MdDS Reset VORtex User Manual

Introduction

Introduction

May 31, 2021
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About MdDS Reset VORtex

About MdDS Reset VORtex

January 5, 2022

MdDS Reset VORtex is a medical device intended to treat Mal de Débarquement Syndrome (MdDS). The treatment is only intended for those persons who have had a proper diagnosis of MdDS by a professional. A patient can do the treatment by her/himself, or assisted by a family member or friend, or administered/supervised by a professional. This user manual explains how to use the system.

You can click on the images below to enlarge them; press the escape key to close the image again.

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MdDS treatment overview and advice

MdDS treatment overview and advice

January 18, 2022
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What's the underlying basis for this treatment?

What's the underlying basis for this treatment?

January 19, 2022

The hypothesis underlying our treatment is that MdDS is caused by a maladaptation of the functional component of the Vestibulo-Ocular Reflex (VOR) called velocity storage, whose readaptation can be stimulated by exposure to whole-field visual motion coupled with head tilts.

Or to explain it slightly easier... Visual input from your eyes is an important component of your overall sense of balance. That visual input is stored in an area of the brain, the Vestibulo-Ocular Reflex (VOR). With MdDS, that visual balance information has been stored incorrectly. Our treatment enforces a readaption of the VOR, by showing stripes running in the opposite direction of the recorded sense of movement, combined with head tilting.

This kind of treatment has been practiced for many years now using optokinetic booths (OKN booths) around the world. Our treatment, MdDS Reset VORtex, is simply a more mobile version of such an OKN cabin but achieves the same effect.

So, MdDS Reset VORtex or an OKN Cabin perform a "reset" of the VOR. But after the treatment, it is important to "set" the VOR again with normal visual vestibular information, which is why it is strongly advised to go out directly after the treatment: take a walk, go biking, do a sport with hand-eye coordination, like tennis or badminton or another ballsport. This is really important.

What does the treatment look like?

What does the treatment look like?

January 18, 2022

As said above, the MdDS Reset VORtex mimics treatment in the optokinetic cabin (OKN cabin). In such a circular cabin, a patient is placed on a chair in the center of the cabin. Moving stripes are projected on the sides of the cabin, and the patient moves her/his head from left to right in a given frequency while concentrating on the passing stripes.

MdDS Reset VORtex shows those vertical (or horizontal, if that is the requirement) stripes on a smartphone mounted inside VR glasses. As the patient, with the VR glasses on, moves her/his head from left to right, the moving stripes remain vertical (or horizontal). That way the same optokinetic stimulus is delivered to the patient.

Click here to see both OKN cabin and MdDS Reset VORtex in action.

Warning: you will be shown moving optokinetic images. Be careful if you are sensitive to such visual patterns.

The treatment itself consists of two 4-minute sessions, as is the case with treatment using the OKN cabin.

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What to expect as a patient when using the treatments

What to expect as a patient when using the treatments

March 22, 2022

In a sample of 77 patients treated over the last couple of years, the specialists at the University of Antwerp and Sint-Augustinus Hospital recorded a success rate for optokinetic (OKN) treatment of 76%. The OKN treatment consisted of both the OKN cabin and MdDS Reset VORtex, with comparable results for each.

This means that as a patient, you have a very high probability that MdDS Reset VORtex can indeed help you, but like with all medicins or treatments, there is no guarantee.

Experience also learns that patients react differently to optokinetic (OKN) treatment with either the OKN cabin or MdDS Reset VORtex. Some patients immediately feel a positive impact, for others it will take a number of days and treatments before feeling an improvement, and there may be patients for whom it will take a couple of weeks.

This means that an approach with patience to these treatments is advised. Please give it the good part of a week (with two treatment sessions per day, one in the morning and one in the afternoon) first to see if it helps. If you do not feel improvement, then please consider changing the direction of the stripes as explained in this section, but proceed with caution - stripes direction is to be taken seriously.

