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Preliminary Results Using Galvanic Vestibular Reduction as a Non-Pharmaceutical Tool for Motion Sickness Mitigation

Introduction: Alterations in vestibular sensory processing following G-transitions lead to motion sickness and spatial disorientation upon return to Earth’s gravity. The use of non-pharmaceutical mitigation for motion sickness has several potential advantages over drug treatment options. The purpose of this study was to validate a non-pharmaceutical tool using galvanic vestibular reduction (GVR) to mitigate G-transitional induced motion sickness and spatial disorientation. Methods: Using a repeated measures counter-balanced design, motion sickness and perception are obtained during Coriolis cross-coupling stimuli on a rotating chair across three GVR treatment interventions: throughout stimulus testing (prevention), following symptom onset (rescue), and placebo control. Subjects perform up to 10 sets of pitch head movements during constant rotation. For each set, head movement is cued every 10 seconds, alternating between pitch forward (chin resting to chest) and pitch backward (head upright) for a total of 7 forward and backward movements. During each head movement, subjects are asked to use a joystick to record the magnitude of their perceived rotation along all three axes. During the 2-minute pause between sets, motion sickness symptom scoring was obtained using the Pensacola Diagnostic Index and subject discomfort (0-20) ratings. Performance on a sensorimotor and cognitive test battery is measured during a fourth session to map changes in GVR level with functional performance. Results: Fifteen of 30 subjects have completed testing to date. Preliminary findings suggest GVR may be more effective in reducing symptoms in subjects who self-report less susceptibility on a pre-test motion sickness susceptibility questionnaire. Based on the joystick measures, GVR significantly reduces both the magnitude (mean 22% - 34%) and duration (mean 42% - 49%) of perceived roll and pitch sensation with head movements during constant rotation. It is important to note that comparable levels of GVR (up to 2.5mA) does not impair performance on a functional test battery including mobility and balance tasks. Discussion: Our preliminary findings suggest GVR may be useful in reducing disorienting roll and pitch illusions associated with Coriolis cross-coupling stimuli. While transfer to post-flight treatment will need to be validated, the potential advantages of our non-pharmaceutical countermeasure approach would be to provide rapid therapeutic effect while allowing continuous titration of GVR amplitude during recovery to maintain operational performance.

Gaurav Pradhan↗
NASA NTRS1992

Investigation of anti-motion sickness drugs in the squirrel monkey

Early attempts to develop an animal model for anti-motion sickness drugs, using dogs and cats; were unsuccessful. Dogs did not show a beneficial effect of scopolamine (probably the best single anti-motion sickness drug for humans thus far) and the findings in cats were not definitive. The authors have developed an animal model using the squirrel monkey (Saimiri sciureus) of the Bolivian phenotype. Unrestrained monkeys in a small lucite cage were tested in an apparatus that induces motion sickness by combining vertical oscillation and horizontal rotation in a visually unrestricted laboratory environment. Signs of motion sickness were scored using a rating scale. Ten susceptible monkeys (weighing 800-1000 g) were given a total of five tests each, to establish the baseline susceptibility level. Based on the anticholinergic activity of scopolamine, the sensitivity of squirrel monkey to scopolamine was investigated, and the appropriate dose of scopolamine for this species was determined. Then various anti-motion sickness preparations were administered in subsequent tests: 100 ug scopolamine per monkey; 140 ug dexedrine; 50 ug scopolamine plus 70 ug dexedrine; 100 ug scopolamine plus 140 ug dexedrine; 3 mg promethazine; 3 mg promethazine plus 3 mg ephedrine. All these preparations were significantly effective in preventing motion sickness in the monkeys. Ephedrine, by itself, which is marginally effective in humans, was ineffective in the monkeys at the doses tried (0.3-6.0 mg). The squirrel monkey appears to be a good animal model for antimotion sickness drugs. Peripherally acting antihistamines such as astemizole and terfenadine were found to be ineffective, whereas flunarizine, and an arginine vasopressin V1 antagonist, showed significant activity in preventing motion sickness.

