Driving simulator sickness: Impact on driving performance, influence of blood alcohol concentration, and effect of repeated simulator exposures

Mixing transcutaneous vagal nerve stimulation and galvanic cutaneous stimulation to decrease simulator adaptation syndrome

Purpose

Simulator Adaptation Syndrome arises from a perceptual discordance between expected and actual motion, giving rise to symptoms such as nausea and disorientation. This research focused on determining the benefit of Transcutaneous Vagal Nerve Stimulation (tVNS) and Galvanic Cutaneous Stimulation (GCS), where both were applied in conjunction, as compared to their administration in isolation, to decrease Simulator Adaptation Syndrome (SAS).

Method

A driving simulation study was proposed where SAS, body balance, and driving performance were measured. These measurements were taken during seven different stimulation scenarios with a baseline condition without stimulation compared against tVNS and GCS conditions.

Results

The main result showed that the combination of tVNS and GCS reduced SAS and improved body balance and driving performance more successfully than their administration in isolation.

Conclusion

Similar neuromodulation in the temporoparietal junction is proposed to mitigate SAS for GCS and tVNS (although additional explanations are discussed). Applying both techniques simultaneously is encouraged to decrease SAS in future interventions.

Analysis of speed reductions and crash risk of aggressive drivers during emergent pre-crash scenarios at unsignalized intersections

Aggressive driver behavior (ADB) is often linked with road crashes, especially during crash imminent situations. Previous studies demonstrated that ADB was positively correlated with collision risk; however, this relationship has not quantified evidently. This study aimed to analyze drivers' collision risk and speed reduction behavior during an emergent pre-crash scenario (such as a conflict encroaching into an unsignalized intersection at different critical time gaps) using a driving simulator. The effect of ADB on crash risk is investigated using the time to collision (TTC). Further, drivers' collision evasive behavior is analyzed using speed reduction time (SRT) survival probabilities. Fifty-eight Indian drivers are identified as aggressive, moderately aggressive, and, non-aggressive based on aggressive indicators such as vehicle kinematics (percentage of the time spent in speeding and rapid accelerations, maximum brake pressure, etc.). Two separate models are built to analyze ADB effects on TTC and SRT using a Generalized Linear Mixed Model (GLMM) and a Weibull Accelerated Failure Time (AFT) model, respectively. From the results, it can be observed that aggressive drivers' TTC and SRT are reduced by 82% and 38%, respectively. Compared to a 7 sec conflict approaching time gap, TTC is reduced by 18%, 39%, 51%, and 58% for 6 sec, 5 sec, 4 sec, and 3 sec conflict approaching time gaps, respectively. The estimated SRT survival probabilities for aggressive, moderately aggressive and non-aggressive drivers are 0%, 3% and 68% at 3 sec of conflict approaching time gap, respectively. SRT survival probability increased by 25% for matured drivers and decreased by 48% for drivers who tend to engage in frequent speeding. Important implications of the study findings are discussed.

Presence and simulator sickness predict the usability of a virtual reality attention task

Attention is the ability to actively process specific information within one's environment over longer periods of time while disregarding other details. Attention is an important process that contributes to overall cognitive performance from performing every day basic tasks to complex work activities. The use of virtual reality (VR) allows study of the attention processes in realistic environments using ecological tasks. To date, research has focused on the efficacy of VR attention tasks in detecting attention impairment, while the impact of the combination of variables such as mental workload, presence and simulator sickness on both self-reported usability and objective attention task performance in immersive VR has not been examined. The current study tested 87 participants on an attention task in a virtual aquarium using a cross-sectional design. The VR task followed the continuous performance test paradigm where participants had to respond to correct targets and ignore non-targets over 18 min. Performance was measured using three outcomes: omission (failing to respond to correct targets), commission errors (incorrect responses to targets) and reaction time to correct targets. Measures of self-reported usability, mental workload, presence and simulator sickness were collected. The results showed that only presence and simulator sickness had a significant impact on usability. For performance outcomes, simulator sickness was significantly and weakly associated with omission errors, but not with reaction time and commission errors. Mental workload and presence did not significantly predict performance. Our results suggest that usability is more likely to be negatively impacted by simulator sickness and lack of presence than performance and that usability and attention performance are linked. They highlight the importance of considering factors such as presence and simulator sickness in attention tasks as these variables can impact usability.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-023-00782-3.

