<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT04420949</url>
  </required_header>
  <id_info>
    <org_study_id>2020-0632</org_study_id>
    <secondary_id>A176000</secondary_id>
    <secondary_id>EDUC/KINESIOLOGY</secondary_id>
    <secondary_id>Protocol Version 5/1/2020</secondary_id>
    <secondary_id>1UL1TR002373-01</secondary_id>
    <nct_id>NCT04420949</nct_id>
  </id_info>
  <brief_title>Sensory Training for Visual Motion Sickness</brief_title>
  <official_title>High-precision Immersive Robotic Environment for Sensorimotor Training</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>University of Wisconsin, Madison</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Center for Advancing Translational Sciences (NCATS)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>University of Wisconsin, Madison</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      This is a preliminary study to determine the reliability and validity of new tests of&#xD;
      orientation and balance, as well as to test the effects of a new treatment for visually&#xD;
      induced dizziness. Tests involve determining vertical alignment. The treatment is task-based&#xD;
      and involves focusing attention on internal body sensations to help improve the sense of&#xD;
      upright. Testing is done twice before and twice after treatment, which is provided&#xD;
      twice-weekly during a three-week period between testing. The total time participants are&#xD;
      involved in the study is approximately six weeks.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Falls are a major concern for people living in countries all over the world. Tens of millions&#xD;
      of people who fall are seriously injured and hundreds of thousands of people who fall die&#xD;
      every year. People who are dizzy are far more likely to fall. The investigators are&#xD;
      particularly interested in working with people who have dizziness that is caused by watching&#xD;
      motion or looking at complex patterns (e.g. checkerboard patterns, walking through grocery&#xD;
      store aisles, riding in vehicles, or watching movies).&#xD;
&#xD;
      This type of dizziness or vertigo is typically described as motion sickness or, more&#xD;
      specifically, visually-induced dizziness. This problem affects adults who are healthy and&#xD;
      adults who have a variety of health conditions. No diagnostic tests for this condition exist&#xD;
      at this time and the treatments currently being used may result in worsening dizziness for&#xD;
      some patients.&#xD;
&#xD;
      New tests were created for orientation and balance, as well as a new treatment for&#xD;
      visually-induced dizziness. This is a preliminary study of the reliability and validity of&#xD;
      the tests we developed, as well as whether the new treatment created results in reduced&#xD;
      dizziness, improved balance, and changes in daily functioning.&#xD;
&#xD;
      It is not known whether the new tests of orientation and balance are better, worse, or the&#xD;
      same as existing tests in the ability to detect problems, nor is it known if the new&#xD;
      treatment technique is any better, worse, or the same as existing treatments for dizziness&#xD;
      and imbalance. It is hypothesized that the new tests will be accurate and able to detect&#xD;
      problems in impaired adults. Additionally, that the treatment will result in less dizziness,&#xD;
      better balance, and reduced risk of falling.&#xD;
&#xD;
      The plan is to enroll a total of 30 people in this study, 15 who are healthy and 15 who have&#xD;
      visually-induced dizziness due to a vestibular (inner ear) problem. Each participant will&#xD;
      complete several questionnaires and tests of balance performance before and after undergoing&#xD;
      the treatment. Participants attend 8 visits over 6 weeks. Each study visit lasts&#xD;
      approximately 60 minutes.&#xD;
&#xD;
      During visits 1 and 2, which is a double baseline phase, the reliability and validity of the&#xD;
      new testing procedures will be assessed. All participants will then enter the treatment phase&#xD;
      (visits 2 through 7) and will attend twice-weekly appointments for three consecutive weeks.&#xD;
      Following the treatment phase, participants will be re-assessed twice, immediately after&#xD;
      (visit 7) and one week after (visit 8) completing treatment. During this phase, the&#xD;
      short-term effectiveness of the treatment will be assessed.&#xD;
&#xD;
      Participants will complete questionnaires that measure the intensity of visually-induced&#xD;
      dizziness, perceived handicap due to dizziness, and the impact of dizziness on daily&#xD;
      functioning. Performance measures include the ability to determine what is upright based on&#xD;
      the internal sense of gravity (verticality), standing upright, and walking-related balance&#xD;
      tasks. The verticality tests are performed while the participant is secured in a harness and&#xD;
      are either standing upright or tilted to the left or to the right. The testing task is to&#xD;
      determine upright based on using internal body sensations. The standing balance test is&#xD;
      performed on a platform that measures balance. The verticality tests and the standing balance&#xD;
      test are experimental.&#xD;
&#xD;
      The treatment is task-based and is performed while the participant is supported in a harness&#xD;
      and wearing virtual reality goggles. During the treatment, participants are either standing&#xD;
      upright or tilted to the left or to the right. The treatment involves focusing attention on&#xD;
      internal body sensations to help determine whether an image that is presented in an otherwise&#xD;
      black virtual environment is aligned with gravity. Other visual and sound cues will be&#xD;
      eliminated to prevent the use of these cues from influencing decisions about what is upright.&#xD;
      As the participant becomes more successful at determining what is upright, the difficulty of&#xD;
      the treatment task is gradually increased.&#xD;
&#xD;
      Participants symptoms will be monitored throughout the testing and treatment. Participants&#xD;
      are given regular rest breaks and may request to rest at any time. Participation is voluntary&#xD;
      and may be discontinued at any time.&#xD;
&#xD;
      The investigators anticipate only mild and infrequent side effects related to testing and&#xD;
      treatment. The results of this study may influence how orientation and balance are assessed&#xD;
      and how visually-induced dizziness is treated.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date type="Actual">March 19, 2021</start_date>
  <completion_date type="Actual">June 30, 2021</completion_date>
  <primary_completion_date type="Actual">June 30, 2021</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Non-Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <intervention_model_description>The study will be conducted in three phases. The first phase is for baseline testing. The second phase is when treatment occurs. The third phase is for follow up testing. Participants will be tested twice during the baseline and follow up phases. Six treatment sessions will occur during the treatment phase.</intervention_model_description>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
    <masking_description>It is not possible to mask this behavioral intervention. The study team small; thus, masking of the study team is also not possible.</masking_description>
