An old approach to a novel problem: effect of combined balance therapy on virtual reality induced motion sickness: a randomized, placebo controlled, double-blinded study.

BACKGROUND: The objective of this study was to investigate the impact of a rehabilitation program aimed at addressing vestibular and proprioceptive deficits, which are believed to underlie the pathophysiology of motion sickness. METHODS: A total of 121 medical students with motion sickness participated in this study and were randomly divided into intervention (n = 60) and placebo control (n = 61) groups. The intervention group underwent combined balance, proprioception, and vestibular training three times a week for 4 weeks, while the control group received placebo training. The study assessed various measurements, including the Virtual reality sickness questionnaire (VRSQ), tolerance duration, enjoyment level measured by VAS, stability levels using Biodex, and balance with the Flamingo balance test (FBT). All measurements were conducted both at baseline and 4 weeks later. RESULTS: There was no significant difference in pre-test scores between the intervention and control groups, suggesting a similar baseline in both groups (p > 0.05). The results showed a significant improvement in VRSQ, tolerance duration, VAS, Biodex, and FBT scores in the intervention group (p < 0.05). While, the control group showed a significant increase only in VAS scores after 4 weeks of training (p < 0.05). A statistically significant improvement was found between the groups for VRSQ (p < 0.001), tolerance duration (p < 0.001), VAS (p < 0.001), Biodex (p = 0.015), and FBT scores (p < 0.05), in favor of the intervention group. CONCLUSIONS: A combined balance training program for motion sickness proves to be effective in reducing motion sickness symptoms, enhancing user enjoyment, and extending the usage duration of virtual reality devices while improving balance and stability. In contrast, placebo training did not alter motion sickness levels. These findings offer valuable insights for expanding the usage of virtual reality, making it accessible to a broader population.

[Research Progress in Physiological Evaluation and Treatment of Visually Induced Motion Sickness in Virtual Reality].

Visually induced motion sickness(VIMS)is the major barrier to be broken in the development of virtual reality(VR)technology,which seriously affects the progress in the VR industry.Therefore,the detection and evaluation of VIMS has become a hot research topic nowadays.We review the progress in physiological assessment of VIMS in VR based on several physiological indicators,including electroencephalogram(EEG),postural sway,eye movements,heart rate variability,and skin electrical signals,and summarize the available therapies,aiming to provide an outlook on the future research directions of VIMS.

Motion sickness: current concepts and management.

PURPOSE OF REVIEW: Motion sickness is an ancient phenomenon that affects many people. Nausea, vomiting, disorientation, sweating, fatigue, and headache are just few of the many signs and symptoms that are commonly experienced during an episode of motion sickness. In the present review, we will provide an overview of the current research trends and topics in the domain of motion sickness, including theoretical considerations, physiological and neural mechanisms, individual risk factors, and treatment options, as well as recommendations for future research directions. RECENT FINDINGS: More recently, motion sickness has been in the focus of attention in the context of two global technological trends, namely automated vehicles and virtual reality. Both technologies bear the potential to revolutionize our daily lives in many ways; however, motion sickness is considered a serious concern that threatens their success and acceptance. The majority of recent research on motion sickness focuses on one of these two areas. SUMMARY: Aside from medication (e.g. antimuscarinics, antihistamines), habituation remains the most effective nonpharmacological method to reduce motion sickness. A variety of novel techniques has been investigated with promising results, but an efficient method to reliably prevent or minimize motion sickness has yet to emerge.

Galvanic vestibular stimulation as a novel treatment for seasickness.

