Demonstrating the potential for dynamic auditory stimulation to contribute to motion sickness

Evaluating the effect of multi-sensory stimulations on simulator sickness and sense of presence during HMD-mediated VR experience

Some lines of evidence have shown that sensory input, especially related to vestibular and somatosensory stimulation, may reduce the symptoms related to simulator sickness and increase the sense of presence in VR. The present study aims at understanding how mechanical vibration and auditory stimulation can be used to improve user experience in the context of VR mediated by head-mounted displays. Four different groups comprising a total of 80 participants were tested under different conditions of sensory input (visual and vibration, visual-auditory, combined visual-auditory and vibratory, and visual only), during a VR roller-coaster experience. No significant differences in simulator sickness were found between the groups exposed to seat vibration and/or audio. However, sense of presence showed to be increased when vibratory stimuli were included. Post-hoc analyses showed that female users but not male ones, experienced an increase of sense of presence when vibratory stimulation was used. Practitioner summary: The study showed that including sound or vibration stimulation during VR experience does not reduce simulator sickness. However, sense of presence is promoted by vibratory stimulation. Post-hoc analyses showed that female users experienced an increase of sense of presence by vibratory stimulation, but not male ones.

Virtual Reality Tailored to the Needs of Post-ICU Patients: A Safety and Immersiveness Study in Healthy Volunteers

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Objectives:

ICU treatments frequently result in long-term psychologic impairments, negatively affecting quality of life. An effective treatment strategy is still lacking. The aim of this study was to describe and evaluate the safety and immersiveness of a newly designed ICU-specific virtual reality module.

Design:

A randomized controlled healthy volunteer trial.

Setting:

ICU of the Franciscus Gasthuis & Vlietland Hospital (Rotterdam, the Netherlands), a large teaching hospital.

Participants:

Forty-five virtual reality–naive healthy volunteers.

Interventions:

Volunteers were randomized to three arms: the head-mounted display virtual reality group (n = 15), the 2D group (n = 15), and the crossover group (n = 15). Safety was assessed by changes in vital signs and the occurrence of simulator sickness (Simulator Sickness Questionnaire). Immersiveness was assessed using the Igroup Presence Questionnaire.

Measurements and Main Results:

Volunteers in the head-mounted display virtual reality group experienced more mild symptoms of simulator sickness, expressed as symptoms of dizziness (p = 0.04) and stomach awareness (p = 0.04), than the 2D group. Nevertheless, none of the individual Simulator Sickness Questionnaire items were scored as being severe, no changes in vital signs were observed, and no sessions were prematurely stopped. Volunteers in the crossover group experienced a higher total presence (p < 0.001) when using head-mounted display virtual reality, expressed as a higher sense of presence (p < 0.001), more involvement (p < 0.01), and more experienced realism (p < 0.001).

Conclusions:

ICU-specific virtual reality appears safe and more immersive than 2D, implicating that ICU-specific virtual reality is feasible for clinical use. One should however be aware of simulator sickness-related symptoms. Future research is needed to confirm these findings in survivors of critical illness.

Comparison of visual fatigue caused by head-mounted display for virtual reality and two-dimensional display using objective and subjective evaluation

This study aimed to evaluate objective and subjective visual fatigue experienced before and after performing a visual task while using a head-mounted display for virtual reality (VR-HMD) and two-dimensional (2D) display. Binocular fusion maintenance (BFM) was measured using a binocular open-view Shack-Hartmann wavefront aberrometer equipped with liquid crystal shutters. Twelve healthy subjects performed the BFM test and completed a questionnaire regarding subjective symptoms before and after performing a visual task that induces low visually induced motion sickness (VIMS). BFM (p = .87) and total subjective eye symptom scores (p = .38) were not significantly different between both groups, although these values were significantly lower after the visual task than before the task within both groups (p < .05). These findings suggest that visual fatigue after using a VR-HMD is not significantly different from that after using a 2D display in the presence of low-VIMS VR content. Practitioner summary: Objective and subjective evaluation of visual fatigue were not significantly different with the use of a head-mounted display for virtual reality (VR-HMD) and two-dimensional display. These results should be valuable not only to engineers developing VR content but also to researchers involved in the evaluation of visual fatigue using VR-HMD. Abbreviations: VR: virtual reality; VR-HMD: head-mounted display for virtual reality; BFM: binocular fusion maintenance; BWFA: binocular open-view Shack-Hartmann wavefront aberrometer.