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A formal MdDS diagnosis is crucial

A formal MdDS diagnosis is crucial

January 18, 2022

Our treatment, MdDS Reset VORtex, is intended only for those patients with a positive MdDS diagnosis. If you do not have MdDS the experience may altogether not be very pleasant. We know that it is often not easy to get a proper vestibular diagnosis, and we will help you any way we can, so if you are unsure, please leave us a note and we will see if we can help you.

Do know that there are many balance disorders, and only MdDS can be treated with MdDS Reset VORtex. Please get a proper MdDS diagnose from a medical expert before using our product.

Please be advised that when you agree to our terms and conditions, which you have to do before using our treatment, you confirm that you have a proper MdDS diagnosis.

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Treatment and feedback to measure progress

Treatment and feedback to measure progress

January 19, 2022

An MdDS Reset VORtex treatment consists of 5 steps:

  1. Subjective feedback on how you feel prior to the treatment;
  2. Objective feedback on your balance capability using a Romberg balance test prior to the treatment;
  3. The actual optokinetic (OKN) stripes treatment;
  4. Objective feedback using a Romberg after the treatment;
  5. Subjective feedback on how you feel now after the treatment.

After the treatment itself, go out! Fill your brains again with normal visual information. Take a walk, go biking, do a ball sport... Do this for about an hour or so. This is really crucial in order to get true benefit from the treatment.

The subjective and objective feedback data is captured and allows for progress tracking over a series of treatments - are you gradually getting better or not? If not, some corrective measures need to be taken.

Direction of the optokinetic stripes

Direction of the optokinetic stripes

January 18, 2022

As you may know, MdDS is caused by an incorrect registration of visual balance information by the Vestibulo-Ocular Reflex (VOR), which causes the rocking, bobbing and swaying sensations. Optokinetic treatment tries to reverse the incorrectly registered information by reversing the direction which causes the balance discomfort. Determining the correct direction of the stripes is therefore crucial in order to achieve a positive treatment.

There are ways to determine the direction that needs to be applied to a patient:

  • An Unterberger or Fukuda stepping test: as you can see in this demonstration this test tries to determine in which direction the patient diverges, by having the patient closing her/his eyes, arms stretched in front, and stepping in place for 1 minute (or 50 steps). Make sure you have enough free space and never do this stepping test alone - have someone in the room to protect you from bumping into things or falling. If after the test the patient clearly stands in a particular direction, then the stripes should be administered in the opposite direction;
  • The patient may experience a clear direction in which she/he is pulled; the stripes should be administered in the opposite direction. Also, if the sensation is left/right, then vertical stripes should be delivered (to the left or the right); if the sensation is more to and fro, then horizontal stripes are in order (up or down).

Both these points may help to determine the direction of stripes that need to be delivered, but unfortunately they are not a 100% reliable indicator. If after a couple of treatments you do not feel any improvement, please consider changing the direction of the stripes; this direction can be set in the preferences menu. Alternatively, you can seek advice from a medical expert.

Warning: MdDS Reset VORtex is not a toy

Warning: MdDS Reset VORtex is not a toy

January 18, 2022

A final note of warning: MdDS Reset VORtex is not a toy. These treatments will affect you, and when used correctly, hopefully for the positive, but only if you are indeed an MdDS patient. 

  • Do not experiment without any reason with MdDS Reset VORtex;
  • Do not run stripes in another direction if that is not warranted (e.g. treatment has no or little effect, then a change in direction can help) or advised by a specialist;
  • Do not extend the duration of the treatments;
  • Use the prescribed treatment sequence (2 treatments of 4 minutes with 5 minutes pauze in between);
  • Do not overuse the treatments - it will not necessarily help you and can have negative effects. Two treatment sessions per day is the advised frequency.