  </study_design_info>
  <primary_outcome>
    <measure>Rod and Disk Test (RDT) Mean Performance</measure>
    <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
    <description>An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Multisensory Balance Evaluation (MBE) as Measured by the Intersection Point Height</measure>
    <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
    <description>This test is designed to assess balance during quiet standing in different sensory conditions. Participants perform one trial (lasting 30 seconds) of each condition. All trials are performed while standing on a force plate with the feet in a self-selected, comfortable position. The visual environment is controlled using an Oculus Rift. The surface conditions are either non-compliant or compliant. The frequency-dependent height of the Intersection Point (IP) of the ground reaction force is the main metric. The overall height of the IP curve obtained while the participant stands on a firm surface with their eyes open is the primary outcome. The height of IP ranges from 0 to 4.0, and higher values represent greater stability.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Subjective Visual Vertical (SVV) Mean Performance</measure>
    <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
    <description>An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Rod and Frame Test (RFT) Mean Performance</measure>
    <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
    <description>An image of a rod will be projected inside a tilted frame within the central portion of the visual field. The surrounding virtual environment will be void. The frame will be tilted by +/- 20° in the frontal plane. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, mean performance in this population is 6.51 (sd 7.8). Higher values indicate greater deviations of perceived vertical from earth vertical.</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Vision-related Dizziness Questionnaire (VRDQ) Total Score</measure>
    <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
    <description>The VRDQ is used to quantify vision-related dizziness. This outcome measure consists of 25 questions comprising two subscales [frequency and severity of symptoms]. The range of scores for each sub-scale is 0 to 100 points. The total score is the average of both sub-scales. Higher scores represent greater frequency and severity of symptoms. Test-retest reliability for the VRDQ is well above the good performance level and convergent validity for the VRDQ was demonstrated with the Dizziness Handicap Inventory (DHI). Spearman correlation coefficients are 0.75 between the DHI and VRDQ frequency scale and 0.76 between the DHI and VRDQ severity scale.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Dizziness Handicap Inventory (DHI) Total Score</measure>
    <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
    <description>The DHI is used to assess the severity of self-perceived disability secondary to dizziness. The tool is comprised of 25 questions which are score as yes = 4 points, sometimes = 2 points, and no = 0 points. The total score has a range of 0 to 100 points. The reliability and validity of the DHI have been established.</description>
  </secondary_outcome>
  <other_outcome>
    <measure>Activities-specific Balance Confidence Scale (ABCS) Average Score</measure>
    <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
    <description>The ABCS is a measure of balance-related confidence. The scale is made up of 16 questions for which respondents rate their level of perceived confidence in not becoming unsteady or falling. The average score ranges from 0 to 100 percent. Higher scores indicate greater balance-related confidence. The reliability and validity of the ABCS has been established in adults with and without a history of falling.</description>
  </other_outcome>
  <other_outcome>
    <measure>Vestibular Activities and Participation Measure (VAPM) Average Score</measure>
    <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
    <description>The VAPM is a 34-item questionnaire that is used to assess the impact of vestibular dysfunction on daily activities and participation in various life roles. The psychometrics for this tool have been established for adults with vestibular disorders. The average score ranges from 0 to 4. Higher scores indicate greater impact of vestibular symptoms on daily activities and participation in various life roles.</description>
  </other_outcome>
  <other_outcome>
    <measure>Vestibular Rehabilitation Benefits Questionnaire (VRBQ) Total Score at the End of the Trial</measure>
    <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
    <description>The VRBQ was developed to assess outcomes from vestibular rehabilitation. The 22 questions are based on a literature review, participant interviews, and items from other measures. These questions are divided into three sub-scales: dizziness and anxiety (6), motion provoked dizziness (5), and quality of life (11). The total score ranges from 0-100 percent and scores &gt; 0 percent indicate the presence of symptoms, functional loss, or decreased quality of life. See http://www.isvr.soton.ac.uk/audiology/vrbq.htm for more information regarding the scoring methodology. It has been validated against other measures. The VRBQ is designed to measure the difference between the participant's current state of symptoms and quality of life compared to a state that is normal for the individual.</description>
  </other_outcome>
  <other_outcome>
    <measure>Functional Gait Assessment (FGA) Total Score</measure>
    <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
    <description>The FGA is a 10-item, observational, test of walking. Score for each item range from 0 to 3 and, thus, the total score ranges from 0 to 30. Use of an assistive device is permitted. Higher scores indicate greater stability during walking. The psychometrics of the FGA have been established for adults with balance disorders.</description>
  </other_outcome>
  <other_outcome>
    <measure>Walking Speed</measure>
    <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
    <description>Gait speed has been shown to be a reliable and valid measure of functional balance in adults. Gait speed will be recorded during a 10-meter walk test. Participants will walk for 2-meters before entering and after exiting the 6-meter long recording section. A stopwatch will be used for timing.</description>
  </other_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">10</enrollment>
  <condition>Dizziness</condition>
  <condition>Vertigo</condition>
  <condition>Motion Sickness</condition>
  <arm_group>
    <arm_group_label>Healthy</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Vestibular-impaired</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.</description>
  </arm_group>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Sensory re-weighting</intervention_name>
    <description>During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
    <arm_group_label>Healthy</arm_group_label>
    <arm_group_label>Vestibular-impaired</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Healthy Participants:&#xD;
&#xD;
        Inclusion Criteria: Participants must&#xD;
&#xD;
          -  have normal self-reported cognitive function&#xD;
&#xD;
          -  speak English fluently&#xD;
&#xD;
          -  weigh less than 225 pounds and be less than 6'4&quot;&#xD;
