Motion sickness

Motion sickness
Classification and external resources
ICD-10	T75.3
ICD-9	994.6
OMIM	158280
DiseasesDB	11908
MeSH	D009041

Motion sickness or kinetosis, also known as travel sickness, is a condition in which a disagreement exists between visually perceived movement and the vestibular system's sense of movement. Depending on the cause, it can also be referred to as seasickness, car sickness, simulation sickness or airsickness.^[1]

Dizziness, fatigue, and nausea are the most common symptoms of motion sickness.^[2] Sopite syndrome in which a person feels fatigue or tiredness is also associated with motion sickness. Nausea in Greek means seasickness (naus means ship).^[3][4] If the motion causing nausea is not resolved, the sufferer will usually vomit.

Cause

The most common hypothesis for the cause of motion sickness is that it functions as a psychological defense mechanism against neurotoxins.^[5] The area postrema in the brain is responsible for inducing vomiting when poisons are detected, and for resolving conflicts between vision and balance. When feeling motion but not seeing it (for example, in a ship with no windows), the inner ear transmits to the brain that it senses motion, but the eyes tell the brain that everything is still. As a result of the discordance, the brain will come to the conclusion that one of them is hallucinating and further conclude that the hallucination is due to poison ingestion. The brain responds by inducing vomiting, to clear the supposed toxin.

Types

Motion sickness can be divided into three categories:

1. Motion sickness caused by motion that is felt but not seen
2. Motion sickness caused by motion that is seen but not felt
3. Motion sickness caused when both systems detect motion but they do not correspond.

Motion is felt but not seen

In these cases, motion is sensed by the vestibular system and hence the motion is felt, but no motion or little motion is detected by the visual system.

Carsickness

A specific form of motion sickness, car sickness is quite common and often evidenced by the inability to read a map or book during travel. Car sickness results from the sensory conflict arising in the brain from differing sensory inputs. The eyes mostly see the interior of the car which is motionless while the vestibular system of the inner ear senses motion as the vehicle goes around corners or over hills and even small bumps. Therefore the effect is worse when looking down but may be lessened by looking outside of the vehicle.

Airsickness

Airsickness is a sensation which is induced by air travel.^[1] It is a specific form of motion sickness and is considered a normal response in healthy individuals. It is essentially the same as carsickness but occurs in an airplane. However, some significant differences are that an airplane may bank and tilt sharply and due to the small window sizes, unless the passenger is at a window seat he is likely to see only the stationary interior of the plane. Another factor is that while in flight, the view out of windows may be blocked by clouds, preventing a passenger at the window from seeing the moving ground or moving lower clouds.

Sea-sickness

Seasickness is a form of motion sickness characterized by a feeling of nausea and, in extreme cases, vertigo experienced after spending time on a craft on water.^[1] It is, again, essentially the same as carsickness, though the motion of a watercraft tends to be more constant. It is typically brought on by the rocking motion of the craft^[6] or movement while immersed in water.^[7] As with airsickness, it can be difficult to visually detect motion even if one looks outside of the boat as water does not offer fixed points with which to visually judge motion. Poor visibility conditions, such as fog, may worsen seasickness. Some sufferers of carsickness are resistant to seasickness and vice-versa.

Centrifuges

Rotating devices such as centrifuges used in astronaut training and amusement park rides such as the Rotor, Mission: Space and the Gravitron can cause motion sickness in many people. While the interior of the centrifuge does not appear to move, one will experience a sense of movement. In addition, centrifugal force can cause the vestibular system to give one the sense that downward is in the direction away from the center of the centrifuge rather than the true downward direction.

Dizziness due to spinning

When one spins and stops suddenly, fluid in the inner ear continues to rotate causing a sense of continued spinning while one's visual system no longer detects motion.

Motion that is seen but not felt

In these cases, motion is detected by the visual system and hence the motion is seen, but no motion or little motion is sensed by the vestibular system. Motion sickness arising from such situations has been referred to as Visually Induced Motion Sickness (VIMS).^[8]

Motion sickness due to films and other video

This type of sickness is particularly prevalent when susceptible people are watching films on large screens such as IMAX but may also occur in regular format theaters or even when watching TV. For the sake of novelty, IMAX and other panoramic type theaters often show dramatic motions such as flying over a landscape or riding a roller coaster. This type of motion sickness can be prevented by closing one's eyes during such scenes.

In regular format theaters, an example of a movie that caused motion sickness in many people is The Blair Witch Project. Theaters warned patrons of its possible nauseating effects, cautioning pregnant women in particular. Blair Witch was filmed with a handheld camcorder, which was subjected to considerably more motion than the average movie camera.

Home movies, often filmed with a hand-held camera, also tend to cause motion sickness in those that view them. The camera-person rarely notices this during filming since his/her sense of motion matches the motion seen through the camera viewfinder. Those who view the film afterward only see the movement, which may be considerable, without any sense of movement. Using the zoom function seems to contribute to motion sickness as well as zooming is not a normal function of the eye. The use of a tripod or a camcorder with image stabilization technology while filming can minimize this effect.