The use of transcutaneous Vagal Nerve Stimulation as an effective countermeasure for Simulator Adaptation Syndrome

This research focused on investigating the effectiveness of Transcutaneous Vagal Nerve Stimulation (tVNS) as compared to Galvanic Cutaneous Stimulation (GCS) at mitigating Simulator Adaptation Syndrome (SAS). Fifty drivers (mean age = 23.04 ± 17.71 years old, twenty-two men) participated in a driving simulation experiment. The total scores of the Simulator Sickness Questionnaire, head movements (body balance index), and driving performance variables were measured under five stimulation conditions: i) baseline (no stimulation delivered), ii) sham GCS, iii) sham tVNS, iv) active GCS, and v) active tNVS. The results showed that tVNS alleviated SAS and improved driving performance variables more effectively than GCS. We conclude that GCS and tVNS have similar neurological mechanisms to reduce SAS, providing possible explanations for the greater effectiveness of tVNS. We encourage the use of tVNS to decrease SAS.

Detecting mild cognitive impairment and dementia in older adults using naturalistic driving data and interaction-based classification from influence score

Several recent studies indicate that atypical changes in driving behaviors appear to be early signs of mild cognitive impairment (MCI) and dementia. These studies, however, are limited by small sample sizes and short follow-up duration. This study aims to develop an interaction-based classification method building on a statistic named Influence Score (i.e., I-score) for prediction of MCI and dementia using naturalistic driving data collected from the Longitudinal Research on Aging Drivers (LongROAD) project. Naturalistic driving trajectories were collected through in-vehicle recording devices for up to 44 months from 2977 participants who were cognitively intact at the time of enrollment. These data were further processed and aggregated to generate 31 time-series driving variables. Because of high dimensional time-series features for driving variables, we used I-score for variable selection. I-score is a measure to evaluate variables' ability to predict and is proven to be effective in differentiating between noisy and predictive variables in big data. It is introduced here to select influential variable modules or groups that account for compound interactions among explanatory variables. It is explainable regarding to what extent variables and their interactions contribute to the predictiveness of a classifier. In addition, I-score boosts the performance of classifiers over imbalanced datasets due to its association with the F1 score. Using predictive variables selected by I-score, interaction-based residual blocks are constructed over top I-score modules to generate predictors and ensemble learning aggregates these predictors to boost the prediction of the overall classifier. Experiments using naturalistic driving data show that our proposed classification method achieves the best accuracy (96%) for predicting MCI and dementia, followed by random forest (93%) and logistic regression (88%). In terms of F1 score and AUC, our proposed classifier achieves 98% and 87%, respectively, followed by random forest (with an F1 score of 96% and an AUC of 79%) and logistic regression (with an F1 score of 92% and an AUC of 77%). The results indicate that incorporating I-score into machine learning algorithms could considerably improve the model performance for predicting MCI and dementia in older drivers. We also performed the feature importance analysis and found that the right to left turn ratio and the number of hard braking events are the most important driving variables to predict MCI and dementia.

EEG-based analysis of various sensory stimulation effects to reduce visually induced motion sickness in virtual reality

The use of virtual reality (VR) is frequently accompanied by motion sickness, and approaches for preventing it are not yet well established. We explored the effects of synchronized presentations of sound and motion on visually induced motion sickness (VIMS) in order to reduce VIMS. A total of 25 participants bicycle riding for 5 min with or without sound and motion synchronization presented on a head-mounted display. As a result, the VIMS scores measured by the fast motion sickness scale and simulator sickness questionnaire were significantly lower in the participants who experienced the riding scene with sound and motion than those who experienced the riding scene with sound only, motion only, or neither. Furthermore, analysis of the EEG signal showed that the higher the VIMS, the significant increase in alpha and theta waves in the parietal and occipital lobes. Therefore, we demonstrate that the simultaneous presentation of sound and motion, closely associated with synchronous and visual flow speed, is effective in reducing VIMS while experiencing simulated bicycle riding in a VR environment.

Evaluation of Driver's Reaction Time Measured in Driving Simulator

This article evaluates the driver’s reaction times in a driving simulator environment. The research focused mainly on young drivers under the age of 26, who cause many accidents. Each participating driver provided basic information later used for mathematical-statistical analysis. The main advantage of driving simulators is limitless usage. It is possible to simulate situations that would be unacceptable in real road traffic. Therefore, this study is also able to examine drunk driving. The main goal of the article is to evaluate if gender, practice, or alcohol significantly affected the reaction time of 30 drivers. We also focused on drinking before driving for a smaller number of the drivers; ten of them performed driving under the influence of alcohol. For these mathematical-statistical purposes, we used a one-sample t-test, a paired-samples t-test, an independent-sample t-test, and a correlation analysis together with the assessment of its statistical significance.

