Effect of Gaze Stability Exercises on Chronic Motion Sensitivity: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: Motion sensitivity is a common condition among the general population and may be accompanied by postural instability and anxiety. Preliminary studies suggest that minimal dosage of gaze stability exercises improves postural stability in young adults with chronic motion sensitivity. The aim of this study was to investigate the effect of progressive gaze stability exercises on postural stability, motion sensitivity, and anxiety in healthy young adults with chronic motion sensitivity. METHODS: We conducted a single-blind randomized controlled trial to assess the effect of gaze stability exercises on chronic motion sensitivity. Forty-one participants of both genders ages 20 to 40 years with chronic motion sensitivity were randomly assigned to 2 groups. The intervention group performed gaze stability exercises while the sham group performed saccadic eye movement exercises for 6 weeks. Computerized Dynamic Posturography with Immersion Virtual Reality (CDP-IVR)-condition 1 (C1) and condition 2 (C2)-Motion Sensitivity Quotient (MSQ), Motion Sickness Sensitivity Susceptibility Questionnaire Short Form (MSSQ-Short: MSA, MSB), and State-Trait Anxiety Inventory for Adults (STAI Form Y-2) were the outcome measures used. RESULTS: There was no significant group × time interaction for MSA, MSB, MSSQ percentile, STAI, MSQ, C1 mean, or C2 mean. However, posttreatment a significant difference in the mean CDP-IVR score of C2 was identified between the 2 groups. For C2, the intervention group demonstrated a 117% increase in the mean CDP-IVR score compared with a 35.2% increase in the sham group. MSQ reduced significantly from baseline to 6 weeks postintervention in the intervention group (4.0 ± 1.2 vs 1.9 ± 0.9). Anxiety was significantly reduced in the sham group only (38.2 ± 1.9 vs 35.8 ± 2.2). DISCUSSION AND CONCLUSIONS: Based on the results of this study, progressive gaze stability exercises appear to have value for managing chronic motion sensitivity in healthy young adults. Further research with larger sample size and broader age range is needed to generalize these findings.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A203).

[Modern means of statokinetic improvement and vestibular rehabilitation].

The article presents the results of studying the effectiveness of the complex vestibular workouts based on non-invasive neuromodulation technology in 37 healthy patients aged 18-20 years who have symptoms of aerial sickness in 5 or less minutes. Non-invasive neuromodulation wire-familiarize with the apparatus for vestibular rehabilitation "Brain-Port" (USA), performing electric tactile stimulation of the tongue with biofeedback. An indicator of statokinetic stability was considered from time to tolerance to the vestibular load up to development of vegetative manifestations of aerial sickness. 'Improvement of statokinetic tolerability vestibular training confirmed by computed posturography and gait analysis. Increase of statokinetic stability accompanied not only by an increase in exposure, necessary for motion sickness, but also a decrease in autonomic manifestations, which are the main obstacle to the operator's military activities. Improving balance and gait performance after the swipe-of vestibular training course demonstrates the possible realization of two mechanisms of compensatory and restorative processes: sensory substitution equilibrium function and induction of neuroplasticity in short time.

Enhanced perceptions of control and predictability reduce motion-induced nausea and gastric dysrhythmia.

Nausea is a debilitating condition that is typically accompanied by gastric dysrhythmia. The enhancement of perceived control and predictability has generally been found to attenuate the physiological stress response. The aim of the present study was to test the effect of these psychosocial variables in the context of nausea, motion sickness, and gastric dysrhythmia. A 2x2, independent-groups, factorial design was employed in which perceived control and predictability were each provided at high or low levels to 80 participants before exposure to a rotating optokinetic drum. Ratings of nausea were obtained throughout a 6-min baseline period and a 16-min drum rotation period. Noninvasive recordings of the electrical activity of the stomach called electrogastrograms were also obtained throughout the study. Nausea scores were significantly lower among participants with high control than among those with low control, and were significantly lower among participants with high predictability than among those with low predictability. Estimates of gastric dysrhythmia obtained from the EGG during drum rotation were significantly lower among participants with high predictability than among those with low predictability. A significant interaction effect of control and predictability on gastric dysrhythmia was also observed, such that high control was only effective for arresting the development of gastric dysrhythmia when high predictability was also available. Stronger perceptions of control and predictability may temper the development of nausea and gastric dysrhythmia during exposure to provocative motion. Psychosocial interventions in a variety of nausea contexts may represent an alternative means of symptom control.