NASA Discipline Neuroscience↗
NASA NTRS2006

A Countermeasure for Space Motion Sickness

Overall, the results obtained in both the U.S. and the Russian space programs indicate that most space crews will experience some symptoms of motion sickness (MS) causing significant impact on the operational objectives that must be accomplished to assure mission success. At this time the primary countermeasure for MS requires the administration of Promethazine. Promethazine is not a benign drug, and is most frequently administered just prior to the sleep cycle to prevent its side effects from further compromising mission objectives. Clearly other countermeasures for SMS must be developed. Currently the primary focus is on two different technologies: (1) developing new and different pharmacological compounds with less significant side effects, (2) preflight training. The primary problem with all of these methods for controlling MS is time. New drugs that may be beneficial are years from testing and development, and preflight training requires a significant investment of crew time during an already intensive pre-launch schedule. Granted, motion sickness symptoms can be minimized with either of the two methods detailed above, however, it may be possible to develop a countermeasure that does not require either extensive adaptation time or exposure to motion sickness. Approximately 25 years ago Professor Geoffrey Melvill Jones presented his work on adaptation of the vestibuloocular reflex (VOR) using optically reversed vision (left-right prisms) during head rotations in the horizontal plane. It was of no surprise that most subjects experienced motion sickness while wearing the optically reversing prisms. However, a serendipitous finding emerged during this research showing that the same subjects did not experience motion sickness symptoms when wearing the reversing prisms under stroboscopic illumination. The mechanism, by which this side-effect was believed to have occurred, is not clearly understood. However, the fact that no motion sickness was ever noted, suggests the possibility of producing functionally useful adaptation during space flight without the penalty of disabling motion sickness by controlling the rate of the adaptive process by means of an appropriate stroboscopically presented environment. After several recent meetings with Professor Melvill Jones, we were encouraged to repeat the motion sickness portions of his and Mandl's 1981 stroboscopic experiment. In conducting this experiment we used a randomized cross-over design where subjects were randomly assigned to either a stroboscopic flash or no strobe for their first exposure in the experimental design. Twenty subjects (19 subjects completed the study) read a short passage from Treasure Island mounted on the wall approximately 1 m from their eyes while wearing left-right reversing prisms. The strobe on time of 3 microseconds and flash frequency of 4 Hz was set to equal that used in the original study. Motion sickness was scored using a modified Miller and Graybiel scale that we constructed to include symptoms that may be elicited under conditions where reversing prisms are worn. On this scale a score of 5 represented Malaise IIa (mild motion sickness) and a score of 8 or above is approaching frank sickness. Symptoms were tracked and recorded every 5 min during the task. Testing was limited to 30 min unless the subject had reached the MIIa score, at which time the test was terminated. Performance under stroboscopic illumination was significantly better than when the subjects read under normal room illumination while wearing the left-right reversing prisms. Based on these results we developed a goggle system using LCD material that can be strobed. To evaluate the effectiveness of stroboscopic goggles we tested an additional 9 subjects in addition to retesting 10 used in the stroboscopic pilot study described above. These 19 subjects wore a pair of strobing LCD goggles that could be cycled at 4 Hz. These subjects wore the goggles while also wearing left-right reversg prisms. Results while wearing the goggles showed that none of the 19 subjects scored at the MIIa level on the motion sickness rating scale. When the goggles did not flash (no strobe), 11 of the 19 developed symptoms above the MIIa criteria. As a countermeasure the goggles seem to be effective, even with an on time of 10 msec (time the goggles are clear). We have also collected anecdotal data, from our personnel in the Neuroscience Laboratory at the Johnson Space Center, suggesting that the goggles may effective in preventing carsickness.

