Dizziness is a common symptom after a concussion, brain injury, or vestibular disorder. For some people, however, dizziness and unsteadiness continue long after the original injury or illness has healed. One possible explanation is Persistent Postural-Perceptual Dizziness
(PPPD).
Persistent Postural-Perceptual Dizziness (PPPD) is a condition in which the brain has difficulty processing information from the balance, visual, and sensory systems. PPPD is considered a functional vestibular disorder. This means that persistent symptoms are related to changes in how the brain processes sensory and balance information, rather than ongoing structural damage to the brain or inner ear.
People with PPPD often describe:
These symptoms can be particularly confusing because a person may have normal vestibular testing or medical imaging even though they continue to feel dizzy.
PPPD often begins after an event that disrupts the body's balance system. Possible triggers include:
After the initial event, the brain may become hypervigilant and rely too heavily on vision or conscious control to maintain balance. Instead of automatically trusting information from the vestibular system, the brain may continually “check” for signs of dizziness or instability. This can create a cycle:
The good news is that the brain can learn new patterns and PPPD can be treated!
Treatment is typically individualized and may include a combination of vestibular rehabilitation, psychological strategies, and medication when appropriate.
Gradual exposure to movements and visual environments that trigger symptoms can help the brain become less sensitive over time. Balance training and sensory- reweighting exercises can also help individuals regain confidence in their balance system.
Treatment can focus on returning to everyday activities that have become difficult, such as grocery shopping, using screens, navigating busy environments, or participating in community activities.
When dizziness is accompanied by cognitive fatigue or difficulty processing information, SLPs can help address the cognitive demands of everyday environments and develop strategies for managing symptoms.
Anxiety, fear, and negative expectations can sometimes contribute to the dizziness cycle. Psychological support can help individuals understand their symptoms, develop effective coping strategies, and gradually return to activities they have been avoiding.
If dizziness, unsteadiness, or visual sensitivity continues to interfere with work, school, driving, exercise, shopping, or social activities, it may be worth talking with a healthcare provider or rehabilitation professional who understands vestibular disorders and brain injury.
At Brain Rehab Network, our interdisciplinary team looks at the whole person, not just one symptom, to understand what may be contributing to persistent dizziness and develop a personalized plan to help people get back to living.
If persistent dizziness, balance problems, or visual sensitivity are interfering with your daily life, Contact Brain Rehab Network to learn more about our rehabilitation services and how we may be able to help.
