European Archives of Oto-Rhino-Laryngology

, Volume 266, Issue 8, pp 1199–1203 | Cite as

Vestibular rehabilitation with electrotactile vestibular substitution: early effects



We aimed to determine the early efficacy of vestibular rehabilitation with electrotactile vestibular substitution system (EVSS) as a new treatment modality in patients with bilateral vestibular loss due to aminoglycoside-induced ototoxicity. Six men and four women with bilateral vestibular failure were rehabilitated with EVSS prospectively. Patients were trained with EVSS for ten sessions each lasted 20 min, two sessions per day. Sensory organization test (SOT) protocol and dizziness handicap inventory (DHI) were used to compare pre- and post-training results of the rehabilitative treatment. Post-training tests were done at the first day of post-treatment period. All ten patients in the standardized testing subset demonstrated improved scores in the composite SOT scores and in the functional transfer testing with DHI after 5 days of training with the EVSS. In conclusion, these preliminary results demonstrate efficacy of the EVSS in improving patients symptoms and signs and signify the evidence of sensory substitution in the early post-training period.


Vestibular rehabilitation Balance Electrotactile substitution Brain–machine interface Ototoxicity 



The authors thanks Omer Utku Erzengin, PhD, Department of Biostatistics, Tubitak MAM, for his support and statistical analysis, and Ayer Kucukmetin AS, for her support in collecting data and the help in the training sessions.

Conflict of interest

There was no financial support for this study.


  1. 1.
    Gillespie MB, Minor LB (1999) Prognosis in bilateral vestibular hypofunction. Laryngoscope 109(1):35–41. doi:10.1097/00005537-199901000-00008 CrossRefPubMedGoogle Scholar
  2. 2.
    Rinne T, Bronstein AM, Rudge P, Gresty MA, Luxon LM (1995) Bilateral loss of vestibular function. Acta Otolaryngol Suppl 520(Pt 2):247–250. doi:10.3109/00016489509125239 CrossRefPubMedGoogle Scholar
  3. 3.
    Lee H, Yi HA, Lee SR, Ahn BH, Park BR (2005) Drop attacks in elderly patients secondary to otologic causes with Meniere’s syndrome or non-Meniere peripheral vestibulopathy. J Neurol Sci 232:71–76. doi:10.1016/j.jns.2005.01.012 CrossRefPubMedGoogle Scholar
  4. 4.
    Brown KE, Whitney SL, Wrisley DM, Furman JM (2001) Physical therapy outcomes for persons with bilateral vestibular loss. Laryngoscope 111(10):1812–1817. doi:10.1097/00005537-200110000-00027 CrossRefPubMedGoogle Scholar
  5. 5.
    Telian SA, Shepard NT, Smith-Wheelock M, Hoberg M (1991) Bilateral vestibular paresis: diagnosis and treatment. Otolaryngol Head Neck Surg 104(1):67–71PubMedGoogle Scholar
  6. 6.
    Whitney SL, Marchetti GF, Schade AI (2006) The relationship between falls history and computerized dynamic posturography in persons with balance and vestibular disorders. Arch Phys Med Rehabil 87(3):402–407. doi:10.1016/j.apmr.2005.11.002 CrossRefPubMedGoogle Scholar
  7. 7.
    Bach-y-Rita P, Danilov YP, Tyler ME, Grimm RJ (2005) Late human brain plasticity: vestibular substitution with a tongue Brain Port human–machine interface. J Intellectica 40:115–122Google Scholar
  8. 8.
    Jacobson GP, Newman CW (1990) The development of the Dizziness Handicap Inventory. Arch Otolaryngol Head Neck Surg 116:424–427PubMedGoogle Scholar
  9. 9.
    Whitney SL, Wrisley DM, Brown KE, Furman JM (2004) Is perception of handicap related to functional performance in persons with vestibular dysfunction? Otol Neurotol 25(2):139–143. doi:10.1097/00129492-200403000-00010 CrossRefPubMedGoogle Scholar
  10. 10.
    Danilov Y, Tyler M (2005) Brainport: an alternative input to the brain. J Integr Neurosci 4(4):537–550. doi:10.1142/S0219635205000914 CrossRefPubMedGoogle Scholar
  11. 11.
    Bach-Y-Rita P (2005) Emerging concepts of brain function. J Integr Neurosci 4(2):183–205. doi:10.1142/S0219635205000768 CrossRefPubMedGoogle Scholar
  12. 12.
    Bach-y-Rita P, W Kercel S (2003) Sensory substitution and the human–machine interface. Trends Cogn Sci 7(12):541–546. doi:10.1016/j.tics.2003.10.013 Google Scholar
  13. 13.
    Cowand JL, Wrisley DM, Walker M, Strasnick B, Jacobson JT (1998) Efficacy of vestibular rehabilitation. Otolaryngol Head Neck Surg 118(1):49–54. doi:10.1016/S0194-5998(98)70374-2 CrossRefPubMedGoogle Scholar
  14. 14.
    Uneri A, Polat P (2008) Vertigo, dizziness and imbalance in the elderly. J Laryngol Otol 122(5):466–469. doi:10.1017/S0022215107000424 CrossRefPubMedGoogle Scholar
  15. 15.
    Sampaio E, Maris S, Bach-y-Rita P (2001) Brain plasticity: ‘visual’ acuity of blind persons via the tongue. Brain Res 908(2):204–207. doi:10.1016/S0006-8993(01)02667-1 CrossRefPubMedGoogle Scholar
  16. 16.
    Wall PD (1980) Mechanisms of plasticity of connection following damage in adult mammalian nervous systems. In: Bach-y-Rita P (ed) Recovery of function: theoretical considerations for brain injury rehabilitation. Hans Huber, Bern, pp 91–105Google Scholar
  17. 17.
    Ptito M, Moesgaard SM, Gjedde A et al (2005) Crosss-modal plasticity revealed by electrotactile stimulation of the tongue in the congenitally blind. Brain 128:606–614. doi:10.1093/brain/awh380 CrossRefPubMedGoogle Scholar
  18. 18.
    Tyler M, Danilov Y, Bach-y-Rita P (2003) Closing an open-loop control system: vestibular substitution through the tongue. J Integr Neurosci 2(2):159–164. doi:10.1142/S0219635203000263 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Balance CenterAcıbadem Oncology and Neurology HospitalIstanbulTurkey
  2. 2.Acıbadem Hastanesi KozyatağıIstanbulTurkey

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