Motion sickness is the cause of major physical discomfort and impaired performance in many susceptible individuals. Some habituate to sea conditions, whereas others remain chronically susceptible, requiring lifelong pharmaceutical treatment. The present study sets out to investigate whether galvanic vestibular stimulation (GVS) coupled with rotatory chair stimulation could mimic sea conditions and alleviate motion sickness symptoms in individuals deemed chronically susceptible. Thirty seasickness susceptible subjects, after at least six months of regular sailing, were enrolled in a prospective, single-blind, randomised controlled study. The treatment group underwent GVS coupled with inverse phase rotatory chair impulse in sinusoidal harmonic acceleration protocol. The control group underwent a sham procedure. All subjects performed repeated velocity step tests to determine the vestibular time constant (Tc) and completed a seasickness questionnaire. The GVS rotatory chair procedure decreased the prevalence of severe seasickness. The number of motion sickness clinic visits and anti-motion sickness drug consumption were reduced in the treatment group three-month post intervention as compared to control. In addition, there was significant reduction of Tc in the treatment group. GVS coupled with rotatory chair impulse could decrease motion sickness severity, induce neurophysiological learning processes and promote habituation to seasickness in chronic susceptible subjects. This is a novel and promising non-pharmacological method to treat motion sickness susceptible individuals. Furthermore, the investigation demonstrated that adaptation to sea conditions may take place even after years of susceptibility to seasickness. This study was retrospectively registered on August 10th 2021 and assigned the identifier number NCT05004818.

Transcutaneous Electrical Acustimulation Ameliorates Motion Sickness Induced by Rotary Chair in Healthy Subjects: A Prospective Randomized Crossover Study.

OBJECTIVES: Motion sickness (MS) is a common physiological response to real or virtual motion. The purpose of this study was to investigate the effects of transcutaneous electrical acustimulation (TEA) on MS and the underlying mechanisms in healthy subjects. MATERIALS AND METHODS: A total of 50 healthy participants were recruited and randomly assigned into two groups to complete two separate sessions in a crossover study. A Coriolis rotary chair was used as a model to provoke severe MS. The total tolerable rotation time and Graybiel scoring scale were recorded. Gastric slow waves were detected by electrogastrogram. The autonomic nervous function, including the vagal activity, was evaluated by the analysis of heart rate variability derived from the electrocardiogram recording. The serum levels of arginine vasopressin (AVP) and norepinephrine (NE) were examined. RESULTS: Of note, 22 participants in TEA and only 11 participants in the sham-TEA session completed the entire five-rotation MS stimuli (p = 0.019). TEA significantly prolonged the total tolerable rotation time of MS stimuli (220.4 ± 11.59 vs 173.6 ± 12.3 seconds, p < 0.001) and lowered MS symptom scores (12.56 ± 2.03 vs 22.06 ± 3.0, p < 0.001). TEA improved the percentage of normal gastric slow waves, compared with sham-TEA (56.0 ± 2.1% vs 51.6 ± 2.0%, p = 0.033). TEA also significantly enhanced vagal activity compared with sham-TEA (0.41 ± 0.02 vs 0.31 ± 0.02, p < 0.001). In addition, the increased serum levels of AVP and NE on MS stimulation were markedly suppressed by TEA treatment, compared with sham-TEA (AVP, 56.791 ± 4.057 vs 79.312 ± 10.036 ng/mL, p = 0.033; NE, 0.388 ± 0.037 vs 0.501 ± 0.055 ng/mL, p = 0.021). CONCLUSIONS: Needleless TEA is a potent therapeutic approach for severe MS, as it increases participants' tolerance and ameliorates MS symptoms, which may be attributed to the integrative effects of TEA on autonomic functions and neuroendocrine balance.

Visual Vertigo, Motion Sickness, and Disorientation in Vehicles.

Environmental circumstances that result in ambiguity or conflict with the patterns of sensory stimulation may adversely affect the vestibular system. The effect of this conflict in sensory information may be dizziness, a sense of imbalance, nausea, and motion sickness sometimes even to seemingly minor daily head movement activities. In some, it is not only exposure to motion but also the observation of objects in motion around them such as in supermarket aisles or other places with visual commotion; this can lead to dizziness, nausea, or a feeling of motion sickness that is referred to as visual vertigo. All people with normal vestibular function can be made to experience motion sickness, although individual susceptibility varies widely and is at least partially heritable. Motorists learn to interpret sensory stimuli in the context of the car stabilized by its suspension and guided by steering. A type of motorist's disorientation occurs in some individuals who develop a heightened awareness of perceptions of motion in the automobile that makes them feel as though they may be rolling over on corners and as though they are veering on open highways or in streaming traffic. This article discusses the putative mechanisms, consequences and approach to managing patients with visual vertigo, motion sickness, and motorist's disorientation syndrome in the context of chronic dizziness and motion sensitivity.

