While literature supports a multimodal approach, physiotherapists may lack appropriate training or resources. Consequently, this case report describes management strategies for a patient with PPPD in an outpatient setting utilizing vestibular rehabilitation therapy (VRT).
A 65-year-old male Veteran with a history of PTSD and anxiety presented to an outpatient physiotherapy clinic with persistent dizziness. Audiology initially diagnosed him with acute vestibular neuritis caused by an ear infection, with intermittent symptoms. Three months later, he was scheduled for a physiotherapy evaluation, where his symptoms had become constant. cervical dizziness was ruled out using joint mobility assessment, seated cervical torsion test, and cervical relocation test. Central vestibular lesion was excluded through smooth pursuits, saccades, and vestibular-ocular reflex cancellation. Peripheral vestibular hypofunction was ruled out using the head impulse test and symptom quality. Based on the examination results, the patient’s characteristics matched all five diagnostic criteria proposed by the Bárány Society for PPPD. Vestibular rehabilitation therapy, focusing on substitution, adaptation, and habituation strategies, was used to address the symptoms of dizziness and impaired functional tasks. Progress was tracked using subjective reports, the Dizziness Handicap Inventory (DHI), the Activities-Specific Balance Confidence Scale (ABC), and the Patient-Specific Functional Scale (PSFS).
After attending 15 physiotherapy visits over 33 weeks, the patient reported improvements from pre-test to post-treatment in frequency (constant to once daily), duration (constant to 5-10 minutes), and intensity (7/10 to 0-3/10) of dizziness. On the PSFS, he marked Driving (pre: 2/10, post: 6/10), Walking (pre: 1/10, post: 5/10), and Curb/Stairs (pre: 1/10, post: 4/10), all showing clinically significant improvements. DHI (pre: 46, post: 34) and ABC (pre: 82.8%, post: 88.1%) scores improved but were not clinically significant.
Individuals with PPPD experience significant distress and functional impairment, which can exacerbate symptoms. This case report outlines management using vestibular rehabilitation therapy. Results indicate improvements in the patient’s subjective symptom quality and function. The absence of clinically significant improvements in DHI and ABC scores may be due to their assessment being conducted at visit four, where improvements had already occurred. However, all outcomes trended towards clinical significance.
Recognizing PPPD in Veterans is critical due to its correlation with PTSD and anxiety. Therefore, clinicians must organize a thorough evaluation to rule in/out differential diagnoses and account for contributory factors or comorbidities. Once accurately diagnosed, vestibular rehabilitation alone can reduce symptoms and improve function in patients with PPPD.
PPPD
vestibular rehabilitation