&#xD;
          -  be able to support their body weight in an upright posture for 15 minutes at a time&#xD;
&#xD;
          -  be able to follow the guidelines regarding permitted and prohibited additional&#xD;
             treatments outlined in this protocol&#xD;
&#xD;
        Exclusion Criteria: Participants must not&#xD;
&#xD;
          -  be pregnant or planning to become pregnant while in &quot;on study&quot; status&#xD;
&#xD;
          -  have best-corrected visual acuity &gt; 20/70&#xD;
&#xD;
          -  have a self-reported, uncompensated, binocular vision abnormality, such as strabismus,&#xD;
             amblyopia, or diplopia&#xD;
&#xD;
          -  have peripheral neuropathy&#xD;
&#xD;
          -  have a self-reported history of frequent syncope (&gt;1/month)&#xD;
&#xD;
        Participants with Visually-induced Dizziness:&#xD;
&#xD;
        Inclusion Criteria: Participants must&#xD;
&#xD;
          -  have self-reported symptoms of visually-induced dizziness&#xD;
&#xD;
          -  have normal self-reported cognitive function&#xD;
&#xD;
          -  speak English fluently&#xD;
&#xD;
          -  weigh less than 225 pounds and be less than 6'4&quot;&#xD;
&#xD;
          -  be able to support their body weight in an upright posture for 15 minutes at a time&#xD;
&#xD;
          -  be able to follow the guidelines regarding permitted and prohibited additional&#xD;
             treatments outlined in this protocol&#xD;
&#xD;
        Exclusion Criteria: Participants must not&#xD;
&#xD;
          -  be participating in vestibular and balance rehabilitation therapy and/or be pregnant&#xD;
             or planning to become pregnant while in &quot;on study&quot; status&#xD;
&#xD;
          -  have best-corrected visual acuity &gt; 20/70&#xD;
&#xD;
          -  have a self-reported, uncompensated, binocular vision abnormality, such as strabismus,&#xD;
             amblyopia, or diplopia&#xD;
&#xD;
          -  have peripheral neuropathy, and/or 5) have a self-reported history of frequent syncope&#xD;
             (&gt;1/month)&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>79 Years</maximum_age>
    <healthy_volunteers>Accepts Healthy Volunteers</healthy_volunteers>
  </eligibility>
  <location>
    <facility>
      <name>University of Wisconsin-Madison</name>
      <address>
        <city>Madison</city>
        <state>Wisconsin</state>
        <zip>53705</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <verification_date>May 2023</verification_date>
  <study_first_submitted>May 15, 2020</study_first_submitted>
  <study_first_submitted_qc>June 4, 2020</study_first_submitted_qc>
  <study_first_posted type="Actual">June 9, 2020</study_first_posted>
  <results_first_submitted>June 29, 2022</results_first_submitted>
  <results_first_submitted_qc>December 28, 2022</results_first_submitted_qc>
  <results_first_posted type="Actual">January 25, 2023</results_first_posted>
  <last_update_submitted>May 17, 2023</last_update_submitted>
  <last_update_submitted_qc>May 17, 2023</last_update_submitted_qc>
  <last_update_posted type="Actual">June 15, 2023</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>verticality</keyword>
  <keyword>postural balance</keyword>
  <keyword>visual dependence</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Vertigo</mesh_term>
    <mesh_term>Dizziness</mesh_term>
    <mesh_term>Motion Sickness</mesh_term>
  </condition_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
    <ipd_description>There is not plan to share individual participant data.</ipd_description>
  </patient_data>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol and Statistical Analysis Plan</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>No</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>July 30, 2021</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/49/NCT04420949/Prot_SAP_001.pdf</document_url>
    </provided_document>
    <provided_document>
      <document_type>Informed Consent Form</document_type>
      <document_has_protocol>No</document_has_protocol>
      <document_has_icf>Yes</document_has_icf>
      <document_has_sap>No</document_has_sap>
      <document_date>January 12, 2021</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/49/NCT04420949/ICF_000.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <group_list>
        <group group_id="P1">
          <title>Healthy</title>
          <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
        </group>
        <group group_id="P2">
          <title>Vestibular-impaired</title>
          <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Overall Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="5"/>
                <participants group_id="P2" count="5"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="5"/>
                <participants group_id="P2" count="5"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="0"/>
                <participants group_id="P2" count="0"/>
              </participants_list>
            </milestone>
          </milestone_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>Healthy</title>
          <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
        </group>
        <group group_id="B2">
          <title>Vestibular-impaired</title>
          <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
        </group>
        <group group_id="B3">
          <title>Total</title>
          <description>Total of all reporting groups</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="5"/>
            <count group_id="B2" value="5"/>
            <count group_id="B3" value="10"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="41.02" spread="16.14"/>
                    <measurement group_id="B2" value="43.12" spread="16.78"/>
                    <measurement group_id="B3" value="42.07" spread="15.56"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="5"/>
                    <measurement group_id="B2" value="5"/>
                    <measurement group_id="B3" value="10"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Ethnicity (NIH/OMB)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Hispanic or Latino</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Not Hispanic or Latino</title>
                  <measurement_list>
                    <measurement group_id="B1" value="5"/>
                    <measurement group_id="B2" value="5"/>
                    <measurement group_id="B3" value="10"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Unknown or Not Reported</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race (NIH/OMB)</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>American Indian or Alaska Native</title>
                  <measurement_list>
                    <measurement group_id="B1" value="1"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="1"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Asian</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Native Hawaiian or Other Pacific Islander</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Black or African American</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>White</title>
                  <measurement_list>
                    <measurement group_id="B1" value="4"/>
                    <measurement group_id="B2" value="5"/>
                    <measurement group_id="B3" value="9"/>
                  </measurement_list>
                </category>
                <category>
                  <title>More than one race</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Unknown or Not Reported</title>
