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Phenytoin as a countermeasure for motion sickness in NASA maritime operations

Seasickness is the most prevalent form of motion sickness and is an operational problem during Space Shuttle Solid-fueled Rocket Booster (SRB) retrieval. Phenytoin has been shown to protect against motion sickness induced by Coriolis stress. We exposed SRB recovery personnel to off-vertical rotation and sea motion after phenytoin or placebo. Phenytoin blood levels of at least 9 micrograms/ml were protective against motion sickness at sea. No change in susceptibility to nitrogen narcosis was seen in divers in chamber tests at 460 KPa. Phenytoin was used during the performance of critical and hazardous tasks during training and actual SRB recovery operations. Phenytoin is an effective operational countermeasure for motion sickness for selected SRB crew members.

Woodard, Daniel↗

Chinese hyper-susceptibility to vection-induced motion sickness

Little is known about the factors that control individual differences in susceptible to motion sickness. A serendipitous observation in our laboratory that most Chinese subjects become motion sick prompted this study. We used a rotating optokinetic drum to provoke motion sickness and compared gastric responses and symptom reports of Chinese, European-American, and African-American subjects. There was no difference in the responses of European-American and African-American subjects; however, Chinese subjects showed significantly greater disturbances in gastric activity and reported significantly more severe symptoms. We suggest that this hypersusceptibility presents a natural model for the study of physiological mechanisms of nausea and other symptoms of motion sickness.

Stern, Robert M.↗

Stroboscopic Vision as a Treatment for Space Motion Sickness

Stroboscopic illumination reduces the severity of motion sickness symptoms, and shutter glasses with a flash frequency of 4 Hz are as effective as a strobe light. Stroboscopic illumination appears to be an effective countermeasure where retinal slip is a significant factor in eliciting motion sickness. Additional research is currently underway to evaluate the stroboscopic glasses efficacy in a variety of different motion environments. Specifically, carsickness, sickness during the microgravity periods of parabolic flight and sea sickness. Possible mechanisms underlying the effectiveness of the glasses are also being investigated. There is evidence from pilot studies showing that the glasses, when strobed at the 4 Hz frequency, reduce saccade velocity to visually presented targets is reduced by approximately half of the normal values. It is interesting to note that adaptation to space flight may also slow saccade velocity.

Reschke, Millard F.↗

An appraisal of the value of vitamin B12 in the prevention of motion sickness

It has been suggested that vitamin B12 given by intramuscular injection can significantly reduce the occurrence of motion sickness in susceptible individuals (Banks, 1980). Since it is known that B12 influences the metabolism of histidine and choline, dietary precursors to neurotransmitters with established roles in motion sickness, an experimental evaluation has been undertaken of the efficacy of B12 in the prevention of motion sickness induced by controlled coriolis simulation. Subjects executed standardized head movements at successively higher rpm until a malaise III endpoint was reached. Following two baseline tests with this motion stressor, subjects received a B12 injection, a second injection two weeks later, and a final motion sickness test three weeks later. No significant differences in the susceptibility to motion sickness were noted after B12.

Kohl, R. L.↗

Motion sickness and otolith sensitivity - A pilot study of habituation to linear acceleration

Astronauts, particularly in Skylab flights, experienced varying degrees of motion sickness lasting 3-5 days. One possible mechanism for this motion sickness adaptation is believed to be a reduction in otolith sensitivity with an attendant reduction in sensory conflict. In an attempt to determine if this hypothesis is valid, a ground-based pilot study was conducted on a vertical linear accelerator. The extent of habituation to accelerations which initially produced motion sickness was evaluated, along with the possible value of habituation training to minimize the space motion sickness problem. Results showed that habituation occurred for 6 of the 8 subjects tested. However, in tests designed to measure dynamic and static otolith function, no significant differences between pre- and post-habituation tests were observed. Cross habituation effects to a standard Coriolis acceleration test were not significant. It is unlikely that ground-based pre-habituation to linear accelerations of the type examined would alter susceptibility to space motion sickness.

