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Persistent Postural-Perceptual Dizziness(PPPD/3PD)
Do you feel a chronic feeling of rocking, imbalance, fogginess, unsteadiness, swimming, floating, lightheadedness, pulling, pushing, or dizziness?
What is Persistent Postural-Perceptual Dizziness?
Persistent Postural-Perceptual Dizziness, often called PPPD or 3PD, is a condition that causes chronic dizziness and imbalance. Unlike vertigo, which feels like spinning, PPPD usually feels more like rocking, swaying, lightheadedness, or being "off balance." The quality of the dizziness can vary depending on the individual.
People with PPPD often describe their symptoms as:
- Lasting for 3 months or longer
- Happening most days (with good and bad days)
- Feeling worse when standing, walking, moving the head, or in visually busy places (such as grocery stores, scrolling on a phone, or driving)
Diagnostic Criteria
Adopted from the ICVD:
PPPD is a chronic vestibular disorder defined by criteria A-E below. All five criteria must be fulfilled to make the diagnosis.
- A.One or more symptoms of dizziness, unsteadiness, or non-spinning vertigo are present on most days for 3 months or more.
- 1.Symptoms last for prolonged (hours-long) periods of time, but may wax and wane in severity.
- 2.Symptoms need not be present continuously throughout the entire day.
- B.Persistent symptoms occur without specific provocation, but are exacerbated by three factors:
- 1.Upright posture
- 2.Active or passive motion without regard to direction or position, and
- 3.Exposure to moving visual stimuli or complex visual patterns.
- C.The disorder is precipitated by conditions that cause vertigo, unsteadiness, dizziness, or problems with balance including acute, episodic, or chronic vestibular syndromes, other neurologic or medical illnesses, or psychological distress.
- 1.When the precipitant is an acute or episodic condition, symptoms settle into the pattern of criterion A as the precipitant resolves, but they may occur intermittently at first, and then consolidate into a persistent course.
- 2.When the precipitant is a chronic syndrome, symptoms may develop slowly at first and worsen gradually.
- D.Symptoms cause significant distress or functional impairment.
- E.Symptoms are not better accounted for by another disease or disorder
What causes PPPD?
PPPD often develops after a trigger that affects part of the balance system, such as:
- An inner ear disorder (like vestibular neuritis or BPPV)
- Vestibular Migraine
- A concussion or whiplash injury
- A medical illness or prolonged recovery period
- High stress, anxiety, or depression
Even after the original issue improves, the brain's balance system may stay "stuck" in an overprotective mode resulting in an aberrant cycle. This can lead to ongoing dizziness, unsteadiness, and sensitivity to motion or busy environments.
Is PPPD treatable?
Yes, PPPD is very treatable. It may take extended time or shorter time depending on the individual to get full resolution. Many people see significant improvement with the right approach, which often includes:
- Vestibular Rehabilitation Therapy (VRT): customized exercises to retrain balance and reduce dizziness, these must be performed by a vestibular therapist who has expensive experience or expertise with PPPD. Not all vestibular therapists are experts in treating PPPD.
- Education and support: understanding how PPPD works and knowing that symptoms can resolve
- Stress management or counseling (such as CBT): Understanding poor thought patterns and how they contribute to worsening symptoms
- Medication: certain prescription medications can help when combined with Vestibular Rehabilitation
What makes our approach to Vestibular Rehab different?
Expertise.
Dr. Ian Haslam of Integrated Movement and Health has years of experience treating some of the most challenging and complex patients with acute and chronic dizziness conditions, including but not limited to Persistent Postural-Perceptual Dizziness (PPPD), Vestibular Migraine, Meniere's, and other types of Functional Neurological Disorder (FND). He has treated numerous patients with PPPD. These patients often include those who have failed traditional Vestibular Therapy with other physical therapists, yet Dr. Haslam was able to return them to their previous level of function and resolve their dizziness. Dr. Haslam has treated multiple patients in-state and out of state from the University of Pennsylvania's Balance Center, Dr. Jeffrey Staab, MD at the Mayo Clinic, and other specialists, including ENT's and neurologists in the Philadelphia and surrounding areas.
Approach.
We take a holistic approach to your care; we don't just view you as your condition, but as a whole person. Sometimes, this requires addressing additional components that are important but often overlooked, such as anxiety, depression, or compounding orthopedic or neurological conditions. These factors can make it more challenging to understand and follow a plan of care related to your condition. We lastly believe that a positive attitude and a supportive environment are key to achieving success.
Philosophy.
We believe that physical therapy is not just about treating injuries, but about empowering our patients to take control of their own health and well-being. We prioritize education and prevention to help our patients achieve long-term results.
What past patients have to say:
"If you have 3 PD, Dr. Haslam is the ONLY physical therapist you want to work with. He is truly a knowledgeable specialist in the area of balance/vestibular problems, and as a bonus, he is a great practitioner and has also treated and helped me in more commonly known areas of PT. Dr. Haslam has empathy, listens exceptionally well, and
"If you have 3 PD, Dr. Haslam is the ONLY physical therapist you want to work with. He is truly a knowledgeable specialist in the area of balance/vestibular problems, and as a bonus, he is a great practitioner and has also treated and helped me in more commonly known areas of PT. Dr. Haslam has empathy, listens exceptionally well, and has the ability to asks questions that helped me better explain my symptoms. He is an unbelievable innovator when it comes to devising therapies that specifically targeted my needs. And, Dr. Haslam views patient teaching and education as one of the very important and necessary components in not only treating patients, but in helping them understand what is happening with their bodies, get better, and stay well. I am a health care provider and in my 55 years of practice Dr. Haslam is one of the very few practitioners I've come across with this unique mixture of knowledge, skills, and abilities. For all those who have 3 PD and need a DPT who specializes in this area OR you need a great physical therapist, Dr. Haslam is the DPT you will be glad to see and treat you."