Mal de Debarquement Syndrome.

Mal de debarquement syndrome (MdDS) is a disorder of persistent vertigo characterized by a feeling of oscillation such as rocking, bobbing, or swaying. It is triggered by passive motion, typically by exposure to water, air, or land transportation. This syndrome affects middle-aged individuals who are predominantly women. MdDS presents as a balance disorder that carries significant risk of morbidity due to both the direct effects of balance impairment and associated symptoms of fatigue, cognitive slowing, and visual motion intolerance. The Barany Society will be publishing criteria for diagnosing persistent MdDS. In addition, more insight has been gained into the pathophysiology of MdDS, with current hypotheses pointing to a cerebral and cerebellar basis. Treatments have expanded beyond medication trials, and now include the use of noninvasive brain stimulation and readaptation of the vestibulo-ocular reflex.

Effect of Acupuncture on the p38 Signaling Pathway in Several Nervous System Diseases: A Systematic Review.

Acupuncture is clinically used to treat various diseases and exerts positive local and systemic effects in several nervous system diseases. Advanced molecular and clinical studies have continually attempted to decipher the mechanisms underlying these effects of acupuncture. While a growing understanding of the pathophysiology underlying several nervous system diseases shows it to be related to inflammation and impair cell regeneration after ischemic events, the relationship between the therapeutic mechanism of acupuncture and the p38 MAPK signal pathway has yet to be elucidated. This review discusses the latest advancements in the identification of the effect of acupuncture on the p38 signaling pathway in several nervous system diseases. We electronically searched databases including PubMed, Embase, and the Cochrane Library from their inception to April 2020, using the following keywords alone or in various combinations: "acupuncture", "p38 MAPK pathway", "signaling", "stress response", "inflammation", "immune", "pain", "analgesic", "cerebral ischemic injury", "epilepsy", "Alzheimer's disease", "Parkinson's disease", "dementia", "degenerative", and "homeostasis". Manual acupuncture and electroacupuncture confer positive therapeutic effects by regulating proinflammatory cytokines, ion channels, scaffold proteins, and transcription factors including TRPV1/4, Nav, BDNF, and NADMR1; consequently, p38 regulates various phenomena including cell communication, remodeling, regeneration, and gene expression. In this review article, we found the most common acupoints for the relief of nervous system disorders including GV20, GV14, ST36, ST37, and LI4. Acupuncture exhibits dual regulatory functions of activating or inhibiting different p38 MAPK pathways, contributing to an overall improvement of clinical symptoms and function in several nervous system diseases.

[The Mal de Débarquement Syndrome]. / Syndrome du mal de débarquement.

The Mal de Débarquement Syndrome (MdDS) is characterized by a persistent (> 1 month) sensation of self-motion, most of the time initially motion-triggered (i.e. boat, car, airplane travel). The symptoms are markedly diminished during a new exposure to passive motion. Female are more often affected. The vestibular functional assessment and cerebral imaging are normal. Chronic fatigue, headache, hypersensitivity to visual stimuli are other classical features of MdDS. The impact of MdDS on quality of life is significant. Maladaptation of the vestibulo-ocular reflex, abnormal functional connectivity as well as gonadal hormones imbalance are possible causes of the MdDS. Exposure to optokinetic stimulations, and transcranial magnetic stimulations open therapeutic perspectives.

