A Virtual Reality Four-Square Step Test for Quantifying Dynamic Balance Performance in People with Persistent Postural Perceptual Dizziness

Moshe M.H. Aharoni, Anat V. Lubetzky, Zhu Wang, Maya Goldman, Tal Krasovsky

Research output: Contribution to journalConference articlepeer-review


Persistent-postural perceptual dizziness (PPPD) is a recently-defined diagnosis of chronic vestibular symptoms, which is exacerbated by exposure to moving objects and self-motion but is typically undetectable by clinical tests. The current work evaluates the feasibility of a novel paradigm for evaluation of dynamic balance within complex visual environments in people with PPPD-the Virtual Reality Four Step Square Test (FSST-VR). The FSSTVR measures spatiotemporal head kinematics while subjects perform the FSST pattern of 8 steps in a predefined sequence in a virtual environment of varying levels of visual complexity. Eight healthy individuals and 3 people diagnosed with PPPD were asked to perform the FSST-VR while spatiotemporal head kinematics and heartrate were measured. Additionally, participants reported their anxiety levels and cybersickness. Results indicated that performance of the FSST-VR is feasible and did not aggravate symptoms for people with PPPD. Descriptive statistics further may suggest that people with PPPD move less smoothly and perform smaller steps in anteroposterior direction, corresponding with the visual stimuli flow in the virtual environment. Data collection is ongoing and may provide further evidence as to dynamic balance in people with PPPD within complex virtual environments that mimic visual load in daily living.

Original languageEnglish
Article number9082568
JournalInternational Conference on Virtual Rehabilitation, ICVR
StatePublished - 2019
Event2019 International Conference on Virtual Rehabilitation, ICVR 2019 - Tel Aviv, Israel
Duration: 21 Jul 201924 Jul 2019

Bibliographical note

Funding Information:
FSST-VR: An HTC Vive commercially-available system (HTC Corporation, Taoyuan City, Taiwan) was used for projecting the virtual environment and measuring head kinematics as part of the FSST-VR paradigm. The system was supported by a laptop PC (ASUS GL502VM-i7-7700H, NVIDIA GeForce GTX1070 graphic card and 32GB DRAM DDR4 memory). The virtual environments (programmed in Unity version 5.2.1f; ©Unity Technologies, San Francisco, California) include three levels of visual stimuli (Figure 1):

Publisher Copyright:
© 2019 IEEE.


  • HTC Vive
  • dynamic balance
  • head-mounted display
  • sensory integration
  • visual stimuli

ASJC Scopus subject areas

  • Electrical and Electronic Engineering
  • Computer Networks and Communications


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