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Setting up MdDS Reset VORtex

Setting up MdDS Reset VORtex

January 18, 2022
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MdDS Reset VORtex system overview

MdDS Reset VORtex system overview

January 18, 2022

The MdDS Reset VORtex functionally consists of two pieces of software, running on two different devices:

  • The Viewer: a smartphone which sits inside the VR glasses and which are worn by the patient.
  • The Controller: controls the Viewer on another device. You can use any device to run the Controller, both desktop and smartphone.

Minimum requirements:

  • Viewer: a set of VR glasses, designed to hold a smartphone;
  • Viewer: an Android-based smartphone, with a screen as large as possible (preferably 6" or more), but which still fits your VR glasses;
  • Controller: any desktop (PC/Mac/Linux), tablet or smartphone (iPhone or Android) with a browser;
  • Both devices need to have an internet connection. It is not necessary that they are on the same network - the system also works between networks. So one could e.g. be on the hospital's network, and the other connected via 4G, that works fine. But it is probably easiest and most straightforward to have them connected to the same wifi network.

Unfortunately we currently do not support the iPhone as a Viewer device, because of the lack of support by Apple of some VR standards we use (WebXR). When that changes we will be more than happy to support the iPhone.

Phone compatibility check

Phone compatibility check

January 18, 2022

The MdDS Reset VORtex Viewer software needs to be able to access certain sensors in the smartphone in order to be able to function properly. To ensure that a specific smartphone can be used as an MdDS Reset VORtex Viewer, we have set up a testpage at https://mddsreset.io/deviceinfo. If you open that page on a smartphone (and ONLY on a smartphone), you'll get a result page that looks a bit like the screenshot below. If all necessary sensors are present and the browser is capable of accessing them, you'll get a screenshot like the one below, with green checkmarks. If something is not accessible the checkbox will be red.

In theory (and as far as we know) every Android smartphone that passes this test can be used as a Viewer device. Apple iPhone is currently not supported as a Viewer.

Scan the QR code below with your intended Viewer device to see if your phone is compatible.

Choosing a new smartphone as MdDS Reset VORtex Viewer

Choosing a new smartphone as MdDS Reset VORtex Viewer

February 23, 2022

If you need to purchase a new Android phone to use as an MdDS Reset VORtex Viewer, you need to know if it has the following characteristics:

  • Android-based phone (iOS is unfortunately currently not supported as a Viewer - see below)
  • Large screen: preferably 6 inches and up
  • Has Accelerator sensor
  • Has Gyroscope
  • Has Compass

Don't worry, there are a lot of phones that comply. There is an outstanding website called GSM Arena that can help you in choosing the correct phone. Its Phone Finder page allows you to select the right criteria. Here are direct links to currently available compatible phones of some of the more popular brands:

Alternatively, you can go to a store and scan the QR code below with the device you want to buy to check if it is compatible.

These are the phones we have used and tested and we know will definitely work and that we therefore can recommend:

  • Samsung Galaxy A21S (purchased December 2020)
  • OPPO A54 5G (purchased November 2021)
  • OnePlus Nord CE 5G 128 GB (purchased November 2021)
  • Xiaomi Poco X3 Pro 128 GB (purchased November 2021)
  • vivo Y21 (purchased November 2021)
  • Realme 6i (purchased January 2022)

A good tip to get a device somewhat cheaper: the Samsung Galaxy A21S (every part of this phone's name counts, including the 'S'!) has been discontinued in the meantime by Samsung. That means that it is often available on secondhand sites like Ebay. Here's the selection I found on the Belgian Ebay site. So maybe check your local secondhand sources to score one?

There are phones however that we know that do NOT work: the Samsung Galaxy A32 and the Samsung Galaxy A22. They both have a bug that prevents our software to run properly. It's a faulty WebRTC implementation if you want to know - we are not the only ones who have run into this problem. So please get another phone, preferably a model that we know works.

Some more investigation shows that the A22 and the A32 share the same chipset, which is not present in any of the phones we know that work (chipset Mediatek MT6769V/CU Helio G80). It is still an assumption, but for the moment we do not advise to purchase a phone with that chipset.