Simulation sickness

Simulation sickness, or simulator sickness, is a condition where a person exhibits symptoms similar to motion sickness caused by playing computer/simulation/video games.

The symptoms are often described as quite similar to that of motion sickness, and can range from headache, drowsiness, nausea, dizziness, vomiting and sweating. Research done at the University of Minnesota had students play Halo for less than an hour, and found that up to 50 percent felt sick afterwards.^[9]

In a study conducted by U.S. Army Research Institute for the Behavioral and Social Sciences in a report published May 1995 titled "Technical Report 1027 - Simulator Sickness in Virtual Environments", out of 742 pilot exposures from 11 military flight simulators, "approximately half of the pilots (334) reported post-effects of some kind: 250 (34%) reported that symptoms dissipated in less than 1 hour, 44 (6%) reported that symptoms lasted longer than 4 hours, and 28 (4%) reported that symptoms lasted longer than 6 hours. There were also 4 (1%) reported cases of spontaneously occurring flashbacks."^[10][11]

The phenomenon was well known in popular culture before it was known as simulation sickness. In the 1983 comedy film Joysticks, the manager of a local video arcade says, "The reason why I never play any of these games, well, they make me physically ill. I mean, every time I look in one of the screens, they make me dizzy."

Motion sickness due to virtual reality

Motion sickness due to virtual reality is very similar to simulation sickness and motion sickness due to films. In virtual reality, however, the effect is made more acute as all external reference points are blocked from vision, the simulated images are three-dimensional and in some cases stereo sound that may also give a sense of motion. The world's most advanced simulator, the NADS-1, located at the National Advanced Driving Simulator, is capable of accurately stimulating the vestibular system with a 360-degree horizontal field of view and 13 degree of freedom motion base.^[12] Studies have shown that exposure to rotational motions in a virtual environment can cause significant increases in nausea and other symptoms of motion sickness.^[13]

Space sickness

Space sickness was effectively unknown during the earliest spaceflights, as these were undertaken in very cramped conditions; it seems to be aggravated by being able to freely move around, and so is more common in larger spacecraft.^[1] Around 60% of Space Shuttle astronauts currently experience it on their first flight; the first case is now suspected to be Gherman Titov, in August 1961 onboard Vostok 2, who reported dizziness and nausea. However, the first significant cases were in early Apollo flights; Frank Borman on Apollo 8 and Rusty Schweickart on Apollo 9. Both experienced identifiable and reasonably severe symptoms—in the latter case causing the mission plan to be modified.

Motions that are seen and felt but do not correspond

Coriolis effect

When moving within a rotating reference frame such as in a centrifuge or environment where gravity is simulated with centrifugal force, the coriolis effect causes a sense of motion in the vestibular system that does not match the motion that is seen.

Sometimes when riding a vehicle for a long time on a badly maintained road at a very slow (10–20 km/h) speed the two senses fail to correspond. Due to the poor road quality the vehicle will jerk too much giving a sense of severe motion to the inner ear, but due to the slow speed the eye doesn't sense a proportional amount of motion.

Treatment

Many cures and preventatives for motion sickness have been proposed.

Device

One eyewear device named ViBAN was issued a U.S. motion sickness patent and is designed to block motion outside a moving vehicle, a primary cause of motion or car sickness, allowing the wearer to focus on reading or electronic devices inside the vehicle. Removal of the outside visual stimuli may work in some affected by motion sickness or car sickness, however it is not known to help those with sea sickness, which is most often associated with inner ear conflict.US Patent 6,275,998:

Activity

One common suggestion is to simply look out of the window of the moving vehicle and to gaze towards the horizon in the direction of travel. This helps to re-orient the inner sense of balance by providing a visual reaffirmation of motion.

In the night, or in a ship without windows, it is helpful to simply close one's eyes, or if possible, take a nap. This resolves the input conflict between the eyes and the inner ear. Napping also helps prevent psychogenic effects (i.e. the effect of sickness being magnified by thinking about it).

A simple method for relieving common and mild car sickness is chewing^{[citation needed]}. Chewing gum has an uncanny effectiveness for reducing car sickness in those affected. Chewing gum, however, is not the only thing one may chew to relieve mild effects of car sickness, snacking on sweets or just chewing in general seems to reduce adverse effects of the conflict between vision and balance.

Fresh, cool air can also relieve motion sickness slightly, although it is likely this is related to avoiding foul odors which can worsen nausea.^[14]

Medication

Over-the-counter and prescription medications are readily available, such as Dramamine (dimenhydrinate),^[15] Stugeron (cinnarizine), and Bonine/Antivert (meclizine). Though Stugeron is available in countries other than the United States, it is not available in the United States itself, either over the counter or by prescription. The FDA banned it in the United States after it was implicated in triggering palsy.^[16]

Scopolamine is effective^[17] and is sometimes used in the form of transdermal patches (1.5 mg) or as a newer tablet form (0.4 mg). The selection of a transdermal patch or scopolamine tablet is determined by a doctor after consideration of the patient's age, weight, and length of treatment time required.