Potvin, A. R.↗

An Evaluation of the Frequency and Severity of Motion Sickness Incidences in Personnel Within the Command and Control Vehicle (C2V)

The purpose of this study was to assess the frequency and severity of motion sickness in personnel during a field exercise in the Command and Control Vehicle (C2V). This vehicle contains four workstations where military personnel are expected to perform command decisions in the field during combat conditions. Eight active duty military men (U.S. Army) at the Yuma Proving Grounds in Arizona participated in this study. All subjects were given baseline performance tests while their physiological responses were monitored on the first day. On the second day of their participation, subjects rode in the C2V while their physiological responses and performance measures were recorded. Self-reports of motion sickness were also recorded. Results showed that only one subject experienced two incidences of emesis. However, seven out of the eight subjects reported other motion sickness symptoms; most predominant was the report of drowsiness, which occurred a total of 19 times. Changes in physiological responses were observed relative to motion sickness symptoms reported and the different environmental conditions (i.e., level, hills, gravel) during the field exercise. Performance data showed an overall decrement during the C2V exercise. These findings suggest that malaise and severe drowsiness can potentially impact the operational efficiency of the C2V crew. It was concluded that conflicting sensory information from the subject's visual displays and movements of the vehicle during the field exercise significantly contributed to motion sickness symptoms. It was recommended that a second study be conducted to further evaluate the impact of seat position or orientation and C2V experience on motion sickness susceptibility. Further, it was recommended that an investigation be performed on behavioral methods for improving crew alertness, motivation, and performance and for reducing malaise.

Cowings, Patricia S.↗

Buspirone blocks motion sickness and xylazine-induced emesis in the cat

The ability of buspirone to prevent motion sickness and the mechanism of the buspirone action were tested in cats pretreated (s.c. injection) by buspirone 30 min before being subjected to motion stimulus (in a device described by Crampton and Lucot, 1985) or to an injection of an emetic drug xylazine (using only cats susceptible to motion sickness or to xylazine, respectively). Buspirone treatment was found to block motion sickness with an effective dose-50 of 0.46 mg/kg. Buspirone pretreatment (with 4.0 mg/kg) has also significantly blocked vomiting in cats later injected with 0.66 mg/kg xylazine. The results indicate that buspirone is acting at the vomiting center, the point of convergence for the separate mechanisms subserving chemically-induced emesis and motion sickness.

Lucot, James B.↗

Elicitation of motion sickness by head movements in the microgravity phase of parabolic flight maneuvers

Susceptibility to motion sickness was tested in 44 subjects during parabolic flight maneuvers in a KC-135 aircraft. The subjects were categorized as: (1) insusceptible; (2) moderately susceptible; or (3) highly susceptible to motion sickness during exposure to varying degrees of gravito-inertial force. After categorization, three types of head movements were evaluated to determine the effect on the subjects' baseline susceptibility. Ten cycles of head movements were made in three different parabolas until nausea was reached or 40 parabolas had been completed. All types of head movements significantly increased susceptibility for all categories; eyes-open conditions were always more stressful than eyes-closed conditions for each type of head movement. It is concluded that head movements in microgravity can elicit symptoms of motion sickness. It is suggested that head movements play an etiological role in space motion sickness. In ground based studies where head movements are necessary to elicit symptoms, they are also necessary to elicit adaptation to the microgravity environment.

Lackner, J. R.↗

Use of physical culture to increase resistance of sailors to motion sickness

From 50% to 70% of sailors are exposed to motion sickness in storms. A program of physical exercises is described and tested for effectiveness in preventing this problem. In comparing the results of tests of susceptibility to motion sickness given to groups before and after a program of exercises and to a control group, it is found that physical education can strengthen the vestibulary apparatus and help prevent motion sickness.

