PPPD (Persistend Postural Perceptual Dizziness)

Resources

Definition. A possible related syndrome is MdDS (Mal de Debarquement Syndrome).

A good pdf document on what it is and how to treat it.

Exercises

A good list of exercises.

Gaze stabilization

Mark a point on the wall while seated a couple of meters away. Keep looking at it while moving the head left and right, or up and down, or even diagonally. Begin with 15 seconds, daily.

Increase time if it is too easy

Then increase difficulty by moving in more directions the head.

Then do the exercise standing

Then do the exercise on a “busy” wall (one with many colours or hanged stuff on it, not mostly empty)

Left-right movements

Quickly move the head from left to right and back, with a little pause when looking straight ahead. Do not look at anything, just try to cause some dizziness.

Increase time as soon as it is too easy

Throwing ball

Take a ball and throw it towards the ceiling, catching it on the way down. Focus on the ball throughout the exercise.

Throw ball under knee

Throw ball from hand to hand under one knee. Focus on the ball throughout the exercise.

Standing and sitting

Stand from a sitting position and sit again, repeatedly, for 15-30 seconds. Focus your stare on a fixed point ahead of you.

Once it is too easy, try by increasing time and then by having your eyes shut

Left-right laying

On a bed, alternatively lay on the left and then on the right, progressively faster

Head rotation

While standing, rotate the head from left to right, progressively faster

Head bending

In a sitting position, bend your head down to look at the floor then up to look at the ceiling.

  1. Lead your head with your eyes focusing on the floor and the ceiling.
  2. Repeat this 10 times. Stop and wait for symptoms to resolve, about 30 seconds.
  3. Repeat entire process 2 more times.

Sitting routine

  1. Shrug shoulders – 20 times.
  2. Turn shoulders to right and then to left – 20 times.
  3. Rotate head, shoulders and trunk – 20 times each: a. Rotate upper body right to left with eyes open, then repeat with eyes closed. b. Rotate upper body left to right with eyes open, then repeat with eyes closed.
  4. Bend forward and touch ground then sit up. Keep eyes focused on wall – 20 times.
  5. Bend forward and touch ground then sit up. Move eyes to floor and back – 20 times.
  6. Eye movements (head is still): a. Up and down (focusing on finger). b. Side to side (focusing on finger). c. Finger to tip of nose and out (focusing on finger).

Standing with one foot in front of the other

In a corner, practice standing “heel to toe” (one foot in front of the other with the heel of one foot touching the toe of the other foot) with eyes open for 30 seconds. The goal is to stand for the entire 30 seconds without touching the wall. You may make this more challenging by crossing arms across chest. If this is too hard at first, try standing “almost heel to toe” (with feet touching at big toes and ankles). Once you have mastered these with eyes open, practice with eyes closed.

Stand with heels together

Look straight ahead and hold balance (attempt only with assistance).

Walking in a straight line

In a hallway or next to a wall, practice walking in a straight line for 5 minutes with one foot in front of the other or “heel to toe” (with the heel of one foot touching the toe of the other foot). If this is too hard at first, practice walking “almost heel to toe” and gradually work to heel to toe touching.

Walking combined with head turning

In a hallway or open space, practice walking in a straight line while turning head and eyes left and right with every other step (i.e. when you step with your left you look left, when you step with your right you look right). Continue for the length of the hallway or about 20 feet. Repeat the process 3 times. Now repeat the entire process 3 more times but this time looking at the ceiling or floor. You will need to rest between repetitions and let symptoms calm.

Smooth pursuit

Holding a single target, keep eyes fixed on the target. Slowly move it side to side for 30 seconds while head stays still. Perform in the sitting position. Progress to the standing position as tolerated. Now repeat moving head up and down. Repeat 20 times in each direction per session. Do 3 sessions per day.