Based on that information is this the blacklist of phones NOT to buy:

  • BLU G91s
  • Honor Play 5T Pro
  • Huawei Y9a
  • Infinix Note 8
  • Micromax In 1
  • Realme Narzo 10
  • Samsung Galaxy A22
  • Samsung Galaxy A32
  • Samsung Galaxy F22
  • Samsung Galaxy M32
  • vivo Y33s
  • vivo Y53s 4G

Remember, you can always test a new phone by going to https://mddsreset.io/deviceinfo on that phone or scan the QR code below with that phone.

Choosing the right VR glasses

Choosing the right VR glasses

January 18, 2022

The VR glasses are needed to hold the MdDS Reset VORtex Viewer device. They are simple 'masks' without any electronics, mainly plastic with plastic lenses inside. They typically retail for less than €/$/£50.

We have been using the VR-i EVOLUTION 3S VR glasses which work perfectly, but there are many others that are just as good. Try and find VR glasses which are similar, and can hold smartphones of more than 6 inches (which is preferred).

You do not need any add-ons like remote controls or headsets, just simple VR glasses are fine.

Know your role: patient or caregiver

Know your role: patient or caregiver

January 18, 2022

There are different roles within MdDS Reset VORtex:

  • Patient: the actual person receiving the MdDS treatment (at home or in a medical facility). A patient needs to register first to get an account on the platform, and pay for a subscription if she/he intends to use MdDS Reset VORtex;
  • Caregiver: someone who supports multiple patients, either giving them the treatment in their facility or supervising patients who use MdDS Reset VORtex at home in a selfcare scenario. Currently caregivers need to apply for an account - we will streamline this in the future. Please mail us at hello@mddsreset.com for more information.
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Registering as a patient

Registering as a patient

May 17, 2022

In order to get access to MdDS Reset VORtex, you first need to register as a patient on the platform (https://mddsreset.io/register/patient). Registration is free, and gives you unlimited access to the complete functionality of the treatment.

So, fill in all the fields of the Registration form (as shown in the screenshot), make sure that you repeat your chosen password exactly, check the "I'm not a robot" checkbox, and click the Register button in the lower right corner.

As said, registration is free, but we would appreciate if you would consider making a donation to keep our service running. Thank you very much!

Patient profile and preferences

Patient profile and preferences

February 22, 2022

In the MdDS Reset VORtex Controller or Viewer you can click the avatar in the upper right corner to show a menu (the avatar either shows a small profile picture of yourself, or your initials). The menu look more or less like the screenshot below. In that menu, choose "Profile" to access your profile details and preferences dialog box, as shown in the second screenshot. In this dialog box, you can do the following:

Personal profile:

  • Change or complete your personal details;
  • Enter your Inter Pupillary Distance (IPD) - see below

Viewer device preferences:

  • Direction: the direction the stripes are running to. Please refer to the section "Direction of the optokinetic stripes" before making any changes, and definitely do not change this lightly. The default value here is left, because a majority of patients is helped most with stripes running to the left;
  • Volume: the volume of the sound assisting you during the Optokinetic (OKN ) treatment (AKA the stripes);
  • Show center spot: projects a small red dot in the middle of the Viewer screen during the stripes treatment - some patients find this helpful, but most do not, so best not to change this if your treatment is going well.

Make all changes you want to, and press the Submit button at the bottom to store your preferences.

Running an MdDS treatment with MdDS Reset VORtex

Running an MdDS treatment with MdDS Reset VORtex

January 4, 2022
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Logging in on both Controller and Viewer

Logging in on both Controller and Viewer

December 23, 2021

When you are ready to use MdDS Reset VORtex, take both your Controller and your Viewer, and with the web browser on both devices go to https://mddsreset.io. You will see the message that you need to log in first (see screenshot below). Click the Login button in the upper right corner, this will open the Login screen.

