Motion sickness and motion characteristics of vessels at sea.
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Symposium on motion sickness. II. Medication for motion sickness prior to and during World War II.
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Humans↗
Why is the driver rarely motion sick? The role of controllability in motion sickness.
The central hypothesis of the work is that the dimension of control-no control plays an important role in motion sickness. Although it is generally agreed that having control over a moving vehicle greatly reduces the likelihood of motion sickness, few studies have addressed this issue directly, and the theoretical explanation for this phenomenon is not completely clear. In this study, we equated groups differing in controllability for head movement, vision, activity, and predictability, which have often been suggested in the literature as explanations for the driver's immunity to motion sickness. Twenty-two pairs of yoked subjects were exposed to nauseogenic rotation. One subject of each pair had control over the rotation and head movements, while the other was exposed passively to the same motion stimulus. Subjects who had control reported significantly fewer motion sickness symptoms and less of a decrement in their well-being, as compared to the yoked subject without control. The results are discussed in relation to Reason's sensory rearrangement theory and the concept of feed-forward mechanisms in motion perception.
Adult↗
Motion sickness susceptibility.
Motion sickness can be caused by a variety of motion environments (e.g., cars, boats, planes, tilting trains, funfair rides, space, virtual reality) and given a sufficiently provocative motion stimulus almost anyone with a functioning vestibular system can be made motion sick. Current hypotheses of the 'Why?' of motion sickness are still under investigation, the two most important being 'toxin detector' and the 'vestibular-cardiovascular reflex'. By contrast, the 'How?' of motion sickness is better understood in terms of mechanisms (e.g., 'sensory conflict' or similar) and stimulus properties (e.g., acceleration, frequency, duration, visual-vestibular time-lag). Factors governing motion sickness susceptibility may be divided broadly into two groups: (i) those related to the stimulus (motion type and provocative property of stimulus); and (ii) those related to the individual person (habituation or sensitisation, individual differences, protective behaviours, administration of anti-motion sickness drugs). The aim of this paper is to review some of the more important factors governing motion sickness susceptibility, with an emphasis on the personal rather than physical stimulus factors.
Animals↗
Scopolamine for preventing and treating motion sickness.
BACKGROUND: Motion sickness - the discomfort experienced when perceived motion disturbs the organs of balance - may include symptoms such as nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation and headaches. The control and prevention of these symptoms have included pharmacological, behavioural and complementary therapies. Although scopolamine has been used in the treatment and prevention of motion sickness for decades, there have been no systematic reviews of its effectiveness. OBJECTIVES: To assess the effectiveness of scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination for motion sickness in persons (both adults and children) without known vestibular, visual or central nervous system pathology. SEARCH STRATEGY: The Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (OVID, 1966 to March Week 1 2004), EMBASE (1974 to 2004) CINAHL (Ovid, 1982 to March Week 1 2004) and reference lists of retrieved studies were searched for relevant studies. No language restrictions were applied. SELECTION CRITERIA: All parallel-arm, randomised controlled trials (RCTs) focusing on scopolamine versus no therapy, placebo, other drugs, behavioural and complementary therapy or two or more of the above therapies in combination were included. Outcomes relating to the prevention of onset or treatment of clinically-defined motion sickness, task ability and psychological tests, changes in physiological parameters and adverse effects were considered. DATA COLLECTION AND ANALYSIS: Data from the studies were extracted independently by two authors using standardised forms. Study quality was assessed. Dichotomous data were expressed as odds ratio (OR) and a pooled OR was calculated using the random effects model. MAIN RESULTS: Of 27 studies considered potentially relevant, 12 studies enrolling 901 subjects met the entry criteria. Scopolamine was administered via transdermal patches, tablets or capsules, oral solutions or intravenously. Scopolamine was compared against placebo, calcium channel antagonists, antihistamine, meth-scopolamine or a combination of scopolamine and ephedrine. Studies were generally small in size and of varying quality. Scopolamine was more effective than placebo in the prevention of symptoms. Comparisons between scopolamine and other agents were few and suggested that scopolamine was superior (versus meth-scopolamine) or equivalent (versus antihistamines) as a preventative agent. Evidence comparing scopolamine to cinnarizine or combinations of scopolamine and ephedrine is equivocal or minimal. Although sample sizes were small, scopolamine was no more likely to induce drowsiness, blurring of vision or dizziness compared to other agents. Dry mouth was more likely with scopolamine than with meth-scopolamine or cinnarizine. No studies were available relating to the therapeutic effectiveness of scopolamine in the management of established symptoms of motion sickness. REVIEWERS' CONCLUSIONS: The use of scopolamine versus placebo in preventing motion sickness has been shown to be effective. No conclusions can be made on the comparative effectiveness of scopolamine and other agents such as antihistamines and calcium channel antagonists. In addition, no randomised controlled trials were identified that examined the effectiveness of scopolamine in the treatment of established symptoms of motion sickness.