                  <measurement_list>
                    <measurement group_id="B1" value="0"/>
                    <measurement group_id="B2" value="0"/>
                    <measurement group_id="B3" value="0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Region of Enrollment</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>United States</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="5"/>
                    <measurement group_id="B2" value="5"/>
                    <measurement group_id="B3" value="10"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Visual Vertigo Analog Scale (VVAS)</title>
          <description>The VVAS is a measure of the intensity of visual vertigo symptoms. The measure consists of a series of nine visual analog scales. Each scale ranges from 0 to 10. We report the total score, which is multiplied by 100. The range is from 0 to 900, and higher scores indicate greater severity of visual vertigo.</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="0" spread="0"/>
                    <measurement group_id="B2" value="163.4" spread="150.8"/>
                    <measurement group_id="B3" value="81.7" spread="132"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Rod and Disk Test (RDT) Mean Performance</title>
        <description>An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.</description>
        <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Rod and Disk Test (RDT) Mean Performance</title>
          <description>An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.</description>
          <units>degrees</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="17" spread="7.5"/>
                    <measurement group_id="O2" value="13.3" spread="4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 2</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7.8" spread="8.8"/>
                    <measurement group_id="O2" value="12.1" spread="6.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 7</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="12.4" spread="6.7"/>
                    <measurement group_id="O2" value="10.3" spread="4.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="12.6" spread="5.3"/>
                    <measurement group_id="O2" value="10.3" spread="7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Multisensory Balance Evaluation (MBE) as Measured by the Intersection Point Height</title>
        <description>This test is designed to assess balance during quiet standing in different sensory conditions. Participants perform one trial (lasting 30 seconds) of each condition. All trials are performed while standing on a force plate with the feet in a self-selected, comfortable position. The visual environment is controlled using an Oculus Rift. The surface conditions are either non-compliant or compliant. The frequency-dependent height of the Intersection Point (IP) of the ground reaction force is the main metric. The overall height of the IP curve obtained while the participant stands on a firm surface with their eyes open is the primary outcome. The height of IP ranges from 0 to 4.0, and higher values represent greater stability.</description>
        <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Multisensory Balance Evaluation (MBE) as Measured by the Intersection Point Height</title>
          <description>This test is designed to assess balance during quiet standing in different sensory conditions. Participants perform one trial (lasting 30 seconds) of each condition. All trials are performed while standing on a force plate with the feet in a self-selected, comfortable position. The visual environment is controlled using an Oculus Rift. The surface conditions are either non-compliant or compliant. The frequency-dependent height of the Intersection Point (IP) of the ground reaction force is the main metric. The overall height of the IP curve obtained while the participant stands on a firm surface with their eyes open is the primary outcome. The height of IP ranges from 0 to 4.0, and higher values represent greater stability.</description>
          <units>meters</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.5" spread="0.23"/>
                    <measurement group_id="O2" value="0.53" spread="0.17"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 2</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.42" spread="0.18"/>
                    <measurement group_id="O2" value="0.52" spread="0.15"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 7</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.37" spread="0.17"/>
                    <measurement group_id="O2" value="0.39" spread="0.08"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.46" spread="0.15"/>
                    <measurement group_id="O2" value="0.37" spread="0.11"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Subjective Visual Vertical (SVV) Mean Performance</title>
        <description>An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.</description>
        <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Subjective Visual Vertical (SVV) Mean Performance</title>
          <description>An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.</description>
          <units>degrees</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="-1.34" spread="1.65"/>
                    <measurement group_id="O2" value="-1.3" spread="3.76"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 2</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="-1.14" spread="1.36"/>
                    <measurement group_id="O2" value="-1.4" spread="1.86"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 7</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="-.21" spread="0.5"/>
                    <measurement group_id="O2" value="-1.96" spread="1.17"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.0" spread="1.85"/>
                    <measurement group_id="O2" value="-2.22" spread="2.08"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Rod and Frame Test (RFT) Mean Performance</title>
        <description>An image of a rod will be projected inside a tilted frame within the central portion of the visual field. The surrounding virtual environment will be void. The frame will be tilted by +/- 20° in the frontal plane. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, mean performance in this population is 6.51 (sd 7.8). Higher values indicate greater deviations of perceived vertical from earth vertical.</description>
        <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Rod and Frame Test (RFT) Mean Performance</title>
          <description>An image of a rod will be projected inside a tilted frame within the central portion of the visual field. The surrounding virtual environment will be void. The frame will be tilted by +/- 20° in the frontal plane. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, mean performance in this population is 6.51 (sd 7.8). Higher values indicate greater deviations of perceived vertical from earth vertical.</description>
          <units>degrees</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.9" spread="4.9"/>
                    <measurement group_id="O2" value="7.9" spread="2.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 2</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.7" spread="4.3"/>
                    <measurement group_id="O2" value="7.2" spread="3.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 7</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.6" spread="1.7"/>
