Motion sickness and postural sway in console video games

Potential factors contributing to observed sex differences in virtual-reality-induced sickness

Virtual reality (VR) technology has been widely adopted for several professional and recreational applications. Despite rapid innovation in hardware and software, one of the long prevailing issues for end users of VR is the experience of VR sickness. Females experience stronger VR sickness compared to males, and previous research has linked susceptibility to VR sickness to the menstrual cycle (Munafo et al., Exp Brain Res 235(3):889-901). Here we investigated the female versus male experience in VR sickness while playing an immersive VR game, comparing days of the menstrual cycle when hormones peak: day 15 (ovulation-peak estrogen) and day 22 (mid-luteal phase-peak progesterone). We found that immersion duration was greater in the second session than the first, and discomfort was lessened, suggesting a powerful adaptation with repeated exposure. Due to the estrogen levels changing along with the exposure, there was no clear independent impact of that; note, though, that there was a significant difference between self-report and physiological measures implying that GSR is potentially an unreliable measure of motion sickness. Although prior work found a delay over 2 days between session would not allow adaptation and habituation to reduce VR sickness susceptibility, we found that a week delay has potential success.

The Open Gallery for Arts Research (OGAR): An open-source tool for studying the psychology of virtual art museum visits

To expand the tools available to arts researchers in psychology, we present the Open Gallery for Arts Research (OGAR), a free, open-source tool for studying visitor behavior within an online gallery environment. OGAR is highly extensible, allowing researchers to modify the environment to test different hypotheses, and it affords assessing a wide range of outcome variables. After describing the tool and its development, we present a proof-of-concept study that evaluates OGAR's usability and performance and illustrates some ways that it can be used to study the psychology of virtual visits. With a sample of 44 adults from an online participant panel who freely explored OGAR, we observed that OGAR had good usability based on high scores on the System Usability Scale and rare instances of self-reported nausea, among other usability markers. Furthermore, using position and viewing data provided by OGAR, we found that participants navigated the gallery and interacted with the artwork in predictable and coherent ways that resembled visitor behavior in real-world art museums. OGAR appears to be a promising tool for researchers and art professionals interested in how people navigate and experience virtual and real art spaces.

The eSports Medicine: Pre-Participation Screening and Injuries Management-An Update

Recently, electronic sports (eSports) became one of the growing forms of new media due to the wide diffusion of games and online technologies. Even if there is still a debate about the definition and characterization of eSports, eAthletes train heavily, compete in tournaments, must abide by competition, association, and governing body rules, just like all other athletes. Furthermore, as in any other competitive discipline, there can be injuries. Aberrant sitting posture, repetitive movements, screen vision, prolonged playing hours, and a sedentary lifestyle can lead to several medical hazards in musculoskeletal, ophthalmology, neurological, and metabolic systems. Moreover, several cardiovascular changes occur in eAthletes. This paper aims to explore the different injuries that can occur in a professional eAthlete, suggesting how every high-level gamer could benefit from a pre-participation evaluation and a correct injury prevention strategy.

Antihistamines for motion sickness

BACKGROUND

Motion sickness is a syndrome that occurs as a result of passive body movement in response to actual motion, or the illusion of motion when exposed to virtual and moving visual environments. The most common symptoms are nausea and vomiting. Antihistamines have been used in the management of motion sickness for decades, however studies have shown conflicting results regarding their efficacy.

OBJECTIVES

To assess the effectiveness of antihistamines in the prevention and treatment of motion sickness in adults and children.

SEARCH METHODS

The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 7 December 2021.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in susceptible adults and children in whom motion sickness was induced under natural conditions such as air, sea and land transportation. We also included studies in which motion sickness was induced under experimental conditions (analysed separately). Antihistamines were included regardless of class, route or dosage and compared to no treatment, placebo or any other pharmacological or non-pharmacological interventions.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Our primary outcomes were 1) the proportion of susceptible participants who did not experience any motion sickness symptoms; 2) the proportion of susceptible participants who experienced a reduction or resolution of existing symptoms. Secondary outcomes were 1) physiological measures (heart rate, core temperature and gastric tachyarrhythmia (electrogastrography)) and 2) adverse effects (sedation, impaired cognition, blurred vision). We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS

We included nine RCTs (658 participants). Studies were conducted across seven countries, with an overall age range of 16 to 55 years. Motion sickness was induced naturally in six studies and experimentally in four studies (rotating chair). All the naturally induced studies only evaluated first-generation antihistamines (cinnarizine and dimenhydrinate). Risk of bias across the studies varied, with mostly low risk for random sequence generation and allocation concealment, and mostly high risk for selective reporting. Only the experimentally induced studies measured physiological parameters and only the naturally induced studies evaluated adverse effects. There were no studies that clearly assessed the paediatric population. Antihistamines versus placebo or no treatment Antihistamines are probably more effective than placebo at preventing motion sickness symptoms under natural conditions (symptoms prevented: 25% placebo; 40% antihistamines) (risk ratio (RR) 1.81, 95% confidence interval (CI) 1.23 to 2.66; 3 studies; 240 participants) (moderate-certainty). The evidence is very uncertain about the effect of antihistamines on preventing motion sickness under experimental conditions (standardised mean difference (SMD) 0.32, 95% CI -0.18 to 0.83; 2 studies; 62 participants) (very low-certainty). No studies reported results on the resolution of existing motion sickness symptoms. Antihistamines may result in little or no difference in gastric tachyarrhythmia under experimental conditions (mean difference (MD) -2.2, 95% CI -11.71 to 7.31; 1 study; 42 participants) (low-certainty). No studies reported results for any other physiological measures. When compared to placebo, antihistamines may be more likely to cause sedation (sedation: 44% placebo; 66% antihistamines) (RR 1.51, 95% CI 1.12 to 2.02; 2 studies; 190 participants) (low-certainty); they may result in little or no difference in blurred vision (blurred vision: 12.5% placebo; 14% antihistamines) (RR 1.14, 95% CI 0.53 to 2.48; 2 studies; 190 participants) (low-certainty); and they may result in little or no difference in terms of impaired cognition (impaired cognition: 33% placebo; 29% antihistamines) (RR 0.89, 95% CI 0.58 to 1.38; 2 studies; 190 participants) (low-certainty). Antihistamines versus scopolamine The evidence is very uncertain about the effect of antihistamines on preventing motion sickness under natural conditions when compared to scopolamine (symptoms prevented: 81% scopolamine; 71% antihistamines) (RR 0.89, 95% CI 0.68 to 1.16; 2 studies; 71 participants) (very low-certainty). No studies were performed under experimental conditions. No studies reported results on the resolution of existing motion sickness symptoms. The evidence is very uncertain about the effect of antihistamines on heart rate under natural conditions (narrative report, 1 study; 20 participants; "No difference in pulse frequency"; very low-certainty). No studies reported results for any other physiological measures. When compared to scopolamine, the evidence is very uncertain about the effect of antihistamines on sedation (sedation: 21% scopolamine; 30% antihistamines) (RR 0.82, 95% CI 0.07 to 9.25; 2 studies; 90 participants) (very low-certainty) and on blurred vision (narrative report: not a significant difference; 1 study; 51 participants; very low-certainty). No studies evaluated impaired cognition. Antihistamines versus antiemetics Antihistamines may result in little or no difference in the prevention of motion sickness under experimental conditions (MD -0.20, 95% CI -10.91 to 10.51; 1 study; 42 participants) (low-certainty). The evidence is of low certainty due to imprecision as the sample size is small and the confidence interval crosses the line of no effect. No studies assessed the effects of antihistamines versus antiemetics under natural conditions. No studies reported results on the resolution of existing motion sickness symptoms. Antihistamines may result in little or no difference in gastric tachyarrhythmia (MD 4.56, 95% CI -3.49 to 12.61; 1 study; 42 participants) (low-certainty). No studies reported results for any other physiological measures. No studies evaluated sedation, impaired cognition or blurred vision. One study reported physiological data for this outcome, evaluating gastric tachyarrhythmia specifically. Antihistamines may result in little or no difference in gastric tachyarrhythmia (MD 4.56, 95% CI -3.49 to 12.61; 1 study; 42 participants; low-certainty evidence). This evidence is of low certainty due to imprecision as the sample size is small and the confidence interval crosses the line of no effect. Antihistamines versus acupuncture The evidence is very uncertain about the effects of antihistamines on the prevention of motion sickness under experimental conditions when compared to acupuncture (RR 1.32, 95% CI 1.12 to 1.57; 1 study; 100 participants) (very low-certainty). This study did not assess the prevention of motion sickness under natural conditions, nor the resolution of existing motion sickness symptoms. There was no study performed under natural conditions. Physiological measures and adverse effects were not reported.

