AD-A244 243 AGARDADVISORY GROUP FOR AEROSPACE RESEARCH & DEVELOPMENT7 RUE ANCELLE 92200 NEUILLY SUR SEINE FRANCE

AGARD LECTURIN SERIES 178

Motion Sickness:Significance in Aerospace Operationsand Prophylaxis(Le Mal des Transports: son Importance pour lesOperations Mrospatiales et Prophylaxies)

This material in this publication was assembled in strpport a Lecture Seriesunder the sponsorship of the Aerospace Medical Panel of AGARDand the Consultant and E~xchange Programme of AGARD presented on7th--th October 1991 in Toronto, Canada, 24th-25th October 1991in Athens, Greece and 28th-29th October 1991 In De Bilt, The Netherlands.

-- - NORTH ATLANTIC TREATY ORGANIZATION

.. MIJTl• - • Publinsld September 1991

D ,..tributionl dAvollablityon BackCover

AGARD-LS-175

ADVISORY GROUP FOR AEROSPACE RESEARCH & DEVELOPMENT7 RUE ANCELLE 92200 NEUILLY SUR SEINE FRANCE

UI"t. T d. '

AGARD LECTURE SERIES 175

Motion Sickness: t"' . "Significance in Aerospace Operations 'and Prophylaxis(Le Mal dcs Transports: son Inmportance potr IsrOptrdtion(s)l .Adeospatiales ct Prophylaxics) . ............. __

91-16659

This tImtct'iti in this ptlilicltiou n wu, assei hicd to supporna I .*cture SeriesUlndeCr 111t sjoIsofshi ip of the Aerospace Medical Panel of A(0iAI.)and the (Collnsttl11rt and EI-aclngc P'roglinumne ol AGARI) presented onl7th--sth O 1tobeI 1991 in Trillto, Canlida, 24th--25th October 1991in Athens, (itrecce und 2Hth-29th October 1991 in De) Bih, IThe Netherhlmds.

- North Atlantic Treaty OrganizationOrgan/sation du TraitW de !Atintique Nord

~l I1 27 7

The Mission of AGARD

A m~tdingtt) its( imrter, t 1w ission of AOA RD is to b ring together the leading personalities oft Iho NATOn Intion% in thli field (sof science and techtoelogy relitting to nerospaLL for the following purposes:

- R~ecommendinag effective ways fur the moembier nation~s to use thseir research laid divoeopment capabili ties for tiecommon benelfitof the NATO community;

-Providing tscif litific and tltcladiendassistance to the Military Committee [inthe field (if ltero~sliae rtieniirh andJewloprnin t (with psarticulatr regard to its military application);

- Cotln(nuausly stim olattingadimvtes i I the aerospace sciences relevant to strengtheuinig the cmmnton defence postu re;

- 1Imprtoving thc co-operationi arrong memrber nations inl aerospace research and development;

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with research laid des'elvpmaunt probalemts lit tte aeroslinee field.

'The highest me thotity within AGAIII in tite Notionail Delegates B~oard consisting of offleltidly t1)lpoinitLJsenior repsresentativesfroitieach atnhr to.iem;.;simiI ofACIAIU is carried out Ithruught the PanelN whicht ar contaised of experts appointedby~ tile Nuiitlal Delegates, thy ,Com~uhet aniwdrt.xthantge rograininite nd the Acrospace ApplicationisStudites Progritmnin~le,remtIlts of AGARI) work tire reported tu the mtembher nations aitd thk: NATO Akuthorities tltto-uih the A(IARI series; ofpublliltcations of which thlis is one,

Participationt in Ali actn~ivities ishby Invitation (olly lai~d is normalaly limited to citizemms of the NT'O nattions.

