Neural and functional changes following vestibular rehabilitation in persistent postural-perceptual dizziness: A case...

Persistent Postural Perceptual Dizziness (PPPD) is defined by chronic dizziness and impaired balance, often associated with disruptions in cortical activity and vestibular pathways.

The primary objective of this report is to assess the effects of a six-week home-based vestibular rehabilitation regimen on dizziness, postural stability, cortical activation, and white matter microstructural integrity in a woman diagnosed with PPPD.

A 24-year-old female patient presenting with chronic dizziness, balance deficits, and frequent falls characteristic of PPPD participated in a six-week home-based vestibular rehabilitation intervention. Outcomes were measured using the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale (VSS), center of pressure (COP) analysis during static postural assessment, functional near infrared spectroscopy (fNIRS), and diffusion tensor imaging (DTI).

Following the intervention, the DHI score decreased from 28 to 18, but it failed to meet the minimal clinically important difference of 18 points. Furthermore, the VSS score dropped from 46 to 39 but remained above the mean score of 20.8 for patients with chronic dizziness, indicating limited improvement in subjective symptoms. In contrast, objective measures demonstrated robust recovery; COP parameters decreased by 27-72%, notably exceeding standard improvement thresholds of 15-25%. Furthermore, fNIRS revealed reduced cortical activation suggesting enhanced neural efficiency, and DTI showed a two- to four-fold volume increase in the lateral vestibulospinal tracts (VST), confirming structural plasticity.

In this case, while subjective symptom improvements were limited, home-based vestibular rehabilitation was associated with substantial objective postural recovery. These functional gains coincided with structural adaptations in the VST and enhanced cortical efficiency, highlighting the potential value of objective biomechanical and neuroimaging assessments in monitoring therapeutic responses in PPPD.