Presence and Cybersickness in Virtual Reality Are Negatively Related: A Review

In order to take advantage of the potential offered by the medium of virtual reality (VR), it will be essential to develop an understanding of how to maximize the desirable experience of "presence" in a virtual space ("being there"), and how to minimize the undesirable feeling of "cybersickness" (a constellation of discomfort symptoms experienced in VR). Although there have been frequent reports of a possible link between the observer's sense of presence and the experience of bodily discomfort in VR, the amount of literature that discusses the nature of the relationship is limited. Recent research has underlined the possibility that these variables have shared causes, and that both factors may be manipulated with a single approach. This review paper summarizes the concepts of presence and cybersickness and highlights the strengths and gaps in our understanding about their relationship. We review studies that have measured the association between presence and cybersickness, and conclude that the balance of evidence favors a negative relationship between the two factors which is driven principally by sensory integration processes. We also discuss how system immersiveness might play a role in modulating both presence and cybersickness. However, we identify a serious absence of high-powered studies that aim to reveal the nature of this relationship. Based on this evidence we propose recommendations for future studies investigating presence, cybersickness, and other related factors.

The search for instantaneous vection: An oscillating visual prime reduces vection onset latency

Typically it takes up to 10 seconds or more to induce a visual illusion of self-motion (“vection”). However, for this vection to be most useful in virtual reality and vehicle simulation, it needs to be induced quickly, if not immediately. This study examined whether vection onset latency could be reduced towards zero using visual display manipulations alone. In the main experiments, visual self-motion simulations were presented to observers via either a large external display or a head-mounted display (HMD). Priming observers with visually simulated viewpoint oscillation for just ten seconds before the main self-motion display was found to markedly reduce vection onset latencies (and also increase ratings of vection strength) in both experiments. As in earlier studies, incorporating this simulated viewpoint oscillation into the self-motion displays themselves was also found to improve vection. Average onset latencies were reduced from 8-9s in the no oscillating control condition to as little as 4.6 s (for external displays) or 1.7 s (for HMDs) in the combined oscillation condition (when both the visual prime and the main self-motion display were oscillating). As these display manipulations did not appear to increase the likelihood or severity of motion sickness in the current study, they could possibly be used to enhance computer generated simulation experiences and training in the future, at no additional cost.

Anxiety Partially Mediates Cybersickness Symptoms in Immersive Virtual Reality Environments

The use of virtual reality (VR) in psychological treatment is expected to increase. Cybersickness (CS) is a negative side effect of VR exposure and is associated with treatment dropout. This study aimed to investigate the following: (a) if gender differences in CS can be replicated, (b) if differences in anxiety and CS symptoms between patients and controls can be replicated, and (c) whether the relationship between exposure to VR and CS symptoms is mediated by anxiety. A sample (N = 170) of participants with different levels of psychosis liability was exposed to VR environments. CS and anxiety were assessed with self-report measures before and after the VR experiment. This study replicated gender differences in CS symptoms, most of which were present before exposure to VR. It also replicated findings that a significant correlation between anxiety and CS can be found in healthy individuals, but not in patients. In a VR environment, anxiety partially mediated CS symptoms, specifically nausea and disorientation. A partial explanation for the differences found between patients and controls may lie in a ceiling effect for the symptoms of CS. A second explanation may be the partial overlap between CS symptoms and physiological anxiety responses. CS symptoms reported at baseline cannot be explained by exposure to VR, but are related to anxiety. Caution is required when interpreting studies on both CS and anxiety, until the specificity in measurements has been improved. Since anxiety mediated the CS symptoms, CS is expected to decline during treatment together with the reduction of anxiety.

Vection is the main contributor to motion sickness induced by visual yaw rotation: Implications for conflict and eye movement theories

This study investigated the role of vection (i.e., a visually induced sense of self-motion), optokinetic nystagmus (OKN), and inadvertent head movements in visually induced motion sickness (VIMS), evoked by yaw rotation of the visual surround. These three elements have all been proposed as contributing factors in VIMS, as they can be linked to different motion sickness theories. However, a full understanding of the role of each factor is still lacking because independent manipulation has proven difficult in the past. We adopted an integrative approach to the problem by obtaining measures of potentially relevant parameters in four experimental conditions and subsequently combining them in a linear mixed regression model. To that end, participants were exposed to visual yaw rotation in four separate sessions. Using a full factorial design, the OKN was manipulated by a fixation target (present/absent), and vection strength by introducing a conflict in the motion direction of the central and peripheral field of view (present/absent). In all conditions, head movements were minimized as much as possible. Measured parameters included vection strength, vection variability, OKN slow phase velocity, OKN frequency, the number of inadvertent head movements, and inadvertent head tilt. Results show that VIMS increases with vection strength, but that this relation varies among participants (R2 = 0.48). Regression parameters for vection variability, head and eye movement parameters were not significant. These results may seem to be in line with the Sensory Conflict theory on motion sickness, but we argue that a more detailed definition of the exact nature of the conflict is required to fully appreciate the relationship between vection and VIMS.

