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Despite proposed roles of visuo-vestibular dysfunction and sensory conflict, longitudinal objective evidence remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the longitudinal effects of virtual reality\u2013based vestibular rehabilitation (VR), cognitive behavioral therapy (CBT), and their integration (VR\u2009+\u2009CBT) on objective visuo-vestibular processing and symptom burden in adults with PEDS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a four-arm longitudinal study, 48 earthquake-exposed adults with PEDS were evaluated at baseline, post-intervention, and 3-month follow-up following an 8-week intervention. Objective visuo-vestibular outcomes were assessed using an immersive virtual reality\u2013based system, including static and dynamic subjective visual vertical (SVV\/DSVV), rod-and-frame test (RFT), and visual motion sensitivity (VMS) tests. Subjective outcomes included dizziness-related handicap (DHI) and post-traumatic stress symptoms (PCL-5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Dizziness-related disability and trauma-related symptoms improved over time across groups, indicating clinical modifiability of PEDS. Objective measures demonstrated a domain-specific response profile: SVV and DSVV remained largely stable, whereas RFT showed improvement in active treatment arms, suggesting reduced visual frame dependence. VMS outcomes exhibited differential trajectories, with the integrated VR\u2009+\u2009CBT group showing the most consistent and durable modulation under visually provocative conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Recovery in PEDS appears to involve selective modulation of context-dependent visuo-vestibular processing rather than uniform changes across all spatial orientation measures. Integrated VR\u2009+\u2009CBT yields the most coherent and durable benefits in visually demanding domains, supporting multidisciplinary models that jointly address sensory conflict and cognitive\u2013emotional mechanisms after major earthquakes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13767-4","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T17:06:49Z","timestamp":1774372009000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment-related modulation of visuo-vestibular integration in post-earthquake dizziness syndrome: a longitudinal virtual reality\u2013based study"],"prefix":"10.1007","volume":"273","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2164-393X","authenticated-orcid":false,"given":"Hanifi","family":"Korkmaz","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9429-2248","authenticated-orcid":false,"given":"I\u015f\u0131l \u00c7akmak","family":"Karaer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7866-4569","authenticated-orcid":false,"given":"K\u00fcbra","family":"Orman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5623-8291","authenticated-orcid":false,"given":"Burcu","family":"Talu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1453-0937","authenticated-orcid":false,"given":"Feyza","family":"\u0130nceo\u011flu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"13767_CR1","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.comppsych.2006.12.003","volume":"48","author":"CH Chen","year":"2007","unstructured":"Chen CH, Tan HK, Liao LR, Chen HH, Chan CC, Cheng JJ et al (2007) Long-term psychological outcome of 1999 Taiwan earthquake survivors: a survey of a high-risk sample with property damage. 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