection systems simulate grocery store aisles that range from visually simple (think white paper goods) to daunting (imagine pain relievers, vitamins, and allergy remedies). A person walking on the treadmill controls his or her own speed up the aisle and turns down the next aisle by pushing on one side of a real shopping cart adapted for the facility.

The idea is that individuals with dizziness and balance problems can lessen their symptoms over several weeks by practicing for at least an hour per week at increasingly complex tasks in the virtual grocery store, explains Susan Whitney, Ph.D., associate professor of physical therapy at the University of Pittsburgh School of Health and Rehabilitation Sciences.

"What we're doing here is physical and behavioral therapy. We expose people to gradually more complex scenes," says Dr. Whitney. The aisles in the virtual store become progressively more challenging as a person successfully navigates from one to the next. In balance therapy sessions, people try to locate a product beginning with easy tasks such as finding paper towels in the paper goods aisle. They work their way towards more complex, visually challenging tasks such as finding a small, colorful spice jar amid scores of baking ingredients.

The patients' ability to control their own speed and discontinue the session if symptoms occur serves to lessen anxiety and fear, Dr. Whitney explains. Then practice at various assigned tasks in the virtual store helps improve their ability to balance and restore confidence. "They seem to get a lot less dizzy," she says.

The facility is unique in the United States, and Dr. Whitney knows of only one other virtual grocery store for balance rehabilitation in the world—at the University of Haifa in Israel.

To help assess the effectiveness of virtual reality therapy, Dr. Whitney is currently conducting a clinical trial with people who experience dizziness and balance problems. If clinical trials show promising results, Dr. Whitney says, the next step would be to work on developing a plug-and-play version of the virtual reality grocery store for practical use in a physical therapy clinic or at home. Dr. Whitney envisions a head-mounted visor system, similar to commercial gaming systems, to recreate the virtual grocery store experience. Although results of the clinical trial are not in, researchers are optimistic. "It appears that people who are bothered by motion get better," says Dr. Whitney.

AudiologyOnline would like to thank Linda Joy from NIDCD for the original source material for this article.