Persistent Postural Perceptual Dizziness (PPPD)

Persistent postural-perceptual dizziness (PPPD) is a chronic disorder characterised by a constant sense of dizziness, often lightheaded in nature associated with instability often described as swaying. PPPD commonly develops from a vertiginous cause including BPPV and vestibular migraine, where maladaptation occurs in an attempt to stabilise or prevent vertiginous episodes from occurring.

HISTORY:

A 60 year old lady (GA) who describes a 15 year history of constant dizziness and an inability to walk independently on uneven pavement, with associated nausea if walks for more than five minutes. GA is unable to read and had to retire due to no longer being able to work between two computer screens without extreme lightheadedness, headaches and nausea.

EXAMINATION:

GA able to walk independently but if asked to visually scan or change direction when walking, she reported disorientation and lightheadedness and almost fell with turning. Standing balance is compromised with eyes closed = 3.47 seconds (immediate fall without supervision) and she reports fractures to six toes over the last three years when walking in the dark.

TREATMENT:

With six treatment sessions over a two month period which included progression of an Adaptation exercise program, balance and dual task gait activities, progressing into uncontrolled environments and then into the community, and mobilisation of the neck and upper thoracic regaining freedom of her selective movement, GA made an excellent recovery. Her commitment to this program and diligence with following progressions at home, allowed achievement of her goal to regain her physical independence and to read again.

OUTCOME:

GA reported at completion of our program:

• Reduced fatigue, nausea and dizziness – only occasional lightheadedness with ≥ 20 minutes in social situations.
• Able to manage all uncontrolled busy environments and walking independently, and balance now safely > 30 seconds with eyes closed.
• Returned to reading.