If you have ever been on a ship for a long time, you know the strange feeling when you have solid ground under your feet again: The ground seems to sway similar to a ship.
As a rule, this disappears after a few minutes or hours. If someone was on a longer cruise, then it can take until the next morning for the world to get back on track.
About ¾ of all seafarers reported a feeling of swaying (forward/backward, up/down, sideways), according to one publication, but this dissipates after about 24 hours in the vast majority. In one study, even more than 90% were affected.
In addition to a sea voyage, flights, train journeys or other irritating movement experiences can also be at the beginning. Very often a combination of movement and uncertainty is found.
In a few people, the symptoms persist for weeks, months or even years. There are no clear figures about the frequency of the symptoms, it is suspected that it may be more common than is known in everyday medical practice. This condition is called Mal de Debarquement. This is derived from the French Mal = disease and Debarquement = to leave a ship. In English, it is referred to as Mal de Debarquement Syndrome (MdDS).
About MdDS
The focus is on the feeling of swaying in all directions, similar to being on a boat. Some patients can indicate whether they seem to be on a "small boat" with short movements or then again on an "ocean liner".
In addition to the core symptomatology (rocking), after a while there are other symptoms: Drowsiness, dizziness, nausea, balance disorders, disorientation, headaches, fatigue, sensitivity to stimuli, concentration disorders, tinnitus, increased anxiety , depressiveness and other functional disorders.
Who is often affected?
There is still little confirmed knowledge here. However, there is clear evidence that the following groups are more frequently affected:
- Women
- People who are prone to seasickness
- People with depressive symptoms
- People who have been exposed to particularly strong fluctuations
- It is also possible that migraine patients suffer more frequently from the unpleasant swaying following a sea voyage. From my own observations, people with higher sensitivity, anxiety and other functional disorders seem to be particularly affected.
Case history
The 65-year-old Angelika came accompanied by her husband and rose heavily from the chair in the waiting room. Her husband Carsten immediately grabbed her under the arm. The walk to the consulting room was slow, wide-legged and unsteady.
The following had happened: Carsten had wished for a trip by ship for his 65th birthday, and Angelika had finally agreed after much hesitation. She was afraid of the sea and feared getting seasick.
Her fears were realized: the trip was a complete fiasco. Strong winds were followed by storms, and Angelika lay in her cabin most of the time with severe nausea. She longed only to finally have solid ground under her feet again. Carsten had a guilty conscience about having done this to his wife.
When they were finally back on land, she was horrified to discover that the swaying had not stopped at all, but had continued abruptly. Angelica burst into tears, she had the feeling of having to struggle for breath, her heart was racing.
Carsten's heart was also swaying a little, which he found almost amusing. After a few hours, however, it was over. Not so with Angelica. The swaying would not subside. Not after days, not after weeks and not even after months.
Almost 1 ½ years the swaying already lasted when Angelika came to us. What she had learned: It only got better when she lay down. And that's why she practically only lay on the couch during the day. She didn't go out of the house anymore, had hardly any social contacts and felt increasingly miserable. She became tired, exhausted, sensitive to stimuli and depressed.
Therapy
Angelica was very scared when we started therapy. She felt completely helpless and dared to take practically no step without a support person at her side. However, it did her good to have her tense neck and back muscles massaged and loosened. For the walking and balance training, however, she really needed to overcome herself, as the swaying got worse in the first few days.
By the end of the first week of training, however, there was hope for improvement. She was able to take a few steps back on her own. After that, things went uphill - with setbacks. After three weeks she was able to walk freely again and Angelika was able to participate in life more or less normally. The swaying was much better, however, she still sometimes felt not quite secure on her feet.
Video: About MdDS (English Version)
Background
Designation and frequency
This illusion of movement occurs in most people who have been on a swaying surface for a long time. Scientific studies speak of up to 80% of all healthy people perceiving at least a slight swaying when walking on land. A short-term impairment is of course not a disease and is called "Mal de Debarquement" (MDD) thus without the addition "syndrome".