Le syndrome du mal de débarquement (MdDS) est caractérisé par la persistance d'une sensation de mouvement (> 1 mois), souvent suite à un déplacement en moyen de transport. Les symptômes sont nettement diminués lors d'une nouvelle exposition à un mouvement passif. Les femmes sont plus fréquemment atteintes. Le bilan fonctionnel vestibulaire et l'imagerie cérébrale sont normaux. La fatigue chronique, les céphalées, l'hypersensibilité aux stimuli visuels sont également caractéristiques du MdDS. L'impact sur la qualité de vie est significatif. Une mauvaise adaptation du réflexe vestibulo-oculaire, un trouble de la connectivité fonctionnelle ainsi qu'un dérèglement des hormones gonadiques pourraient être à l'origine du MdDS. L'exposition à des stimulations optocinétiques et la stimulation magnétique transcrânienne ouvrent des perspectives thérapeutiques.

Visually induced motion sickness can be alleviated by pleasant odors.

Visually induced motion sickness (VIMS) is a common side effect in virtual environments and simulators. Several countermeasures against VIMS exist, but a reliable method to prevent or ease VIMS is unfortunately still missing. In the present study, we tested whether olfactory cues can alleviate VIMS. Sixty-two participants were exposed to a 15-min-long video showing a first-person-view bicycle ride that had successfully induced VIMS in previous studies. Participants were randomly assigned to one of three groups; the first group was exposed to a pleasant odor (rose) while watching the video, the second group was exposed to an unpleasant odor (leather), and the third group was not exposed to any odor. VIMS was measured using a verbal rating scale (0-20) and the Simulator Sickness Questionnaire. Results showed that only half of the participants who were exposed to the odor did notice it (n = 21), whereas the other half failed to detect the odor. However, among those participants who did notice the odor, the rose scent significantly reduced the severity of VIMS compared to the group that did not notice the odor. A moderate positive correlation between odor sensitivity and VIMS showed that participants with higher odor sensitivity also reported stronger VIMS. Our results demonstrate that olfaction can modulate VIMS and that a pleasant odor can potentially reduce VIMS. The relationship between olfactory perception, olfactory sensibility, and VIMS is discussed.

Use of controlled diaphragmatic breathing for the management of motion sickness in a virtual reality environment.

Evidence indicates that activation of the parasympathetic nervous system (PNS) suppresses physiological responses associated with motion sickness. Research also shows paced breathing increases PNS activation; the current study examines the use of paced diaphragmatic breathing (DB) training to quell motion sickness symptoms. Healthy participants (N = 60) were pre-screened for motion sickness susceptibility. Participants were then randomly assigned to either a control condition, focusing on environmental awareness, or to an experimental condition implementing paced DB. Following this, participants were exposed to a virtual reality (VR) motion sickness experience, while heart rate variability, breathing rate (RPM), and motion sickness ratings were collected. Results demonstrated participants in the DB condition had higher PNS activation and reported fewer motion sickness symptoms during the VR experience than the participants in the control condition. Results suggest that the DB protocol can be used to significantly increase PNS tone and decrease the development of motion sickness symptoms.

Virtual reality application matches the most established treatment for Mal de Debarquement Syndrome: A non-inferiority, randomized, open clinical trial.

Mal de Debarquement Syndrome (MdDS) is a debilitating neuro-otological disorder where individuals consistently feel self-motion, often triggered by motion like being on a boat (MT-MdDS). Due to the unknown pathophysiological mechanism, available treatment options for managing symptoms are limited. Our objective was to develop a virtual reality application (VRA) to simulate the full field optokinetic stimulation (OKS) booth and evaluate its efficacy compared to the standard treatment. In our randomized, open, non-inferiority clinical trial with 30 â€‹MT-MdDS patients, 15 received the OKS booth and 15 the new VRA over four consecutive days. Two 4-min treatment blocks were scheduled in the morning and afternoon, with a total of four blocks. Treatment effectiveness was evaluated through questionnaires and posturography. Our findings suggest that the choice of modality does not significantly differ in achieving an overall improvement in symptoms. We advocate that the VRA can be used as an accessible alternative to the booth method worldwide, effectively mitigating MdDS symptoms and enhancing the QoL of numerous MdDS patients.

