49 YOF with Mal de Debarquement Syndrome (MdDS) improves with Neuro-Rehabilitation
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Missouri Functional Neurology and Chiropractic, LLC, United States
Background:
A 49 YOF presents with a diagnosis of Mal de Debarquement Syndrome (MdDS). She states it began 6 months ago after a 5-day boat cruise. She describes it as a rocking sensation as if she was still on the boat that gets better while she is sitting still but increases as soon as she moves such as walking. She states she is also consistently falling backwards. She has recently returned from the New York research clinic for MdDS for a week of therapy with no symptom relief and has attempted physical therapy with no symptom relief as well. Patient has a history of lumbar spine vertebral fusion of L4/5.
Methods:
Neurological testing was performed which included Btracks modified Clinical Test of Sensory Integration and Balance (mCTSIB), Rand short form health questionnaire intake form (SF-36), and a subjective Borg scale. mCTSIB testing results showed patient scoring 61st percentile with eyes open on a firm surface, 2nd percentile with eyes closed on a firm surface, 22nd percentile with eyes open on a perturbed surface, and 33rd percentile with eyes closed on a perturbed surface, SF-36 questionnaire revealed Physical Function at the 80th percentile, Role Physical at the 75th percentile, Body Pain at the 74th percentile, General Health at the 76th percentile, Vitality at the 50th percentile, Social Functioning at the 37th percentile, Role Emotional at the 33rd percentile, and Mental Health at the 56th percentile, subjective Borg scale rocking sensation rated at a 0/10 when sitting still and a 5/10 when walking. The bedside neurological examination revealed decreased gain of eye pursuits going downwards and in both diagonal planes, a positive right head impulse test for decreased gain, a continuous downbeat nystagmus upon removing fixation, increased right patella reflex graded at a 3+ compared to left, positive right extinction of shoulder during right cheek and shoulder testing, gait revealed bilateral cantilever arms and wide based gait and patient fell turning around counterclockwise, a positive left arm for dysdiadochokinesia during rapid alternating movement testing, positive left arm finger to nose testing missing with eyes closed and an intention tremor, a positive left heel to shin tapping for dysrhythmia, symptoms were reproduced with lumbar spine flexion, lumbar spine left rotation, and lumbar spine left lateral flexion motions.
Treatment consisted of 12-1 hour visits in 7 weeks which included low back electric stimulation, passive left arm/leg figure-8 movements, passive movement of the head fast right/slow left on a single dot with gaze stability, passive fast posterior pitch/slow back to neutral on a single dot gaze stability, lumbar spine 128 Hz tuning fork vibration, lumbar spine repetitive peripheral somatosensory stimulation (RPSS), Mckenzie wall side glides stretching right/left/right, lumbar spine left rotation isometric hold, the Cat-Camel exercise, feet together eyes closed resisted balance training.
At-home exercises prescribed consisted of lumbar spine rotation isometrics, Mckenzie wall side glides, downward optokinetic stripes, passive bouncing on an exercise ball, passive single dot gaze stability followed by eyes closed feet together resisted balance training.
Outcome:
7-Week Follow-up Diagnostics:
SF-36 questionnaire showed Physical Function at the 95th percentile, Role Physical at the 90th percentile, Body Pain at the 95th percentile, General Health at the 90th percentile, Vitality at the 90th percentile, Social Functioning at the 80th percentile, Role Emotional at the 80th percentile, Mental Health at the 88th percentile. Btracks mCTSIB testing results showed with eyes open on a firm surface at the 96th percentile, eyes closed on a firm surface at the 91st percentile, eyes open on a perturbed surface at the 95th percentile, eyes closed on a perturbed surface at the 89th percentile.
Normal gain of the head impulse testing, no eye nystagmus upon removing fixation, Patient subjective score of 5/10 for rocking sensation while walking went to a 0/10 on the subjective Borg scale. Patient states she consistently leaves the office without the “rocking sensation” but that it will return within a couple of days to a 2/10 when walking if she does not do her exercises.
Conclusion:
Overall the patients Btracks mCTSIB scoring improved in every condition at 7-weeks. The SF-36 questionnaire showed improvement in all categories at 7-weeks. There was an improvement of subjective “rocking sensation” at 7-weeks follow-up. The current case supports multimodal neurological rehabilitation as an effective treatment for Mal de Debarquement Syndrome (MdDS). Further research needs to be done and investigated to include the most common body part and movement that is involved that brings on the symptoms in MdDS patients, in this case lumbar spine flexion/left rotation/left lateral flexion.
Keywords:
Mal de Debarquement Syndrome (MdDS),
Neurosciece,
Neurorehabilitation,
Neurology,
Clinical Neuroscience
Conference:
International Symposium on Clinical Neuroscience, Orlando, United States, 24 May - 26 May, 2019.
Presentation Type:
Poster Presentation
Topic:
Clinical Neuroscience
Citation:
Schmidt
M
(2019). 49 YOF with Mal de Debarquement Syndrome (MdDS) improves with Neuro-Rehabilitation.
Front. Neurol.
Conference Abstract:
International Symposium on Clinical Neuroscience.
doi: 10.3389/conf.fneur.2019.62.00055
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Received:
11 Mar 2019;
Published Online:
27 Sep 2019.
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Correspondence:
Dr. Michael Schmidt, Missouri Functional Neurology and Chiropractic, LLC, Centralia, United States, mofuncneuro@gmail.com