Salanin, I. V.↗

Effects of scopolamine on autonomic profiles underlying motion sickness susceptibility

The purpose of this study was to examine the effects of scopolamine on the physiological patterns occurring prior to and during motion sickness stimulation. In addition, the use of physiological profiles in the prediction of motion sickness was evaluated. Sixty subjects ingested either 0.6 mg scopolamine, 2.5 mg methoscopolamine, or a placebo. Heart rate (HR), respiratory sinus arrhythmia (an index of vagal tone), and electrogastrograms were measured prior to and during the exposure to a rotating optokinetic drum. Compared to the other groups, the scopolamine group reported fewer motion sickness symptoms, and displayed lower HR, higher vagal tone, enhanced normal gastric myoelectric activity, and depressed gastric dysrhythmias before and during motion sickness induction. Distinct physiological profiles prior to drum rotation could reliably differentiate individuals who would develop gastric discomfort from those who would not. Symptom-free subjects were characterized by high levels of vagal tone and low HR across conditions, and by maintaining normal (3 cpm) electrogastrographic activity during drum rotation. It was concluded that scopolamine offered motion sickness protection by initiating a pattern of increased vagal tone and gastric myoelectric stability.

Uijtdehaage, Sebastian H. J.↗

The Effects of Promethazine on Human Performance, Mood States, and Motion Sickness Tolerance

Intramuscular (IM) injections of promethazine in 25 mg or 50 mg dosages are commonly used to treat space motion sickness in astronauts. The present study examined the effects of IM injections of promethazine on neuropsy-chological performance, mood states, and motion sickness tolerance in humans. Twelve men, mean age 36 plus or minus 3.1 participated in one training (no injections) and three treatment conditions: a 25 mg injection of promethazine, a 50 mg injection of promethazine, and a placebo injection of sterile saline. Each condition, spaced at 7 day intervals, required an 8-10 hr session in which subjects were given four repetitions of 12 performance tasks, and one rotating chair motion sickness test. On the training day subjects were trained on each task to establish stability and proficiency. On treatment days, the order in which the drug or placebo was assigned to subjects was counter-balanced and a double-blind technique was used. Statistically significant decrements in performance were observed on 10 of 12 tasks when subjects were given 25 mg or 50 mg of promethazine as compared to the placebo. Performance decrements were associated with mean blood alcohol dose equivalency levels of 0.085% for 25 mg and 0. 1 37% for 50 mg dosages. The mood scale results showed significant changes in individual subjective experiences with maximum deterioration in the arousal state and fatigue level. When compared to placebo significant increases in motion sickness tolerance were found for both dosages of promethazine. These data suggest that effective dosages of promethazine currently used to counteract motion sickness in astronauts may significantly impair task components of their operational performance.

Cowings, Patricia S.↗

Autogenic-Feedback Training for the Control of Space Motion Sickness

This paper presents case-studies of 9 shuttle crewmembers (prime and alternates) and one U.S. Navy F-18 pilot, as they participated in all preflight training and testing activities in support of a life sciences flight experiment aboard Spacelab-J, and Spacelab-3. The primary objective of the flight experiment was to determine if Autogenic-feedback training (AFT), a physiological self-regulation training technique would be an effective treatment for motion sickness and space motion sickness in these crewmembers. Additional objectives of this study involved the examining human physiological responses to motion sickness on Earth and in space, as well as developing predictive criteria for susceptibility to space motion sickness based on ground-based data. Comparisons of these crewmembers are made to a larger set of subjects from previous experiments (treatment and "test-only" controls subjects). This paper describes all preflight methods, results and proposed changes for future tests.

Cowings, Patricia S.↗

Effects of Autonomic Conditioning on Motion Sickness Tolerance

This paper presents case-studies of 9 shuttle crewmembers (prime and alternates) and one U.S. Navy F-18 pilot, as they participated in all preflight training and testing activities in support of a life sciences flight experiment aboard Spacelab-J, and Spacelab-3. The primary objective of the flight experiment was to determine if Autogenic-feedback training (AFT), a physiological self-regulation training technique would be an effective treatment for motion sickness and space motion sickness in these crewmembers. Additional objectives of this study involved the examining human Physiological- responses to motion sickness on Earth and in space, as well as developing predictive criteria for susceptibility to space motion sickness based on ground-based data. Comparisons of these crewmembers are made to a larger set of subjects from previous experiments (treatment and test-only controls subjects). This paper describes all preflight methods, results and proposed changes for future tests.