Humans↗
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.
Adult↗
Space motion sickness.
Space motion sickness, presumably triggered by sudden entry into a weightless environment, occurred with unexpected frequency and severity among astronauts who flew the Skylab missions. Recovery from symptoms was complete within 3-5 days, and as revealed by the Skylab M131 Human Vestibular Function Experiment, all crewmembers were immune to experimentally induced motion sickness after mission day 8. This syndrome has been recognized as a possible threat to the early mission well-being and operational efficiency of at least some individuals who will fly space missions in the future. The causes of space motion sickness are not clearly understood, nor have satisfactory methods been identified to date for its prediction, prevention and treatment. In order to minimize the potential impact of this syndrome on Space Shuttle crew operations the National Aeronautics and Space Administration has organized a broad program of inter-disciplinary research involving a large number of scientists in the United States. Current research on the etiology of space motion sickness is based to a large extent on the so called sensory conflict theory. Investigations of the behavioral and neurophysiological consequences of intralabyrinthine, as well as intermodality sensory conflict are being performed. The work in this area is being influenced by the presumed alterations that occur in otolith behavior in weightlessness. In addition to sensory conflict, the possible relationship between observed cephalad shifts of body fluids in weightlessness and space motion sickness is being investigated. Research to date has failed to support the fluid shift theory. Research underway to identify reliable test methods for the prediction of susceptibility to space motion sickness on an individual basis includes attempts to (a) correlate susceptibility in different provocative environments; (b) correlate susceptibility with vestibular and non-vestibular response parameters, the latter including behavioral, hemodynamic and biochemical factors and (c) correlate susceptibility with rate of acquisition and length of retention of sensory adaptation. Controlled studies are also being performed during parabolic flight as a means of attempting to validate predictive tests for susceptibility to this syndrome. Research to develop new or improved countermeasures for space motion sickness is underway in two primary areas. One of these involves anti-motion sickness drugs. Significant achievements have been realized with regard to the identification of new highly efficacious drug combinations, dose levels and routes of administration. Although pronounced individual variations must be accounted for in selecting the optimum drug and dose level, combinations of promethazine plus ephedrine or scopolamine plus dexidrine are presently the drugs of choice. Work is also underway to identify side effects associated with anti-motion sickness drug use and to identify new drugs which may selectively modify activity in central neural pathways involved in motion sickness. In addition to research on drugs, efforts are being made to develop practical vestibular training methods. Variables which influence rate of acquisition of adaptation, length of retention of adaptation and transfer of protective adaptation to new environments are being evaluated. Also, included in this area is the use of biofeedback and autogenic therapy to train individuals to regulate autonomic responses associated with motion sickness. While valuable new knowledge is expected to evolve from these combined research programs, it is concluded that the final validation of predictive tests and countermeasures will require a series of controlled space flight experiments.
Adaptation, Physiological↗
Gender differences in motion sickness history and susceptibility to optokinetic rotation-induced motion sickness.
PURPOSE: The present study investigated gender differences in motion sickness history and susceptibility to optokinetic rotation-induced motion sickness. METHODS AND RESULTS: The study included two phases. In Phase 1, 485 subjects filled out a survey of previous incidence of motion sickness. Results indicated that women reported significantly greater incidence of feeling motion sickness than did men on buses, on trains, on planes, in cars, and on amusement rides before the age of 12 yr; and on buses, on trains, on planes, in boats, on ships, in cars, on amusement rides, and on swings between the ages of 12 and 25 yr. Women also reported significantly higher incidence of being actually sick than did men on buses before the age of 12 yr and on buses, on ships, and in cars between the ages of 12 and 25 yr. In Phase 2, each of the 47 subjects viewed an optokinetic rotating-drum for 16 min. Subjects' subjective symptoms of motion sickness (SSMS) were obtained during drum rotation. The results showed that there were no significant differences on SSMS scores between men and women. CONCLUSION: Although women reported greater incidence in motion sickness history, women did not differ from men in severity of symptoms of motion sickness while viewing a rotating optokinetic drum.
