The Short Answer Educational content only. Any suspected concussion warrants medical evaluation. Consult vestibular-trained physical therapist, neuro-optometrist, or concussion specialist for individualized guidance. Mal de debarquement syndrome (MdDS) is persistent rocking, swaying, or bobbing sensation triggered by prolonged passive motion exposure or concussion (Silverberg et al., 2020). Symptoms characteristically improve during passive motion (driving, boat, plane) and worsen when motion stops. Female-predominant condition affecting approximately 90% women. Post-concussion MdDS is rarer than motion-triggered MdDS but occurs. Diagnosis requires persistent rocking sensation for 1+ month, absence of vertigo, and clinical exclusion of other vestibular disorders. Treatment includes vestibular rehabilitation, SSRI or SNRI medication, and optokinetic stimulation protocols. Recovery variable. MdDS causes persistent rocking sensation. Persistent rocking sensation. Symptoms improve with passive motion. Improve with passive motion. Female-predominant condition. Female-predominant condition. MdDS Diagnostic Criteria Persistent rocking, swaying, or bobbing 1+ month. Persistent rocking 1+ month. Symptoms improve during passive motion. Improve during passive motion. Symptoms worsen when motion stops. Worsen when motion stops. Absence of vertigo. Absence of vertigo. Preceded by prolonged motion or trauma. Preceded by prolonged motion or trauma. Clinical exclusion of other vestibular disorders. Clinical exclusion of other disorders. Triggers for MdDS Cruise ship travel (most common). Cruise ship travel most common. Long flights. Long flights. Extended car travel. Extended car travel. Concussion. Concussion. Whiplash. Whiplash. Migraine. Migraine. Hormonal changes. Hormonal changes. Spontaneous onset possible. Spontaneous onset possible. How Concussion Triggers MdDS Vestibular processing disruption. Vestibular processing disruption. Cerebellar involvement. Cerebellar involvement. Neural entrainment to motion frequencies. Neural entrainment. Failure to habituate to motion cues. Failure to habituate. Vestibular-visual mismatch persistence. Vestibular-visual mismatch. Symptoms Rocking sensation. Rocking sensation. Swaying sensation. Swaying sensation. Bobbing sensation. Bobbing sensation. Feeling of being on a boat. Feeling on a boat. Improvement while driving. Improvement while driving. Worsening at rest. Worsening at rest. Fatigue. Fatigue. Cognitive fog. Cognitive fog. Anxiety. Anxiety. Treatment Approach Optokinetic stimulation (Dai protocol). Optokinetic stimulation Dai protocol. Vestibular rehabilitation. Vestibular rehabilitation. SSRI medication (sertraline, escitalopram). SSRI sertraline escitalopram. SNRI medication (venlafaxine). SNRI venlafaxine. Benzodiazepines short-term. Benzodiazepines short-term. Cognitive behavioral therapy. Cognitive behavioral therapy. Multidisciplinary approach. Multidisciplinary approach. Prognosis Variable recovery. Variable recovery. Some spontaneous recovery within months. Some spontaneous recovery within months. Chronic in others. Chronic in others. Treatment improves symptoms 60-70%. Treatment improves symptoms 60-70%. Post-concussion MdDS often more persistent. Post-concussion MdDS often more persistent. Supporting Mobility Routine These exercises support MdDS recovery through cervical mobility and nervous system regulation. JME 155 Diaphragmatic breathing supports vagal tone and parasympathetic regulation during concussion recovery. 10 breaths every 60-90 minutes. JME 14 Chin tucks reduce upper cervical tension common in concussion injury. 10 repetitions with 5-second holds. JME 1 Cervical rotation supports cerebral blood flow and nervous system regulation. 10 repetitions each direction. JME 150 Thoracic rotation restores breathing depth shallow during concussion recovery. 8 repetitions per direction. Start your 3-day free trial for joint-specific mobility programs that support nervous system regulation through concussion recovery. How is MdDS different from PPPD? MdDS is triggered by prolonged passive motion exposure and improves during passive motion. PPPD is triggered by upright posture and worsens with motion. MdDS characterized by rocking sensation. PPPD characterized by unsteadiness and visual motion sensitivity. Distinct but related functional vestibular disorders. Different treatment protocols. Can MdDS resolve on its own after concussion? Post-concussion MdDS sometimes resolves spontaneously within weeks to months. Chronic MdDS persists over years without treatment. Treatment improves symptoms in 60-70% of patients. Optokinetic stimulation protocols show promise. SSRI and SNRI medications support recovery. Early diagnosis and treatment improve outcomes. What is the Dai optokinetic protocol for MdDS? Dai optokinetic protocol uses full-field visual stimulation with head roll to reset vestibular processing in MdDS. Developed by Mount Sinai Hospital. Effective in 60-70% of patients. Available at specialized MdDS centers. Multiple sessions required. Alternative to medication and traditional vestibular rehabilitation. Why is MdDS more common in women? MdDS affects approximately 90% women. Female predominance associated with hormonal factors, migraine comorbidity, and possibly vestibular processing differences. Perimenopause common triggering period. Estrogen effects on vestibular processing proposed. Migraine common comorbidity contributing to female predominance. Should I see a specialist for post-concussion MdDS? Yes. Vestibular neurologist or neuro-otologist supports diagnosis. Vestibular-trained physical therapist provides rehabilitation. Mount Sinai MdDS Foundation and MdDS Foundation provide resources. Psychiatrist for medication selection. Multidisciplinary approach essential. References Patricios, J. S., et al. (2023). Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine, 57(11), 695-711. PubMed Silverberg, N. D., et al. (2020). Management of concussion and mild traumatic brain injury: a synthesis of practice guidelines. Archives of Physical Medicine and Rehabilitation, 101(2), 382-393. PubMed