Balance implants or external prostheses: Which is the wave of the future?

Balance impairments affect a large population of individuals especially the elderly, in addition to those with vestibular deficits, CNS disorders, peripheral lower-leg neuropathies, and stroke. When vestibular or proprioceptive function is deficient, essential tasks such as postural control and gaze stabilization are not performed normally. Furthermore, the quality of life of patients is significantly impaired. Recognizing the reduced quality of life, increased financial costs, and increased mortality risk associated with falls, a major scientific effort is underway to determine which of two new techniques holds the most promise of significantly reducing fall risk: vestibular implants or wearable external sensory augmentation devices. Both techniques aim to supplement or replace the vestibular system, either directly or via sensory augmentation or substitution, as this system plays a crucial role in the control of balance. Regardless of the effectiveness of these systems, both have to be measured against the effects of focused balance training alone. The questions that need to be answered about these systems are similar to those of cochlear implants three decades ago: which technique will improve quality of life most cost-effectively? Then the discussion was between cochlear implants or vibrotactile feedback of sound via a wristband. While an artificial vestibular implant system might be the appropriate solution for many persons with balance impairments, such systems are just on the cusp of clinical reality. A few patients with total vestibular loss have received implants very similar to cochlear implants, but with the capability of restoring vestibulo-ocular function