However, a small proportion of shore walkers do not get rid of this discomfort. This is a real disease with a considerable impact on the quality of life and is then called "Mal de Debarquement Syndrome" (MDDS).
Trigger
In most cases, the symptoms occur immediately after a passive movement (ship, plane, car, bus, etc.). However, recently we have also seen some patients in whom the symptomatology reported with a delay of one or more days. At the same time, it is sometimes difficult to recognize the triggering situation. Even rocking on a rocking chair, driving over a pothole with a car, even walking is apparently capable of irritating our balance.
Fear and panic
In many cases, severe anxiety or a panic attack plays a significant role in the development of MdDS.
Panic attacks in combination with an irritating movement apparently lead to a wrong linkage in the complex system of movement control.
For example, one patient reported suddenly experiencing a violent jolt while passing an object on the roadway during his usual commute to work. He said he was incredibly frightened and developed a panic attack. He had even gone to the hospital out of fear, where no abnormality was found.
Since that day, unfortunately, he now suffers from the constant feeling of a pseudo-motion like in a car.
Background
Overall, the causes are only beginning to be understood. However, it is clear that the so-called "vestibulo-ocular reflex" is of central importance. To understand this, the following considerations.
When you turn your head, the retina of your eye captures a new image. How can you now know that you have only looked in a different direction and that the world has not turned around you? This is only possible because at the same time your organ of equilibrium and the muscles of the neck have provided another piece of information: You have actively turned your head! The brain processes this to the impression: The world is stable and I have moved.
Self-experiment
You can find out how important this reflex is with a three-step experiment (start the movie above).
Take a text (book, newspaper) and read a few lines while moving your head about 20-30° in a nodding motion from down to up again (as if you were nodding a "yes" all the time). You can still read the text reasonably well.
Now hold your head steady and move the page/book again by 20-30° in the same rhythm still up and down. You will quickly notice: Significantly more difficult!
Finally, ask a partner to move the page/book up and down again by the same angle and at the same speed. The result: completely illegible!
The explanation: In the first case you get very several space. and movement information (eye muscles, equilibrium organ, neck muscles). In the second case, the additional information comes only from the arms. And in the third case you are missing the information from your own body completely.
Eye movements
The eyes perform complex compensatory movements when the head moves.
- Left-right
- Up-down
- Rotational movements
Similarly, the neck muscles, back and legs contribute to stabilization. There are sensors in all of these muscle groups that provide information about tension and position.
Adaptation
During a sea voyage (or similar movement), the body is constantly moving. The system of eyes, equilibrium organ, muscles and especially the central stimulus processing now works like the stabilization system of a camera. Despite the movement, subjectively a stable image of the outside world is created.
For example, you can bounce on a trampoline and at the same time you are able to perceive the outside world in a stable way. You could effortlessly talk to someone, could possibly watch a TV program on the side. If you take a video camera with you on the trampoline for comparison, you will immediately see the drastic difference between the unbearably blurred film recording and the stable image you perceived internally.
In short, we have an extraordinarily "advanced" stabilization system that even the most modern cameras can't match.
During a sea voyage (or similar movement), the body is constantly moving. The system of eyes, equilibrium organ, muscles and especially the central stimulus processing now works like the stabilization system of a camera. Despite the movement, subjectively a stable image of the outside world is created.
For example, you can bounce on a trampoline and at the same time you are able to perceive the outside world in a stable way. You could effortlessly talk to someone, could possibly watch a TV program on the side. If you take a video camera with you on the trampoline for comparison, you will immediately see the drastic difference between the unbearably blurred film recording and the stable image you felt internally.&
In short, we have an exceptionally "advanced" stabilization system that even the most modern cameras can't match.
Model presentation
Even though it is not completely clear scientifically how exactly a Mal de Debarquement Syndrome is to be understood, we assume that it is about an uncompleted resetting. The brain has successfully adjusted to a situation (swaying) and fails to make the new correction (solid ground). It remains in "sway mode" and continues to provide the information that would be necessary to compensate for swaying of the environment.
Thus it becomes understandable that the symptomatology subsides in most of the affected persons as soon as they go back to the swaying ground (boat, car, airplane, train, etc.). Now everything is right again.
