1. Effect of the BrainPort™ Balance Device on Patients with Mal de Debarquement Syndrome
Robert J. Stanley, MD
Kimberly L. Skinner, MPT
Yuri Danilov, PhD

2. Mal de Debarquement Syndrome (MdDS)
“Bad Disembarkment”
Rare – but more common than reported
Misunderstood
Life-altering
Usually follows a cruise or similar activity

3. MdDS: Balance Symptoms
Key=Persistent sensation of motion
Difficulty maintaining balance
Ataxia
Dizziness
Sx’s may abate during auto travel, yet increase afterwords

4. MdDS: Other Symptoms Fatigue Concentration problems
“Heavy head” / Headache
Memory loss
Anxiety and/or Depression

5. MdDS: Diagnosis No definitive test to diagnose Clinical diagnosis
Patients often include middle-aged women

6. MdDS: Etiology ? Unknown
? Inappropriate vestibular adaptation after a motion experience
? Migraine variant
? Under reliance on vestibular and visual inputs and increased dependence on somatosensory system for balance

7. MdDS: Prognosis May last months to years
Symptoms often recur secondary to motion challenge or stress

8. MdDS: Treatment No known cure Physical Therapy – may help
Medication (eg. Benzodiazepines, amitriptyline) may help

9. BrainPort™ Balance Device

10. Stimulus and Response
Accelerometer sends head position information to the electrode array on tongue
Patient feels tongue stimulus relative to head position (e.g. head left = signal on left side of array)
Patient maintains a centered body position by keeping the signal at center of tongue
Patient continues this task for 20 minutes, standing with eyes closed

11. BrainPort™ Balance Device: Why The Tongue
High density of nerve endings
Minimal electrical stimulation required
Receives and transmits signals to the brain at high resolution and speed
Close proximity to vestibular pathways
Consistent electrical contact
Constant chemical environment
Saliva is a good electrolyte
Non-invasive

12. Subject adjusts stimulus to
Patient Training
Subject stands with
eyes closed, using the signal on their tongue to maintain a centered position
Subject adjusts stimulus to
a comfortable level

13. Results Improved symptoms
Decreased rocking sensation when still and after walking
Decreased head pressure
Easier to control visual disruptions

14. Results Improved function
Able to turn head and change directions when walking without veering to one side
Exhibits confident, normal gait
Stable when standing on right and left leg.
Able to stand in tandem Romberg position with eyes open and closed

15. Improved function cont.
Results
Improved function cont.
Improved sleep
Improved cognitive awareness
Less difficulty with words
Feels more stable

16. Improved function cont.
Results
Improved function cont.
Less difficulty with driving
Able to shop in busy environment and fluorescent lighting without being disturbed
Able to walk comfortably in a crowd

17. Results

18. Results

19. Results

20. Results

21. Theories: Why does it work?
? Biofeedback  Head stabilization
? Head stabilization  affect on tonic neck reflexes
? Activation of vestibular nucleus through direct stimulation of lingual nerve pathway

22. Scope of Patients Tested
Nature of Deficit
Etiologies Tested
Common Observations
Peripheral
Ototoxicity
Ménière's disease
Acoustic Neuroma
Perilymphatic Fistulas
Endolymphatic Hydrops
Vestibular neuritis
Improved
Decreased
Balance
Posture
Gait
DHI
ABC
DGI
Falls
Stiffness
Rigidity
Fatigue
Oscillopsia
Central
Migraine
Auto Immune degeneration
Mal de Debarquement
Idiopathic origin
Age-related vestibular loss
Non-Vestibular
Central
Cerebellar lesion
Cerebellar ataxia – stroke, brain trauma
Parkinson’s Disease

23. Other Ongoing Studies Bilateral Vestibular Loss
Mayo Clinic
Washington University
University of Wisconsin
Unilateral Vestibular Loss
HNO Klinik, UKB, Berlin
Universitätisklinik der RWTH, Aachen
Hôspital Lariboisière, Paris
Great Ormond Street Hospital, London
Elderly with Balance Dysfunction