AUTHORS' CONCLUSIONS

There is probably a reduction in the risk of developing motion sickness symptoms under naturally occurring conditions of motion when using first-generation antihistamines, in motion sickness-susceptible adults, compared to placebo. Antihistamines may be more likely to cause sedation when compared to placebo. No studies evaluated the treatment of existing motion sickness, and there are few data on the effect of antihistamines in children. The evidence for all other outcomes and comparisons (versus scopolamine, antiemetics and acupuncture) was of low or very low certainty and we are therefore uncertain about these effects of antihistamines.

Motion sickness decreases low back function and changes gene expression in military aircrew

BACKGROUND

Motion sickness and low back disorders are prevalent and debilitating conditions that affect the health, performance, and operational effectiveness of military aircrews. This study explored the effects of a motion sickness stimulus on biomechanical and genetic factors that could potentially be involved in the causal pathways for both disorders.

METHODS

Subjects recruited from a military population were exposed to either a mild (n = 12) or aggressive (n = 16) motion sickness stimulus in a Neuro-Otologic Test Center. The independent variable of interest was the motion sickness stimulus exposure (before vs. after), though differences between mild and aggressive stimuli were also assessed. Dependent measures for the study included motion sickness exposure duration, biomechanical variables (postural stability, gait function, low back function, lumbar spine loading), and gene expression.

FINDINGS

Seven of twelve subjects experiencing the mild motion sickness stimulus endured the full 30 min in the NOTC, whereas subjects lasted an average of 13.2 (SD 5.0) minutes in the NOTC with the aggressive motion sickness stimulus. Mild motion sickness exposure led to a significant decrease in the postural stability measure of sway area, though the aggressive motion sickness exposure led to a statistically significant increase in sway area. Both stimuli led to decreases in low back function, though the decrease was only statistically significant for the mild protocol. Both stimuli also led to significant changes in gene expression.

INTERPRETATION

Motion sickness may alter standing balance, decrease low back function, and lead to changes in the expression of genes with roles in osteogenesis, myogenesis, development of brain lymphatics, inflammation, neuropathic pain, and more. These results may provide preliminary evidence for a link between motion sickness and low back disorders.

Cybersickness and postural stability of first time VR users playing VR videogames

This study investigated symptoms of cybersickness and postural instability experienced by new users of head-mounted display virtual reality (HMD-VR), playing VR videogames over long and repeated sessions, and moderation of these symptoms by previous videogame experience and intensity of videogame stimulus. Cybersickness (SSQ) and postural stability (anterior-posterior path-velocity) of new users of VR (n = 80) was collected PRE-VR, POST-VR and 10 min after completing (POST-RECOVERY) a VR gaming experience. Users comprised of videogamers (n = 40) and non-videogamers (n = 40), who were randomly assigned to play either action (high-intensity stimuli) or adventure (low-intensity stimuli) games in VR for 30 min and repeated twice, one week apart. All participants, irrespective of gaming status and genre of game, experienced significant cybersickness after 30 min in VR using current-generation HMD-VR technology, and did not adapt (POST-VR) after two sessions. However videogamers were able to recover (POST-RECOVERY) from cybersickness induced in VR significantly better than non-videogamers. All participants experienced significantly better postural stability after 30 min in VR, irrespective of gaming experience or genre of game. Developers should create VR experiences that minimise negative symptoms of cybersickness and postural instability experience by new users of VR.

Effects of Exergaming on College Students' Situational Interest, Self-Efficacy, and Motion Sickness

Objective: Given the low levels of physical activity (PA) among U.S. college students, the use of exergaming as a supplement to traditional exercise may promote higher levels of motivation and PA. Therefore, this study’s purpose was to examine the effect of two different exergames on college students’ situational interest (SI), self-efficacy (SE), and equilibrium change (EQC) compared to traditional treadmill walking. Methods: Sixty college students (30 female; Mage = 23.6 ± 4.1 years; MBMI = 23.9 ± 4.0 kg/m2) participated in three separate 20 min exercise sessions: (1) Xbox 360 Kinect Just Dance; (2) Xbox 360 Kinect Reflex Ridge; and (3) traditional treadmill walking at 4.0 mph. Participants’ SI, SE, and EQC were measured after each session using a series of validated surveys. Results: A mixed model analysis of covariance (ANCOVA) with repeated measures evaluated mean differences between exercise sessions for all outcomes. Significant main effects were observed between the three exercise sessions (all p < 0.01). Specifically, Just Dance and Reflex Ridge sessions yielded significantly higher SI scores than treadmill exercise, F (10, 49) = 54.61, p < 0.01, η2 = 0.92. In addition, participants experienced significantly lower EQC in Reflex Ridge than in treadmill exercise, F (2, 58) = 4.26, p = 0.02, η2 = 0.13. No differences were identified for SE. Conclusion: The integration of exergaming into traditional exercise routines may help to promote higher levels of SI but not SE amongst college students. RR exergaming also demonstrated low EQC as compared to traditional exercise. Experimental study designs are warranted to provide additional evidence on the efficacy of exergaming.