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Contents

Page

Abstract/Abrkgk iv

List of Authors/Speakers v

Reference

Signs and Symptoms of Motion Sickness and its Basic Nature Iby KYi, Money

Motion Sickness and Its Relation to Some Forms orSpatlal Orientation: 2Mechanisms and Theory

by F.I:, ucdry

Physical Characteristics ofStilnull Provoking Motion Sickness 3by M,.Griiffiin

Signlflcation Opira.domwlle des ('in,,oses pour I'AIr, rEspace el la Survic en Mer 4par A. Ig.r

Factors Influencing SusceptIbilily: Individual D)iffcrences and I hltimii Factors 5by Ft.F(iucdry

Space Sickness 6Aby K,. Motley

Simulator Sickness 611by KY,, Motlcy

Sea Sickness 7lly M,J, (rlfii'Ll

Evaluation e Pridiction de Ia Susceptilbilit6 aux (Oin,,oses 1per A. [.gcr

Prevention land Treatm||ent of Motiotn Sickness: Non- i'haruuaicol)glcalI heraily 9by JI.R, .Sttll

Assessment of Drug Effectiveness It)by W,.10NI. '~VOIld

Ma|nagement of Acute and Chronic Motion Sickness I|by J.R.ItIS tt

BlIollugraphv

,'Li

Abstract

IIs ariisplice activities, iiiotiiii sick ness, spsecifimclly iiirsieklness, conititiiu's lii Ilit it 15iilllei sltriiig Ilyiiig tritiiiiig ttuiii igiilasitipu'titiiils ifo titrerew andI pisseuigirs (e.g. puriitroopsi. SitilittorM siekiteSS cIIe de~grade flie s'ffes'iivetiess ol'siniitiltitiir trtininiigtied spaice sickliess reduces the effivieiiev i~isi' lsriiiilils. Scalsjckness% is ;listi if ileriivitjctill ciinieri'i ill si fur1 as It tilleets tlircressopelatitig floiii slips andt [lie ssil-ivavtihlty of' ditched aviatiors,

'fli ILecture Series has liceti designed. srinittuily. to ;id piactising Flight Surigeois in thle serioritatice if their stiasry curechuti's, It slhiild ifsm lie ifl jlicierst I to thers whlo wish iti ohibtaii sit sseiiew Il' recenti udvunees ill lie itiitl-stiiidiiif iftite

ietiiiliigy and treaiutiitt of motiitna sickness:

T111 t(Ofics 11) heC CIAitLt ill thle 12 lectures ;ire:

1. Iiiiicuidl ctit its of mtiii ifiii tknusis2. (Juiertiiiutl slgttifictinte o oif ttnt siektitss3. Aetiology tids tictriifhiysiiliigival iieliiistiisr4. I hssicul chalu cei isiic~s of Iriiviicttsitiitiiii.m5. Sielnfil fenture-s of 1iiispitee, sea mtid sitmulatoriiirekiess(I. Scleelitiol litis assessliett of su~sceptibility7. Iriifsliy'ttsis ti mtuliviiu geiiicit.

[Ie II cetuIte Series Wsill cuitteuid sWilli 41 Roun~d 'Blibtle IDiscussiion.

fl its Iectuire Ser ies, sfpionsoiretl by lie Aersiiifuev Medical I'ttiel oii M( iAI) has lucit ihtieic ttes lv li CiitssIiIitiIt ta11ilI aehtinge IloitsttiittieI1

Abre'ge

Is's cqiliupttge et ful pisgrs (cyst le Is flntircLilitistcsf)tfil'iI s':gisseI Acuis~iisipriiiulc i IleviluetriitiitILe till sIc sitliktlatenl licult Initie :i l'el'icacii& teeiiin teti t enI sittinllitti cut Ic uetmill de lespltec reifiit les cafaitick' dessJ'titiiiitittic. I.e titl d'tier lest Vlcgilolies'it nitl domitints letitcludetsutuicsfis'il dais III 111uesu1C 11. if t'iiit'eitis ItS c't111fittgc's itIISt'Ssitu Ic Litie s IIiCet Ill stI'iVtilhifitftiles llisituetis s;Iicutl ass t 11iniristiges.

