Mal de Debarquement and Posture: Reduced Reliance on Vestibular and Visual Cues

Objective: The neural mismatch theory assumes that the intersensory conflicts leading to motion sickness are resolved by changes in the relative weighting of the various senses that contribute to orientation. If this sensory rearrangement persists after disembarkment, it might result in mal de debarquement (MD): ataxia and a rocking sensation sometimes felt after landing. The objective of the present study was to examine possible changes in sensory organization in naval crew members with differing susceptibility to MD with computerized dynamic posturography (CDP). Study Design: Cross-sectional parallel-group design. Methods: Seventeen subjects susceptible to MD (SMD) and 17 subjects nonsusceptible to MD (NSMD) (healthy male volunteers aged 18-22) participated in the study. CDP was performed twice with each subject, before and immediately after sailing, using the EquiTest system (NeuroCom, Inc., Clackamas, OR). Results: The SMD group showed a significant reduction in their scores on sensory organization tests 3, 4, and 5 after sailing. Sensory pattern analysis revealed reduced use of inputs from the vestibular and visual systems to maintain balance. Prolonged latencies of the motor responses to unexpected pitch perturbations were also recorded in the postsailing CDP of the SMD group. Reduced performance on the presailing CDP task, which presents the greatest challenge to the vestibular system, was found to control for the presence of MD postsailing. Conclusions: The results show that MD is associated with postural instability, slower motor reflexes, and larger sways in response to abrupt changes in the body's center of gravity. These findings may be explained by under reliance on vestibular and visual inputs and increased dependence on the somatosensory system for the maintenance of balance.