                    <measurement group_id="O2" value="8.2" spread="6.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="7.6" spread="1.9"/>
                    <measurement group_id="O2" value="5.9" spread="3.45"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Vision-related Dizziness Questionnaire (VRDQ) Total Score</title>
        <description>The VRDQ is used to quantify vision-related dizziness. This outcome measure consists of 25 questions comprising two subscales [frequency and severity of symptoms]. The range of scores for each sub-scale is 0 to 100 points. The total score is the average of both sub-scales. Higher scores represent greater frequency and severity of symptoms. Test-retest reliability for the VRDQ is well above the good performance level and convergent validity for the VRDQ was demonstrated with the Dizziness Handicap Inventory (DHI). Spearman correlation coefficients are 0.75 between the DHI and VRDQ frequency scale and 0.76 between the DHI and VRDQ severity scale.</description>
        <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Vision-related Dizziness Questionnaire (VRDQ) Total Score</title>
          <description>The VRDQ is used to quantify vision-related dizziness. This outcome measure consists of 25 questions comprising two subscales [frequency and severity of symptoms]. The range of scores for each sub-scale is 0 to 100 points. The total score is the average of both sub-scales. Higher scores represent greater frequency and severity of symptoms. Test-retest reliability for the VRDQ is well above the good performance level and convergent validity for the VRDQ was demonstrated with the Dizziness Handicap Inventory (DHI). Spearman correlation coefficients are 0.75 between the DHI and VRDQ frequency scale and 0.76 between the DHI and VRDQ severity scale.</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0" spread="0"/>
                    <measurement group_id="O2" value="90.8" spread="90"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 2</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0" spread="0"/>
                    <measurement group_id="O2" value="86" spread="80"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 7</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0" spread="0"/>
                    <measurement group_id="O2" value="74" spread="103"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0" spread="0"/>
                    <measurement group_id="O2" value="76" spread="76"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Dizziness Handicap Inventory (DHI) Total Score</title>
        <description>The DHI is used to assess the severity of self-perceived disability secondary to dizziness. The tool is comprised of 25 questions which are score as yes = 4 points, sometimes = 2 points, and no = 0 points. The total score has a range of 0 to 100 points. The reliability and validity of the DHI have been established.</description>
        <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Dizziness Handicap Inventory (DHI) Total Score</title>
          <description>The DHI is used to assess the severity of self-perceived disability secondary to dizziness. The tool is comprised of 25 questions which are score as yes = 4 points, sometimes = 2 points, and no = 0 points. The total score has a range of 0 to 100 points. The reliability and validity of the DHI have been established.</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.4" spread="0.9"/>
                    <measurement group_id="O2" value="19.2" spread="22"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 2</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.4" spread="0.9"/>
                    <measurement group_id="O2" value="24.4" spread="22.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 7</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1" spread="2"/>
                    <measurement group_id="O2" value="23" spread="27"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.8" spread="1.1"/>
                    <measurement group_id="O2" value="18.4" spread="24.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Other Pre-specified</type>
        <title>Activities-specific Balance Confidence Scale (ABCS) Average Score</title>
        <description>The ABCS is a measure of balance-related confidence. The scale is made up of 16 questions for which respondents rate their level of perceived confidence in not becoming unsteady or falling. The average score ranges from 0 to 100 percent. Higher scores indicate greater balance-related confidence. The reliability and validity of the ABCS has been established in adults with and without a history of falling.</description>
        <time_frame>Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Activities-specific Balance Confidence Scale (ABCS) Average Score</title>
          <description>The ABCS is a measure of balance-related confidence. The scale is made up of 16 questions for which respondents rate their level of perceived confidence in not becoming unsteady or falling. The average score ranges from 0 to 100 percent. Higher scores indicate greater balance-related confidence. The reliability and validity of the ABCS has been established in adults with and without a history of falling.</description>
          <units>percent</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="99" spread="0.8"/>
                    <measurement group_id="O2" value="91.8" spread="10"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 2</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="99" spread="1"/>
                    <measurement group_id="O2" value="88" spread="15"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 7</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="99" spread="1.3"/>
                    <measurement group_id="O2" value="93.5" spread="7.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="99" spread="0.7"/>
                    <measurement group_id="O2" value="95.6" spread="6.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Other Pre-specified</type>
        <title>Vestibular Activities and Participation Measure (VAPM) Average Score</title>
        <description>The VAPM is a 34-item questionnaire that is used to assess the impact of vestibular dysfunction on daily activities and participation in various life roles. The psychometrics for this tool have been established for adults with vestibular disorders. The average score ranges from 0 to 4. Higher scores indicate greater impact of vestibular symptoms on daily activities and participation in various life roles.</description>
        <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Vestibular Activities and Participation Measure (VAPM) Average Score</title>
          <description>The VAPM is a 34-item questionnaire that is used to assess the impact of vestibular dysfunction on daily activities and participation in various life roles. The psychometrics for this tool have been established for adults with vestibular disorders. The average score ranges from 0 to 4. Higher scores indicate greater impact of vestibular symptoms on daily activities and participation in various life roles.</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0" spread="0"/>
                    <measurement group_id="O2" value="0.84" spread="0.79"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0" spread="0"/>
                    <measurement group_id="O2" value="0.33" spread="0.48"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Other Pre-specified</type>