Cyber sickness in low-immersive, semi-immersive, and fully immersive virtual reality

It is known that virtual reality (VR) experience may cause cyber sickness. One aspect of VR is an immersion or otherwise sense of presence, the sense of feeling oneself in a virtual world. In this paper an experiment which was conducted in order to find the link between level of immersion and cyber sickness felt by participants is presented. Eighty-nine participants aged between 19 and 36 years have been equally divided into four groups with different level of VR immersion. The low-immersive group was represented by PC with monoscopic screen, the semi-immersive group was represented by CAVE with stereoscopic projector, the fully immersive group was represented by VR head-mounted display, and the last group was the control group without any kind of immersion. The task for the participants was to navigate through the maze for a specified amount of time (10 min). The Simulator Sickness Questionnaire was used as a subjective measure tool for cyber sickness level and Grooved Pegboard Test for assessing the fine dexterity, both before and after the experiment. Regarding the time spend in VR the fully immersive environment had the biggest problems as more than half of the participants had to stop before 10 min (p < 0.001). Concerning the cyber sickness, the significant increase in nausea score between pre-test and post-test scores has been observed in semi-immersive group (p = 0.0018) and fully immersive group (p < 0.0001). The increase in oculomotor score was smaller. The significant difference was noted only in fully immersive group (p = 0.0449). In spite of great nausea factor after the VR immersion the participants did not show a decrease of fine dexterity in any group (p < 0.001).

Eye Movements during Dynamic Scene Viewing are Affected by Visual Attention Skills and Events of the Scene: Evidence from First-Person Shooter Gameplay Videos

The role of individual differences during dynamic scene viewing was explored. Participants (N=38) watched a gameplay video of a first-person shooter (FPS) videogame while their eye movements were recorded. In addition, the participants’ skills in three visual attention tasks (attentional blink, visual search, and multiple object tracking) were assessed. The results showed that individual differences in visual attention tasks were associated with eye movement patterns observed during viewing of the gameplay video. The differences were noted in four eye movement measures: number of fixations, fixation durations, saccade amplitudes and fixation distances from the center of the screen. The individual differences showed during specific events of the video as well as during the video as a whole. The results highlight that an unedited, fast-paced and cluttered dynamic scene can bring about individual differences in dynamic scene viewing.

Feasibility of full immersive virtual reality video game on balance and cybersickness of healthy adolescents

Various virtual reality (VR) games with head-mounted displays (HMDs) can provide immersive experiences, but are often accompanied by negative experiences. We investigated the feasibility of immersive virtual reality game on balance and cybersickness in healthy adolescents. This is cross-over design. This study included 11 healthy adolescents. Balance and cybersickness were measured in the following three conditions. First, as a baseline, only balance was measured while no immersive virtual reality game was being played. Second, balance and cybersickness were measured while the participants played an immersive virtual reality game with a fixed background. Third, balance and cybersickness were measured while the participants played an immersive virtual reality game with a moving background. A force plate was used to measure balance, while the Questionnaire (VRSQ) and Simulator Sickness Questionnaire (SSQ) were used to measure cybersickness. Sway velocity and length significantly increased during the game with a moving background compared to baseline and a fixed background game (p < 0.05). VRSQ and SSQ scores significantly increased during the game with a fixed and moving background compared to baseline (p < 0.05) and were significantly higher with use of the moving versus fixed background (p < 0.05). This study demonstrated that playing an immersive virtual reality game with a moving background could negatively affect balance and cybersickness. These results will help to select game contents that can reduce side effects when applying VR HMD to various fields in the future.

Control of a virtual vehicle influences postural activity and motion sickness in pre-adolescent children

Among adults, persons in control of a vehicle (i.e., drivers) are less likely to experience motion sickness compared to persons in the same vehicle who do not control it (i.e., passengers). This "driver-passenger effect" is well-known in adults, but has not been evaluated in children. Using a yoked-control design with seated pre-adolescent children, we exposed dyads to a driving video game. In each dyad, one child (the driver) drove the virtual vehicle. Their performance was recorded, and later shown to the other child (the passenger). Thus, visual motion stimuli were identical for the members of each dyad. During exposure to the video game, we monitored the quantitative kinematics of head and torso movements. Participants were instructed to discontinue participation immediately if they experienced any symptoms of motion sickness, however mild. Accordingly, the movements that we recorded preceded the onset of motion sickness. Results revealed that Passengers (73.08%) were more likely than Drivers (42.31%) to state that they were motion sick. Drivers tended to move more than passengers, and with a greater degree of multifractality. The magnitude of movement was greater among participants who later reported motion sickness than among those who did not. In addition, for the multifractality of movement a statistically significant interaction revealed that postural precursors of motion sickness differed qualitatively between Drivers and Passengers. Overall, the results reveal that control of a virtual vehicle reduces the risk of motion sickness among pre-adolescent children.

Floor-vibration VR: Mitigating Cybersickness Using Whole-body Tactile Stimuli in Highly Realistic Vehicle Driving Experiences

This work addresses cybersickness, a major barrier to successful long-exposure immersive virtual reality (VR) experiences since user discomfort frequently leads to prematurely ending such experiences. Starting from sensory conflict theory, we posit that if a vibrating floor delivers vestibular stimuli that minimally match the vibration characteristics of a scenario, the size of the conflict between the visual and vestibular senses will be reduced and, thus, the incidence and/or severity of cybersickness will also be reduced. We integrated a custom-built, computer-controlled vibrating floor in our VR system. To evaluate the system, we implemented a realistic off-road vehicle driving simulator in which participants rode multiple laps as passengers on an off-road course. We programmed the floor to generate vertical vibrations similar to those experienced in real off-road vehicle travel. The scenario and driving conditions were designed to be cybersickness-inducing for users in both the Vibration and No-vibration conditions. We collected subjective and objective data for variables previously shown to be related to levels of cybersickness or presence. These included presence and simulator sickness questionnaires (SSQ), self-rated discomfort levels, and the physiological signals of heart rate, galvanic skin response (GSR), and pupil size. Comparing data between participants in the Vibration group (N=11) to the No-Vibration group (N=11), we found that Delta-SSQ Oculomotor response and the GSR physiological signal, both known to be positively correlated with cybersickness, were significantly lower (with large effect sizes) for the Vibration group. Other variables differed between groups in the same direction, but with trivial or small effect sizes. The results indicate that the floor vibration significantly reduced some measures of cybersickness.

