Vestibular Rehabilitation for Motion-Triggered Mal de Debarquement Syndrome (MDDS)
Vestibular rehabilitation is generally beneficial for patients with motion-triggered MDDS, showing improvements in quality of life and postural balance, though it should not be used during acute episodes. 1, 2
Effectiveness of Vestibular Rehabilitation for MDDS
- Vestibular rehabilitation (VR) refers to a wide range of physical exercises and maneuvers intended to promote recovery of function and mitigation of symptoms related to balance disorders 1
- VR has been shown to improve symptom control, safety, reduce risk of falls, improve confidence, and enhance quality of life in patients with vestibular disorders 1
- Studies demonstrate that VR improves quality of life (p < 0.001) and reduces intensity of dizziness (p = 0.003) in patients with vestibular complaints 2
- VR works through repetition of specific physical exercises that activate central neuroplastic mechanisms to achieve adaptive compensation of impaired vestibular functions 3
Safety Considerations and Potential Risks
- VR is generally considered safe with a preponderance of benefit over harm according to high-quality systematic reviews 1
- Potential risks include cost of therapy, time for appointments, and possible temporary exacerbation of acute symptoms 1
- VR should NOT be recommended during acute vertigo attacks as it may worsen symptoms 1, 4
- Traditional VR programs may have limited effectiveness specifically for MDDS patients compared to those with peripheral vestibular impairments 5
Special Considerations for MDDS
- MDDS differs from other vestibular disorders like Ménière's disease or BPPV, requiring specific approaches 6
- MDDS is characterized by persistent sensations of rocking and swaying that typically begin after prolonged motion exposure (usually sea voyages) 7
- Recent research questions the effectiveness of traditional VR for MDDS, as one study found that while VR reduced sway velocity, it failed to modify frequency content or improve Dizziness Handicap Inventory scores in MDDS patients 5
- A specialized protocol involving optokinetic stimulation paired with head roll at 0.167 Hz has shown a 64.1% success rate for MDDS treatment, which may be more effective than traditional VR approaches 8
Recommended Approach
- For chronic imbalance in MDDS patients, VR should be offered as it generally improves quality of life and postural balance 1, 2
- VR should be avoided during acute symptom exacerbations 1, 4
- Patients should be informed that traditional VR may have limited effectiveness specifically for MDDS compared to other vestibular disorders 5
- Consider specialized protocols like optokinetic stimulation with head roll, which have shown better success rates (64.1%) specifically for MDDS 8
- Monitor progress regularly, as improvements in postural balance can be observed through functional tests even when not detected by stabilometry 2
Common Pitfalls to Avoid
- Misdiagnosing MDDS as another vestibular disorder like BPPV or Ménière's disease, which have different treatment approaches 6
- Using vestibular suppressants long-term, which can interfere with central compensation and delay recovery 4, 9
- Expecting immediate results from VR, as benefits typically develop over weeks of consistent practice 1, 2
- Failing to recognize that MDDS symptoms often improve with re-exposure to motion, unlike other vestibular disorders 7