        <title>Vestibular Rehabilitation Benefits Questionnaire (VRBQ) Total Score at the End of the Trial</title>
        <description>The VRBQ was developed to assess outcomes from vestibular rehabilitation. The 22 questions are based on a literature review, participant interviews, and items from other measures. These questions are divided into three sub-scales: dizziness and anxiety (6), motion provoked dizziness (5), and quality of life (11). The total score ranges from 0-100 percent and scores &gt; 0 percent indicate the presence of symptoms, functional loss, or decreased quality of life. See http://www.isvr.soton.ac.uk/audiology/vrbq.htm for more information regarding the scoring methodology. It has been validated against other measures. The VRBQ is designed to measure the difference between the participant's current state of symptoms and quality of life compared to a state that is normal for the individual.</description>
        <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Vestibular Rehabilitation Benefits Questionnaire (VRBQ) Total Score at the End of the Trial</title>
          <description>The VRBQ was developed to assess outcomes from vestibular rehabilitation. The 22 questions are based on a literature review, participant interviews, and items from other measures. These questions are divided into three sub-scales: dizziness and anxiety (6), motion provoked dizziness (5), and quality of life (11). The total score ranges from 0-100 percent and scores &gt; 0 percent indicate the presence of symptoms, functional loss, or decreased quality of life. See http://www.isvr.soton.ac.uk/audiology/vrbq.htm for more information regarding the scoring methodology. It has been validated against other measures. The VRBQ is designed to measure the difference between the participant's current state of symptoms and quality of life compared to a state that is normal for the individual.</description>
          <units>percent</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.4" spread="3.8"/>
                    <measurement group_id="O2" value="27.8" spread="27.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2" spread="2.5"/>
                    <measurement group_id="O2" value="20.2" spread="28.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Other Pre-specified</type>
        <title>Functional Gait Assessment (FGA) Total Score</title>
        <description>The FGA is a 10-item, observational, test of walking. Score for each item range from 0 to 3 and, thus, the total score ranges from 0 to 30. Use of an assistive device is permitted. Higher scores indicate greater stability during walking. The psychometrics of the FGA have been established for adults with balance disorders.</description>
        <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Functional Gait Assessment (FGA) Total Score</title>
          <description>The FGA is a 10-item, observational, test of walking. Score for each item range from 0 to 3 and, thus, the total score ranges from 0 to 30. Use of an assistive device is permitted. Higher scores indicate greater stability during walking. The psychometrics of the FGA have been established for adults with balance disorders.</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="28.8" spread="1.6"/>
                    <measurement group_id="O2" value="29" spread="1.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="29.6" spread="0.89"/>
                    <measurement group_id="O2" value="29.3" spread="1.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
      <outcome>
        <type>Other Pre-specified</type>
        <title>Walking Speed</title>
        <description>Gait speed has been shown to be a reliable and valid measure of functional balance in adults. Gait speed will be recorded during a 10-meter walk test. Participants will walk for 2-meters before entering and after exiting the 6-meter long recording section. A stopwatch will be used for timing.</description>
        <time_frame>Visit 1 (Week 1) and Visit 8 (Week 5)</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Healthy</title>
            <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
          <group group_id="O2">
            <title>Vestibular-impaired</title>
            <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
          </group>
        </group_list>
        <measure>
          <title>Walking Speed</title>
          <description>Gait speed has been shown to be a reliable and valid measure of functional balance in adults. Gait speed will be recorded during a 10-meter walk test. Participants will walk for 2-meters before entering and after exiting the 6-meter long recording section. A stopwatch will be used for timing.</description>
          <units>meters per second</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="5"/>
                <count group_id="O2" value="5"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <title>Visit 1</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.14" spread="0.20"/>
                    <measurement group_id="O2" value="2.05" spread="0.46"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Visit 8</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.17" spread="0.27"/>
                    <measurement group_id="O2" value="2.17" spread="0.18"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>6 weeks</time_frame>
      <group_list>
        <group group_id="E1">
          <title>Healthy</title>
          <description>Healthy adults with visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
        </group>
        <group group_id="E2">
          <title>Vestibular-impaired</title>
          <description>Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.&#xD;
Sensory re-weighting: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="5"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="5"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="5"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="5"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="5"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="5"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>All Principal Investigators ARE employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <limitations_and_caveats>Due to Covid-19 restrictions, enrollment in this study was lower than planned.</limitations_and_caveats>
    <point_of_contact>
      <name_or_title>Dr. Kreg Gruben</name_or_title>
      <organization>University of Wisconsin - Madison</organization>
      <phone>608 262 2711</phone>
      <email>kreg.gruben@wisc.edu</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT04420949
org study id: 2020-0632
secondary id: A176000
secondary id: EDUC/KINESIOLOGY
secondary id: Protocol Version 5/1/2020
secondary id: 1UL1TR002373-01
nct id: NCT04420949
lead sponsor: 
collaborator: 
has dmc: No
is fda regulated drug: No
is fda regulated device: No
This is a preliminary study to determine the reliability and validity of new tests of
      orientation and balance, as well as to test the effects of a new treatment for visually
      induced dizziness. Tests involve determining vertical alignment. The treatment is task-based
      and involves focusing attention on internal body sensations to help improve the sense of
      upright. Testing is done twice before and twice after treatment, which is provided
      twice-weekly during a three-week period between testing. The total time participants are
      involved in the study is approximately six weeks.
