title: Acrophobia and pathological height vertigo: indications for vestibular physical therapy?
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA. whitney@pitt.edu
authors.forename: Susan L
authors.initials: SL
authors.lastname: Whitney
authors.forename: Rolf G
authors.initials: RG
authors.lastname: Jacob
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Sparto
authors.forename: Ellen F
authors.initials: EF
authors.lastname: Olshansky
authors.forename: Gail
authors.initials: G
authors.lastname: Detweiler-Shostak
authors.forename: Emily L
authors.initials: EL
authors.lastname: Brown
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Furman
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D011795:Surveys and Questionnaires; D014717:Vertigo / Q000503:physiopathology / Q000534:rehabilitation*; D015837:Vestibular Diseases / Q000503:physiopathology / Q000534:rehabilitation*; D014724:Vestibular Function Tests