Phobic postural vertigo. Body sway during visually induced roll vection

Patients with phobic postural vertigo (PPV) often report a particularly increased unsteadiness when looking at moving visual scenes. Therefore, the differential effects of large-field visual motion stimulation in roll plane on body sway during upright stance were analyzed in 23 patients with PPV, who had been selected for the integrity of their vestibular and balance systems, and in 17 healthy subjects. Visual motion stimulation induced a sensation of apparent body motion (roll vection) in all patients and normal subjects. Normal subjects showed an increased lateral sway path with a lateral shift of the center of pressure (COP) in stimulus direction (mean 1.67 cm, SD 1.63). The patients also exhibited an increase in sway path during visual motion stimulation; however, their body sway differed from that of normals in that there was no lateral displacement of COP (mean 0.19 cm, SD 0.73). The lateral displacement of COP and the increase in RMS of body sway during visual motion stimulation were significantly greater in normals than in the patients ( p<0.05). The patients' increased body sway without COP deviation does not imply an increased risk of falling. Two explanations are conceivable for this increased body sway without body deviation in patients with PPV: (a) the patients rely more on proprioceptive and vestibular rather than on visual cues to regulate upright stance; or (b) they depend on visual, vestibular, and proprioceptive information, but the threshold at which they initiate a compensatory body sway opposite in direction to a perceived body deviation is lower than in normal subjects. The data support the second explanation.