Alcohol and Alcohol Combined with Texting: Evaluation of Driving Impairment Effects in a Closed-Course Section

OBJECTIVE

Examine the driving impairment effects of alcohol alone and of alcohol combined with texting.

METHODS

Fifteen drivers (nine male, six female; mean age: 31.1 ± 6.9 years, range: 23 to 43 years) with similar drinking habit (i.e., social drinkers) completed a lap in a closed-course section in six different situations: (I) sober; (II) sober and while texting; (III) 30 minutes after ingesting a moderate dose of ethanol (0.50 g/kg); (IV) 30 minutes after drinking and while texting; (V) 60 minutes after drinking, (VI) 60 minutes after drinking and while texting. Driving performance was analyzed by means of maximum and mean speed, braking time and braking distance; and ability to control the car (i.e., evaluating if the drivers hit a traffic cone or exceeded the boundaries of the course). P values of < 0.05 were considered significant.

RESULTS

Pre and post-alcohol consumption results show a significant increase concerning the drivers' mean and maximum speed after drinking (p < 3.2x10^-8). However, neither alcohol nor texting had significant effects on braking parameters (p > 0.05). Traffic cones were knocked down only in texting experiments. In addition, when using the cell phone drivers tended to reduce the speed, and to accelerate abruptly right after they finish texting.

CONCLUSION

Our findings strengthen the hypothesis that even moderate alcohol doses may significantly impair the driving performance. Additionally, alcohol and texting have complementary effects on driving impairment, and their combination represents a significant risk factor for crashes.

Modelling brake transition time of young alcohol-impaired drivers using hazard-based duration models

Braking performance of drivers is a crucial factor in evaluating the collision patterns and implementing road safety measures. Further, alcohol is known to impair driving control. The present study aims to examine the influence of a comprehensive range of Blood Alcohol Concentration (BAC) levels (0%, 0.03 %, 0.05 % and 0.08 %) on brake transition times of drivers. As young drivers show significantly higher crash risks compared to the experienced drivers, fifty-four young Indian drivers in the age group of 21-25 years (forty males and fourteen females) participated in the driving simulator experiments. The study adopted the framework of a within-subjects design, where each driver encountered rural and urban driving scenarios in a counterbalanced order, during experimental driving at each of the four BAC levels. Their brake transition times were estimated with respect to sudden pedestrian crossing events. Weibull Accelerated Failure Time (AFT) models with shared frailty were developed for quantifying the effects of BAC levels along with driver attributes on brake transition time. Preliminary analysis showed significant main effects of BAC (p < 0.001) and driving environment (p = 0.002) on brake transition time; however, their interaction effect was not significant (p = 0.485). The models revealed that 0.03 %, 0.05 % and 0.08 % BACs significantly reduced the brake transition times by 16 %, 28 % and 52 % in rural driving environment, and by 23 %, 37 % and 53 % in urban driving environment, compared to 0% BAC. The study outcomes may find application in assisting collision warning systems which take into account the braking behaviour of drivers.

Profiling of cybersickness and balance disturbance induced by virtual ship motion immersion combined with galvanic vestibular stimulation

Profile of cybersickness and balance disturbance induced by virtual ship motion alone and in combination with galvanic vestibular stimulation (GVS) remained unclear. Subjects were exposed to a ship deck vision scene under simulated Degree 5 or 3 sea condition using a head-mounted virtual reality display with or without GVS. Virtual ship motion at Degree 5 induced significant cybersickness with symptom profile: nausea syndrome > central (headache and dizziness) > peripheral (cold sweating) > increased salivation. During a single session of virtual ship motion exposure, GVS aggravated balance disturbance but did not affect most cybersickness symptoms except cold sweating. Repeated exposure induced cybersickness habituation which was delayed by GVS, while the temporal change of balance disturbance was unaffected. These results suggested that vestibular inputs play different roles in cybersickness and balance disturbance during virtual reality exposure. GVS might not serve as a potential countermeasure against cybersickness induced by virtual ship motion.