Adolescent↗
Motion sickness during off-vertical axis rotation: prediction by a model of sensory interactions and correlation with other forms of motion sickness.
Motion sickness (MS) susceptibility of 108 normal subjects was measured during off-vertical axis rotation (OVAR) as a function of angular velocity (60-180 degrees/s). The chair rotated about a longitudinal axis tilted 30 degrees with respect to gravity. For each velocity, we measured the duration of exposure necessary to evoke a moderate malaise, with a limit of 30 min. MS appeared the fastest at a rotation velocity of 105 degrees/s; higher or lower velocities were less provocative. These results are in good agreement with predictions made by Zupan et al. [in ICANN'94, Springer-Verlag, 1995] by means of a MS mathematical model derived from a model of sensory interactions [Droulez and Darlot, in Attention and Performance, Vol. 13, Lawrence Erlbaum, Hillsdale, 1989]. We also found that MS susceptibility during OVAR is positively correlated with susceptibility to other forms of MS. Since OVAR induces sensory messages very different from those induced by other provocative stimulations, this could suggest that the sensitivity of a common final vegetative locus is an important factor of the individual differences in susceptibility to MS.
Adult↗
Chlorpheniramine for motion sickness.
BACKGROUND: Motion sickness remains a significant problem for travelers and for those involved in naval, aviation and space operations. Many motion sickness remedies are also sedating, making them undesirable in many settings. METHODS: We studied chlorpheniramine as a potential motion sickness treatment. A placebo-controlled, double-blind, dose-ranging trial was performed to establish the most effective dose and the drug's effects on cognition. Eighteen normal, motion sickness susceptible subjects received placebo, low dose (4 mg) or high dose (12 mg) chlorpheniramine 3.5 hours before off-axis vertical rotation. Cognitive testing included a battery of objective and subjective tests performed before drug ingestion, at peak drug effect and following rotation. RESULTS: Chlorpheniramine significantly increased the time in the chair compared to placebo at high dose (7.2 minutes to 11.7 minutes) and low dose (7.2 minutes to 10.2 minutes). Chlorpheniramine did not affect performance on objective cognitive tests. Subjects reported significantly more sleepiness and less alertness with high-dose chlorpheniramine, although they could not reliably determine when they had received active drug. CONCLUSION: Chlorpheniramine is effective and could be considered for use against motion sickness. Chlorpheniramine also has the potential to be administered transdermally.
Adult↗
Motion sickness susceptibility to optokinetic rotation correlates to past history of motion sickness.
PURPOSE: This study investigated correlations between motion sickness susceptibility to a rotating optokinetic drum and past history of motion sickness. METHOD: There were 49 subjects who filled out a questionnaire on motion sickness history (MSH) who participated in the experiment. Each subject sat in an optokinetic drum for a 12-min baseline and a 12-min drum rotation period. Subjects' motion sickness symptoms (MSS) and electrogastrograms (EGG's) were measured. RESULTS: There were significant correlations between MSH scores and MSS scores during drum rotation (r = 0.5392, p < 0.001), and between MSH scores and EGG 4-9 cycles per minute (cpm) spectral intensity ratios between drum rotation and baseline periods (r = 0.5320, p < 0.001). Further analysis indicated that the mean MSS scores during the drum rotation period were 11.50 for the top 33% MSH scorers, 4.18 for the middle 34% MSH scorers, and 3.63 for the bottom 33% MSH scorers. The mean EGG 4-9 cpm spectral intensity ratios between drum rotation and baseline periods were 2.62 for the top 33% MSH scorers, 1.44 for the middle 34% MSH scorers, and 1.21 for the bottom 33% MSH scorers. CONCLUSION: These results indicated that past history of motion sickness correlates with severity of motion sickness provoked by optokinetic rotation.