Reschke, M. F.↗
NASA NTRS1994

The effects of autogenic-feedback training on motion sickness severity and heart rate variability in astronauts

Space motion sickness (SMS) affects 50 percent of all people during early days of spaceflight. This study describes the results of two Shuttle flight experiments in which autogenic-feedback training (AFT), a physiological conditioning method, was tested as a treatment for this disorder. Of the six who were designated as flight subjects (two women and four men), three were given treatment and three served as controls (i.e., no AFT). Treatment subjects were given 6 hours of preflight AFT. Preflight results showed that AFT produced a significant increase in tolerance to rotating chair motion sickness tests. Further, this increased tolerance was associated with changes in specific physiological responses and reports of reduced malaise. Flight results showed that two of the three control subjects experienced repeated vomiting on the first mission day, while one subject experienced only moderate malaise. Of the three treatment subjects, one experienced mild discomfort, one moderate discomfort, and one severe motion sickness. Only the three control subjects took medication for symptom suppression. Measures of cardiac function reflective of vagal control were shown to be affected especially strongly on the first day of space flight. AFT given for control of heart rate, respiration, and other autonomic activity influenced both the vagal control measures and SMS. These data suggest that AFT may be an effective treatment for space motion sickness; however, this cannot be demonstrated conclusively with the small number of subjects described.

Toscano, William B.↗
NASA NTRS1986

Sudden emesis following parabolic flight maneuvers Implications for space motion sickness

Episodes of emesis unaccompanied by the usual prodomal signs of motion sickness have been reported by astronauts in the Space Shuttle program. Such reports have raised the issue whether space motion sickness has different characteristics from terrestrial motion sickness. Evidence is presented here from parabolic flight experiments that sudden vomiting can occur in response to a provocative vestibular stimulus even when no premonitory symptoms are being experienced. Accordingly, in chronic exposure conditions, the absence of prominent signs or symptoms of motion sickness does not necessarily mean an absence of sensitization.

Lackner, J. R.↗
NASA NTRS1992

Spatial orientation, adaptation, and motion sickness in real and virtual environments

Reason and Brand (1975) noted that motion sickness occurs in many situations involving either passive body motion or active interaction with the world via indirect sensorimotor interfaces (e.g., prism spectacles). As might be expected, motion sickness is being reported in VEs that involve apparent self-motion through space, the best known examples being flight simulators (Kennedy et al., 1990). The goals of this paper are to introduce the motion-sickness symptomatology; to outline some concepts that are central to theories of motion sickness, spatial orientation, and adaptation; and to discuss the implications of some trends in VE research and development.

Dizio, Paul↗
NASA NTRS1989

Sensory conflict in motion sickness: An observer theory approach

Motion sickness is the general term describing a group of common nausea syndromes originally attributed to motion-induced cerebral ischemia, stimulation of abdominal organ afferent, or overstimulation of the vestibular organs of the inner ear. Sea-, car-, and airsicknesses are the most commonly experienced examples. However, the discovery of other variants such as Cinerama-, flight simulator-, spectacle-, and space sickness in which the physical motion of the head and body is normal or absent has led to a succession of sensory conflict theories which offer a more comprehensive etiologic perspective. Implicit in the conflict theory is the hypothesis that neutral and/or humoral signals originate in regions of the brain subversing spatial orientation, and that these signals somehow traverse to other centers mediating sickness symptoms. Unfortunately, the present understanding of the neurophysiological basis of motion sickness is far from complete. No sensory conflict neuron or process has yet been physiologically identified. To what extent can the existing theory be reconciled with current knowledge of the physiology and pharmacology of nausea and vomiting. The stimuli which causes sickness, synthesizes a contemporary Observer Theory view of the Sensory Conflict hypothesis are reviewed, and a revised model for the dynamic coupling between the putative conflict signals and nausea magnitude estimates is presented. The use of quantitative models for sensory conflict offers a possible new approach to improving the design of visual and motion systems for flight simulators and other virtual environment display systems.

