Treatment-related modulation of visuo-vestibular integration in post-earthquake dizziness syndrome: a longitudinal virtual reality-based study

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dc.contributor.authorKorkmaz, Hanifi
dc.contributor.authorKaraer, Isil Cakmak
dc.contributor.authorOrman, Kubra
dc.contributor.authorTalu, Burcu
dc.contributor.authorInceoglu, Feyza
dc.date.accessioned2026-04-04T13:37:32Z
dc.date.available2026-04-04T13:37:32Z
dc.date.issued2026
dc.departmentİnönü Üniversitesi
dc.description.abstractBackgroundPost-earthquake dizziness syndrome (PEDS) is increasingly recognized as a condition marked by persistent dizziness and imbalance after major earthquakes, often without clear peripheral vestibular pathology. Despite proposed roles of visuo-vestibular dysfunction and sensory conflict, longitudinal objective evidence remains limited.ObjectiveTo examine the longitudinal effects of virtual reality-based vestibular rehabilitation (VR), cognitive behavioral therapy (CBT), and their integration (VR + CBT) on objective visuo-vestibular processing and symptom burden in adults with PEDS.MethodsIn a four-arm longitudinal study, 48 earthquake-exposed adults with PEDS were evaluated at baseline, post-intervention, and 3-month follow-up following an 8-week intervention. Objective visuo-vestibular outcomes were assessed using an immersive virtual reality-based system, including static and dynamic subjective visual vertical (SVV/DSVV), rod-and-frame test (RFT), and visual motion sensitivity (VMS) tests. Subjective outcomes included dizziness-related handicap (DHI) and post-traumatic stress symptoms (PCL-5).ResultsDizziness-related disability and trauma-related symptoms improved over time across groups, indicating clinical modifiability of PEDS. Objective measures demonstrated a domain-specific response profile: SVV and DSVV remained largely stable, whereas RFT showed improvement in active treatment arms, suggesting reduced visual frame dependence. VMS outcomes exhibited differential trajectories, with the integrated VR + CBT group showing the most consistent and durable modulation under visually provocative conditions.ConclusionsRecovery in PEDS appears to involve selective modulation of context-dependent visuo-vestibular processing rather than uniform changes across all spatial orientation measures. Integrated VR + CBT yields the most coherent and durable benefits in visually demanding domains, supporting multidisciplinary models that jointly address sensory conflict and cognitive-emotional mechanisms after major earthquakes.
dc.description.sponsorshipMalatya Turgut zal University; Trkiye Bilimsel ve Teknolojik Arascedil;timath;rma Kurumu [124S045]
dc.description.sponsorshipOpen access funding provided by the Scientific and Technological Research Council of Turkiye (TUB & Idot;TAK).
dc.identifier.doi10.1007/s00415-026-13767-4
dc.identifier.issn0340-5354
dc.identifier.issn1432-1459
dc.identifier.issue4
dc.identifier.urihttps://doi.org/10.1007/s00415-026-13767-4
dc.identifier.urihttps://hdl.handle.net/11616/109893
dc.identifier.volume273
dc.identifier.wosWOS:001721876700003
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.language.isoen
dc.publisherSpringer Heidelberg
dc.relation.ispartofJournal of Neurology
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectPost-earthquake dizziness syndrome
dc.subjectVisuo-vestibular integration
dc.subjectSensory conflict
dc.subjectVirtual reality-based assessment
dc.subjectVestibular rehabilitation
dc.subjectCognitive behavioral therapy
dc.titleTreatment-related modulation of visuo-vestibular integration in post-earthquake dizziness syndrome: a longitudinal virtual reality-based study
dc.typeArticle

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