Characterization of Postural Sway in Patients With Persistent Postural-Perceptual Dizziness (PPPD) Using Wearable Motion Sensors

McCaslin, Devin L.; Shepard, Neil T.; Hollman, John H.; Staab, Jeffrey P.

doi:10.1097/mao.0000000000003393

Cited by 14 publications

(18 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…and demographic characteristics, such as a relatively young distribution with anxious/depressive background observed in the present PPPD group, were consistent with those in previous studies (Kim et al, 2020;Bittar and von Sohsten Lins, 2015). The results of posturography in this study were consistent with those in previous reports (Sohsten et al, 2016;McCaslin et al, 2022), showing significant differences in the eyes-closed condition but not in the eyes-open condition compared with HCs.…”

Section: Clinical and Demographic Characteristics Of Persistent Postu...supporting

confidence: 93%

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Yagi

Morita²,

Yamagishi³

et al. 2022

Front. Hum. Neurosci.

View full text Add to dashboard Cite

IntroductionPersistent postural-perceptual dizziness (PPPD) is a chronic vestibular syndrome lasting more than 3 months. The core vestibular symptoms are dizziness, unsteadiness, and non-spinning vertigo, which are exacerbated by upright posture or walking, active or passive motion, and exposure to moving or complex visual stimuli. Among these, visual exacerbation is a key feature of PPPD for which the neural mechanisms are unknown. We hypothesized that vestibular symptoms may be exacerbated by visual stimuli through gaze behavioral change after exposure to moving or complex visual stimuli. The study aimed to examine gaze stability after exposure to moving visual stimuli in patients with PPPD.MethodsFourteen healthy controls (HCs), 27 patients with PPPD, and 12 patients with unilateral vestibular hypofunction (UVH), showing chronic vestibular symptoms for >3 months, were enrolled in the study. The participants were instructed to fixate on the gazing point at the center of a screen for 30 s before and after 90 s of exposure to moving visual stimuli. Gaze stability, best represented by the bivariate contour ellipse area (BCEA), was compared among three groups, both before and after exposure to the moving visual stimuli. Comparisons between pre- and post-moving visual stimuli in BCEA were also conducted. Correlation between the post/pre ratio of BCEA and vestibular tests, several clinical symptom scales including the Dizziness Handicap Inventory, Niigata PPPD Questionnaire, and Hospital Anxiety and Depression Scale, and the exacerbation of dizziness by exposure to moving visual stimuli was examined in the PPPD group.ResultsBCEA, both before and after exposure to moving visual stimuli in the PPPD group, was not different from that in HC and UVH groups. In the PPPD group, BCEA increased significantly after exposure to moving visual stimuli. The post/pre ratio of BCEA correlated with the occurrence of exacerbation of the dizziness sensation by exposure to moving visual stimuli; however, it did not correlate with vestibular tests or clinical symptom scales.ConclusionPatients with PPPD were more likely to exhibit gaze instability after exposure to moving visual stimuli, which potentially exacerbated vestibular symptoms. This phenomenon may help elucidate the neural mechanisms of visual exacerbation in patients with PPPD.

show abstract

Section: Clinical and Demographic Characteristics Of Persistent Postu...supporting

confidence: 93%

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Yagi

Morita²,

Yamagishi³

et al. 2022

Front. Hum. Neurosci.

View full text Add to dashboard Cite

show abstract

“…PPPD brings together varying aetiological and mechanistic models, and evolves from previously described visual vertigo, space-motion discomfort, phobic postural vertigo and chronic subjective dizziness, the latter which removed the need for specific psychological factors to be present. Its pathophysiology is thought to include locomotion and spatial orientation alterations (eg, abnormal postural control stiffening3 and visual dependence4), appropriate adaptations during mobility threats (eg, acute vestibular illnesses), but maladaptive when maintained after acute illness remission. Current pathophysiological models5 hypothesise that these brain functioning shifts are linked to predisposing factors that may be identifiable early in the illness, perhaps before PPPD’s onset, making them possible PPPD predictors.…”