Evaluation of a Human–Machine Interface for Motion Sickness Mitigation Utilizing Anticipatory Ambient Light Cues in a Realistic Automated Driving Setting

Motion sickness (MS) is a syndrome associated with symptoms like nausea, dizziness, and other forms of physical discomfort. Automated vehicles (AVs) are potent at inducing MS because users are not adapted to this novel form of transportation, are provided with less information about the own vehicle’s trajectory, and are likely to engage in non-driving related tasks. Because individuals with an especially high MS susceptibility could be limited in their use of AVs, the demand for MS mitigation strategies is high. Passenger anticipation has been shown to have a modulating effect on symptoms, thus mitigating MS. To find an effective mitigation strategy, the prototype of a human–machine interface (HMI) that presents anticipatory ambient light cues for the AV’s next turn to the passenger was evaluated. In a realistic driving study with participants (N = 16) in an AV on a test track, an MS mitigation effect was evaluated based on the MS increase during the trial. An MS mitigation effect was found within a highly susceptible subsample through the presentation of anticipatory ambient light cues. The HMI prototype was proven to be effective regarding highly susceptible users. Future iterations could alleviate MS in field settings and improve the acceptance of AVs.

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.

Assessing Postural Instability and Cybersickness Through Linear and Angular Displacement

OBJECTIVE

To examine the hypothesis that constant speed is more comfortable than variable speed profiles and may minimize cybersickness.

BACKGROUND

Current best practices for virtual reality (VR) content creation suggest keeping any form of acceleration as short and infrequent as possible to mitigate cybersickness.

METHODS

In Experiment 1, participants experienced repetitions of simulated linear motion, and in Experiment 2, they experienced repetitions of a circular motion. Three speed profiles were tested in each experiment. Each trial lasted 2 min while standing. Cybersickness was measured using the Simulator Sickness Questionnaire (SSQ) and operationally defined in terms of total severity scores. Postural stability was measured using a Wii Balance Board and operationally defined in terms of center of pressure (COP) path length. Postural measures were decomposed into anterior-posterior and medial-lateral axes and subjected to detrended fluctuation analysis.

RESULTS

For both experiments, no significant differences were observed between the three speed profiles in terms of cybersickness or postural stability, and none of the baseline postural measures could predict SSQ scores for the speed profile conditions. An axis effect was observed in both experiments such that normalized COP movement was significantly greater along the anterior-posterior axis than the medial-lateral axis.

CONCLUSION

Results showed no convincing evidence to support the common belief that constant speed is more comfortable than variable speed profiles for scenarios typical of VR applications.

APPLICATION

The present findings offer guidelines for the design of locomotion techniques involving traversal in VR environments.

Postural precursors of motion sickness in head-mounted displays: drivers and passengers, women and men

Motion sickness is preceded by distinctive patterns of postural activity that differ between the sexes. We asked whether such postural precursors of motion sickness might exist before participants were exposed to a virtual driving game presented via a head-mounted display. Men and women either controlled a virtual vehicle (drivers), or viewed a recording of virtual vehicle motion (passengers). Before exposure to the game, we recorded standing body sway while participants performed simple visual tasks (staring at a blank page vs. counting target letters in a block of text). Following game exposure, participants were classified into Well and Sick groups. In a statistically significant interaction, the multifractality of body sway varied as a function of sex, vehicle control, and motion sickness status. The results confirm that postural precursors of motion sickness differ between the sexes, and extend these to the control of virtual vehicles in head-mounted displays. Practitioner Summary: We asked whether postural sway might predict motion sickness during exposure to a driving game via a head-mounted display. Participants drove a virtual car (drivers), or watched recorded car motion (passengers). Beforehand, we measured standing body sway. Postural precursors of motion sickness differed between the sexes and drivers and passengers. Abbreviations: M: meters; SD: standard deviation; kg: kilograms; COP: centre of pressure; AP: anterior-posterior; ML: mediolateral; cm: centimeters; s: seconds; min: minutes; MF: DFA: multifractal detrended fluctuation analysis; DFA: detrended fluctuation analysis; ANOVA: analysis of variance; CI: confidence interval; Hz: hertz; SE: standard error of the mean.

Virtual and augmented reality in a simulated naval engagement: Preliminary comparisons of simulator sickness and human performance

The aim of this study was to compare simulator sickness symptoms while participants wore either a virtual reality (VR) or augmented reality (AR) headset. A secondary aim involved comparing how physical motion affects symptoms. During a simulation, participants wore VR and AR headsets while standing on a motion platform and firing at hostile ships under three motion conditions: No Physical Motion; Synchronous Motion, in which the physical and displayed motion were coupled; and Asynchronous Motion, in which the physical motion did not match the display. Symptoms increased over time but were not different with respect to headset or motion. The VR condition had higher accuracy and faster response time to the commence fire instruction. Further research is necessary to determine if this holds under more extreme motion. The use of VR or AR headsets for training under gentle motion conditions is practicable and should be permissible under normal conditions during deployment.

Are Modern Head-Mounted Displays Sexist? A Systematic Review on Gender Differences in HMD-Mediated Virtual Reality

Modern head-mounted displays (HMDs) are a promising technology. Thanks to their affordable cost and versatility, HMDs are gaining attention from different sectors. However, the experience reported by the users of these technologies is sometimes negative. A number of people, when using an HMD, complain of various types of physical discomfort as well as symptoms like headache, disorientation, and nausea. These symptoms, developed during or after exposure to virtual environments, are commonly referred to with the term simulator sickness. Some scientific studies have shown that women are commonly more sensitive to simulator sickness. However, a gender imbalance in the susceptibility to simulator sickness has not been widely studied in the context of modern HMDs, and the studies that have been done have reported heterogeneous findings. The present systematic review aims to gather the pieces of evidence that support and oppose a gender difference in the susceptibility of simulator sickness in the framework of modern HMDs. We also aim to individuate other gender differences in the experience of the use of these technologies to establish whether there is sufficient evidence to support a gender discrepancy in the user experience.

