Persistent Postural-Perceptual Dizziness (PPPD)
What is Persistent Postural-Perceptual Dizziness?
Previously referred to as phobic postural vertigo, visual vertigo, space-motion discomfort or chronic subjective dizziness, PPPD is the most recent term used for this syndrome. It has three main features:
Dizziness (not vertigo) and/or unsteadiness present on most days and lasting over 3 months. These symptoms are usually continuous though can wax and wane in severity by themselves and/or in response to provocative factors. Symptoms are usually related to body posture and are worse when standing/walking and relieved with sitting/lying down.
Exacerbated by exposure to motion stimuli - both of self and in the visual surround (e.g. passenger in car, walking in busy supermarket)
Exacerbated by performance of precision visual tasks (e.g. reading or using a computer)
PPPD is almost always triggered by an acute neuro-otologic (vestibular), medical, psychiatric illness or acute psychological distress. The syndrome rarely has a spontaneous onset and is not progressive. PPPD can co-exist with chronic or recurrent disorders, such as Vestibular Migraine or BPPV.
How Does it Happen?
There is still ongoing research as to how PPPD develops. One hypothesis is that the initial event produces strong physical responses (eg vertigo, nausea), often associated with high anxiety. Following that, the person becomes more sensitive to subsequent movements. This can then lead to the avoidance of any provocative activities as well as altered thought processes (e.g. catastrophic thoughts)
Another theory is that during the acute event, the brain adapts its processing of the information coming in to enable it to maintain postural control during the event. However, after the acute issue resolves, the system does not revert back to normal and the lack of readjustment leads to the development of PPPD
It is thought that behavioural factors can contribute to the development of PPPD. These include a a pre-existing anxiety/depressive disorder and/or high levels of anxiety during an acute event leading to hypervigilance and excessive worry about their symptoms and their consequences
How is it Treated?
Research supports 3 main categories of treatment of PPPD. These are:
Vestibular Rehabilitation, including management of lifestyle factors
Medication such as certain kinds of anti-depressants/anti-anxiety treatments
Psychological therapy such as Cognitive Behavioural Therapy (CBT) and other strategies
Vestibular Rehabilitation is thought to be effective by reversing the hypersensitivity to motion and the altered postural responses associated with PPPD. The program is designed to challenge your vestibular system with repeated exposure to the circumstances/activities/movements which trigger your symptoms to promote a more normal response from it. It is also aimed at eliminating or reducing the secondary effects of PPPD, including examining things like sleep, diet and exercise habits in order to promote more holistic wellbeing
At Equilibrium Rehab, we will assess a range of activities including your eye movements, balance in standing/walking and response to changes in position to evaluate the functioning of the Vestibular System. Based on the assessment findings we will then prescribe an exercise program, give you a written copy of the exercises and explain what to expect. For more information on this, see How We Can Help You.