Section: Introductionmentioning

confidence: 99%

Predictors of persistent postural-perceptual dizziness (PPPD) and similar forms of chronic dizziness precipitated by peripheral vestibular disorders: a systematic review

Trinidade

Cabreira

Goebel

et al. 2023

J Neurol Neurosurg Psychiatry

View full text Add to dashboard Cite

BackgroundThe literature on predictors of persistent postural-perceptual dizziness (PPPD) following peripheral vestibular insults has not been systematically reviewed.MethodsWe systematically reviewed studies on predictors of PPPD and its four predecessors (phobic postural vertigo, space-motion discomfort, chronic subjective dizziness and visual vertigo). Investigations focused on new onset chronic dizziness following peripheral vestibular insults, with a minimum follow-up of 3 months. Precipitating events, promoting factors, initial symptoms, physical and psychological comorbidities and results of vestibular testing and neuroimaging were extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsWe identified 13 studies examining predictors of PPPD or PPPD-like chronic dizziness. Anxiety following vestibular injury, dependent personality traits, autonomic arousal and increased body vigilance following precipitating events and visual dependence, but not the severity of initial or subsequent structural vestibular deficits or compensation status, were the most important predictors of chronic dizziness. Disease-related abnormalities of the otolithic organs and semi-circular canals and age-related brain changes seem to be important only in a minority of patients. Data on pre-existing anxiety were mixed.ConclusionsAfter acute vestibular events, psychological and behavioural responses and brain maladaptation are the most likely predictors of PPPD, rather than the severity of changes on vestibular testing. Age-related brain changes appear to have a smaller role and require further study. Premorbid psychiatric comorbidities, other than dependent personality traits, are not relevant for the development of PPPD.

show abstract

“…standing on foam), compared to controls. [19][20][21] Automated postural and gait parameters in other studies have shown promise as potential diagnostic biomarkers to differentiate patients with peripheral vestibular, cerebellar and persistent postural-perceptual dizziness, 19,22,23 but these instruments are not routinely available. A stiffened ankle strategy with a high frequency of body sway (3.5-8 Hz) has been reported in patients with phobic postural vertigo (a precursor term to persistent posturalperceptual dizziness), related to a tendency to abnormally recruit afferent feedback loops during a quiet stance.…”

Section: Making a Diagnosismentioning

confidence: 99%

Introduction to the assessment and management of persistent postural-perceptual dizziness

Kaski

2024

J. Laryngol. Otol.

View full text Add to dashboard Cite

ObjectivePersistent postural-perceptual dizziness classifies patients with chronic dizziness, often triggered by an acute episode of vestibular dysfunction or threat to balance. Unsteadiness and spatial disorientation vary in intensity but persist for over three months, exacerbated by complex visual environments.MethodLiterature suggests diagnosis relies on a clinical history of persistent subjective dizziness and normal vestibular and neurological examination findings. Behavioural diagnostic biomarkers have been proposed, to facilitate diagnosis.ResultsResearch has focused on understanding the neural mechanisms that underpin this perceptual disorder, with imaging data supporting altered connectivity between neural brain networks that process vision, motion and emotion. Behavioural research identified the perceptual and motor responses to a heightened perception of imbalance.ConclusionManagement utilises head and body motion detection, and downregulation of visual motion excitability, reducing postural hypervigilance and anxiety. Combinations of physical and cognitive therapies, with antidepressant medications, help if the condition is associated with mood disorder.

show abstract

Characterization of Postural Sway in Patients With Persistent Postural-Perceptual Dizziness (PPPD) Using Wearable Motion Sensors

Abstract: Objective: To extend previous investigations of postural control in patients with persistent-postural perceptual dizziness (PPPD).

Cited by 14 publications

References 33 publications

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Gaze instability after exposure to moving visual stimuli in patients with persistent postural-perceptual dizziness

Predictors of persistent postural-perceptual dizziness (PPPD) and similar forms of chronic dizziness precipitated by peripheral vestibular disorders: a systematic review

Introduction to the assessment and management of persistent postural-perceptual dizziness

Contact Info

Product

Resources

About