Motion sickness

For the album by Bright Eyes, see 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 frequently vomit. Unlike ordinary sickness, vomiting in motion sickness tends not to relieve the nausea.^[1]

Occurrence

About 33% of people are susceptible to motion sickness even in mild circumstances such as being on a boat in calm water, although nearly 66% of people are susceptible in more severe conditions.^[1][5][6] Individuals and animals without a functional vestibular system are immune to motion sickness.^[7]

Motion sickness on the sea can result from being in the berth of a rolling boat without being able to see the horizon. Sudden jerky movements tend to be worse for provoking motion sickness than slower smooth ones, because they disrupt the fluid balance more.^[1] A "corkscrewing" boat will upset more people than one that is gliding smoothly across the oncoming waves. Cars driving rapidly around winding roads or up and down a series of hills will upset more people than cars that are moving over smooth, straight roads. Looking down into one's lap to consult a map or attempting to read a book while a passenger in a car may also bring on motion sickness. Motion sickness is greatest for vertical sinusoidal motion in the frequency range of 0.05–0.8 Hz and is maximal at 0.167 Hz.^[8]

Cause

The most common hypothesis for the cause of motion sickness is that it functions as a defense mechanism against neurotoxins.^[7] 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 or Car sickness

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 worst when looking down but may be lessened by looking outside of the vehicle.

Airsickness

Main article: 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. Airsickness occurs when the central nervous system receives conflicting messages from the body (including the inner ear, eyes and muscles) affecting balance and equilibrium. 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, a passenger is likely to see only the stationary interior of the plane. Another factor is that while in flight, there is little that can be seen outside of the windows that would indicate motion to the visual system.

Sea-sickness

Main article: Seasickness

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^[9] or movement while immersed in water.^[10] 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. Some people experience car sickness yet they don't experience seasickness.

Centrifuges

Rotating devices such as centrifuges used in astronaut training and amusement park rides such as the Rotor 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).^[11]

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. There is little way to prevent this type of motion sickness except to close one's eyes during such scenes or to avoid such movies.

In regular format theaters, an example of a movie that caused motion sickness in many people is The Blair Witch Project. Theater patrons were warned of its possible nauseating effects, cautioning pregnant women in particular. In this case, a camcorder was used to film the movie. As the camera was hand held, the camera 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.^[1]

The most common theory for the cause of simulation sickness is that the illusion of motion created by the virtual world, combined with the absence of motion detected by the inner ear, causes the area postrema in the human brain to infer that one is hallucinating and further conclude that the hallucination is due to poison ingestion. The brain responds by inducing nausea and mass vomiting, to clear the supposed toxin.^[7] According to this theory, simulation sickness is just another form of motion sickness.

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.^[12]

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."^[13][14]

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 3-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 16 degree of freedom motion base. Studies have shown that exposure to rotational motions in a virtual environement can cause significant increases in nausea and other symptoms of motion sickness.^[15]

Space sickness

Main article: Space adaptation syndrome

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 proportional amount of motion.

Treatment

Many cures and preventatives for motion sickness have been proposed.

Activity

One common suggestion is to simply look out of the window of the moving vehicle and to gaze toward 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.^[16]

Medication

Over-the-counter and prescription medications are readily available, such as Dramamine (dimenhydrinate),^[17] Stugeron (cinnarizine), and Bonine/Antivert (meclozine).

Scopolamine is effective^[18] 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. 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,^[19] while an earlier study indicated that it had only a placebo effect.^[20] 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.^[21]

Ginger is reported to calm the pyloric valve located at the base of the stomach.^[19] 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.^[22]

Stugeron is not available in the U.S. either over-the-counter or by prescription. It has been implicated in triggering palsy and has been banned by the FDA.^[23]

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.^[24]