Adult↗
Relationship between selected orientation rest frame, circular vection and space motion sickness.
Space motion sickness (SMS) and spatial orientation and motion perception disturbances occur in 70-80% of astronauts. People select "rest frames" to create the subjective sense of spatial orientation. In microgravity, the astronaut's rest frame may be based on visual scene polarity cues and on the internal head and body z axis (vertical body axis). The data reported here address the following question: Can an astronaut's orientation rest frame be related and described by other variables including circular vection response latencies and space motion sickness? The astronaut's microgravity spatial orientation rest frames were determined from inflight and postflight verbal reports. Circular vection responses were elicited by rotating a virtual room continuously at 35 degrees/s in pitch, roll and yaw with respect to the astronaut. Latency to the onset of vection was recorded from the time the crew member opened their eyes to the onset of vection. The astronauts who used visual cues exhibited significantly shorter vection latencies than those who used internal z axis cues. A negative binomial regression model was used to represent the observed total SMS symptom scores for each subject for each flight day. Orientation reference type had a significant effect, resulting in an estimated three-fold increase in the expected motion sickness score on flight day 1 for astronauts who used visual cues. The results demonstrate meaningful classification of astronauts' rest frames and their relationships to sensitivity to circular vection and SMS. Thus, it may be possible to use vection latencies to predict SMS severity and duration.
Adult↗
Medical prevention of space motion sickness--animal model of therapeutic effect of a new medicine on motion sickness.
Space motion sickness (MS) is one of the most important problems in the field of space medicine. In order to prevent space MS, a new medicine, PMPA, has been prepared by means of synthesizing in our laboratory. The purposes of this study were to set up animal models of PMPA against MS, and to observe its effects on anti-MS, and to prove its function of antagonism to choline. Eight cats, forty rabbits and two hundred and ten rats were selected as animal subjects. The parallel swing stimulus, a method causing the reversal syndromes and tests of anti-choline function were used in our experiments. The results are as follows: (1) The score of MS symptoms in cats with PMPA or scopolamine (SCOP) is significantly lower than that in cats with placebo (p<0.01), while the incidences of efficiency and prevention of PMPA (87.5%, 75%) are higher than those of SCOP (75.0%, 50%) in cats. (2) PMPA of 1.6 mg/kg or 0.8 mg/kg could antagonize the reversal syndromes and repress reversal rotation significantly in rabbits like SCOP in comparison with placebo (p<0.01). (3) PMPA could inhibit tremor evoked by oxotremorine or by nicotine-procaine in rats like SCOP, and play an important role in the antagonism to central M-choline and N-choline receptors. The animal experiments demonstrate that PMPA is an effective medicine against MS with antagonism function to choline.
Acceleration↗
Space motion sickness.
Space Motion Sickness (SMS) is the malady which frequently occurs shortly after attainment of sustained exposure to hypogravity. It is characterised by a variety of symptoms, which may proceed to nausea and eventually vomiting. Natural adaptation usually occurs if exposure to hypogravity is maintained. The condition appears to be the manifestation of motion sickness that is specific to hypogravity. It is associated with otolith-canal and otolith-eye conflict. SMS may have operational significance in impairing the performance of spacecraft crews. The condition is likely to be amenable to treatment with anti-motion sickness drugs. It may be possible to reduce any operational effects of SMS by suitable crew selection and training procedures.
Adaptation, Physiological↗
Prevention of PONV with granisetron, droperidol and metoclopramide in female patients with history of motion sickness.
PURPOSE: Motion sickness is one of the patient-related factors associated with postoperative nausea and vomiting (PONV). This study was undertaken to assess the efficacy of granisetron, droperidol and metoclopramide for preventing PONV in female patients with a history of motion sickness undergoing major gynaecological surgery. METHODS: In a prospective, randomized, placebo-controlled, double-blind study, 120 patients received either 1.25 mg droperidol, 10 mg metoclopramide, 40 micrograms.kg-1 granisetron or placebo (saline) iv immediately before induction of anaesthesia. A standardized anaesthetic technique and postoperative analgesia were used in all patients. During the first 24 hr after anaesthesia, the incidence of PONV and adverse events were recorded by nursing-staff. RESULTS: The treatment groups were similar for patient demographics, types of surgery, anaesthetics administered and opioid given. The incidence of PONV was 70%, 50%, 57% and 23% in the placebo, droperidol, metoclopramide and granisetron groups, respectively (P < 0.05; overall chi 2 test). No difference in the incidence of adverse events was observed in either group. CONCLUSION: Granisetron is a better prophylactic antiemetic than droperidol or metoclopramide in female patients with a history of motion sickness undergoing major gynaecological surgery.