Oman, Charles M.↗
NASA NTRS2023

Galvanic Vestibular Reduction Modifies Perception of Coriolis Cross-Coupling and Delays Motion Sickness Onset

INTRODUCTION: Alterations in vestibular sensory processing following G-transitions lead to head movement sensitivity and motion sickness upon return to Earth’s gravity. The purpose of this study was to evaluate whether a non-pharmaceutical tool using galvanic vestibular reduction (GVR) could suppress disorienting illusions and mitigate motion sickness. A similar approach using anodal (inhibitory) currents delivered to both ears has been shown to result in a selective reversible ablation of irregular vestibular afferents [1]. METHODS: Using a repeated measures counter-balanced design, motion sickness and perception were obtained in 26 subjects during Coriolis cross-coupling stimuli on a rotating chair across three GVR treatment interventions: throughout stimulus testing (prevention), following symptom onset (rescue), and placebo control. The GVR peak current was maintained at 2.5 mA across subjects and across prevention / rescue sessions. Subjects performed up to 10 sets of pitch head movements during constant rotation. For each set, head movement was cued every 10 seconds, alternating between pitch forward (chin resting to chest) and pitch backward (head upright) for a total of 7 forward and backward movements. During each head movement, subjects were asked to use a joystick to record the magnitude of their perceived rotation along three axes. During the 2-minute pause between sets, motion sickness symptom scoring was obtained using the Pensacola Diagnostic Index and subject discomfort (0-20) ratings. Performance on a sensorimotor and cognitive test battery was measured during a fourth session to map changes in GVR level with functional performance. RESULTS: Fourteen of the 26 subjects were not susceptible to the motion stressor (i.e., did not reach an endpoint in the control condition). While the time to endpoint, or number of head movements, did not significantly vary across the three GVR conditions in the remaining subjects, the symptom levels were significantly lower through the third set of head movements when GVR was on throughout the testing. Initiating GVR following symptom onset did not appear to alter the symptom progression nor time to motion sickness endpoint. Based on the joystick measures, GVR significantly modified the perceived roll and pitch sensation during head movements, reducing the amplitude of tilt in most subjects. It is important to note that comparable levels of GVR did not impair performance on a functional test battery including mobility, balance and cognitive tasks. DISCUSSION: Our findings suggest GVR may be useful in reducing disorienting roll and pitch illusions and delaying the onset of motion sickness. Further enhancements will be required to individualize the stimulation amplitude and optimize the waveform delivery. Adapting this non-pharmaceutical countermeasure approach to allow self-administered titration of current amplitude during recovery would enable transfer to post-flight treatment of motion sickness. [1] Minor L. B. and Goldberg J. M. (1991) J Neurosci 11, 1636-48. 109, 889-894.

G N Pradhan↗
NASA NTRS1993

Increasing accuracy in the assessment of motion sickness: A construct methodology

The purpose is to introduce a new methodology that should improve the accuracy of the assessment of motion sickness. This construct methodology utilizes both subjective reports of motion sickness and objective measures of physiological correlates to assess motion sickness. Current techniques and methods used in the framework of a construct methodology are inadequate. Current assessment techniques for diagnosing motion sickness and space motion sickness are reviewed, and attention is called to the problems with the current methods. Further, principles of psychophysiology that when applied will probably resolve some of these problems are described in detail.

Stout, Cynthia S.↗
NASA NTRS1986

M.I.T./Canadian vestibular experiments on the Spacelab-1 mission. IV - Space motion sickness: Symptoms, stimuli, and predictability

Three cases of motion sickness that occurred on Spacelab-1 are described. The relation between head movements and symptom intensity is examined. The effects of visual, tactile, and proprioceptive orientation cues on motion sickness are studied. The effectiveness of the drugs used is evaluated and it is observed that the drugs reduce the frequency of vomiting and overall discomfort. Preflight and postflight motion sickness susceptibility data are presented.

