Chronic Dizziness & Vestibular Hypofunction (including PPPD)

Chronic dizziness is often caused by vestibular hypofunction, migraine-related dizziness, or persistent postural-perceptual dizziness (PPPD). Vestibular physical therapy uses gaze stabilization, balance training, and habituation to reduce symptoms and improve function. Evidence-based guidelines strongly support vestibular rehab for peripheral vestibular hypofunction.

Common symptoms

• Dizziness with head turns or walking
• Blurred vision when moving (oscillopsia)
• Imbalance, veering, “floating” sensation
• Motion sensitivity in stores/crowds/screens
• Feeling worse with quick movements or busy visual environments

What’s limiting (why it persists)

• Reduced vestibulo-ocular reflex (VOR) function (eyes can’t stabilize with head motion)
• Poor sensory integration (vision/inner ear/proprioception mismatch)
• Avoidance → deconditioning → more sensitivity
• PPPD pattern: persistent symptoms + visual-motion triggers

What helps

• Reduced vestibulo-ocular reflex (VOR) function (eyes can’t stabilize with head motion)

• Poor sensory integration (vision/inner ear/proprioception mismatch)

• Avoidance → deconditioning → more sensitivity

• PPPD pattern: persistent symptoms + visual-motion triggers