Studying the Effect of Display Type and Viewing Perspective on User Experience in Virtual Reality Exergames

Background: Physical inactivity has been identified as the fourth leading cause of death globally. It is now well established that a sedentary lifestyle is a unique risk factor for several diseases such as type 2 diabetes and cardiovascular disease, which account for about 30% of global mortality. Diabetes is a major preventable cause of costly and debilitating renal failure, heart disease, lower limb amputation, and avoidable blindness. In recent years, the idea of using interactive computing systems that leverage gamification to promote physical activity has been widely researched. Prior studies have shown that exergames, that is those that encourage physical activity, can increase enjoyment and intrinsic motivation compared with conventional exercises; as such, they can be effective in promoting physical and mental health. There has been some research on immersive virtual reality (VR) exergames; however, to the best of our knowledge, it is limited and preliminary. This work aims at filling the gap and investigates the effect of display type (DT) and viewing perspective (VP) on players' exertion, engagement, and overall game experience in immersive VR exergames. Objective: This article aims at examining whether DT and VP can affect gameplay performance, players' exertion, game experience, cybersickness, and electroencephalography (EEG) engagement index when playing a gesture-based (i.e., body motion) exergame. Materials and Methods: Study 1 employed a one-way between-subjects design with 24 participants equally distributed in two groups (immersive VR and 50-inch TV) to perform 12 pre-defined gestures. The main outcome measures were National Aeronautics and Space Administration-Task Load Index (NASA-TLX) workload for each group as well as 7 Likert scale and EEG engagement index for each gesture. Study 2 included 16 participants in playing a game with the gestures selected from study 1. All participants played 4 versions based on combinations of DT (immersive VR and 50-inch TV) and VP (first-person and third-person) to assess exertion (%HR_max, calories consumption, and Borg RPE 6-20), game experience, cybersickness, and EEG engagement index. Results: Study 1 results showed that DT had no effect on the ratings of the gestures, NASA-TLX workload, and EEG engagement index. Study 2 results showed that immersive VR not only resulted in a significantly higher exertion (%HR_max, calories consumption, and Borg RPE) but also helped achieve better positive game experience in challenge, flow, sensory and imaginative immersion, as well as lower negative affect. We also found that nausea and oculomotor were significantly higher in immersive VR. Conclusion: This pilot study demonstrates that youth who played gesture-based exergame in immersive VR had a higher level of exertion (%HR_max, calories consumption, and Borg RPE), although the number of performed gestures were not significantly different. They also felt that immersive VR was much more challenging, immersive (flow, sensory and imaginative immersion), and had a lower negative affect than a 50-inch TV; however, immersive VR was more likely to make youth have higher cybersickness.

Effects of Immersive Virtual Reality Headset Viewing on Young Children: Visuomotor Function, Postural Stability, and Motion Sickness

PURPOSE

To assess the safety of VR 3D headset (virtual reality 3-dimensional binocular-stereoscopic near-eye display) use in young children. Product safety warnings that accompany VR headsets ban their use in children under age 13 years.

DESIGN

Prospective, interventional, before-and-after study.

METHODS

Recordings were obtained in 50 children (29 boys) aged 4-10 years (mean 7.2 ± 1.8 years). Minimum binocular corrected distance visual acuity (CDVA) was 20/50 (logarithm of the minimum angle of resolution [logMAR] 0.4) and stereoacuity 800 seconds of an arc or better. A Sony PlayStation VR headset was worn for 2 sequential play sessions (of 30 minutes each) of a first-person 3D flying game (Eagle Flight) requiring head movement to control flight direction (pitch, yaw, and roll axes). Baseline testing preceded VR exposure, and each VR session was followed by post-VR testing of binocular CDVA, refractive error, binocular eye alignment (strabismus), stereoacuity, and postural stability (imbalance). Visually induced motion sickness was probed using the Simulator Sickness Questionnaire modified for pediatric use (Peds SSQ). Visual-vestibulo-ocular reflex (V-VOR) adaptation was also tested pre- vs post-trial in 5 of the children. Safety was gauged as a decline or change from baseline in any visuomotor measure.

RESULTS

Forty-six of 50 children (94%) completed both VR play sessions with no significant change from baseline in measures of binocular CDVA (P = .89), refractive error (P = .36), binocular eye alignment (P = .90), or stereoacuity (P = .45). Postural stability degraded an average 9% from baseline after 60 minutes of VR exposure (P = .06). Peds SSQ scores increased a mean 4.7%-comparing pretrial to post-trial-for each of 4 symptom categories: eye discomfort (P = .02), head/neck discomfort (P = .03), fatigue (P = .03), and motion sickness (P = .01). None of the children who finished both trial sessions (94%) asked to end the play, and the majority were disappointed when play was halted. V-VOR gain remained unaltered in the 5 children tested. Three children (6% of participants) discontinued the trial during the first 10 minutes of the first session of VR play, 2 girls (aged 5 and 6 years) and 1 boy (aged 7 years). The girls reported discomfort consistent with mild motion sickness; the boy said he was bored and the headset was uncomfortable. No child manifested aftereffects ("flashbacks") in the days following the VR exposure.

CONCLUSION

Young children tolerate fully immersive 3D virtual reality game play without noteworthy effects on visuomotor functions. VR play did not induce significant post-VR postural instability or maladaption of the vestibulo-ocular reflex. The prevalence of discomfort and aftereffects may be less than that reported for adults.

Emotional and Cognitive Modulation of Cybersickness: The Role of Pain Catastrophizing and Body Awareness

OBJECTIVE

The goal was to investigate the influence of the tendency to catastrophize somatic symptoms and body awareness on motion-related sickness.

BACKGROUND

Influences of emotional and cognitive-evaluative processes on the genesis of motion sickness or cybersickness have rarely been investigated. Brain imaging studies showed activation during cybersickness, resembling the pattern found for pain processing. Two aspects often investigated in this context are pain catastrophizing and body awareness. The present two studies investigated the relationship of motion-related sickness to two tendencies involved in pain processing: pain catastrophizing and body awareness.

METHOD

In the first study, 115 participants reported their motion sickness history, pain catastrophizing, and body awareness. In the second study, 40 participants were exposed to a virtual reality and reported their experience of cybersickness as well as their pain catastrophizing and body awareness.

RESULTS

Pain catastrophizing was positively correlated to motion sickness history and cybersickness. Body awareness did not show a linear effect on motion sickness history or cybersickness. However, the interaction effect of pain catastrophizing and body awareness was significant in both studies.

CONCLUSION

Pain catastrophizing seems to have a detrimental effect on cybersickness symptoms. Body awareness moderated the relationship in the sense that the combination of high pain catastrophizing and low body awareness lead to the highest sickness levels.