Oman, C. M.↗
NASA NTRS1980

Changes in plasma vasopressin during motion sickness in cats

Changes in levels of plasma vasopressin (AVP) and cortisol (C) have been shown to be correlated with motion sickness and nausea in man. As part of the research aimed at validation of the cat as an appropriate animal model for motion sickness research, levels of these hormones were investigated in the cat during motion sickness elicited by vertical linear acceleration of approximately 0.6 Hz and 1 +/- 0.6 G. In Study 1, 15 cats previously screened for susceptibility to motion sickness were prepared with indwelling jugular catheters to permit withdrawl of blood with minimal disruption of the stimulus and minimum stress to the animal. AVP and C were measured in blood samples obtained during exposure to vertical linear acceleration and during control sessions in which the animals were placed in the stationary apparatus. 10 min and 1 min prior to duration; 1, 5, 10, and 20 min after start of motion. Total duration of exposure to motion was 20 min. The data indicate that both AVP and C are elevated during exposure to motion if emesis occurs. AVP reaches maximum levels during or about the same time as emesis, while C increases gradually throughout the period of vertical acceleration. In Study 2, four cats were prepared with indwelling catheters and AVP was measured in blood withdrawn during exposure to the vertical linear acceleration. A single pre-motion sample consisting of three samples drawn 5 min prior to motion onset. Two series of samples consisting of three samples drawn at 3-min intervals were obtained during motion. The first series was initiated at emesis, and the second 25 min after emesis. Results show that levels of circulating AVP were elevated (2 to 27 times the control and pre-motion levels) in the samples taken during emesis and decreased, but remained 1 to 6 times above the pre-motion or control levels within 25 min. The results of these two studies indicate that AVP is elevated during motion-produced emesis than is C. These findings are in general agreement with those obtained from humans under motion sickness conditions, and indicate that it is appropriate to continue to use the cat in studies of hormone changes during motion sickness.

R Fox↗
NASA NTRS1991

Motion sickness severity and physiological correlates during repeated exposures to a rotating optokinetic drum

Fifty-two subjects were exposed to a rotating optokinetic drum. Ten of these subjects who became motion sick during the first session completed two additional sessions. Subjects' symptoms of motion sickness, perception of self-motion, electrogastrograms (EGGs), heart rate, mean successive differences of R-R intervals (RRI), and skin conductance were recorded for each session. The results from the first session indicated that the development of motion sickness was accompanied by increased EGG 4-9 cpm activity (gastric tachyarrhythmia), decreased mean succesive differences of RRI, increased skin conductance levels, and increased self-motion perception. The results from the subjects who had three repeated sessions showed that 4-9 cpm EGG activity, skin conductance levels, perception of self-motion, and symptoms of motion sickness all increased significantly during the drum rotation period of the first session, but increased significantly less during the following sessions. Mean successive differences of RRI decreased significantly during the drum rotation period for the first session, but decreased significantly less during the following sessions. Results show that the development of motion sickness is accompanied by an increase in gastric tachyarrhythmia, and an increase in sympathetic activity and a decrease in parasympathetic activity, and that adaptation to motion sickness is accompanied by the recovery of autonomic nervous system balance.

Hu, Senqi↗
NASA NTRS2007

Stroboscopic Vision as a Treatment for Space Motion Sickness

Results obtained from space flight indicate that most space crews will experience some symptoms of motion sickness causing significant impact on the operational objectives that must be accomplished to assure mission success. Based on the initial work of Melvill Jones we have evaluated stroboscopic vision as a method of preventing motion sickness. Given that the data presented by professor Melvill Jones were primarily post hoc results following a study not designed to investigate motion sickness, it is unclear how motion sickness results were actually determined. Building on these original results, we undertook a three part study that was designed to investigate the effect of stroboscopic vision (either with a strobe light or LCD shutter glasses) on motion sickness using: (1) visual field reversal, (2) Reading while riding in a car (with or without external vision present), and (3) making large pitch head movements during parabolic flight.