Young and under the influence: A systematic literature review of the impact of cannabis on the driving performance of youth

BACKGROUND

Young drivers ages 15-24 continue to constitute a high-risk population for fatal motor vehicle collisions (MVCs) compared to all other age groups. Driving under the influence of cannabis is an important contributor to the high rates of MVCs among youth. Understanding the specific impact of cannabis on the driving performance outcomes of young drivers can inform injury prevention, education, and intervention strategies.

OBJECTIVES

This systematic literature review (SLR) aims to determine the Class (I- highest to IV-lowest) of evidence and level of confidence (A-high to U-insufficient) in the effects of cannabis on the driving performance of young drivers.

METHODS

Registered in PROSPERO (#CRD42020180541), this SLR searched seven data bases and appraised the quality and confidence in the evidence using an established research methodology.

RESULTS

Class II evidence suggests that THC is likely to reduce mean speed, headway distance, and reaction time; and increase lane and steering wheel position variability among young drivers (Level B, moderate confidence).

CONCLUSIONS

This study shows that there is a moderate to low level of confidence on the impact of cannabis on the specific driving performance outcomes of young drivers. A need remains for Class I and II studies that focus on the specific effects on young drivers, distinguish between the biological and socially constructed variables of sex and gender, and includes larger and more representative samples.

Joint and individual effectiveness of galvanic cutaneous stimulation and tactile stimulation at decreasing Simulator Adaptation Syndrome

This research was focused on investigating the effectiveness of galvanic cutaneous stimulation and tactile stimulation jointly and individually at mitigating Simulator Adaptation Syndrome. Forty drivers (mean age = 23.1 ± 3.4 years old, twenty women) participated in a driving simulation experiment. Total scores of the Simulator Sickness Questionnaire, head movements (an index of body balance), and driving performance variables were compared across four different stimulation conditions: i) baseline (where no stimulation was presented), ii) galvanic cutaneous stimulation and iii) tactile stimulation deployed individually, and iv) both techniques deployed jointly. The results showed that both techniques presented in conjunction alleviate Simulator Adaptation Syndrome and improve driving performance more effectively than when they are presented in isolation. Importantly, reduced head movements were only revealed when galvanic cutaneous stimulation was applied. We concluded that the reduction of this syndrome is due to an improvement of body balance (elicited by galvanic cutaneous stimulation), and a distraction from the symptoms (elicited by tactile stimulation). We encourage the use of both techniques simultaneously to decrease Simulator Adaptation Syndrome.

Alcohol-impaired driving in rural and urban road environments: Effect on speeding behaviour and crash probabilities

Speeding behaviour is known to influence crash risk among alcohol-impaired drivers, but this relationship is scarcely explored. The present study investigated the effects of different Blood Alcohol Concentrations (BAC) levels on driving performance with respect to mean speed of drivers and their ability to avoid crashes during sudden events while driving. Eighty-two drivers participated in the simulation driving experiment at four BAC levels (0%, 0.03 %, 0.05 % and 0.08 % BAC) in rural and urban driving scenarios. Two sudden events (pedestrian crossing and road crossing by parked vehicles (a car and a truck) in the perpendicular direction of traffic) were designed to evaluate the crash probabilities in both the driving scenarios. Generalized linear mixed models were developed to analyse the effects of BAC levels and driver attributes (e.g., age, gender) on mean speeds and crash probabilities. Results for mean speed showed that, compared to sober state, drivers drove 3.5 kmph, 5.76 kmph and 8.78 kmph faster at 0.03 %, 0.05 % and 0.08 % BAC respectively in the rural environment and this increment was 3.6 kmph, 3.69 kmph and 4.13 kmph in the urban environment. The model results for crash probabilities revealed that 0.03 %, 0.05 % and 0.08 % BAC levels increased the crash probabilities by 1.9 times, 2 times and 3 times in case of the rural environment and 2 times, 2.3 times and 3.5 times respectively in the urban driving environment.