Falls are a major concern for people living in countries all over the world. Tens of millions
      of people who fall are seriously injured and hundreds of thousands of people who fall die
      every year. People who are dizzy are far more likely to fall. The investigators are
      particularly interested in working with people who have dizziness that is caused by watching
      motion or looking at complex patterns (e.g. checkerboard patterns, walking through grocery
      store aisles, riding in vehicles, or watching movies).

      This type of dizziness or vertigo is typically described as motion sickness or, more
      specifically, visually-induced dizziness. This problem affects adults who are healthy and
      adults who have a variety of health conditions. No diagnostic tests for this condition exist
      at this time and the treatments currently being used may result in worsening dizziness for
      some patients.

      New tests were created for orientation and balance, as well as a new treatment for
      visually-induced dizziness. This is a preliminary study of the reliability and validity of
      the tests we developed, as well as whether the new treatment created results in reduced
      dizziness, improved balance, and changes in daily functioning.

      It is not known whether the new tests of orientation and balance are better, worse, or the
      same as existing tests in the ability to detect problems, nor is it known if the new
      treatment technique is any better, worse, or the same as existing treatments for dizziness
      and imbalance. It is hypothesized that the new tests will be accurate and able to detect
      problems in impaired adults. Additionally, that the treatment will result in less dizziness,
      better balance, and reduced risk of falling.

      The plan is to enroll a total of 30 people in this study, 15 who are healthy and 15 who have
      visually-induced dizziness due to a vestibular (inner ear) problem. Each participant will
      complete several questionnaires and tests of balance performance before and after undergoing
      the treatment. Participants attend 8 visits over 6 weeks. Each study visit lasts
      approximately 60 minutes.

      During visits 1 and 2, which is a double baseline phase, the reliability and validity of the
      new testing procedures will be assessed. All participants will then enter the treatment phase
      (visits 2 through 7) and will attend twice-weekly appointments for three consecutive weeks.
      Following the treatment phase, participants will be re-assessed twice, immediately after
      (visit 7) and one week after (visit 8) completing treatment. During this phase, the
      short-term effectiveness of the treatment will be assessed.

      Participants will complete questionnaires that measure the intensity of visually-induced
      dizziness, perceived handicap due to dizziness, and the impact of dizziness on daily
      functioning. Performance measures include the ability to determine what is upright based on
      the internal sense of gravity (verticality), standing upright, and walking-related balance
      tasks. The verticality tests are performed while the participant is secured in a harness and
      are either standing upright or tilted to the left or to the right. The testing task is to
      determine upright based on using internal body sensations. The standing balance test is
      performed on a platform that measures balance. The verticality tests and the standing balance
      test are experimental.

      The treatment is task-based and is performed while the participant is supported in a harness
      and wearing virtual reality goggles. During the treatment, participants are either standing
      upright or tilted to the left or to the right. The treatment involves focusing attention on
      internal body sensations to help determine whether an image that is presented in an otherwise
      black virtual environment is aligned with gravity. Other visual and sound cues will be
      eliminated to prevent the use of these cues from influencing decisions about what is upright.
      As the participant becomes more successful at determining what is upright, the difficulty of
      the treatment task is gradually increased.

      Participants symptoms will be monitored throughout the testing and treatment. Participants
      are given regular rest breaks and may request to rest at any time. Participation is voluntary
      and may be discontinued at any time.

      The investigators anticipate only mild and infrequent side effects related to testing and
      treatment. The results of this study may influence how orientation and balance are assessed
      and how visually-induced dizziness is treated.
allocation: Non-Randomized
intervention model: Parallel Assignment
intervention model description: The study will be conducted in three phases. The first phase is for baseline testing. The second phase is when treatment occurs. The third phase is for follow up testing. Participants will be tested twice during the baseline and follow up phases. Six treatment sessions will occur during the treatment phase.
primary purpose: Treatment
masking: None (Open Label)
masking description: It is not possible to mask this behavioral intervention. The study team small; thus, masking of the study team is also not possible.
measure: Rod and Disk Test (RDT) Mean Performance
time frame: Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)
description: An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.
measure: Multisensory Balance Evaluation (MBE) as Measured by the Intersection Point Height
time frame: Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)
description: This test is designed to assess balance during quiet standing in different sensory conditions. Participants perform one trial (lasting 30 seconds) of each condition. All trials are performed while standing on a force plate with the feet in a self-selected, comfortable position. The visual environment is controlled using an Oculus Rift. The surface conditions are either non-compliant or compliant. The frequency-dependent height of the Intersection Point (IP) of the ground reaction force is the main metric. The overall height of the IP curve obtained while the participant stands on a firm surface with their eyes open is the primary outcome. The height of IP ranges from 0 to 4.0, and higher values represent greater stability.
measure: Subjective Visual Vertical (SVV) Mean Performance
time frame: Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)
description: An image of a rod will be shown in the central portion of the visual field. The surrounding virtual environment will be void. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without any reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, the mean performance in this population is 0.39 (sd 0.8). Higher scores indicate subjective visual vertical alignment that is farther away from earth vertical.
measure: Rod and Frame Test (RFT) Mean Performance
time frame: Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)
description: An image of a rod will be projected inside a tilted frame within the central portion of the visual field. The surrounding virtual environment will be void. The frame will be tilted by +/- 20° in the frontal plane. A batch of rod angles will be predetermined. This assessment will be completed using an Oculus Rift and without reference to external visual cues. Only binocular testing will be completed. The average value for performance in each position will be used in data analysis. The mean of absolute value of the error in rod alignment measured in degrees for each body position tested will be used as the measurement variable for this outcome, and the primary outcome is the absolute value for mean performance in upright. In a prior study, mean performance in this population is 6.51 (sd 7.8). Higher values indicate greater deviations of perceived vertical from earth vertical.