Rehabilitation from airsickness in military pilots: long-term treatment effectiveness.

BACKGROUND: Airsickness (AS) still represents a major issue in aviation medicine and affects many student pilots and aircrew members. This study aimed at producing an update of the Italian Air Force rehabilitation program for AS, including data on a prolonged follow-up (> 8 yr). METHODS: Data from 20 military pilots with a past history of rehabilitation for incapacitating AS were compared to those of 65 normal controls. All individuals from both samples were categorized as dropouts or successfully employed in fast jets, multiengine air carriers, or helicopters. All AS individuals were analyzed before and after their treatment with the Coriolis Stress test (CST). RESULTS: The AS sample showed similar results with respect to the control group, with the same incidence of dropouts (15% vs. 14%) and destination to rotary wing flight lines (15% vs. 17%). All dropouts were observed within the first year after rehabilitation. A statistically non-significant trend of being employed in transport aircraft (50% of individuals vs. 34% in the control group) rather than in fast jets (20% vs. 35%) was observed in the AS sample. DISCUSSION: Within the AS sample, the rehabilitation protocol had a success rate of 85%. The effects of rehabilitation were long lasting (mean follow up: 8.3 +/- 2.5 yr). Moreover, the flight career of AS treated individuals did not significantly differ from controls. The pretreatment CST was helpful in calibrating the initial intensity and duration of the nauseogenic stimulation, while it was useless as a post-treatment analysis of the outcome from training.

A Smartphone-based gaming system for vestibular rehabilitation: A usability study.

BACKGROUNDVestibular dysfunctions result in a wide range of impairments and can have debilitating consequences on a person's day-to-day activities. Conventional vestibular rehabilitation is effective but suffers from poor therapy compliance due to boredom. Virtual reality technology can make training more engaging and allow precise quantification of the training process. However, most existing technologies for vestibular rehabilitation are expensive and not suitable for use in patients' homes and most clinics. In this pilot study, we developed and evaluated the usability of a smartphone-based head-mounted display (HMD) for vestibular rehabilitation and quantified the simulator sickness induced by the system.METHODSTwo adaptive training games were developed to train discrete and rhythmic head movements in the pitch and yaw planes. The usability and simulator sickness associated with the system were evaluated in a single testing session on healthy subjects and patients with unilateral vestibular dysfunction. Additionally, the head movement kinematics measured during training was also analyzed using different movement quality measures.RESULTSA total of 15 healthy subjects and 15 patients underwent testing with the system. Both groups found the system to be highly usable (>80 score on the system usability scale). Following 20-30 min training with the system, healthy subjects reported minimal simulator sickness symptoms. On the other hand, patients reported a higher incidence rate for symptoms, which could have been the result of their vestibular condition.CONCLUSIONThe current study demonstrated the usability and safety of a smartphone-based system for vestibular rehabilitation. The system is compact, and affordable thus has the potential to become an excellent tool for home-based vestibular rehabilitation.

Use of sensory reweighting for a woman with persistent mal de debarquement: a case report.

BACKGROUND AND PURPOSE: Persistent mal de debarquement is an uncommon disorder occurring after a sea voyage, or a plane or train trip. Symptoms include unsteadiness, rocking sensation, visual motion intolerance, cognitive slowing, and excessive fatigue. It is thought to be a result of faulty multisensory adaptation. The purpose of this case report was to describe the use of sensory reweighting, a therapeutic approach aimed at reweighting the balance between the 3 sensory systems, to decrease symptoms and increase functional abilities of a woman with persistent mal de debarquement. CASE DESCRIPTION: A 69-year-old woman with a 4-year history of persistent mal de debarquement after a plane trip reported a constant feeling of rocking, unsteadiness, and a loss of balance in low lighting or visually rich environments. She experienced a previous fall and had limited her social activities because of her symptoms. INTERVENTIONS: Sensory reweighting therapy was administered twice a week for 10 weeks. Activities included balance training using vestibular, somatosensory, and visual challenges to vary the sensory input available. OUTCOMES: A 5-point increase was observed on the Berg Balance Scale, she doubled her balance time in tandem stance position, and improved from moderate to low impairment on the Dizziness Handicap Inventory. She had a significant change on the Global Rating of Change Scale. Subjectively, she felt she had improved 50% and was less disabled. DISCUSSION: A rehabilitation approach aimed at sensory reweighting improved this patient's function and community reintegration. Her symptoms were reduced and stability and balance improved.