With the account you used to register yourself as an MdDS Reset VORtex user, log in - so either with an email/password combination, or with a social login. After you've logged in, choose "Controller" on the Controller device, and "Viewer" on the Viewer device.

Starting the treatment

Starting the treatment

December 23, 2021

With the Controller and the Viewer connected as explained in the previous step, press the "MdDS treatment" button. The Controller will then ask you to put the Viewer in fullscreen mode - do that by pressing the "Fullscreen" button on the Viewer. Once the Viewer is in fullscreen, the treatment can proceed. Mount the Viewer smartphone in the VR glasses, align the vertical white line in the middle of the screen with the center of the VR glasses and close the lid. Do NOT yet put on the VR glasses.

Subjective patient feedback

Subjective patient feedback

December 23, 2021

In order to assess the effectivity of the MdDS treatment, the patient gives both objective and subjective feedback, before and after the actual treatment. The subjective feedback is a simple but very effective question: How do you feel? on a scale from 0 to 10, with 0 means no symptoms at all, and 10 is the worst possible symptoms. So, as a first step in the treatment, please provide a score to the symptoms, and if you want you can leave an extra note. The patient can enter the same feedback after the treatment.

When the patient has entered the feedback, press "Save and proceed" to go to the next step. 

Controller and Viewer interaction while wearing the VR glasses

Controller and Viewer interaction while wearing the VR glasses

December 23, 2021

After entering the subjective feedback, it is time to put on the VR glasses with the MdDS Reset VORtex Viewer mounted inside. Both the Controller and the Viewer will display a message asking to put on the VR Glasses at this stage (see illustrations). When a patient is wearing the VR glasses, he or she cannot see outside the VR glasses of course. So in order to make selfcare treatments possible, where a patient administers the treatment without outside help, the Controller at this stage changes into one giant button - you can click anywhere on the Controller screen to make the treatment in the Viewer proceed. With the VR glasses on, simply feel where the Controller lies in front of you and click it to go on. 

If you are running the Controller on a desktop or laptop computer, clicking the mouse or the trackpad anywhere on the screen or pressing the spacebar has the same effect.

The Controller and the Viewer interact like this until the treatment is over. The Viewer will show you inside the VR glasses where in the treatment you are, and at the end tells you to take of your VR glasses.

Objective feedback: Romberg balance test

Objective feedback: Romberg balance test

December 23, 2021

Next to the subjective feedback, we run a Romberg balance test on the Viewer to objectively measure the balance capability of the patient, using the sensors inside the Viewer smartphone. Just like the subjective feedback, this objective test is taken before and after the treatment.

So, with the VR glasses on, the patient is required to stand still for a minute, eyes closed, feet close to each other and arms crossed. When the Romberg test starts, the Viewer screen goes black. The sensors in the Viewer smartphone detect the effort the patient needs to put in to stand still. The time series results of the Romberg test are logged and available for analysis later on.

At the same time, the MdDS Reset VORtex Controller shows the actual movements of the patient as recorded by the MdDS Reset VORtex Viewer.

The test is timed automatically for one minute, and the Viewer will tell you when the test is over and will let you proceed to the next step.

MdDS optokinetic treatment

MdDS optokinetic treatment

February 15, 2022

The actual goal of the treatment sequence is the actual delivery of optokinetic stripes in the Viewer device which will treat the patient's MdDS affliction. The stripes will be delivered in the direction determined in the patient's details.

The total procedure consists of two treatments of 4 minutes, during which the stripes will run on the Viewer device (inside the VR glasses on the patient's head), and simultaneously the patient's head is moved from left to right, with the patient focusing on the passing stripes. Moving the head from left to right and back means moving the head from the left shoulder to the right shoulder in a smooth movement.

During the treatment you will hear a musical scale running up and down. The rhythm of that scale is important. What you need to do is to start with your head one shoulder with the lowest note, make it to the other shoulder in time for the highest note, and back to the starting shoulder in time for the next lowest note.