Suspected Mal de Debarquement Syndrome: A Case Report Highlighting the Difficulty in Diagnosis and Management.

MdDS is syndrome of oscillating vertigo following cessation of passive motion. The pathogenesis of this disorder is not well understood, but functional imaging studies suggest cortical connectivity dysfunction in feedback loops of the vestibulo-ocular system and visuo-spatial system. Patients go through multiple appointments and often specialist referrals before being diagnosed. After diagnosis, optimal management is difficult. Several treatment modalities, including medication, vestibular rehabilitation, and neuromodulation, have had variable success in management. We present the case of a young, female active duty Air Force Captain who developed symptoms while deployed. She underwent multiple treatments with variable success. Her clinical course highlights the difficulties for patients and providers posed by suspected MdDS.

Vertigo and dizziness from environmental motion: visual vertigo, motion sickness, and drivers' disorientation.

The normal vestibular system may be adversely affected by environmental challenges which have characteristics that are unfamiliar or ambiguous in the patterns of sensory stimulation they provide. A disordered vestibular system lends susceptibility even to quotidian environmental experiences as the sufferer becomes dependent on potentially misleading, nonvestibular sensory stimuli. In both cases, the sequelae may be vertigo, incoordination, imbalance, and unpleasant autonomic responses. Common environmental motion conditions include visual vertigo, motion sickness, and motorists' disorientation. The core therapy for visual vertigo, motion sickness, and drivers' disorientation is progressive desensitization within a cognitive framework of reassurance and explanation, plus anxiolytic tactics and autogenic control of autonomic symptoms.

Neuronal mechanisms and the treatment of motion sickness.

The aim of this review is to provide an overview of the physiological basis, clinical picture and treatment options for motion sickness. Motion sickness is a well-known nausea and vomiting syndrome in otherwise healthy people. The physical signs of motion sickness occur in both humans and animals during travel by sea, automobile or airplane and in space. Furthermore, some other special situations, such as simulators, the cinema and video games, have been described as causing pseudomotion sickness. Children between 2 and 12 years old are most susceptible to motion sickness, and women are more frequently affected than men. Predisposing factors include menstruation, pregnancy, migraines and possibly a side difference in the mass of otoconia in the vestibular organs. Therapy is directed towards decreasing conflicting sensory input, accelerating the process of adaptation and controlling nausea and vomiting. To control these vegetative symptoms, scopolamine and antihistamines are the most effective drugs.

Transcutaneous Auricular Vagus Nerve Stimulation towards Visually Induced Motion Sickness Reduction: A Pilot Study.

Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel neuromodulation application for vagal afferent stimulation. Owing to its non-invasive nature, taVNS is a potent therapeutic tool for a diverse array of diseases and disorders that ail us. Herein, we investigated taVNS-induced effects on neural activity of participants during visually induced motion sickness. 64-channel electroencephalography (EEG) recordings were obtained from 15 healthy participants in a randomized, within-subjects, cross-over design during sham and taVNS conditions. To assess motion sickness severity, we used the motion sickness assessment questionnaire (MSAQ). We observed that taVNS attenuated theta (4-8 Hz) brain activity in the right frontal, right parietal and occipital cortices when compared to sham condition. The total MSAQ scores, and central, peripheral and sopite MSAQ categorical scores were significantly lower after taVNS compared to sham. These findings reveal for the first time the potential therapeutic role of taVNS toward counter-motion sickness, and suggest that taVNS may be reliable in alleviating symptoms of motion sickness in real-time, non-pharmacologically.Clinical relevance- This suggests taVNS potential to offset motion sickness-induced nausea; which may be of translational value to counter e.g., chemotherapy-induced nausea.

[Simulator sickness as a valid issue of simulator-based research]. / Choroba symulatorowa jako realny problem badan na symulatorach.

