SIRV
International Society for Vestibular Rehabilitation

vestib.org, the site for Vestibular Reeducation

Scrolling syndrome and the omission of vestibular information

Background
First acknowledged by Sémont, Freyss and the team of Lariboisière in the 1980s, it was Freyss who labelled and described the term vestibular omission.

Epidemiology
Scrolling syndrome is common among a large number of patients with established, long-term vestibular disorders.

Etiology
It is a neurosensory function disorder.

Physiopathology
We believe that visual dependencies manifest themselves in two phases:

  • phase 1: transfer of the burden of the use of vestibular information to visual information over time as the vestibular disorder sets in. The integrator centres "switch" to diminish any effects of aberrant vestibular information on equilibration. A healthy and adaptive phase.
  • phase 2: the new use schematics level off, irrespective of how the vestibular disorder evolves, even if it disappears completely.


Clinic
In the question and answer session, complaints centre around isolated incidents of imbalance, without vertigo, that often occur outside the home. The common denominator for all situations reported is a visual scrolling, relatively long-lasting, and at a relatively constant speed. Situations of discomfort are described below:
"I feel bad in large supermarkets" or "I don’t go there any more"
"I feel bad in crowds"
"in the street, I feel bad just as I am crossing the road after waiting and watching the cars drive by"
"I feel bad when walking I look just ahead of my feet"

We hear about situations where the patient is driving along, over taking lorries, or looking at the safety rail or the border that separate the different lanes or the trees that line the road.
The common denominator: scrolling.
 From a clinical perspective, therefore, a suitable name for visual dependence would be scrolling syndrome.
Apart from the Equitest™, using S.O.T.: Sensory Organisation Tests, traditional exploration does not focus on visual dependencies as these are purely functional disorders. There is a risk of leaning towards anxiety brought on by agoraphobia, psychogenic illnesses etc. rather that on the case of this syndrome, as a result of an increase in the neurosensory disruption.
In short, the simplest thing to do is examine imbalance using Whole-Field Optokinetic Stimulation.

Evolution
Rarely does the scrolling syndrome correct itself. Fortunately, it is sensitive to PEC during vestibular rehabilitation.

Treatment
The vast majority of these syndromes completely, or almost completely disappear after between 8 and 12 sessions with Whole-Field Optokinetic Stimulation, usually called a "planetarium projector", developed by Simpson’s team, the CNRS (French National Centre for Scientific Research) and Sémont in France.
The Whole-Field Optokinetic Stimulation generator operates in a very particular and dark environment, using a moving visual pattern: projection of different luminous shapes; a process that continues across the whole visual field.
To conclude, we plead to doctors to examine visual dependencies. It is simply a question  of asking a few questions.
Experience has taught us that Whole-Field Optokinetic Stimulation is an astonishingly powerful system. Improper use, or if the syndrome has not been taken into account, will result in imbalance and neurosensory disruptions. Anxiety-provoking imbalance gives the sensation of not being in control of ones body.
Or worse still, an agoraphobia, but which of course will only be implemented in a secondary manner. Conversely, if these counter-indications and application constraints are strictly adhered to, O.C.C.T. provides us with some astonishing results concerning this disorder, we repeat, purely functional, and in just a few sessions.

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