PPPD is one of the most common causes of chronic dizziness seen in vestibular clinics. It is classed as a functional disorder of balance and spatial orientation as there is abnormal processing is sensory information without the presence of any ongoing structural damage. Usually the condition is caused by an initial vestibular pathology that affects the function of the vestibular system. As people recover structurally from this, their vestibular system remains hypervigilant and sensitive to any changes in position. This can result in patients relying very heavily on visual feedback, being very resistant to moving their head or turning sharply, struggling a lot in busy environments, reduced eye movement and altered walking, even though they have a normal functioning vestibular system. Whilst not an anxiety disorder, high levels of anxiety can amplify symptoms.
Typical presentation:
- Persistent dizziness or unsteadiness lasting >3 months
- Symptoms can fluctuate but present most days
- Worsening with upright posture and complex/busy environments
- Patients will often say things like “I feel like I’m on a rocking ship”, “I’m floating” or “I’m swaying”
- Usually not spinning vertigo and symptoms are better when sat/laid down.
Physiotherapy treatment:
- Promote normal movement e.g. high repetitions of head or eye movement, turning, bending
- Education that their symptoms are real, however the brain is overprotective rather than structurally damaged and movement is safe
- Basic vestibular exercises e.g. keeping eyes fixed on an object while rotating head rhythmically (vestibulo-ocular reflex)
- Introduction of visual motion desensitisation e.g. busy environments or videos to watch
- Reduce reliance upon vision
- Add complexities e.g. exercises on uneven surface, narrow base or dual tasking
- Promoting general exercise
