Short-Term Learning of the Vestibulo-Ocular Reflex Induced by a Custom Interactive Computer Game.

Retinal image slip during head rotation during head rotation drives motor learning in the rotational vestibulo-ocular reflex (rVOR) and forms the basis of gaze-stability exercises that treat vestibular dysfunction. Clinical exercises, however, are unengaging, cannot easily be titrated to the level of impairment, and provide neither direct feedback nor tracking of the patient's adherence, performance, and progress. To address this, we have developed a custom application for rVOR training based on an interactive computer game. In this study, we tested the ability of this game to induce rVOR learning in individuals with normal vestibular function, and we compared the efficacy of single-step and incremental learning protocols. Eighteen participants played the game twice on different days. All participants tolerated the game and were able to complete both sessions. The game scenario incorporated a series of brief head rotations, similar to active head impulses, that were paired with a dynamic acuity task and with a visual-vestibular mismatch (VVM) intended to increase rVOR gain (single-step: 300 successful trials at 1.5x viewing; incremental: 100 trials each of 1.13x, 1.33x, and 1.5x viewing). Overall, rVOR gain increased by 15 ± 4.7 % (mean ± 95% C.I., p < 0.001). Gains increased similarly for active and passive head rotations, and, contrary to our hypothesis, there was little effect of learning strategy. This study shows that an interactive computer game provides robust rVOR training and has the potential to deliver effective, engaging, and trackable gaze-stability exercises to patients with a range of vestibular dysfunction.