APPLICATION

Affective and cognitive modulation of cybersickness symptoms should be considered when exposing risk groups to motion-related adverse stimuli.

Estimating the sensorimotor components of cybersickness

The user base of the virtual reality (VR) medium is growing, and many of these users will experience cybersickness. Accounting for the vast interindividual variability in cybersickness forms a pivotal step in solving the issue. Most studies of cybersickness focus on a single factor (e.g., balance, sex, or vection), while other contributors are overlooked. Here, we characterize the complex relationship between cybersickness and several measures of sensorimotor processing. In a single session, we conducted a battery of tests of balance control, vection responses, and vestibular sensitivity to self-motion. Following this, we measured cybersickness after VR exposure. We constructed a principal components regression model using the measures of sensorimotor processing. The model significantly predicted 37% of the variability in cybersickness measures, with 16% of this variance being accounted for by a principal component that represented balance control measures. The strongest predictor was participants' sway path length during vection, which was inversely related to cybersickness [ r(28) = -0.53, P = 0.002] and uniquely accounted for 7.5% of the variance in cybersickness scores across participants. Vection strength reports and measures of vestibular sensitivity were not significant predictors of cybersickness. We discuss the possible role of sensory reweighting in cybersickness that is suggested by these results, and we identify other factors that may account for the remaining variance in cybersickness. The results reiterate that the relationship between balance control and cybersickness is anything but straightforward. NEW & NOTEWORTHY The advent of consumer virtual reality provides a pressing need for interventions that combat sickness in simulated environments (cybersickness). This research builds on multiple theories of cybersickness etiology to develop a predictive model that distinguishes between individuals who are/are not likely to experience cybersickness. In the future this approach can be adapted to provide virtual reality users with curated content recommendations based on more efficient measurements of sensorimotor processing.

A comparative study of cybersickness during exposure to virtual reality and "classic" motion sickness: are they different?

Existing evidence suggest that cybersickness may be clinically different from "classic", motion-induced motion sickness; this evidence was however obtained in separate studies that focussed on just one of the two conditions. Our aim was to bring clarity to this issue, by directly comparing subjective symptoms and physiological effects of motion sickness induced by physical motion (Coriolis cross-coupling) and by immersion in virtual reality (ride on a roller coaster) in the same subjects. A cohort of 30 young healthy volunteers was exposed to both stimulations in a counter-balance order on two separate days at least one week apart. Nausea scores were recorded during the exposure, and Motion Sickness Assessment Questionnaire (MSAQ) was used to profile subjective symptoms post-experiment. Tonic and phasic forehead skin conductance level (SCL) was measured before and during exposure in both stimulation methods. We found that nausea onset times and maximum nausea ratings were significantly correlated during both provocations (r=0.40, p=0.03 and r=0.56, p=0.0012, respectively). Symptom profiling with the MSAQ revealed substantial and significant correlations between total symptom scores (r=0.69, p&lt;0.0001), between each of four symptom clusters and between 15/18 individual symptoms assessed in both conditions. Both provocations caused increase in tonic SCL associated with nausea, with a close correlation between the conditions (r=0.48, p=0.04). This was accompanied by a significant increase in the amplitude of phasic skin conductance transients in both experiments. We conclude that symptoms and physiological changes occurring during cybersickness and "classical" motion sickness are quite similar, at least during advanced stages of these malaises.

Real-time visual feedback about postural activity increases postural instability and visually induced motion sickness

BACKGROUND

Several studies have shown that the kinematics of standing body sway can be influenced by the provision of real time feedback about postural activity through visual displays.

RESEARCH QUESTION

We asked whether real time visual feedback about the position of the body's center of pressure (COP) might affect body sway and the occurrence of visually induced motion sickness.

METHODS

Standing participants (women) were exposed to complex visual oscillation in a moving room, a device that nearly filled the field of view. During exposure to complex visual oscillations, we provided real time feedback about displacements of the body's center of pressure through a visual display presented on a tablet computer.

RESULTS

The incidence of motion sickness was greater than in a closely related study that did not provide real time feedback. We monitored the kinematics of the body's center of pressure before and during exposure to visual motion stimuli. Body sway differed between participants who reported motion sickness and those who did not. These differences existed before any participants experienced subjective symptoms of motion sickness.

SIGNIFICANCE

Real time visual feedback about COP displacement did not reduce visually induced motion sickness, and may have increased it. We identified postural precursors of motion sickness that may have been exacerbated by the COP display. The results indicate that visual feedback about postural activity can destabilize postural control, leading to negative side effects. We suggest possible alternative types of visual displays that might help to stabilize posture, and reduce motion sickness.

Effects of decades of physical driving on body movement and motion sickness during virtual driving

We investigated relations between experience driving physical automobiles and motion sickness during the driving of virtual automobiles. Middle-aged individuals drove a virtual automobile in a driving video game. Drivers were individuals who had possessed a driver’s license for approximately 30 years, and who drove regularly, while non-drivers were individuals who had never held a driver’s license, or who had not driven for more than 15 years. During virtual driving, we monitored movement of the head and torso. During virtual driving, drivers became motion sick more rapidly than non-drivers, but the incidence and severity of motion sickness did not differ as a function of driving experience. Patterns of movement during virtual driving differed as a function of driving experience. Separately, movement differed between participants who later became motion sick and those who did not. Most importantly, physical driving experience influenced patterns of postural activity that preceded motion sickness during virtual driving. The results are consistent with the postural instability theory of motion sickness, and help to illuminate relations between the control of physical and virtual vehicles.

Correlations between individual susceptibility to visually induced motion sickness and decaying time constant of after-nystagmus

This study examines the correlations between optokinetic after-nystagmus (OKAN) parameters and individual susceptibility to visually induced motion sickness (VIMS). Twenty-seven participants were exposed to vertical black-and-white stripes drifting along the yaw axis at 60° per second for 30 min to collect individual VIMS data (Phase 1). Two weeks after the exposure, OKANs were measured (Phase 2). 19 out of 27 participants (i.e., 70%) exhibited consistent OKAN patterns. Significant correlations between the time constants of OKAN and levels of VIMS experienced by the same viewers were found. Four months later, these 27 participants were invited back for a second OKAN measurement (Phase 3). Twenty-one participants came back. Their two OKAN measurements were significantly correlated (r = 0.69, p = 0.001). Rated levels of VIMS in phase 1 significantly correlated with the time constant of OKAN in both Phase 2 (r = 0.51, p = 0.044) and Phase 3 (r = 0.74, p = 0.006). The implications of the correlation results are discussed.