Autogenic-feedback training exercise is superior to promethazine for control of motion sickness symptoms.

Motion sickness symptoms affect approximately 50% of the crew during space travel and are commonly treated with intramuscular injections of promethazine. The purpose of this paper is to compare the effectiveness of three treatments for motion sickness: intramuscular injections (i.m.) of promethazine, a physiological training method (autogenic-feedback training exercise [AFTE]), and a no-treatment control. An earlier study tested the effects of promethazine on cognitive and psychomotor performance and motion sickness tolerance in a rotating chair. For the present paper, motion sickness tolerance, symptom reports, and physiological responses of these subjects were compared to matched subjects selected from an existing database who received either AFTE or no treatment. Three groups of 11 men, between the ages of 33 and 40 years, were matched on the number of rotations tolerated during their initial rotating-chair motion sickness test. The motion sickness test procedures and the 7-day interval between tests were the same for all subjects. The drug group was tested under four treatment conditions: baseline (no injections), a 25 mg dose of promethazine, a 50 mg dose of promethazine, and a placebo of sterile saline. AFTE subjects were given four 30-minute AFTE sessions before their second, third, and fourth motion sickness tests (6 hours total). The no-treatment control subjects were only given the four rotating-chair tests. Motion sickness tolerance was significantly increased after 4 hours of AFTE when compared to either 25 mg (p < 0.00003) or 50 mg (p < 0.00001) of promethazine. The control and promethazine groups did not differ. AFTE subjects reported fewer or no symptoms at higher rotational velocities than subjects in the control or promethazine groups. The primary physiological effect of promethazine was an inhibition of skin conductance level. The AFTE group showed significantly less heart rate and skin conductance variability during motion sickness tests administered after training.

Vestibular and postural findings in the motion sickness syndrome.

The motion sickness syndrome constitutes varying degrees of subjective motion intolerance and three objective findings: hyperactive VOR (79%), hip sway strategy (60%), and positional nystagmus (42%). It is present in subjects who have a strong history of motion sickness. Vestibular rehabilitation appears to help control symptoms. The study also suggests an inheritance pattern, but a structured pedigree could not be constructed. Prospective studies are warranted to further establish the patterns of the motion sickness syndrome.

Behavioral airsickness management program for student pilots.

The management of recurrent airsickness in student pilots has traditionally involved positive reinforcement of motivation and limited use of medication. The Behavioral Airsickness Management (BAM) program seeks to establish an effective behavioral and cognitive intervention format for managing airsickness symptoms. There were 37 student pilots experiencing recurrent airsickness who were exposed to an assessment and rehabilitation program designed to develop diaphragmatic breathing skills while rapidly reducing physiological tension via cue-evoked relaxation strategies. Cognitive modification techniques were also included in the treatment protocol. Of the 37 students, 35 were returned to their flying training program with no recurrences of the airsickness problems. Cross-validation evidence is offered, as well as hypotheses for the program's success.

The Canadian Forces Airsickness Rehabilitation Program, 1981-1991.

Airsickness is a significant obstacle in the training of some student pilots. When conventional therapy fails, desensitization therapy may be indicated. Using experience gained by the RAF and USAF, the Canadian Forces (CF) began such a program in 1981. This paper reports program results from 1981-1991. Following subject identification, treatment consists of three phases: biofeedback relaxation therapy, ground-based desensitization training and in-flight desensitization therapy with a pilot-flight surgeon. Employing a definition of cure used by the RAF, success was compared with that of the RAF and USAF programs. A total of 22 student pilots have undergone rehabilitation, 17 of whom have been successfully treated for a success rate of 77%. This is comparable to success rates of other programs. It is reaffirmed that desensitization is a valid clinical tool in treatment of airsickness.

