468 - Steadying the Seas: Unlocking the Power of Vestibular Rehabilitation in Mal de Débarquement Syndrome – A Case Report

A 49-year-old male presents with neck and left shoulder pain radiating to his left arm, described as intermittent burning, sharp, and clicking. The pain worsens with lifting and turning his head. He has experienced intermittent vertigo for three years and now feels woozy when bending down or flexing his head. He reports weak grip strength, tingling in his last two fingers (C7-C8 distribution), and had positive Roo’s and Eden’s tests during the exam. Despite some improvement with physical therapy, he continues to struggle with unsteadiness, feeling ungrounded, especially when walking fast. He denies a spinning sensation but consistently feels unsteady, as if on a boat. He was diagnosed with Mal de Débarquement syndrome (MdDS). Treatment included prescription of meclizine and comprehensive vestibular rehabilitation.


Discussions: Vestibular rehabilitation is a specialized physical therapy for alleviating symptoms of vestibular disorders like MdDS. It involves exercises to promote central nervous system compensation for inner ear deficits, focusing on reducing dizziness, imbalance, and visual disturbances by enhancing sensory integration. In MdDS, the therapy often targets vestibulo-ocular reflex (VOR), vestibulospinal reflex (VSR), and vestibulocollic reflex (VCR) readaptation to improve visual gaze, body, and head stabilization, respectfully. Techniques include head roll exercises with visual stimulation, computer-assisted rehabilitation using virtual reality, and sensory reweighting to improve balance and stability.  

Conclusions: In conclusion, this patient’s symptoms improved with vestibular rehabilitation by enhancing central compensation and readaptation of the VOR, VSR, and VCR. This approach improves the persistent sensation of “rocking-motion”, balance and stability, as well as the patient's quality of life.