B.W
"I spent years seeing different doctors with no relief for chronic dizziness- ent, neurosurgery, neurology, cardiology. I saw a dentist who thought I had TMJ issues. I tried upper cervical chiropractic which didn't help me. I went to vision therapy who thought I had BVD but that treatment didn't help. I even saw 2 other vestibular the
"I spent years seeing different doctors with no relief for chronic dizziness- ent, neurosurgery, neurology, cardiology. I saw a dentist who thought I had TMJ issues. I tried upper cervical chiropractic which didn't help me. I went to vision therapy who thought I had BVD but that treatment didn't help. I even saw 2 other vestibular therapists, one at mount Sinai and one at New York Presbyterian. The vestibular therapists I went to did the same thing and it only made my dizziness worse. I found Dr Haslam online and he was the first provider to actually tell me that I had Persistent Postural-Perceptual Dizziness(PPPD) and explained it in detail. His treatment approach is very different and was tailored to my specific issues which made all the difference in resolving my dizziness. If you would have asked me a year ago if I thought that I would have relief from this I probably would have said no but I am so lucky to have found someone who cares and is truly an expert in this condition."
Nilanthi A
"I was treated by Dr. Haslam through telehealth for my chronic dizziness. When I first started seeing him I couldn't go into the grocery store without feeling like I wanted to throw up from being so dizzy. I saw him after I saw multiple other doctors with no improvement. Neurology, ENT, primary care... they just wanted to give me pills
"I was treated by Dr. Haslam through telehealth for my chronic dizziness. When I first started seeing him I couldn't go into the grocery store without feeling like I wanted to throw up from being so dizzy. I saw him after I saw multiple other doctors with no improvement. Neurology, ENT, primary care... they just wanted to give me pills and weren't actually listening to me. Dr. Haslam was the first person to actually listen and explain what was causing my dizziness and now I am 100% back to where I was before. The best for vestibular therapy in Miami!"
Johan P
"I've been seeing Dr Haslam and just completed vestibular therapy for PPPD (chronic dizziness). I could not stand without holding on for more than a minute. And all I can say is he got me through this horrible condition. Where as now I got my life back, I can do normal simple things without holding on. I can highly recommend Dr. Haslam f
"I've been seeing Dr Haslam and just completed vestibular therapy for PPPD (chronic dizziness). I could not stand without holding on for more than a minute. And all I can say is he got me through this horrible condition. Where as now I got my life back, I can do normal simple things without holding on. I can highly recommend Dr. Haslam for anyone suffering with this nasty condition. He's the best!"
J.
"I worked with Dr. Haslam for several months. He really listened to the areas in which I needed help. He provided exercises to address the problems I was experiencing with dizziness and balance. He gave me homework, which really advanced my progress. I am so grateful for his expertise."
J.A
"Dr. Ian Haslam is the best PT for vestibular dizziness. His knowledge and professionalism really helped me deal with my balance problems."
J.R
Frequently Asked Questions
Please reach us via the contact us page if you cannot find an answer to your question and would like to further consult with us.
Most likely, yes, however due to the variable nature of healthcare, no guarantees can be made. That being said, Dr. Haslam has helped numerous people with PPPD. He has helped numerous patients get to very low manageable symptoms to helping patients completely abate their symptoms. This includes patients that were newly diagnosed with PPPD in addition to other patients who didn't have success with past physical therapy or vestibular therapy but saw relief with Dr. Haslam.
Not exactly. Many traditional vestibular therapy programs focus on exercises that train your balance system in a very structured and conscious way. With PPPD, that approach often isn't enough because PPPD is a type of Functional Neurological Disorder(FND), where the brain becomes overly focused on posture, balance, and threat signals.
My approach is different because I treat PPPD as FND. That means I focus on helping your brain reduce over-fixation, shift back into automatic movement, and relearn safe, effortless balance. Instead of drilling into symptoms, we retrain your brains movement patterns so that balance feels natural again, not forced. This approach often leads to faster progress and more lasting change.
I also work with you to identify and address the original trigger that set PPPD into motion and treat other symptoms that may or may not be a direct contributor. Whether the original cause was a vestibular episode, high stress, migraine, or other cause I work to figure it out and treat it. By treating the root cause in addition to the PPPD, we create a more comprehensive path to full and lasting recovery.
This is very individual dependent. Some individuals can see improvement on day 1 and others may see improvement over days, weeks, sometimes even years. Unfortunately, for some individuals improvement can be slow. Some individuals may not even notice their improvements because they are focused on their continued symptoms as opposed to the progress they have made in regards to function. Despite the timeline of progress, PPPD is very treatable!
Given the fact that I am not a licensed social worker, psychologist, or psychiatrist I cannot say that I do official CBT, however I will say that my approach is rooted in the principles of CBT with an emphasis on movement and response to dizziness and symptoms so the psychological piece of dealing with PPPD is not excluded in my treatment approach.
Fill out the contact us form or give us a call to get your first appointment scheduled
If you or someone you know are struggling with chronic dizziness, imbalance, or PPPD, you don't have to live this way. Specialized vestibular therapy and vestibular rehabilitation at Integrated Movement and Health can help you retrain your balance system, reduce symptoms, and regain confidence in your movement.
Contact Us
Integrated Movement and Health.
Phone: 610-679-9051 Email: Admin@integratedmovementandhealth.com
Hours
Monday - Sunday: By Appointment only
Integrated Movement and Health.
Phone: (610) 679-9051 Fax: 610 590-1663
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