Vestibular Rehabilitation in Multiple Sclerosis (VeRMiS)

VeRMiS is a multi-centre study to assess the effectiveness of vestibular rehabilitation in people with MS.

This website provides a range of information about the study, and resources both for people affected by MS and physiotherapists, which we hope you will find helpful. The content of this website will be updated to keep you informed of our progress.

The study will begin recruiting participants in November 2018 and will run for three years.

If there is additional information that you would find helpful please let us know via email so that we can improve the site for everyone.

Study summary

Vertigo, dizziness, poor balance and abnormalities in the control of eye movements are symptoms that may be associated with vestibular problems. Such symptoms are common in people with multiple sclerosis (pwMS), can lead to falls, injury, and a restriction in outdoor mobility, and subsequently may affect social participation and quality of life.

The vestibular system is complex. It consists of the inner ear and vestibular nerve (the peripheral pathways) and pathways in the brain (central pathways) that process information about head and body position. Damage to any of these pathways can result in symptoms of vertigo, dizziness, poor balance and abnormalities of eye movement.

Vestibular rehabilitation (VR) is the standard of care for persons with vestibular problems. VR involves progressive exercises including eye, head, and body movements in sitting, standing, and walking. Given the complexity of symptom presentation in people with MS, such as muscle weakness, spasticity, sensory loss and ataxia, it may be that customised exercises are more effective and cost-effective than home based generic exercises delivered via a booklet, as is current usual practice.

Although MS is a central disorder, approximately 50 per cent of cases of vertigo are caused by a condition called benign paroxysmal positional vertigo (BPPV). In these cases, calcium carbonate crystals from part of the inner ear (otoliths) become dislodged and enter into another part of the inner ear (semi-circular canal) causing symptoms of vertigo on certain head and body movements.

BPPV can be diagnosed and treated at the bedside using specific manoeuvres that aim to move these crystals back into position. Currently these testing and repositioning manoeuvres for BPPV are not routinely performed in pwMS and the success and re-occurrence rates are unclear.

The VeRMiS study will involve 140 ambulant pwMS who present with vertigo and/or dizziness across two study centres: Plymouth and London, UK. 

Participants who are able to take part will attend an initial assessment and then be enrolled in to one of two trial based upon the assessment findings.

Trial one: A pragmatic multi-centre randomised controlled trial to compare the clinical and cost effectiveness of a 12 week customised VR programme vs generic VR.

Trial two: An observational study to determine the success and re-occurrence rate of BPPV symptoms with repositioning manoeuvres.

A range of outcomes, including self-report and clinical tests of dizziness, mobility and quality of life will be measured at intervals throughout the study. 

This website will be updated regularly with study information.