There is an advised pause between the two treatments of five minutes, during which the patient takes off the VR glasses, walks about and relaxes a little. When all treatment steps have been performed, pressing the 'Finish' button at the bottom closes the treatment sequence.

During the session, two dots appear on the Controller:

  • The top dot indicates the position of the head. If the dot is green, the head is held correctly horizontally; if it is red, the head is kept too much down or up;
  • The bottom dot indicates the ideal frequency in which to move the patient's head from left to right.

These dots are only useful if a caregiver is present during the treatment to supervise; an auditory signal will also indicate the ideal rhythm which the patient can follow.

Ending the MdDS Reset VORtex treatment

Ending the MdDS Reset VORtex treatment

December 23, 2021

After the optokinetic treatments, the patient keeps on the VR glasses. A Romberg balance test is performed again. After that test the patient removes the VR glasses, and enters the subjective feedback after the treatment. Subsequently the treatment is over.

MdDS Reset VORtex
User Manual
Table of contents

Introduction
Introduction
Introduction
About MdDS Reset VORtex
About MdDS Reset VORtex
About MdDS Reset VORtex
MdDS treatment overview and advice
MdDS treatment overview and advice
MdDS treatment overview and advice
What's the underlying basis for this treatment?
What's the underlying basis for this treatment?
What's the underlying basis for this treatment?
What does the treatment look like?
What does the treatment look like?
What does the treatment look like?
What to expect as a patient when using the treatments
What to expect as a patient when using the treatments
What to expect as a patient when using the treatments
A formal MdDS diagnosis is crucial
A formal MdDS diagnosis is crucial
A formal MdDS diagnosis is crucial
Treatment and feedback to measure progress
Treatment and feedback to measure progress
Treatment and feedback to measure progress
Direction of the optokinetic stripes
Direction of the optokinetic stripes
Direction of the optokinetic stripes
Warning: MdDS Reset VORtex is not a toy
Warning: MdDS Reset VORtex is not a toy
Warning: MdDS Reset VORtex is not a toy
Setting up MdDS Reset VORtex
Setting up MdDS Reset VORtex
Setting up MdDS Reset VORtex
MdDS Reset VORtex system overview
MdDS Reset VORtex system overview
MdDS Reset VORtex system overview
Phone compatibility check
Phone compatibility check
Phone compatibility check
Choosing a new smartphone as MdDS Reset VORtex Viewer
Choosing a new smartphone as MdDS Reset VORtex Viewer
Choosing a new smartphone as MdDS Reset VORtex Viewer
Choosing the right VR glasses
Choosing the right VR glasses
Choosing the right VR glasses
Know your role: patient or caregiver
Know your role: patient or caregiver
Know your role: patient or caregiver
Registering as a patient
Registering as a patient
Registering as a patient
Patient profile and preferences
Patient profile and preferences
Patient profile and preferences
Running an MdDS treatment with MdDS Reset VORtex
Running an MdDS treatment with MdDS Reset VORtex
Running an MdDS treatment with MdDS Reset VORtex
Logging in on both Controller and Viewer
Logging in on both Controller and Viewer
Logging in on both Controller and Viewer
Starting the treatment
Starting the treatment
Starting the treatment
Subjective patient feedback
Subjective patient feedback
Subjective patient feedback
Controller and Viewer interaction while wearing the VR glasses
Controller and Viewer interaction while wearing the VR glasses
Controller and Viewer interaction while wearing the VR glasses
Objective feedback: Romberg balance test
Objective feedback: Romberg balance test
Objective feedback: Romberg balance test
MdDS optokinetic treatment
MdDS optokinetic treatment
MdDS optokinetic treatment
Ending the MdDS Reset VORtex treatment
Ending the MdDS Reset VORtex treatment
Ending the MdDS Reset VORtex treatment

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