Cybersickness without the wobble: Experimental results speak against postural instability theory

It has been suggested that postural instability is necessary for cybersickness to occur. Seated and standing subjects used a head-mounted display to view a virtual tunnel that rotated about their line of sight. We found that the offset direction of perceived vertical settings matched the direction of the tunnel's rotation, so replicating earlier findings. Increasing rotation speed caused cybersickness to increase, but had no significant impact on perceived vertical settings. Postural sway during rotation was similar to postural sway during rest. While a minority of subjects exhibited postural sway in response to the onset of tunnel rotation, the majority did not. Furthermore, cybersickness increased with rotation speed similarly for the seated and standing conditions. Finally, subjects with greater levels of cybersickness exhibited less variation in postural sway. These results lead us to conclude that the link between postural instability and cybersickness is a weak one in the present experiment.

Motion sickness

Over 2000 years ago the Greek physician Hippocrates wrote, "sailing on the sea proves that motion disorders the body." Indeed, the word "nausea" derives from the Greek root word naus, hence "nautical," meaning a ship. The primary signs and symptoms of motion sickness are nausea and vomiting. Motion sickness can be provoked by a wide variety of transport environments, including land, sea, air, and space. The recent introduction of new visual technologies may expose more of the population to visually induced motion sickness. This chapter describes the signs and symptoms of motion sickness and different types of provocative stimuli. The "how" of motion sickness (i.e., the mechanism) is generally accepted to involve sensory conflict, for which the evidence is reviewed. New observations concern the identification of putative "sensory conflict" neurons and the underlying brain mechanisms. But what reason or purpose does motion sickness serve, if any? This is the "why" of motion sickness, which is analyzed from both evolutionary and nonfunctional maladaptive theoretic perspectives. Individual differences in susceptibility are great in the normal population and predictors are reviewed. Motion sickness susceptibility also varies dramatically between special groups of patients, including those with different types of vestibular disease and in migraineurs. Finally, the efficacy and relative advantages and disadvantages of various behavioral and pharmacologic countermeasures are evaluated.

Differential Gene Expression Profile in the Rat Caudal Vestibular Nucleus is Associated with Individual Differences in Motion Sickness Susceptibility

OBJECTIVE

To identify differentially expressed genes associated with motion sickness (MS) susceptibility in the rat caudal vestibular nucleus.

METHODS

We identified MS susceptible (MSS) and insusceptible (inMSS) rats by quantifying rotation-induced MS symptoms: defecation and spontaneous locomotion activity. Microarray analysis was used to screen differentially expressed genes in the caudal vestibular nucleus (CVN) after rotation. Plasma stress hormones were identified by radioimmunoassay. Candidate genes were selected by bioinformatics analysis and the microarray results were verified by real-time quantitative-PCR (RT-qPCR) methods. By using Elvax implantation, receptor antagonists or recombinant adenovirus targeting the candidate genes were applied to the CVN to evaluate their contribution to MS susceptibility variability. Validity of gene expression manipulation was verified by RT-qPCR and western blot analysis.

RESULTS

A total of 304 transcripts were differentially expressed in the MSS group compared with the inMSS group. RT-qPCR analysis verified the expression pattern of candidate genes, including nicotinic cholinergic receptor (nAchR) α3 subunit, 5-hydroxytryptamine receptor 4 (5-HT4R), tachykinin neurokinin-1 (NK1R), γ-aminobutyric acid A receptor (GABAAR) α6 subunit, olfactory receptor 81 (Olr81) and homology 2 domain-containing transforming protein 1 (Shc1). In MSS animals, the nAchR antagonist mecamylamine significantly alleviated rotation-induced MS symptoms and the plasma β-endorphin response. The NK1R antagonist CP99994 and Olr81 knock-down were effective for the defecation response, while the 5-HT4R antagonist RS39604 and Shc1 over-expression showed no therapeutic effect. In inMSS animals, rotation-induced changes in spontaneous locomotion activity and the plasma β-endorphin level occurred in the presence of the GABAAR antagonist gabazine.

CONCLUSION

Our findings suggested that the variability of the CVN gene expression profile after motion stimulation might be a putative molecular basis for individual differences in MS susceptibility and provide information for the development of new therapeutic strategies for MSS individuals.

Vection and visually induced motion sickness: how are they related?

The occurrence of visually induced motion sickness has been frequently linked to the sensation of illusory self-motion (vection), however, the precise nature of this relationship is still not fully understood. To date, it is still a matter of debate as to whether vection is a necessary prerequisite for visually induced motion sickness (VIMS). That is, can there be VIMS without any sensation of self-motion? In this paper, we will describe the possible nature of this relationship, review the literature that addresses this relationship (including theoretical accounts of vection and VIMS), and offer suggestions with respect to operationally defining and reporting these phenomena in future.