Physical Therapy treatment of MdDS (Mal de debarquement Syndrome)

Timothy C. Hain, MD • Page last modified: September 24, 2022

This page is part of a collection of pages discussing ineffective or at least unproven treatments for MdDS, as judged by the Cancieri et al study (2018). There is more promise in medication treatments.

Physical therapy: The evidence for a positive role for vestibular physical therapy in MdDS is somewhere between nonexistent and weak (Hain and Helminski, 2007). In the Canceri et al survey survey (2018), "Physio" was reported beneficial in 27%, similar in frequency to the effect of vitamins/minerals (25%).

In our original study of MdDS (Hain et al), 10/15 persons who had vestibular rehabilitation reported improvement, but the natural history of MdDS is to improve, and one wonders what would have happened had they not undergone rehabilitation. In other words, this was an uncontrolled study, which sheds no light on whether PT is helpful. Cha commented in passing that "only rare patients seem to be cured by vestibular therapy" (Cha 2012). In fact, the only peer reviewed literature describing physical therapy treatment for MdDS are two case reports (Zimbelman and Watson 1992; Liphart et al, 2014). Of course, it is not known how these cases would have done without PT. In other words, these were not controlled. In general, while many individuals with MdDS undergo vestibular rehabilitation, again because of a lack of controls, it is not possible to determine whether they did any better than persons who were not treated (Hain, Hanna et al. 1999). Thus the efficacy of vestibular rehabilitation for MdDS is unknown.

While we find this idea very doubtful, if MdDS is indeed due to inappropriately high weighting of somatosensory input, vestibular physical therapy protocols that teach down-regulation of somatosensory input seem worth considering. Liphart (2015) reported results of "sensory reweighting therapy in a single atypical case. The single subject "felt she had improved 50%". This is not too different from results of roll OKN adaptation. A controlled trial of vestibular rehabilitation in a large number (i.e. 20) of MdDS subjects could be helpful in clearing up this question (hope someone funds this !). Our guess is that results of vestibular rehabilitation treatment would not be any different than no treatment. Hard to get published too.

If MdDS is instead caused by an internal oscillator developed to predict boat motion, one's treatment strategy should be aimed at manipulation of psychological variables rather than somatosensory integration.

In the Canceri et al survey (2018), Meditation did a little better than "physio" (34%). This suggests that physical therapy has no measurable effect on MdDS. Perhaps however, someone will "find the right protocol". Hope springs eternal ...