The Italian Air Force rehabilitation programme for air-sickness.

Motion Sickness, or kinetosis, is a complex clinical syndrome usually classified according to the environmental situation evoking the symptoms. Among the various forms of motion sickness, air sickness has a significant impact on aircrew readiness and is often a cause for the grounding of aircrew. Unfortunately, standards for clinical testing to accurately predict the sensitivity of each individual to air-sickness are currently lacking. Furthermore, pharmacological prevention is contraindicated for aircrews, whose cognitive tasks involve a high level of vigilance. Therefore, a number of Air Forces have developed their own rehabilitation programmes to counteract air-sickness effects on flight personnel. These programmes may differ in several aspects, such as their duration, instruments used, costs and the technical characteristics of the rehabilitation team. However, reports in the specialized literature, refer to high rates of success, despite the above-mentioned differences. In the autumn of 2000, the Italian Air Force (ITAF) also began its own rehabilitation programme for air-sickness desensitisation. The programme was developed at the Aerospace Medicine Department of the ITAF Flight Test Centre, at the Pratica di Mare Air Force Base, Italy. The ITAF rehabilitation course lasts two weeks, and candidates are first classified according to their clinical history and to their reaction to the Coriolis Stress Test. Thereafter, subjects undergo a personalized desensitisation programme, involving increasingly more intense nauseogenic stimuli by means of various devices. At the same time, a psychological approach, based on autogenous training and cognitive-behavioural therapy, is adopted. The present report refers to data from 17 subjects treated from January 2001. The current clinical outcome is extremely encouraging, with a success rate of 88%. Nevertheless, several aspects of motion sickness rehabilitation are still under investigation, and further research programmes, aimed at improving the final clinical outcome and prolonging the benefits of rehabilitation, are needed.

Revisión bibliográfica y propuesta de guía de manejo para la prevención y rehabilitación de pilotos con predisposición a la aparición de cinetosis / Bibliographic review and guide proposal for the prevention and rehabilitation of pilots predisposed to the appearance of motion sickness

Introducción: La aerocinetosis se caracteriza por la aparición de una sintomatología variada que incluye náuseas y vómitos, mareos, palidez, sudoración, malestar gástrico y en casos más graves alteraciones de la conciencia. Dichos síntomas pueden mantenerse a lo largo de los días aun habiendo acabado la exposición, si la misma fue mantenida en el tiempo. Cuando se presenta en tripulantes puede resultar inhabilitante para la actividad. Objetivos: Se trata de una revisión bibliográfica que cuenta con información obtenida de múltiples fuentes siendo la más importante la que se obtuvo a través de la experiencia personal no solo del autor sino de los especialistas consultados. Material y Método: Describir los aspectos generales del equilibrio en los seres humanos. Describir las principales características de la aerocinetosis. Proponer una guía de manejo para la prevención y rehabilitación de pilotos con predisposición a la aparición de cinetosis. Conclusión: Se realizó en este trabajo una revisión exhaustiva del tema y se aborda la actitud preventiva y terapéutica a seguir, la cual está orientada a brindar información, identificar los síntomas y/o signos y llevar a cabo estrategias de entrenamiento y adaptación al movimiento que le permitirá al piloto que se ve afectado continuar con su actividad de forma adecuada

Introduction: Kinetosis is characterized by the appearance of a varied symptomatology including nausea and vomiting, dizziness, paleness, sweating, gastric discomfort and in more severe cases alterations of consciousness. These symptoms can be maintained throughout the days even if the exposure is finished, if the same was maintained in the time. When it occurs in crew members it can be disabling for the activity. Objectives: To describe the general aspects of balance in humans. Describe the main characteristics of aerocinetosis. To propose a management guide for the prevention and rehabilitation of pilots with predisposition to the onset of motion sickness. Material and method: This is a bibliographical review that has information obtained from multiple sources, the most important of which was obtained through the personal experience of the specialists consulted. Conclusions: A comprehensive review of the topic was carried out and the preventive and therapeutic attitude to be followed, which is aimed at providing information, identifying symptoms and signs and carrying out strategies of training and adaptation to the movement will allow the pilot who is affected to continue his activity properly.