Effects of synchronised engine sound and vibration presentation on visually induced motion sickness

Driving simulator usage is often accompanied by motion sickness, and techniques for its prevention are not yet established. To reduce visually induced motion sickness (VIMS), we investigated the effects of synchronised presentation of engine sounds and motorcycle vibration on VIMS. A total of 80 participants experienced a driving scene with a head-mounted display for 5 minutes with or without synchronised presentation of engine sound and vibration. The results showed that VIMS scores, as measured by the Fast Motion Sickness scale, were significantly lower in participants who experienced the driving scene with sounds and vibration than in those who experienced the scene with sounds only, vibration only, or neither. Multiple regression analyses revealed that susceptibility to VIMS consistently explained the severity of VIMS to some extent but not with perceived realism of the virtual reality (VR) scene, sex, and experiences about VR devices and vehicles. This study demonstrated that simultaneous presentation of engine sounds and vibration, which were synchronous to each other and tightly coupled with the visual flow speed, effectively reduces VIMS while experiencing motorcycling simulators. The findings not only improve practical knowledge for reducing VIMS in driving simulators but also provide evidence for understanding the mechanisms of VIMS.

An investigation on the risk factors associated with driving errors under the influence of alcohol using structural equation modeling

Objective: Driving errors contribute to traffic crashes and thus the causal factors associated with driving errors are of great interest to the road safety researchers. The present study attempts to identify and quantify the effects of various risk factors that are likely to influence driving error with the application of structural equation modeling (SEM). These risk factors include blood alcohol concentration (BAC) levels (0%, 0.03%, 0.05%, and 0.08%), different driving environments (rural, urban), and driver attributes (such as age, gender, education).Method: Eighty-two licensed drivers participated in a driving simulator experiment. They completed driving under the influence of 4 BAC levels in the driving environments within the framework of a full-factorial within-subjects design. Driving error was modeled as an unobserved latent variable based on several driving simulator indicators. An SEM approach was utilized to examine the influence of BAC level, driving environment, and driver attributes on the latent variable pertaining to driving error.Results: The findings suggest the suitability of an SEM approach in the investigation of driving error. The results revealed that all 3 positive BACs (0.03%, 0.05%, and 0.08%) had a significant positive influence on driving error compared to 0% BAC, and the tendency toward driving error increased with increasing BAC (factor loadings for 0.03%, 0.05%, and 0.08% BAC were 0.22, 0.31, and 0.37, respectively). Moreover, driving in an urban environment led to more driving errors compared to a rural environment, including sober drivers. Among the driver attributes, gender and awareness about drink and drive laws were the only factors influencing driving error.Conclusion: This study highlights a novel approach to investigate driving error by modeling it as a latent variable instead of modeling individual performance measures. The successful execution of SEM in alcohol impairment research may serve as a significant step in the human factors field moving from piecemeal analysis to a combined analysis where interrelationships among numerous risk factors and driving error can be established. The study outcomes may serve as a reference while developing strategies to enhance road traffic safety where special emphasis can be given to the critical risk factors influencing driving error identified in the study.

Psychometric evaluation of Simulator Sickness Questionnaire and its variants as a measure of cybersickness in consumer virtual environments

Cybersickness, i.e. visually induced motion sickness, remains as a negative effect that is detrimental to the user experience of VEs (virtual environments) developed for VR (virtual reality) consumers. As the VR technology evolves, it is rather triggered by application aspects rather than hardware limitations. For this reason, there is still a need for a measurement method to assess and compare VEs for cybersickness effects. SSQ (Simulation Sickness Questionnaire) is used for measuring users' level of sickness symptoms and is highly appreciated in VR research. However, it is criticized for its psychometric qualities and applicability in VR, as a measure of cybersickness. Recently, two variants of SSQ were offered for measuring cybersickness, CSQ (Cybersickness Questionnaire) and VRSQ (Virtual Reality Sickness Questionnaire). There is also another variant with a different factor structure, which we call FSSQ, that is based on French translation of SSQ. Our study compares SSQ and these variants for their psychometric qualities; construct validity, discriminant validity, internal reliability, test-retest reliability and sensitivity to distinguish application aspects of VEs that are related to cybersickness. Using a within-subjects experiment design, we evaluated 7 different VEs with 32 participants through 9 sessions, resulting with 288 responses to the 16-item SSQ. Results suggested that both VRSQ and CSQ were valid and reliable measures of cybersickness, as well as being sensitive to application aspects such as translational and rotational movements required by users for navigation in VEs. Compared to SSQ and FSSQ; the cybersickness questionnaires, CSQ and VRSQ, revealed better indicators of validity. On the other hand, we assume that the development of the two cybersickness scales had limitations in sample size to represent VR consumers and limitations in stimuli to represent the applications aspects of consumer VEs. We suggest further evaluation of cybersickness symptoms with larger samples and broader range of applications to identify the symptoms and the construct of a subjective measurement tool.

