In Part I, we saw the 38 year-old female patient, learned the history and discussed assessment options for an individual with Mobius Syndrome. The key now for successful treatment of the Phobic Postural Vertigo, is how we utilized a combination of Cognitive Behavioral Therapy (CBT) and Vestibular Rehabilitation Therapy (VRT). The CBT will allow the patient’s subconscious release in a stepwise progression of physical activities, through additional encouragement and sense of accomplishment. The high-level VRT activities demonstrate to the patient, that although she may have experienced an episode of debilitating vertigo in the past, she is now completely free of symptoms and is capable of returning to normal function.

The assessment and treatment was all performed in a single session of two-hours. We are not attempting to deal with the psychological issues, which are at the genesis of the PPV. It is critically important to remember that this patient is not faking or malingering. They must be treated with respect and not dismissed or be made fun of. Our goal is to recover their balance function and ability to independently ambulate. If they are not already under medical/psychological care we refer to a behavioral health specialist.

PEARLS:
1. There are usually one or more assessment strategies to evaluate equilibrium function regardless of the challenges presented by the patient.
2. Patients with non-organic psychogenic involvement are not uncommon.
3. Balance dysfunction secondary to psychogenic conditions does respond well to a combination of CBT and VRT when applied in conjunction with a full continuum of care including management by behavioral health specialists.

References:
1. Cognitive-behavioral therapy. Rothbaum, Barbara Olasov; Meadows, Elizabeth A.; Resick, Patricia; Foy, DavidW.Foa, Edna B. (Ed); Keane, Terence M. (Ed); Friedman, Matthew J. (Ed), (2000). Effective     treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. ,       (pp. 320-325). New York, NY, US: Guilford Press, xii, 388 pp.
2. Association of Cognitive and Behavioral Therapies (ABCT) www.abct.org
3. Brandt, T. Phobic Postural Vertigo, Neurology, June 1996 vol. 46 no. 6 1515-1519