Dynamic postural stability, symmetry, and smoothness of gait in patients with persistent postural-perceptual dizziness

Background Patients with persistent postural-perceptual dizziness (PPPD) exhibit altered postural and gait dynamics, but development of these changes following precipitating illnesses is poorly understood. Objective To compare posture and gait metrics in patients with PPPD or subacute unilateral vestibulopathies (sAUVP) to healthy controls (HC). Methods Ten patients with sAUVP, nine with PPPD, and eleven HC completed the 10 Meters Walk Test (10MWT) (an eyes open task) and Fukuda Stepping Test (FST) (an eyes closed task). Gait stability, symmetry, and smoothness were compared among groups and correlated with Dizziness Handicap Inventory (DHI) scores. Results 10MWT – Patients with PPPD had lower pelvis stability and gait symmetry than HCs. Patients with sAUVP had only lower pelvis stability. FST – Patients with PPPD and sAUVP had lower gait smoothness than HCs. Patients with sAUVP also had lower gait symmetry. Among patients with PPPD, DHI scores correlated positively with head stability. Conclusions PPPD and sAUVP caused abnormal pelvis stability when walking and gait smoothness when stepping but differed in effects on gait symmetry with the presence/absence of visual inputs. For PPPD, visual stimuli had destabilizing effects, whereas for sAUVP vision aided stability. Symptom severity in patients with PPPD was related to head stability.