Simulators are increasingly being used in both research and training as well as in medicine, e.g., therapy of patients with diagnosed post traumatic stress disorders (PTSD). The use of simulators with strict control of environmental conditions allows for workload assessment or procedures improvement. Despite all the advantages of the utilization of simulators, the simulator sickness issue remains still topical. Simulator sickness may interfere with the measurement accuracy or effectiveness of training or therapy, but it can also be a source of stress for those carrying out the assignments on simulators. This article discusses problems associated with simulator sickness, paying particular attention to the scope of this phenomenon, its explaining theories and measurement methods.

OP deference--Libyan crisis 2011. Non combatant evacuation operations (NEO) --role one medical experience.

It is the author's belief that Role 1 GDMO led medical care continues to be a potent and adaptable force, capable of operating efficiently and with a high degree of autonomy in potentially high threat environments. The medical team was able to adapt to the operational demand and retained the full confidence of the command chain, however the MO felt acutely aware of gaps in his New Entry Medical Officer clinical training. Short duration courses such as Advanced Paediatric Life Support, Basic Surgical Skills and MIMMS provide excellent added value for medical officers and increase self confidence. NEMO training in the future may benefit from the inclusion of these. Despite the challenges faced during the NEOs the Role 1 medical team in CUMBERLAND found the experience very rewarding and an example of what they joined the Royal Navy to do.

Preliminary study after two years of use of Nausicaa system for seasickness management.

BACKGROUND: Seasickness is a set of clinical signs from which approximately 30% of the population suffers with a severity and frequency that varies according to the state of the sea and according to each individual susceptibility. The medical treatments are varied but may provide annoying side effects. Vestibular rehabilitation has all its advantages in cases of professional unfitness. The objective of this work is to validate the first results of rehabilitation of seasickness using the Nausicaa system developed at the HIA in Brest. MATERIALS AND METHODS: Retrospective study of the first 2 years of use of the Nausicaa system, from commissioning in November 2016 until December 2018. Twenty-eight patients were treated exclusively by the Nausicaa system with a minimum of 1 year of follow-up and a minimum of 90 days at sea per year. RESULTS: The average intensity of seasickness of these sailors decreased from 8.96 to 4.5 and the inability to hold one's post from 8.36 to 3.7 after 10 rehabilitation sessions using this system. The Graybiel and Miller score was markedly improved (decrease of 2 to 3 grades) in 62% of the patients, and partially improved (decrease of one grade) in 20% of the sailors. A total of 82% of rehabilitated patients were improved by this treatment without any side effects. CONCLUSIONS: The analysis of the results on a retrospective questionnaire describing clinical signs 1 year later is necessarily subjective. The use of visual analogic scales from 1 to 10 concerning the intensity of motion sickness and the inability to hold one's position seems to be an easy way to assess discomfort. The comparison with other series seems to show a slight superiority of the Nausicaa system compared to optokinetic rehabilitation or by visual simulator alone.

Vibro-motor Reprocessing Therapy towards Managing Motion Sickness Reduction: Evidence from EEG.

This study examines the neural activities of participants undergoing vibro-motor reprocessing therapy (VRT) while experiencing motion sickness. We evaluated the efficacy of vibro-motor reprocessing therapy, a novel therapeutic technique based on eye movement desensitization and reprocessing (EMDR), in reducing motion sickness. Based on visually induced motion sickness in two sets of performed sessions, eight participants were exposed to VRT stimulation in a VRT/non-VRT setting. Simultaneously, brain activity changes were recorded using electroencephalography (EEG) at baseline and during stimulus exposure, and comparisons made across the VRT/non-VRT conditions. A significant reduction in the alpha (8-12 Hz) spectral power was observed in the frontal and occipital locations, consistent across all participants. Furthermore, significant reductions were also found in the frontal and occipital delta (0.5-4 Hz) and theta (4-8 Hz) spectral power frequency bands between non-VRT and VRT conditions (p < 0.05). Our results offer novel insights for a potential nonpharmacological treatment and attenuation of motion sickness. Furthermore, symptoms can be observed, and alleviated, in real-time using the reported techniques. Clinical relevance - Instead of using drugs to treat motion sickness, patients could safely use this VRT technique.