Interestingly, many pharmacological treatments which are effective for nausea and vomiting in some medical conditions may not be effective for motion sickness. For example, metoclopramide and prochlorperazine, although widely used for nausea, are ineffective for motion-sickness prevention and treatment.^{[citation needed]} This is due to the physiology of the CNS vomiting centre and its inputs from the chemoreceptor trigger zone versus the inner ear. Sedating anti-histamine medications such as promethazine work quite well for motion sickness, although they can cause significant drowsiness.

Ginger root is commonly thought to be an effective anti-emetic. One trial review indicated that sucking on crystallized ginger or sipping ginger tea can help to relieve the nausea,^[18] while an earlier study indicated that it had only a placebo effect.^[19] Tests conducted on the television shows Mythbusters and Food Detectives support the theory that ginger is an effective treatment for the nausea caused by motion sickness.^[20]

Ginger is reported to calm the pyloric valve located at the base of the stomach.^[18] This relaxation of the valve allows the stomach to operate normally whereby the contents will enter the small intestine instead of being retained within the stomach. It is this undesirable effect of retention in the stomach that eventually results in vomiting. Vomiting is not seasickness but is only a symptom or side effect; although the effect most commonly associated with seasickness. This link reports on a ginger study; notice the comment about less vomiting when taking ginger, but not less nausea.^[21] Whether ginger ale is as effective as ginger root for this purpose has been disputed.

Electronic

As astronauts frequently have motion sickness, NASA has done extensive research on the causes and treatments for motion sickness. One very promising looking treatment is for the person suffering from motion sickness to wear LCD shutter glasses that create a stroboscopic vision of 4 Hz with a dwell of 10 milliseconds.^[22]

References

Do Visual Background Manipulations Reduce Simulator Sickness? In Proceedings of International Workshop on Motion Sickness / academic papers on a solution at http://www.hitl.washington.edu/projects/common/papers.php?idx=23

External links

Look up motion sickness in Wiktionary, the free dictionary.

• Motion Sickness from MedlinePlus
• Motion Sickness Prevention and Treatment, from a Medical College of Wisconsin website
• Visually induced motion sickness research
• Golding JF., Motion Sickness Susceptibility Autonomic Neuroscience: Basic and Clinical 129 (2006) 67–76
• Ji, J.T.T., So, R.H.Y. and Cheung, R.T.F. (2009) Isolating the effects of vection and optokinetic nystagmus on visually induced motion sickness during exposure to optokinetic stimuli. Human Factors, 51(5), pp. 739–751.
• Rolnick, A., & Bles, W. (1989). Performance and well being under tilting conditions: the effects of visual reference and artificial horizon. Aviation, Space and Environmental Medicine, 60, 779-785
• Rolnick, A. & Gordon, C. R. (1991). The effects of motion induced sickness on military performance. In R. Gal & J. Mangelsdorff (Eds.), Handbook of Military Psychology. Chichester: Wiley.
• Rolnick, A., Lubow, R.E., 1991. Why is the driver rarely sick? The role of controllability in motion sickness. Ergonomics 34, 867–879.
• So, R.H.Y., Lo, W.T. and Ho, A.T.K., (2002) "Effects of navigation speed on the level of cybersickness caused by an immersive virtual environment". Human Factors, 43(3), 2002, pp. 452–261.

v t e Motion sickness Types Airsickness Seasickness Space adaptation syndrome Medicine Treatment Dramamine Bonine Marezine Promethazine Other treatment Acupressure wristbands

v t e Consequences of external causes (T66–T78, 990–995) Temperature/radiation elevated temperature Hyperthermia Heat syncope reduced temperature Hypothermia Immersion foot syndromes Trench foot Tropical immersion foot Warm water immersion foot Chilblains Frostbite Aerosol burn Cold intolerance Acrocyanosis Erythrocyanosis crurum radiation Radiation poisoning Radiation burn Chronic radiation keratosis Eosinophilic, polymorphic, and pruritic eruption associated with radiotherapy Radiation acne Radiation cancer Radiation recall reaction Radiation-induced erythema multiforme Radiation-induced hypertrophic scar Radiation-induced keloid Radiation-induced morphea Air Hypoxia/Asphyxia Barotrauma Aerosinusitis Decompression sickness High altitude Altitude sickness Chronic mountain sickness HAPE HACE Food Starvation Maltreatment Physical abuse Sexual abuse Psychological abuse Travel Motion sickness Seasickness Airsickness Space adaptation syndrome Adverse effect Hypersensitivity Anaphylaxis Angioedema Allergy Arthus reaction Adverse drug reaction Other Electric shock Drowning Lightning injury Ungrouped skin conditions resulting from physical factors Dermatosis neglecta Pinch mark Pseudoverrucous papules and nodules Sclerosing lymphangiitis Tropical anhidrotic asthenia UV-sensitive syndrome environmental skin conditions Electrical burn frictional/traumatic/sports Black heel and palm Equestrian perniosis Jogger's nipple Pulling boat hands Runner's rump Surfer's knots Tennis toe Vibration white finger Weathering nodule of ear Wrestler's ear Coral cut Painful fat herniation Uranium dermatosis iv use Skin pop scar Skin track Slap mark Pseudoacanthosis nigricans Narcotic dermopathy