Cowings, P. S.↗

Some of the mechanisms underlying motion sickness

Some of the mechanisms contributing to the occurrence of motion sickness are discussed. It is stated that the primary factor is a loss of stability in the vestibular system caused by repetitive sensory inputs that are abnormal in terms of the central vestibular patterning encountered. Evidence is presented supporting the opinion that motion sickness is an epiphenomenon superimposed on any responses in the reflex category due to vestibular influences that cross a temporary linkage to reach nonvestibular sites where first-order motion sickness symptoms have their immediate origin.

Graybiel, A.↗

The relation of motion sickness to the spatial-temporal properties of velocity storage

Tilting the head in roll to or from the upright while rotating at a constant velocity (roll while rotating, RWR) alters the position of the semicircular canals relative to the axis of rotation. This produces vertical and horizontal nystagmus, disorientation, vertigo, and nausea. With recurrent exposure, subjects habituate and can make more head movements before experiencing overpowering motion sickness. We questioned whether promethazine lessened the vertigo or delayed the habituation, whether habituation of the vertigo was related to the central vestibular time constant, i.e., to the time constant of velocity storage, and whether the severity of the motion sickness was related to deviation of the axis of eye velocity from gravity. Sixteen subjects received promethazine and placebo in a double-blind, crossover study in two consecutive 4-day test series 1 month apart, termed series I and II. Horizontal and vertical eye movements were recorded with video-oculography while subjects performed roll head movements of approx. 45 degrees over 2 s to and from the upright position while being rotated at 138 degrees /s around a vertical axis. Motion sickness was scaled from 1 (no sickness) to an endpoint of 20, at which time the subject was too sick to continue or was about to vomit. Habituation was determined by the number of head movements that subjects made before reaching the maximum motion sickness score of 20. Head movements increased steadily in each session with repeated testing, and there was no difference between the number of head movements made by the promethazine and placebo groups. Horizontal and vertical angular vestibulo-ocular reflex (aVOR) time constants declined in each test, with the declines being closely correlated to the increase in the number of head movements. The strength of vertiginous sensation was associated with the amount of deviation of the axis of eye velocity from gravity; the larger the deviation of the eye velocity axis from gravity, the more severe the motion sickness. Thus, promethazine neither reduced the nausea associated with RWR, nor retarded or hastened habituation. The inverse relationship between the aVOR time constants and number of head movements to motion sickness, and the association of the severity of motion sickness with the extent, strength, and time of deviation of eye velocity from gravity supports the postulate that the spatiotemporal properties of velocity storage, which are processed between the nodulus and uvula of the vestibulocerebellum and the vestibular nuclei, are likely to represent the source of the conflict responsible for producing motion sickness.

NASA Discipline Neuroscience↗

Autogenic Feedback Training Exercise: Controlling Physiological Responses to Mitigate Motion Sickness

During space travel approximately 50 of the crew experience symptoms of motion sickness that can range from mild forms of nausea or dizziness to severe malaise and vomiting1. Developing an effective treatment for these symptoms has become a priority of the National Aeronautics and Space Administration (NASA). Autogenic-Feedback Training Exercise (AFTE) is a nonpharmacological countermeasure for mitigating motion sickness. It involves training subjects to control physiological responses in high stress environments2. The primary goal of this experiment is to evaluate the effectiveness of AFTE for increasing tolerance to motion sickness in high stress environments.

motion sickness↗

Treatment of motion sickness in parabolic flight with buccal scopolamine

Treatment of acute motion sickness induced by parabolic flight with a preparation of scopolamine placed in the buccal pouch was investigated. Twenty-one subjects flew aboard a KC-135 aircraft operated by NASA which performed parabolic maneuvers resulting in periods of 0-g, 1-g, and 1.8-g. Each subject flew once with a tablet containing scopolamine and once with a placebo in a random order, crossover design. Signs and symptoms of motion sickness were systematically recorded during each parabola by an investigator who was blind to the content of the tablet. Compared with flights using placebo, flights with buccal scopolamine resulted in significantly lower scores for nausea (31-35 percent reduction) and vomiting (50 percent reduction in number of parabolas with vomiting). Side effects of the drug during flight were negligible. It is concluded that buccal scopolamine is more effective than a placebo in treating ongoing motion sickness.

Norfleet, William T.↗