COMPREHENSIVE NEUROREHABILITATION PROGRAM IMPROVES MAL DE DEBARQUEMENT SYMPTOMS IN 38 YEAR OLD MAN
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1
Carrick Institute of Clinical Neuroscience and Rehabilitation, United States
Background:
A 38 year old man presented with chief complaints of feeling every day like he was rocking on a boat fore and aft, up and down, as well as disequilibrium. Symptoms began eighteen months prior to presentation. Low frequency hearing loss of 20% in the right ear had been found. His symptoms were exacerbated by passive vestibular stimulation (e.g. sitting in a rocking chair) and walking into larger-sized rooms. He noted that two glasses of beer or wine temporarily decreased his symptoms, as did lorazepam and diazepam. His symptoms affected his quality of life because he was afraid to exacerbate his symptoms by simply going shopping and was feeling withdrawn socially.
Methods:
Neurological examination revealed complete loss of right arm swing during dual tasking of gait, plasticity of the eyes in right yaw and backwards pitch. VNG testing showed a small slow drift of the eyes down and mainly to the left with some occasional refixation and recentering of the eyes. Vertical pursuits upwards were saccadic. Vertical saccades upward were slower than downward. Optokinetic (OPK) testing to right demonstrated inappropriately long slow phases and an inadequate number of saccades. During the examination it was discovered that standing and walking perpendicular to an OPK stimulus moving in the same direction as gait would exacerbate his symptoms.
After 30 days on an anti-inflammatory diet did not decrease his symptoms, he was treated over three days with a multimodal neurorehabilitation program consisting of canal-specific gaze stabilization exercises, combinations of near target view and balance beams and foam pads, combination ambulation-fixation exercises, as well as active and passive translation.
Results:
After three days of treatment, the patient report 90% improvement in his symptoms. His symptoms were no longer exacerbated by the OPK stimulation. Right arm swing during dual tasking of gait improved. Vertical saccades improved as did OPK responses. He was able to go shopping at a large mall with no symptoms. Two weeks later, he had maintained the same level of improvement.
Conclusion:
The author suggests further investigation into multimodal neurorehabilitation in the treatment of Mal de Debarquement Syndrome.
Keywords:
Mal de Debarquement Syndrome,
Vestibular rehabilitation therapy,
Neurorehabilitation,
optokinetic stimulation,
Gaze stabilization
Conference:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function, Orlando, United States, 7 Oct - 9 Oct, 2016.
Presentation Type:
Poster Presentation
Topic:
Abstracts ISCN 2016
Citation:
Clark
DJ
(2016). COMPREHENSIVE NEUROREHABILITATION PROGRAM IMPROVES MAL DE DEBARQUEMENT SYMPTOMS IN 38 YEAR OLD MAN.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience: Clinical Neuroscience for Optimization of Human Function.
doi: 10.3389/conf.fneur.2016.59.00054
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Received:
02 Sep 2016;
Published Online:
07 Sep 2016.
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Correspondence:
Dr. David J Clark, Carrick Institute of Clinical Neuroscience and Rehabilitation, Cape Canaveral, FL, United States, mail@doctordavidclark.com