Reschke, Millard F.↗
NASA NTRS2005

Stroboscopic Goggles for Reduction of Motion Sickness

A device built around a pair of electronic shutters has been demonstrated to be effective as a prototype of stroboscopic goggles or eyeglasses for preventing or reducing motion sickness. The momentary opening of the shutters helps to suppress a phenomenon that is known in the art as retinal slip and is described more fully below. While a number of different environmental factors can induce motion sickness, a common factor associated with every known motion environment is sensory confusion or sensory mismatch. Motion sickness is a product of misinformation arriving at a central point in the nervous system from the senses from which one determines one s spatial orientation. When information from the eyes, ears, joints, and pressure receptors are all in agreement as to one s orientation, there is no motion sickness. When one or more sensory input(s) to the brain is not expected, or conflicts with what is anticipated, the end product is motion sickness. Normally, an observer s eye moves, compensating for the anticipated effect of motion, in such a manner that the image of an object moving relatively to an observer is held stationary on the retina. In almost every known environment that induces motion sickness, a change in the gain (in the signal-processing sense of gain ) of the vestibular system causes the motion of the eye to fail to hold images stationary on the retina, and the resulting motion of the images is termed retinal slip. The present concept of stroboscopic goggles or eyeglasses (see figure) is based on the proposition that prevention of retinal slip, and hence, the prevention of sensory mismatch, can be expected to reduce the tendency toward motion sickness. A device according to this concept helps to prevent retinal slip by providing snapshots of the visual environment through electronic shutters that are brief enough that each snapshot freezes the image on each retina. The exposure time for each snapshot is less than 5 ms. In the event that a higher rate of strobing is necessary for adequate viewing of the changing scene during rapid head movements, the rate of strobing (but not the exposure time) can be controlled in response to the readings of rate-of-rotation sensors attached to the device.

Reschke, M. F.↗
NASA NTRS1988

Comparison of aerobic fitness and space motion sickness during the Shuttle program

Space motion sickness (SMS) is an important problem for short-duration space flight; 71 percent of STS crewmembers develop SMS symptoms. The search for effective countermeasures and factors that correlate with sensitivity has been extensive. Recently, several investigators have linked aerobic fitness with motion sickness sensitivity in the 1-G or high-G environment. This paper compares the aerobic fitness of 125 Shuttle crewmembers with their SMS symptom category. Aerobic fitness data were obtained from the exercise tolerance test conducted nearest the time of launch. SMS data were derived from the medical debrief summaries. Mean maximum oxygen consumption values for crewmembers in four SMS categories (none, mild, moderate, severe) were 44.55, 44.08, 46.5, and 44.24 ml/kg per min, respectively. Scattergrams with linear regression analysis, comparing aerobic fitness and SMS symptom classification are presented. Correlation coefficients comparing SMS categories vs. aerobic fitness for men and women reveal no definite relationship between the two factors.

Jennings, Richard T.↗
NASA NTRS1993

Reliability of Autonomic Responses and Malaise Across Multiple Motion Sickness Stimulation Tests

There is general agreement that a high degree of variability exists between subjects in their autonomic nervous system responses to motion sickness stimulation. Additionally, a paucity of data exists that examines the variability within an individual across repeated motion sickness tests. Investigators have also examined the relationship of autonomic responses to motion sickness development. These investigations have used analyses at discrete points in time to describe this relationship. This approach fails to address the time course of autonomic responses and malaise development throughout the motion sickness test. Our objectives were to examine the reliability of autonomic responses and malaise using the final minute of the motion sickness test across five testing occasions, to examine the reliability of the change in autonomic responses and the change in malaise across five testing occasions, and to examine the relationship between changes in autonomic responses and changes in malaise level across the entire motion sickness test. Our results indicate that, based on the final minute of testing, the autonomic responses of heart rate, blood volume pulse, and respiration rate are moderately stable across multiple tests. Changes in heart rate, blood volume pulse, respiration rate, and malaise throughout the test duration were less stable across the tests. We attribute this instability to variations in individual susceptibility and the error associated with estimating a measure of autonomic gain.

Stout, Cynthia S.↗
NASA NTRS1990

The neurochemical and neuropharmacological basis of motion sickness

An apparatus suitable for producing motion sickness in laboratory animals and constructed at the university is herein described. The apparatus is a modified version of that previously described by Fox and Daunton. It consists of a 66-inch steel arm anchored at the center to a wooden platform and attached to a motor that makes the arm move in a see-saw fashion. At each end of the steel arm is mounted an aluminum disc that can be rotated by a motorized device. Detachable cages are mounted on each disc for animal holding. The animal can then be exposed to rotational motion by rotation of the aluminum disc, or to see-saw motion simultaneously (Cross-coupled). The apparatus is presently being used in our laboratory to study the neuropharmacological basis of motion sickness in the rat. The device can be adapted for use with other animal species by modifying the cage mounted on the aluminum discs.

Walker, C. A.↗