Persistent Postural Perceptual Dizziness (PPPD)

What Is PPPD?

Persistent - the symptoms are there most of the time
‍Postural - because symptoms tend to be worse when patients are upright or moving, and better when lying down
Perceptual - it is something that is felt by the patient, but not obvious to others
Dizziness - a feeling of unsteadiness, rather than the world spinning (vertigo)
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PPPD can effect anyone of any age or either sex. Most patients are young patients (under 50). Some studies have found incident rates of 4% in the general population per year. PPPD, or 3PD, can results from an acute bout of dizziness of other vestibular conditions. It has been shown to be the cause of 15-20% of dizziness symptoms. PPPD can appear after an acute bout ofVestibular Neuritis, Labyrinthitis, Ménière's disease, Vestibular Migraines, Whiplash Stroke o post-Concussion.
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The underlying mechanism of PPPD isn't fully understood, it appears that there is a failure of the central postural control centres of the balance system to properly adapt once the acute issue has resolved. This leads to a mismatch in the processing of balance sensations reaching the brain, thus leading to a sense of instability or dizziness.

What Are The Symptoms Of PPPD?

The symptoms of PPPD include:
unsteadiness - a feeling of walking "as if drunk" or "on a boat"
vibrations inside the body
difficulty concentrating
short-term memory loss

Symptoms tend to be worse in busy or visually stimulating environments (such a as a pub, shopping centre or grocery store) but can also persist in bed at night. One of the most frustrating aspects of PPPD for patients is that others cannot see the problem, and they feel mis-understood by friends, family, or work colleagues. They may have also been dismissed as being ‘just anxious’ or told that there is nothing serious and to "get on with life".

How Does Physiotherapy Help?

Diagnosis:
Through a comprehensive history and a series of tests, that involve both ruling out primary conditions and testing for PPPD, a diagnosis and list of vestibular dysfunctions will be determined. For a true diagnosis of PPPD symptoms should be present for 3 or more months. We do not advise waiting 3 months to seek help. Within the first three months we can rule out other causes of the dizziness. The quicker an assessment is conducted, the quicker a treatment plan can be implemented to reduce the symptoms.

Treatment:
‍ Once the primary cause of PPPD has been treated, the vestibular dysfunctions can be addressed. This will include improving vestibular ocular reflexes and cancellations, resetting the vestibular system so that it can process the balance sensations correctly and improving functional balance and re-establishing confidence in daily activities.
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Your physiotherapist will also provide you with specific exercises to restore the balance to the vestibular system so that your sense of orientation and the stability of your vision improve and you feel more confident in your balance.

After the Session:
You may feel an instant change in your symptoms. Your physiotherapist will provide a structured program with exercises to complete at home. 67-69% of patients see a significant improvement in their symptoms after treatment. On average patients will find significant or complete resolution of their symptoms following three to four sessions.