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Working-age adults' perspectives on living with persistent postural-perceptual dizziness: a qualitative exploratory study.

ABSTRACT: OBJECTIVES:To (a) explore the experiences of persistent postural-perceptual dizziness (PPPD), formerly chronic subjective dizziness on the personal, work and social lives of working-age adults; (b) enhance current understandings of the condition and its impact on the lives of working-age adults and (c) highlight points for consideration and importance to clinical practice. METHODS:This qualitative exploratory study drew on interpretive descriptive methodology. Working-age adults (n=8) diagnosed with PPPD were recruited from a single New Zealand community-based specialist clinic. Data from interviews (n=8) and postinterview reflections (n=2) were analysed using thematic analysis. RESULTS:Three themes were constructed: (1) It sounds like I'm crazy-referring to the lack of medical, social and self-validation associated with PPPD; (2) I'm a shadow of my former self-representing the impact of the condition on sense of self and life trajectory and (3) How will I survive?- highlighting individual coping processes. CONCLUSION:This study contributed to the existing body of knowledge by highlighting the complexity and fluidity of experiencing PPPD. It also drew attention to the tension between the acute illness framework that forms the basis of many therapeutic interactions and the enduring psychosocial support needs of the person experiencing PPPD. The findings highlighted that contextual factors need to be taken into account and that a person-centred and biopsychosocial approach, rather than a condition-specific biomedical approach, is needed for care to be perceived as meaningful and satisfactory.

SUBMITTER: Sezier AEI

PROVIDER: S-EPMC6500355 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Working-age adults' perspectives on living with persistent postural-perceptual dizziness: a qualitative exploratory study.

Sezier Ann Elisabeth Ignace AEI Saywell Nicola N Terry Gareth G Taylor Denise D Kayes Nicola N

BMJ open 20190401 4

<h4>Objectives</h4>To (a) explore the experiences of persistent postural-perceptual dizziness (PPPD), formerly chronic subjective dizziness on the personal, work and social lives of working-age adults; (b) enhance current understandings of the condition and its impact on the lives of working-age adults and (c) highlight points for consideration and importance to clinical practice.<h4>Methods</h4>This qualitative exploratory study drew on interpretive descriptive methodology. Working-age adults ( ...[more]

PMID: 30940754

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Project description:BACKGROUND:Persistent postural-perceptual dizziness (PPPD) is a common functional vestibular disorder characterized by persistent symptoms of non-vertiginous dizziness and unsteadiness that are exacerbated by upright posture, self-motion, and exposure to complex or moving visual stimuli. Recent physiologic and neuroimaging data suggest that greater reliance on visual cues for postural control (as opposed to vestibular cues-a phenomenon termed visual dependence) and dysfunction in central visuo-vestibular networks may be important pathophysiologic mechanisms underlying PPPD. Dysfunctions are thought to involve insular regions that encode recognition of the visual effects of motion in the gravitational field. METHODS:We tested for altered activity in vestibular and visual cortices during self-motion simulation obtained via a visual virtual-reality rollercoaster stimulation using functional magnetic resonance imaging in 15 patients with PPPD and 15 healthy controls (HCs). We compared between groups differences in brain responses to simulated displacements in vertical vs horizontal directions and correlated the difference in directional responses with dizziness handicap in patients with PPPD. RESULTS:HCs showed increased activity in the anterior bank of the central insular sulcus during vertical relative to horizontal motion, which was not seen in patients with PPPD. However, for the same comparison, dizziness handicap correlated positively with activity in the visual cortex (V1, V2, and V3) in patients with PPPD. CONCLUSION:We provide novel insight into the pathophysiologic mechanisms underlying PPPD, including functional alterations in brain processes that affect balance control and reweighting of space-motion inputs to favor visual cues. For patients with PPPD, difficulties using visual data to discern the effects of gravity on self-motion may adversely affect balance control, particularly for individuals who simultaneously rely too heavily on visual stimuli. In addition, increased activity in the visual cortex, which correlated with severity of dizziness handicap, may be a neural correlate of visual dependence.

Dataset Information

Working-age adults' perspectives on living with persistent postural-perceptual dizziness: a qualitative exploratory study.

Publications

Working-age adults' perspectives on living with persistent postural-perceptual dizziness: a qualitative exploratory study.

Similar Datasets

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