People with persistent postural-perceptual dizziness demonstrate altered postural strategies in complex visual and cognitive environments

Anat V. Lubetzky, Moshe M.H. Aharoni, Liraz Arie, Tal Krasovsky

Research output: Contribution to journalArticlepeer-review


BACKGROUND: People with PPPD report imbalance, increase in symptoms and impaired function within complex visual environments, but understanding of the mechanism for these behaviors is still lacking. OBJECTIVE: To investigate postural control in PPPD we compared changes in center of pressure (COP) and head kinematics of people with PPPD (N = 22) and healthy controls (N = 20) in response to different combinations of visual and cognitive perturbations during a challenging balance task. METHODS: Participants stood in a tandem position. Static or moving stars (0.2 Hz, 5 mm or 32 mm amplitude, anterior-posterior direction) were displayed through a head-mounted display (HTC Vive). On half the trials, participants performed a serial-3 subtraction task. We measured medio-lateral and anterior-posterior path and acceleration of COP and head. RESULTS: Controls significantly increased all COP and head parameters with the cognitive task whereas PPPD increased only COP ML path and acceleration. Only controls significantly increased head anterior-posterior medio-lateral acceleration with moving visual load. Cognitive task performance was similar between groups. CONCLUSIONS: We observed altered postural strategies in people with PPPD, in the form of reduced movement with challenge, particularly around the head segment. The potential of this simple and portable head-mounted display setup for differential diagnosis of vestibular disorders should be further explored.

Original languageEnglish
Pages (from-to)505-517
Number of pages13
JournalJournal of Vestibular Research: Equilibrium and Orientation
Issue number6
StatePublished - 2021

Bibliographical note

Funding Information:
The authors report no conflict of interest. Dr. Lubetzky was funded by grants from the National Institutes of Health National Rehabilitation Research Resource to Enhance Clinical Trials (REACT) pilot award and an Emerging Research Grant from Hearing Health Foundation. The sponsors had no role in the study design, collection, analysis and interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Publisher Copyright:
© 2021 - IOS Press. All rights reserved.


  • PPPD
  • balance
  • dual task
  • head mounted display
  • sensory integration
  • virtual reality

ASJC Scopus subject areas

  • Neuroscience (all)
  • Otorhinolaryngology
  • Sensory Systems
  • Clinical Neurology


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