Adult↗
Optokinetic motion sickness: continuous head movements attenuate the visual induction of apparent self-rotation and symptoms of motion sickness.
Symptoms of motion sickness are sometimes experienced during exposure to optokinetic stimulation. Two experimetns were performed to compare the symptoms of motion sickness elicited when subjects were exposed to incremental changes in optokinetic stimulation while sitting passively and while continuously executing shoulder-to-shoulder head movements. In the first experiment, a fixed head-movement frequency (20 cpm) was used, wheras in the second the subjects varied the frequency of their head movements in order to maintain suppression of illusory self-rotation. In both experiments, subjects in the head-moving condition had fewer and less severe symptoms of motion sickness and experienced illusory self-rotation after longer exposure times and at higher optokinetic velocities than in the head-stationary condition. Subjects in th- head-movement condition of the second experiment increased the frequency of their head movements as the velocity of optokinetic stimulation increased. The symptoms of motion sickness elicited during optokinetic stimulation tended to be dizziness, headache, eye-strain, and stomach awareness appearing in no fixed order. The pattern and constellation of symptoms are unlike those elicited by vestibular stimulation.
Eye Movements↗
Managing space motion sickness.
Space motion sickness is a well-recognized problem for space flight and affects 73% of crewmembers on the first 2 or 3 days of their initial flight. Illness severity is variable, but over half of cases are categorized as moderate to severe. Management has included elimination of provocative activities and delay of critical performance-related procedures such as extra-vehicular activity (EVA) or Shuttle landing during the first three days of missions. Pharmacological treatment strategies have had variable results, but intramuscular promethazine has been the most effective to date with a 90% initial response rate and important reduction in residual symptoms the next flight day. Oral prophylactic treatment of crewmembers with difficulty on prior flights has had mixed results. In order to accommodate more aggressive pharmacologic management, crew medical officers receive additional training in parenteral administration of medications. Preflight medication testing is accomplished to reduce the risk of unexpected performance decrements or idiosyncratic reactions. When possible, treatment is offered in the presleep period to mask potential treatment-related drowsiness. Another phenomenon noted by crewmembers and physicians as flights have lengthened is readaptation difficulty or motion sickness on return to Earth. These problems have included nausea, vomiting, and difficulty with locomotion or coordination upon early exposure to gravity. Since landing and egress are principal concerns during this portion of the flight, these deficits are of operational concern. Postflight therapy has been directed at nausea and vomiting, and meclizine and promethazine are the principal agents used. There has been no official attempt at prophylactic treatment prior to entry. Since there is considerable individual variation in postflight deficit and since adaptation from prior flights seems to persist, it has been recommended that commanders with prior shuttle landing experience be named to flights of extended duration.
Antiemetics↗
Objective and subjective time courses of recovery from motion sickness assessed by repeated motion challenges.
The aim of this study was to determine whether the time course of recovery of tolerance, as assessed objectively by rechallenge with motion, paralleled the subjective recovery from motion sickness. Subjects (n = 20) were exposed to 5 pairs of nauseogenic motion challenges in which the time interval between the end of the first and the start of the second of each pair ranged from 15 min to 2 h. The cross-coupled motion challenge had an incrementing profile of rotational velocity from 4 degrees to 92 degrees.s-1 in steps of 4 degrees.s-1 every 30 s, with 8 head movements per 30 s, of approximately 45 degrees, and was continued to the point of moderate nausea. Objective loss of tolerance decreased from 15 min to 60 min after the first challenge, but increased again at 2 h. By contrast, most individuals reported subjective recovery by 15 min to 30 min. It was concluded that there is an underlying effect of motion sickness that sensitizes the response to subsequent motion for a period of at least 2 h. This underlying objective effect can occur in the absence of subjective symptoms, has a slower time course than the subjective recovery from symptoms, and appears to be non-monotonic.
Adult↗