Motion Equilibrium Reprocessing Therapy (MERT) with Computer Assisted Rehabilitation Environment (C.A.R.E.N)

Motion Equilibrium Reprocessing Therapy (MERT) can be used in all patients who need to be treated for maintainance of balance like appears in non – progressive vestibular, motor and neurological conditions. MERT is the most advanced habituation therapy for patients with non – progressive vestibular disease.

We are proud to be the first private facility in the US providing MOTION BASED EQUILIBRIUM REPROCESSING THERAPY, which has been successfully used by the military to treat pilots suffering from motion sickness.



The results achieved with C.A.R.E.N are not attainable by conventional physical therapy. C.A.R.E.N treatment combines sensory motor training, visual exercises and habituation treatment.Vestibular disease can handicap people physically, emotionally and socially. Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia.Conventional treatment with Betahistine, Carbamazepine and oral steroids as well as head rotation exercises by Cawthorne and Cooksey have limited indication and varying response rates.
Patients affected with peripheral vestibulopathies are usually frustrated with inability to find the right treatment.Virtual reality rehabilitation is a new method which has shown results superior to conventional treatment options.

A woman during C.A.R.E.N sesion at NYDNRehab in NYC

At DNR we specialize in treatment of balance and vestibular disorders
with the help of C.A.R.E.N (Computer assisted Rehabilitation
Environment) – the most advanced technology for treatment of balance
and vestibular disorders that is available for the first time in the NYC.


MERT is based on military desensitization principles within Virtual Environment.

The 6 DoF ( Degrees of Freedom) virtual reality motion base of C.A.R.E.N is used to expose patient to sinusoidal vertical passive whole body motion in gradually increasing intensity while fixating the eye site on rolldome and/or optokinetic drum through virtual reality 180 degrees screen.


3-5 times a week for two consecutive weeks

MERT conceptual model and MERT lab at NYDNRehab

MERT is based on military desensitization principles within Virtual


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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