The virtual reality head-mounted display Oculus Rift induces motion sickness and is sexist in its effects

Anecdotal reports suggest that motion sickness may occur among users of contemporary, consumer-oriented head-mounted display systems and that women may be at greater risk. We evaluated the nauseogenic properties of one such system, the Oculus Rift. The head-mounted unit included motion sensors that were sensitive to users' head movements, such that head movements could be used as control inputs to the device. In two experiments, seated participants played one of two virtual reality games for up to 15 min. In Experiment 1, 22% of participants reported motion sickness, and the difference in incidence between men and women was not significant. In Experiment 2, motion sickness was reported by 56% of participants, and incidence among women (77.78%) was significantly greater than among men (33.33%). Before participants were exposed to the head-mounted display system, we recorded their standing body sway during the performance of simple visual tasks. In both experiments, patterns of pre-exposure body sway differed between participants who (later) reported motion sickness and those who did not. In Experiment 2, sex differences in susceptibility to motion sickness were preceded by sex differences in body sway. These postural effects confirm a prediction of the postural instability theory of motion sickness. The results indicate that users of contemporary head-mounted display systems are at significant risk of motion sickness and that in relation to motion sickness these systems may be sexist in their effects.

Visual Information and Support Surface for Postural Control in Visual Search Task

When standing on a reduced support surface, people increase their reliance on visual information to control posture. This assertion was tested in the current study. The effects of imposed motion and support surface on postural control during visual search were investigated. Twelve participants (aged 21 ± 1.8 years; six men and six women) stood on a reduced support surface (45% base of support). In a room that moved back and forth along the anteroposterior axis, participants performed visual search for a given letter in an article. Postural sway variability and head-room coupling were measured. The results of head-room coupling, but not postural sway, supported the assertion that people increase reliance on visual information when standing on a reduced support surface. Whether standing on a whole or reduced surface, people stabilized their posture to perform the visual search tasks. Compared to a fixed target, searching on a hand-held target showed greater head-room coupling when standing on a reduced surface.

Postural sway in men and women during nauseogenic motion of the illuminated environment

We exposed standing men and women to motion relative to the illuminated environment in a moving room. During room motion, we measured the kinematics of standing body sway. Participants were instructed to discontinue immediately if they experienced any symptoms of motion sickness, however mild. For this reason, our analysis of body sway included only movement before the onset of motion sickness. We analyzed the spatial magnitude of postural sway in terms of the positional variability and mean velocity of the center of pressure. We analyzed the multifractality of postural sway in terms of the width of the multifractal spectrum and the degree of multiplicativity of center of pressure positions. Results revealed that postural sway differed between participants who later reported motion sickness and those who did not, replicating previous effects. In a novel effect, postural responses to motion of the illuminated environment differed between women and men. In addition, we identified statistically significant interactions that involved both Sex and motion sickness status. Effects were observed separately in the spatial magnitude and multifractality of sway. The results were consistent with the postural instability theory of motion sickness (Riccio and Stoffregen in Ecol Psychol 3:195-240, 1991) and suggest that Sex differences in motion sickness may be related to Sex differences in the control and stabilization of bodily activity.

Self-driving carsickness

This paper discusses the predicted increase in the occurrence and severity of motion sickness in self-driving cars. Self-driving cars have the potential to lead to significant benefits. From the driver's perspective, the direct benefits of this technology are considered increased comfort and productivity. However, we here show that the envisaged scenarios all lead to an increased risk of motion sickness. As such, the benefits this technology is assumed to bring may not be capitalised on, in particular by those already susceptible to motion sickness. This can negatively affect user acceptance and uptake and, in turn, limit the potential socioeconomic benefits that this emerging technology may provide. Following a discussion on the causes of motion sickness in the context of self-driving cars, we present guidelines to steer the design and development of automated vehicle technologies. The aim is to limit or avoid the impact of motion sickness and ultimately promote the uptake of self-driving cars. Attention is also given to less well known consequences of motion sickness, in particular negative aftereffects such as postural instability, and detrimental effects on task performance and how this may impact the use and design of self-driving cars. We conclude that basic perceptual mechanisms need to be considered in the design process whereby self-driving cars cannot simply be thought of as living rooms, offices, or entertainment venues on wheels.

Sex differences in visual performance and postural sway precede sex differences in visually induced motion sickness

Motion sickness is more common among women than among men. Previous research has shown that standing body sway differs between women and men. In addition, research has shown that postural sway differs between individuals who experience visually induced motion sickness and those who do not and that those differences exist before exposure to visual motion stimuli. We asked whether sex differences in postural sway would be related to sex differences in the incidence of visually induced motion sickness. We measured unperturbed standing body sway before participants were exposed to visual motion stimuli that induced motion sickness in some participants. During postural testing, participants performed different visual tasks. Results revealed that postural sway was affected by visual tasks, consistent with the literature. In addition, we found a statistically significant three-way interaction between visual tasks, sex, and (subsequent) motion sickness status. These results suggest that sex differences in motion sickness may be related to sex differences in the control of postural balance.

Coupling of postural activity with motion of a ship at sea

On land, body sway during stance becomes coupled with imposed oscillations of the illuminated environment or of the support surface. This coupling appears to have the function of stabilizing the body relative to the illuminated or inertial environment. In previous research, the stimulus has been limited to motion in a single axis. Little is known about our ability to couple postural activity with complex, multi-axis oscillations. On a ship at sea, we evaluated postural activity using measures of body movement, as such, and we separately evaluated a direct measure of coupling between body movement and ship motion. Participants were tested while facing fore-aft and athwartship. We compared postural activity between participants who had been seasick at the beginning of the voyage and those who had not. Coupling of postural activity with ship motion differed between body axes as a function of body orientation relative to the ship. In addition, coupling differed between participants who had been seasick at the beginning of the voyage and those who had not. We discuss the results in terms of implications for general theories of postural control, and for prediction of susceptibility to seasickness in individuals.

Efficient and Effective Change Principles in Active Videogames

Active videogames have the potential to enhance population levels of physical activity but have not been successful in achieving this aim to date. This article considers a range of principles that may be important to the design of effective and efficient active videogames from diverse discipline areas, including behavioral sciences (health behavior change, motor learning, and serious games), business production (marketing and sales), and technology engineering and design (human-computer interaction/ergonomics and flow). Both direct and indirect pathways to impact on population levels of habitual physical activity are proposed, along with the concept of a game use lifecycle. Examples of current active and sedentary electronic games are used to understand how such principles may be applied. Furthermore, limitations of the current usage of theoretical principles are discussed. A suggested list of principles for best practice in active videogame design is proposed along with suggested research ideas to inform practice to enhance physical activity.

