Vestibular Rehabilitations Therapy (VRT) in Patients with Persistent Postural Perceptual Dizziness (PPPD)

Abstract

Abstract Background Persistent functional dizziness has been known for many years under various names, including phobic postural vertigo (PPV), visual vertigo and chronic subjective dizziness (CSD). In response to an initiative by the Bárány Society 2017, these terms have recently been grouped together under the umbrella term ‘Persistent Postural-Perceptual Dizziness PPPD' and have been given their own diagnostic criteria. Aim of the Work To evaluate posture and cognitive functions in patients with PPPD and to study the efficacy of VRT for management of abnormal postural control in patients with PPPD utilizing subjective and objectives outcome measures. Materials and Methods Thirty-three PPPD patients participated in this study. Selection of study group was based on the diagnostic criteria for PPPD proposed by Barany society shown in the International Classification of Vestibular Disorders (ICVD) 2017. Every patient was subjected to history taking, cognitive functions assessment (Mini Mental State Examination and Anxiety and Depression Assessment), Arabic Version of Dizziness Handicap Inventory (DHI), vestibular laboratory tests: Videonystagmography VNG, Video Head Impulse vHIT, cervical and ocular Vestibular Evoked Myogenic Potentials, and Computerized Dynamic Posturography CPD). All patients received Vestibular Rehabilitations Therapy (VRT). Assessment of VRT outcome was conducted by DHI and SOT after 6 weeks of VRT. Results Unsteadiness (91%), dizziness (85%), and non-spinning vertigo (76%) were the three main symptoms of PPPD patients. Additionally, patients with PPPD demonstrated questionable (39.4%) and mild cognitive impairment (30.3%). According to vestibular laboratory tests, (42.4%) of patients had peripheral vestibular abnormality, (30.3%) showed normal laboratory test. There was statistically significant difference between before and after VRT as regards DHI and all the sensory analysis of posturography conditions of (SOT). Conclusion Supervised sessions using smart CDP systems and home- based VRT were effective in improving patients with PPPD evidenced by subjectively improved DHI scores and objectively improved SOT results.