See also

• Acclimatization

References

1. ^ ^{a b c d e f g h} Benson, AJ (2002). "35". Motion Sickness. In: Medical Aspects of Harsh Environments. 2. Washington, DC. http://www.bordeninstitute.army.mil/published_volumes/harshEnv2/HE2ch35.pdf. Retrieved 2008-05-09. 
2. ^ Motion Sickness Prevention and Treatment
3. ^ Woodhouse's English-Greek Dictionary Page 745
4. ^ Woodhouse's English-Greek Dictionary Page 766
5. ^ PC Today Article - Motion Sickness
6. ^ So, R.H.Y., Finney, C.M. and Goonetilleke, R.S., "Motion sickness susceptibility and occurrence in Hong Kong Chinese." Contemporary Ergonomics 1999, Taylor & Francis, pp.88-92.
7. ^ ^{a b c} General Medical Officer (GMO) Manual: Clinical Section: Motion Sickness
8. ^ O'Hanlon JF, McCauley ME. (1974).Motion sickness incidence as a function of the frequency and acceleration of vertical sinusoidal motion. Aerosp Med. 45(4):366-9. PMID 4821729
9. ^ Gahlinger PM (2000). "A comparison of motion sickness remedies in severe sea conditions". Wilderness Environ Med 11 (2): 136–7. doi:10.1580/1080-6032(2000)011[0136:LTTE]2.3.CO;2. PMID 10921365. 
10. ^ Norfleet WT, Peterson RE, Hamilton RW, Olstad CS (January 1992). "Susceptibility of divers in open water to motion sickness". Undersea Biomed Res 19 (1): 41–7. PMID 1536062. http://archive.rubicon-foundation.org/2621. Retrieved 2008-05-09. 
11. ^ So, R.H.Y. and Ujike, H. (2010) Visually induced motion sickness, visual stress and photosensitive epileptic seizures: what do they have in common? - Preface to the special issue. Applied Ergonomics, 41(4), pp.491-393.
12. ^ Could video games be making your kids sick?^{[dead link]}
13. ^ CyberEdge Information Services: Health & Safety, Simulator Sickness in Virtual Environments: Executive Summary
14. ^ Video Game Simulator Sickness^{[dead link]}
15. ^ So, R.H.Y. and Lo, W.T. (1999) "Cybersickness: An Experimental Study to Isolate the Effects of Rotational Scene Oscillations." Proceedings of IEEE Virtual Reality '99 Conference, March 13–17, 1999, Houston, Texas. Published by IEEE Computer Society, pp.237-241.
16. ^ FAA Medical Certification / Alcohol / Substance / Drugs - Motion Sickness
17. ^ Weinstein SE, Stern RM (October 1997). "Comparison of marezine and dramamine in preventing symptoms of motion sickness". Aviat Space Environ Med 68 (10): 890–4. PMID 9327113. 
18. ^ Spinks A, Wasiak J, Villanueva E, Bernath V (2007). Wasiak, Jason. ed. "Scopolamine (hyoscine) for preventing and treating motion sickness". Cochrane database of systematic reviews (Online) (3): CD002851. doi:10.1002/14651858.CD002851.pub3. PMID 17636710. 
19. ^ ^{a b} Ernst, E.; and M. H. Pittler (1 March 2000). "Efficacy of ginger for nausea and vomiting: a systematic review of randomized clinical trials" (PDF). British Journal of Anaesthesia 84 (3): 367–371. PMID 10793599. http://bja.oxfordjournals.org/cgi/content/abstract/84/3/367. Retrieved 2006-09-06. 
20. ^ Wood CD. Pharmacological countermeasures against motion sickness. In Crampton GH, ed. Motion and Space Sickness. CRC Press, Boca Raton, 1990, p. 344.
21. ^ Wikipedia. "Episode Listing (Wikipedia)". http://en.wikipedia.org/wiki/MythBusters_%282005_season%29#Seasickness_-_Kill_or_Cure.3F. 
22. ^ "Seasickness Studies about ginger". EUROPÄISCHES SEGEL-INFORMATIONSSYSTEM. http://www.esys.org/seekrank/sekrnk11.html. 
23. ^ Letter to editor Latitude 38 Magazine April 2006, by medical doctor detailing the dangers of Stugeron
24. ^ Stroboscopic Vision as a Treatment for Space Motion Sickness

External links

• 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.