Decreasing motion sickness by mixing different techniques

We investigated the effectiveness of galvanic cutaneous stimulation (GCS) and auditory stimulation (AS) together and separately in mitigating motion sickness (MS). Forty-eight drivers (twenty-two men; mean age = 21.58 years) participated in a driving simulation experiment. We compared the total scores of the Simulator Sickness Questionnaire (SSQ) across four different stimulation conditions (GCS, AS, Mixed GCS-AS and no stimulation as a baseline condition). We provided evidence that mixing techniques mitigates MS owing to an improvement in body balance; furthermore, mixing techniques improves driving behavior more effectively than GCS and AS in isolation. We encourage the use of the two techniques together to decrease MS.

Effects of Visually Induced Motion Sickness on Emergency Braking Reaction Times in a Driving Simulator

OBJECTIVE

The study explores associations of visually induced motion sickness (VIMS) with emergency braking reaction times (RTs) in driving simulator studies. It examines the effects over the progression of multiple simulated drives.

BACKGROUND

Driving simulator usage has many advantages for RT studies; however, if it induces VIMS, the observed driving behavior might deviate from real-world driving, potentially masking or skewing results. Possible effects of VIMS on RT have long been entertained, but the progression of VIMS across simulated drives has so far not been sufficiently considered.

METHOD

Twenty-eight adults completed six drives on 2 days in a fixed-base driving simulator. At five points during each drive, pedestrians entered the road, necessitating emergency braking maneuvers. VIMS severity was assessed every minute using the 20-point Fast Motion Sickness Scale. The progression of VIMS was considered in mixed model analyses.

RESULTS

RT predictions were improved by considering VIMS development over time. Here, the relationship of VIMS and RT differed across days and drives. Increases in VIMS symptom severity predicted more prolonged RT after repeated drives on a given day and earlier within each drive.

CONCLUSION

The assessment of VIMS in RT studies can be beneficial. In this context, VIMS measurements in close temporal proximity to the behaviors under study are promising and offer insights into VIMS and its consequences, which are not readily obtainable through questionnaires.

APPLICATION

Driving simulator-based RT studies should consider cumulative effects of VIMS on performance. Measurement and analysis strategies that consider the time-varying nature of VIMS are recommended.

Effect of alcohol use on accelerating and braking behaviors of drivers

Objective: The present study examines the accelerating and braking behaviors of drivers at different blood alcohol concentrations (BACs) in heterogeneous driving conditions using driving simulator experiments. Methods: Eighty-two licensed drivers performed simulated driving in a rural road environment designed in the driving simulator at 4 BAC levels: 0.00, 0.03, 0.05, and 0.08%. Driving performance was analyzed using vehicle control variables such as mean acceleration and mean brake pedal force. Generalized linear mixed models were developed to quantify the effect of different alcohol levels and explanatory variables such as driver's age, gender, and other factors on the driving performance indicators. Results: Alcohol use was reported as a significant factor affecting the accelerating and braking performance of drivers. The acceleration model results indicated that drivers' mean acceleration increased by 0.013, 0.026, and 0.027 m/s² for BAC levels of 0.03, 0.05, and 0.08%, respectively. Results of the brake pedal force model showed that drivers' mean brake pedal force increased by 1.09, 1.32, and 1.44 N for BAC levels of 0.03, 0.05, and 0.08%, respectively. Age was a significant factor in both the models where a 1-year increase in driver age resulted in a 0.2% reduction in mean acceleration and a 19% reduction in mean brake pedal force. Driving experience could compensate for the negative effects of alcohol to some extent while driving. Conclusions: The findings of the present study revealed that drivers tend to be more aggressive and impulsive under the influence of alcohol, which deteriorates their driving performance. Impairment in accelerating and braking behaviors of drivers under the influence of alcohol leads to increased crash probabilities. The conclusions may provide reference in making countermeasures against drinking and driving and contribute to traffic safety.

