David Richardson



A case of Persistent Postural Perceptual Dizziness (PPPD) or (3PD) presented to a Chiropractor with significant symptoms and few neurological signs. This condition had been present for over three decades. These, largely vestibular signs and symptoms included: ‘foggy brain’, difficulty concentrating and reading, an almost constant feeling of disorientation, a feeling of “motion sickness”, and poor balance. Additional symptoms included peripheral vision being sensitive to bright light, phono-phobia and an intolerance to any constant background noise.


Other symptoms of note included that when travelling in a car, the patient would feel like the vehicle was still moving for about twenty seconds after the car had stopped.

He suffered dizziness when arising from the supine to sitting position, especially upon awakening and had reduced neck mobility, which was the reason for his initial consultation to a Chiropractor. Also, upon lifting binoculars to his eyes, he would fall forward to the degree that he had to brace himself before lifting the binoculars up to his face.


The patient had sought various treatments in the past and was given several diagnoses including: Motion Sickness, Benign Paroxysmal Positional Vertigo (BPPV) and ‘vertigo’. Treatment has previously included medication from several general medical practitioners, two neurologists and multiple sessions of physiotherapy. The patient claimed the treatment for BPPV by a physiotherapist reduced symptoms by 50% but the treatment effects did not last beyond 3 days. Medications of various types were reported as ineffective.


Novel vestibular rehabilitation techniques, included using a rotating chair, saccade training, a reaction timer panel and home exercises were utilised to good effect. Four weeks of treatment, alleviated the condition for the first time in over 30 years. The methods used were novel and not considered within the realm of typical general chiropractic management. This case presents a novel ‘Functional Neurological’ approach to management of a condition by a Chiropractor with a special interest in vestibular rehabilitation.


Key Words: PPPD, Chiropractic, Vestibular Rehabilitation, Rotating Chair, Sensory-Motor connectivity.


Case Reports