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Acrophobia and Pathological Height Vertigo: Indications for Vestibular Physical Therapy?

SL Whitney, PT, PhD, NCS, ATC, is Assistant Professor, Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, Pa, and Program Director of the Physical Therapy Department Centers for Rehab Services, Pittsburgh, Pa
RG Jacob, MD, is Professor, Departments of Psychiatry and Otolaryngology, University of Pittsburgh
PJ Sparto, PT, PhD, is Assistant Professor, Departments of Physical Therapy, Otolaryngology, and Bioengineering, University of Pittsburgh
EF Olshansky, DNSc, RNC, FAAN, is Professor and Chair, Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pa
G Detweiler-Shostak, RN, MSN, CS, is Psychiatric Nurse Specialist, Department of Psychiatry, University of Pittsburgh
EL Brown, BS, is research associate, Department of Psychiatry, University of Pittsburgh, and is currently a medical student at the University of Pittsburgh
JM Furman, MD, PhD, is Professor, Departments of Otolaryngology, Physical Therapy, and Bioengineering, University of Pittsburgh

Address all correspondence to Dr Whitney at Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260 (USA) (whitney{at}pitt.edu)

Background and Purpose. Acrophobia (fear of heights) may be related to a high degree of height vertigo caused by visual dependence in the maintenance of standing balance. The purpose of this case report is to describe the use of vestibular physical therapy intervention following behavioral therapy to reduce a patient's visual dependence and height vertigo. Case Description. Mr N was a 37-year-old man with agoraphobia (fear of open spaces) that included symptoms of height phobia. Exposure to heights triggered symptoms of dizziness. Intervention. Mr N underwent 8 sessions of behavioral therapy that involved exposure to heights using a head-mounted virtual reality device. Subsequently, he underwent 8 weeks of physical therapy for an individualized vestibular physical therapy exercise program. Outcomes. After behavioral therapy, the patient demonstrated improvements on the behavioral avoidance test and the Illness Intrusiveness Rating Scale, but dizziness and body sway responses to moving visual scenes did not decrease. After physical therapy, his dizziness and sway responses decreased and his balance confidence increased. Discussion. Symptoms of acrophobia and sway responses to full-field visual motion appeared to respond to vestibular physical therapy administered after completion of a course of behavioral therapy. Vestibular physical therapy may have a role in the management of height phobia related to excessive height vertigo.

Key Words: Acrophobia • Dizziness • Height phobia • Physical therapy • Vestibular rehabilitation • Virtual reality

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				R G Jacob, M S Redfern, and J M Furman Space and motion discomfort and abnormal balance control in patients with anxiety disorders J. Neurol. Neurosurg. Psychiatry, January 1, 2009; 80(1): 74 - 78. [Abstract] [Full Text] [PDF]