The effects of habituation and adding a rest-frame on experienced simulator sickness in an advanced mobility scooter driving simulator

The aim of this article is to investigate the effect of a physical rest-frame, habituation and age on simulator sickness in an advanced mobility scooter driving simulator. Twenty-six young and 34 older adults completed a total of 12 drives in an advanced mobility scooter driving simulator over two visits. A 2x2 crossover design was used to measure the effect of a rest frame that was added to the driving simulator on either the first or second visit. The Simulator Sickness Questionnaire was used to measure simulator sickness symptoms. A significant decrease in simulator sickness was observed between the first and the second visit. Older adults reported more severe simulator sickness symptoms compared to younger participants. No effect of rest-frame could be found. Habituation appears to be the most effective method to reduce simulator sickness in an advanced mobility scooter driving simulator. More research is needed to investigate simulator sickness in patient groups. Practitioner summary: Experiencing simulator sickness is a major problem across all types of simulators. The present experiment investigated the effect of a rest-frame, habituation and age on developing simulator sickness symptoms in an advanced mobility scooter driving simulator. Habituation appeared to be the most effective method to reduce simulator sickness.

Can Simulator Sickness Be Avoided? A Review on Temporal Aspects of Simulator Sickness

Simulator sickness is a syndrome similar to motion sickness, often experienced during simulator or another virtual reality (VR) exposure. Many theories have been developed or adapted from the motion sickness studies, in order to explain the existence of the syndrome. The simulator sickness can be measured using both subjective and objective methods. The most popular self-report method is the Simulator Sickness Questionnaire. Attempts have also been made to discover a physiological indicator of the described syndrome, but no definite conclusion has been reached on this issue. In the present paper, three temporal aspects of the simulator sickness are discussed: the temporal trajectory of the progression of simulator sickness, possibility of adapting VR users in advance and persistence of the symptoms after VR exposure. Evidence found in 39 articles is widely described. As for the first aspect, it is clear that in most cases severity of the simulator sickness symptoms increases with time of exposure, although it is impossible to develop a single, universal pattern for this effect. It has also been proved, that in some cases a threshold level or time point exists, after which the symptoms stop increasing or begin to decrease. The adaptation effect was proved in most of the reviewed studies and observed in different study designs - e.g., with a couple of VR exposures on separate days or on 1 day and with a single, prolonged VR exposure. As for the persistence of the simulator sickness symptoms after leaving the VR, on the whole the study results suggest that such an effect exists, but it varies strongly between individual studies - the symptoms may persist for a short period of time (10 min) or a relatively long one (even 4 h). Considering the conclusions reached in the paper, it is important to bear in mind that the virtual reality technology still evokes unpleasant sensations in its users and that these sensations should be cautiously controlled while developing new VR tools. Certainly, more research on this topic is necessary.

Altered driving performance of symptomatic Huntington's disease gene carriers in simulated road conditions

OBJECTIVE

In clinical practice, patients with Huntington's disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments.

METHODS

This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington's Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups.

RESULTS

Manifest HD drove slower compared to controls and premanifest HD when speed limits increased (80 and 100 km/h) and they had a less steady speed compared to premanifest HD on the motorway and in a 30 km/h zone. Manifest HD also had a larger standard deviation of the lateral position (i.e., more weaving of the car/less vehicle control) compared to controls and premanifest HD on the motorway.

CONCLUSIONS

Manifest HD drive more cautious in a driving simulator when speed limits increase compared to premanifest HD and controls and they have less vehicle control on the motorway. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD.

Evaluation method regarding the effect of psychotropic drugs on driving performance: A literature review

Although automobile driving is necessary for many people, including patients with mental disorders, the influence of psychotropic drugs on driving performance remains unclear and requires scientific verification. Therefore, the objective of this study was to conduct a review of the literature in order to aid the development of a valid evaluation method regarding the influence of medication on driving performance. We conducted a literature search using two sets of terms on PubMed. One set was related to psychotropic drugs, and the other to driving tests. We excluded reviews and case studies and added literature found on other sites. A total of 121 relevant reports were found. The experiments were roughly divided into on-the-road tests (ORT) and driving simulators (DS). Although highway driving tests in ORT are most often used to evaluate driving performance, DS are becoming increasingly common because of their safety and low cost. The validity of evaluation methods for alcohol should be verified; however, we found that there were few validated tests, especially for DS. The scenarios and measurement indices of each DS were different, which makes it difficult to compare the results of DS studies directly. No evaluation indices, except for SD of lateral position, were sufficiently validated. Although highway ORT are the gold standard, DS were shown to have an increasing role in evaluating driving performance. The reliability of DS needs to be established, as does their validation with alcohol in order to accumulate more high-quality evidence.