measure: Vision-related Dizziness Questionnaire (VRDQ) Total Score
time frame: Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)
description: The VRDQ is used to quantify vision-related dizziness. This outcome measure consists of 25 questions comprising two subscales [frequency and severity of symptoms]. The range of scores for each sub-scale is 0 to 100 points. The total score is the average of both sub-scales. Higher scores represent greater frequency and severity of symptoms. Test-retest reliability for the VRDQ is well above the good performance level and convergent validity for the VRDQ was demonstrated with the Dizziness Handicap Inventory (DHI). Spearman correlation coefficients are 0.75 between the DHI and VRDQ frequency scale and 0.76 between the DHI and VRDQ severity scale.
measure: Dizziness Handicap Inventory (DHI) Total Score
time frame: Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)
description: The DHI is used to assess the severity of self-perceived disability secondary to dizziness. The tool is comprised of 25 questions which are score as yes = 4 points, sometimes = 2 points, and no = 0 points. The total score has a range of 0 to 100 points. The reliability and validity of the DHI have been established.
measure: Activities-specific Balance Confidence Scale (ABCS) Average Score
time frame: Visit 1 (Week 1), Visit 2 (Week 2), Visit 7 (Week 4), and Visit 8 (Week 5)
description: The ABCS is a measure of balance-related confidence. The scale is made up of 16 questions for which respondents rate their level of perceived confidence in not becoming unsteady or falling. The average score ranges from 0 to 100 percent. Higher scores indicate greater balance-related confidence. The reliability and validity of the ABCS has been established in adults with and without a history of falling.
measure: Vestibular Activities and Participation Measure (VAPM) Average Score
time frame: Visit 1 (Week 1) and Visit 8 (Week 5)
description: The VAPM is a 34-item questionnaire that is used to assess the impact of vestibular dysfunction on daily activities and participation in various life roles. The psychometrics for this tool have been established for adults with vestibular disorders. The average score ranges from 0 to 4. Higher scores indicate greater impact of vestibular symptoms on daily activities and participation in various life roles.
measure: Vestibular Rehabilitation Benefits Questionnaire (VRBQ) Total Score at the End of the Trial
time frame: Visit 1 (Week 1) and Visit 8 (Week 5)
description: The VRBQ was developed to assess outcomes from vestibular rehabilitation. The 22 questions are based on a literature review, participant interviews, and items from other measures. These questions are divided into three sub-scales: dizziness and anxiety (6), motion provoked dizziness (5), and quality of life (11). The total score ranges from 0-100 percent and scores > 0 percent indicate the presence of symptoms, functional loss, or decreased quality of life. See http://www.isvr.soton.ac.uk/audiology/vrbq.htm for more information regarding the scoring methodology. It has been validated against other measures. The VRBQ is designed to measure the difference between the participant's current state of symptoms and quality of life compared to a state that is normal for the individual.
measure: Functional Gait Assessment (FGA) Total Score
time frame: Visit 1 (Week 1) and Visit 8 (Week 5)
description: The FGA is a 10-item, observational, test of walking. Score for each item range from 0 to 3 and, thus, the total score ranges from 0 to 30. Use of an assistive device is permitted. Higher scores indicate greater stability during walking. The psychometrics of the FGA have been established for adults with balance disorders.
measure: Walking Speed
time frame: Visit 1 (Week 1) and Visit 8 (Week 5)
description: Gait speed has been shown to be a reliable and valid measure of functional balance in adults. Gait speed will be recorded during a 10-meter walk test. Participants will walk for 2-meters before entering and after exiting the 6-meter long recording section. A stopwatch will be used for timing.
arm group label: Healthy
arm group type: Experimental
description: Healthy adults with visually-induced dizziness with undergo the testing and treatment.
arm group label: Vestibular-impaired
arm group type: Experimental
description: Adults with unilateral or bilateral, peripheral vestibular loss who also have visually-induced dizziness with undergo the testing and treatment.
intervention type: Behavioral
intervention name: Sensory re-weighting
description: During training, sensory re-weighting is driven by priming upregulation of somatosensory cues. Two rounds of training, each lasting 15 minutes and block-randomized in sets of 10 trials, are conducted per training visit. In each training trial, participants must determine the direction of gravity and then indicate if the rod being displayed is aligned with gravity or if it needs to rotate clockwise or counterclockwise for that to be so. Participants will be instructed to pay attention to what they feel from their feet, legs, and gut during training and to use that pressure, stretch, movement, and muscle tension feedback to help them sense gravity. Immediate auditory and non-orienting, visual feedback is provided after each trial. A staircase method is used to adapt the level of difficulty based on response accuracy. After two consecutive correct responses, the difficulty increases. After each incorrect response, the difficulty decreases. This process is repeated in each round.
arm group label: Healthy
arm group label: Vestibular-impaired
criteria: 
gender: All
minimum age: 18 Years
maximum age: 79 Years
healthy volunteers: Accepts Healthy Volunteers
facility: 
country: United States
responsible party type: Sponsor
mesh term: Vertigo
mesh term: Dizziness
mesh term: Motion Sickness
sharing ipd: No
ipd description: There is not plan to share individual participant data.
provided document: 
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
limitations and caveats: Due to Covid-19 restrictions, enrollment in this study was lower than planned.
point of contact: 