Problem of avoidance
A second - common - solution is avoidance. Many people notice that the dizziness gets better when they are at rest (chair, couch, bed). But if you are constantly resting, you are no longer exercising the vestibular system. Therefore, already after one week of bed rest, most people suffer from an initial dizziness or unsteadiness in walking. Those who then take this as confirmation that walking is dangerous easily get into a vicious circle that leads to further dizziness. This is - incidentally - a common problem in older people who have been bedridden for a while.
Therapy
Calmness and security
Therefore, the first condition for practicing is security and inner calm. The training always makes more dizziness in the beginning and therefore more anxiety. Therefore, anxiety calming is at the beginning of therapy.
"Don't be afraid!" - that is easy to say. However, those who suffer from dizziness feel centrally insecure. Therefore, in addition to education, we also focus on a calming atmosphere, felt and physically perceptible security.
To convey this sensually, we use massages, warmth or relaxation procedures. They should tell the body: everything is alright!
Training
From our point of view, training in safety is the focus of a promising therapy. The system of eye, balance organ, muscle and joint perception must be recalibrated. This requires practice, practice and again practice!
What prevents practice is, of course, the dizziness and the fear associated with it. Thus, the dizziness prevents the very exercise that could lead out of the dizziness.
But this is only the first step. The more important one is the second: Now the balance has to be challenged by as many complex movements as possible in order to reorganize itself. The interaction of the eyes and the felt movement of the body is most important. It is to be learned that the world is represented also under different movements, nevertheless stably inside.
Therefore, we expose the bodies to numerous movement impulses and thereby promote the stable perception of the outside world. Walking on smooth or irregular surfaces, bouncing, tilt table, head movements with changing images, wobble plate, Galileo, walking with reduced gravity and video animation. Even learning to juggle trains the coordination between eye and body movement. All of this challenges the body to learn new patterns and override the old pattern of movement.
It is important to avoid fear or even panic, otherwise the old organization will be held on to instead of learning something new. Over-exertion but under-exertion (sparing) is therefore equally unfavorable.
As intensive as possible
Another basic principle of training is constant repetition in close temporal relation. So instead of practicing occasionally over a period of months, it is much more effective to immerse oneself in the therapy and experience new things over many hours. Therefore, intensive therapies with an abundance of sensory input are much more effective than half an hour of physical therapy per week.
However, this intensive training does not have to be carried out for long. As a rule, two to three weeks are sufficient to achieve a reorganization of the balance. At the beginning, this is not easy, but then the first successes appear.
For many years, therapeutic options were very limited. The so-called vertigo drugs that were often used proved to be largely ineffective. As in other cases, they are probably even harmful in the long term, since their depressant effect prevents balance learning processes. In view of the anxiety and restlessness, tranquilizers and antidepressants were also used. Their effect was better, but by no means sufficient.
Breakthrough
But then there was a therapeutic breakthrough. At the beginning of it was the consideration that eye movements in MDDS are misadapted and still try in vain to compensate, for example, for a ship's movement. To establish the "land" pattern, patients were asked, as a first step, to imitate the perceived ship motion by tilting their head left-right. At the same time, a slow-moving striped pattern was projected in front of them on a drum-shaped background. The patients were now asked to follow this pattern with their eyes. This exercise was repeated several times a day. The success was overwhelming. 70% of the participants reported improvement or even freedom from symptoms within just one week!
How was this possible? First, the "ship" movement pattern is activated by the head movement. The corresponding involuntary compensatory movement of the eyes is now "forcibly" prevented by fixation on the stripe pattern. The movement pattern "ship" can no longer be maintained and is deactivated. This creates the conditions to be able to switch back to the matching pattern "land".
As we see with us, after months or years, MDDS patients are mentally unsettled and physically-muscularly very tense. For this reason, we pay special attention to a soothing, calming atmosphere during therapy and release the cramps and hardening of the muscles with physiotherapeutic applications. Breathing therapy and supplementary, further dizziness exercises (e.g. on the trampoline) have also proven to be very helpful.