Phobic Postural Vertigo

Abstract

The syndrome of phobic postural vertigo (PPV) was described by Brandt, and it is characterized by subjective dizziness and a disturbance of balance while standing and walking, despite normal values in clinical balance tests. The key lesion is a shift in the coordination of open- and closed-loop mechanisms of postural control: patients with PPV use sensory feedback inadequately during undisturbed stance, and this impairs postural performance, while equilibrium control is normal when a difficult balance task, such as tandem stance on foam rubber with eyes closed, is required just like to that of healthy persons in the same stance conditions. In PPV patients, subjective imbalance is caused by inappropriate balance strategies with higher levels of antigravity muscle activity and co-contraction during the conscious concentration on control of postural stability. The consequent key impairment is postural fear and the key disability is a decreased motor and social autonomy due to a phobic behaviour. Treatment is aimed to obtain the unconsciousness of postural control, reducing energy expending. Thus, rehab has to be pointed to restore correct integration between special and general proprioception and the correct internal representation of posture in order to recover appropriate balance strategies