Impact of the motion and visual complexity of the background on players' performance in video game-like displays

The visual interfaces of virtual environments such as video games often show scenes where objects are superimposed on a moving background. Three experiments were designed to better understand the impact of the complexity and/or overall motion of two types of visual backgrounds often used in video games on the detection and use of superimposed, stationary items. The impact of background complexity and motion was assessed during two typical video game tasks: a relatively complex visual search task and a classic, less demanding shooting task. Background motion impaired participants' performance only when they performed the shooting game task, and only when the simplest of the two backgrounds was used. In contrast, and independently of background motion, performance on both tasks was impaired when the complexity of the background increased. Eye movement recordings demonstrated that most of the findings reflected the impact of low-level features of the two backgrounds on gaze control.

Cinerama sickness and postural instability

Motion sickness symptoms and increased postural instability induced by motion pictures have been reported in a laboratory, but not in a real cinema. We, therefore, carried out an observational study recording sickness severity and postural instability in 19 subjects before, immediately and 45 min after watching a 1 h 3D aviation documentary in a cinema. Sickness was significantly larger right after the movie than before, and in a lesser extent still so after 45 min. The average standard deviation of the lateral centre of pressure excursions was significantly larger only right afterwards. When low-pass filtered at 0.1 Hz, lateral and for-aft excursions were both significantly larger right after the movie, while for-aft excursions then remained larger even after 45 min. Speculating on previous findings, we predict more sickness and postural instability in 3D than in 2D movies, also suggesting a possible, but yet unknown risk for work-related activities and vehicle operation.

PRACTITIONER SUMMARY

Watching motion pictures may be sickening and posturally destabilising, but effects in a cinema are unknown. We, therefore, carried out an observational study showing that sickness then is mainly an issue during the exposure while postural instability is an issue afterwards.

Pre-bout standing body sway differs between adult boxers who do and do not report post-bout motion sickness

Background

Motion sickness is characterized by subjective symptoms that include dizziness and nausea. Studies have shown that subjective symptoms of motion sickness are preceded by differences in standing body sway between those who experience the symptoms and those who are not. Boxers often report dizziness and nausea immediately after bouts. We predicted that pre-bout standing body sway would differ between boxers who experienced post-bout motion sickness and those who did not.

Methodology/Principal Findings

We collected data on standing body sway before bouts. During measurement of body sway participants performed two visual tasks. In addition, we varied stance width (the distance between the heels). Postural testing was conducted separately before and after participants' regular warm-up routines. After bouts, we collected self-reports of motion sickness incidence and symptoms. Results revealed that standing body sway was greater after warm-up than before warm-up, and that wider stance width was associated with reduced sway. Eight of 15 amateur boxers reported motion sickness after a bout. Two statistically significant interactions revealed that standing body sway before bouts differed between participants who reported post-bout motion sickness and those who did not.

Conclusions/Significance

The results suggest that susceptibility to motion sickness in boxers may be manifested in characteristic patterns of body sway. It may be possible to use pre-bout data on postural sway to predict susceptibility to post-bout motion sickness.

Visually induced motion sickness and presence in videogames: The role of sound

Visually induced motion sickness (VIMS) is a well-known phenomenon in virtual environments, simulators, and videogames. We conducted an experiment to analyze the role of sound on the severity of VIMS and the feeling of presence in videogames. Thirty-two subjects first watched a pre-recorded sequence of the game “Mirrors Edge” and then played the game actively. Game-play sound was activated for half of the participants. VIMS was measured via the Simulator Sickness Questionnaire and the Fast Motion Sickness Scale, presence was captured using the Presence Questionnaire. Results showed severe VIMS in all participants during the passive video session, whereas active-play revealed only moderate VIMS. However, in both conditions sound turned out to have no effect, neither on the severity of VIMS nor on the amount of presence. We found a moderate negative correlation between VIMS and presence. The results indicate that sound is less important than often thought.

Role of video games in improving health-related outcomes: a systematic review

CONTEXT

Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes.

EVIDENCE ACQUISITION

Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers.

EVIDENCE SYNTHESIS

Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers.

CONCLUSIONS

There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area.

Gaze and viewing angle influence visual stabilization of upright posture

Focusing gaze on a target helps stabilize upright posture. We investigated how this visual stabilization can be affected by observing a target presented under different gaze and viewing angles. In a series of 10-second trials, participants (N = 20, 29.3 ± 9 years of age) stood on a force plate and fixed their gaze on a figure presented on a screen at a distance of 1 m. The figure changed position (gaze angle: eye level (0°), 25° up or down), vertical body orientation (viewing angle: at eye level but rotated 25° as if leaning toward or away from the participant), or both (gaze and viewing angle: 25° up or down with the rotation equivalent of a natural visual perspective). Amplitude of participants' sagittal displacement, surface area, and angular position of the center of gravity (COG) were compared. Results showed decreased COG velocity and amplitude for up and down gaze angles. Changes in viewing angles resulted in altered body alignment and increased amplitude of COG displacement. No significant changes in postural stability were observed when both gaze and viewing angles were altered. Results suggest that both the gaze angle and viewing perspective may be essential variables of the visuomotor system modulating postural responses.

Validating an efficient method to quantify motion sickness

OBJECTIVE

Motion sickness (MS) can be a debilitating side effect associated with motion in real or virtual environments. We analyzed the effect of expectancy on MS and propose and validate a fast and simple MS measure.

BACKGROUND

Several questionnaires measure MS before or after stimulus presentation, but no satisfactory tool has been established to quickly capture MS data during exposure. To fill this gap, we introduce the Fast MS Scale (FMS), a verbal rating scale ranging from zero (no sickness at all) to 20 (frank sickness). Also, little is known about the role of expectancy effects in MS studies. We conducted an experiment that addressed this issue.

METHOD

For this study, 126 volunteers participated in two experiments. During stimulus presentation, participants had to verbally rate the severity of MS every minute before filling in the Simulator Sickness Questionnaire (SSQ). To measure expectancy effects, participants were separated into three groups with either positive, negative, or neutral expectations.

RESULTS

We compared the verbal ratings with the SSQ scores. Pearson correlations were high for both the SSQ total score (r = .785) and the nausea subscore (r = .828). No expectancy effects were found.

CONCLUSION

The FMS is a fast and valid method to obtain MS data. It offers the possibility to record MS during stimulus presentation and to capture its time course. We found expectancy not to play a crucial role in MS. However, the FMS has some limitations.

APPLICATION

The FMS offers improved MS measurement. It is fast and efficient and can be performed online in environments such as virtual reality.