I 'olijet priticiptill sic cc cycle ui C~le 'Cuitfieutc est sfLfi%~~II titlet iiticaile Mta tittilecitu~s LIe Il'tir II sltisl'tilltiiti.sitratiii ties soilis

Ilitlittite. 11IIcivites'scr ti'ltuiles 11ISo'rsuus sotliltt i iluieui r aic s~'ulthýse ties delIittics jj~gtiiuu~e tirlelgiStI.O ~s ult itt I'liijiitite st'cItiletliuliguc st stil triiiteliviteui 11111 miiils tiitisplis.

I es stIijels qui seriti titil111tes liii'S sleS 12 2'uiiiletuitCUs sitit Ic'S stiistiitts:

I. I eS tisfictis clltisftic's slit ituil1 tIcs vItauSpuri~s2. I Itifistiifct opti-aiiiuii dlt itl sles trttspu risý

I. 'ttthiiltgit 0t It's uikuiiuie etruii'iuiguts-1. 1It'sC I t IrCtet it lik~es Il t ,vsislttss slti uususlut'ivuiviri P vctilitu

I. Is p:IIIiiirtic Iurites sits tititas sIc 'IC1i sI, 'eliecV~"d sic 0 scl Ilk t IIc sitilalcuIr10i. 1.;1 sclsciiiiu ct l'su'ilituitiuti sit Ilk SIlsuLLiiliiite7. Litt prsisularlasie et lit g"ist ii

Ia tItii uuuIthIde ss'rI tu I u1111gtiis's I STCIII IILICSVit Ii si c scte.

Mv iARD ti avii:Arspla

List of Authors/Speakers

Lecture SerIl!-- iireclor: Dr Ai\. BumsonOI

I Wild o S-pecdul Sense~s Div.RAI: lt~Inftmel ii Aviationi NMiiicuincFuinbormigli, I hl~iils CU. 14 6S7,United Kiiigdoini

AUTHOS/SiI'FAKERS

Ir IM,. ,(I H ill Dr K.E. NMcnvyI lead, I l1i:nut~i Fiiclors vseuirch Unit sonlor ScientistI11iite~ 'If Sollid & Vibrafloil Roscurcvh (IS\'R) Defence & Cilvil 1n.4fitutlc or lIivlroiimcitill MedicineThei Unimclily of soil IIIit 111t 11 113.3 Shelppud Avniuc West

Southaiimptoni, S09) SN I j) 0 B3ox 2)00) lDowisvjiewUniL'd Kir~gidoi Ontalrio. M 3 M3111

Dr FE, Jued ry Po.IWJnt'v~Naival A~crospiice Medicail Resea~rch Loiborziory Profuii. D~i W.J.On ithuis NdrU vuhc

Naval Air Station vnAciunislrhMdlsh ci) iI'ensuicia, F1.32508-.5700 A dmcibcig h~~ Meic V tu

Unitd Shti., It105 AZ Amsuwtdiu Zuidiioo

The NetheurlanidsD octceir A. 1.geSPIXIA Ni - Avioniklor Dr.1 RH.kSot?Ruclolusidtit (fast noi I III, Vstibuliir PhIysiologyB11 91 RAF Institute or Aviation NMudichic3-1166 SIi IIt MC (Ik Id Wit J IdI NClu I CAde ILarnborougl, I h~tint% (U 14 M7S17

Iliuie UnIhed Kingdomu

SIGNS AND SYMPTOMS OF MOTION SICKESS AND ITS BASIC NATURE

by K.E. MoneySenior Scientist, Defenco and Civil Institute of Environmental Medicine

P.O. Box 2000, North York, Ontario, Canada, M3M 3B9and

Payload Specialist, Canadian Space AgencyOttawa, Canada

ABSTRACT

The cardinal signs and symptoms of motion sickposs are malaise, pallor, (andor/fluahing), cold sweating, abdominal discomfort, changes in gastric motility, andchanges in levels of circulating hormones. Cardiovascular, respiratory, and other signshave also been reported, as have a variety of other sensations, feelings and performancechanges.

It is reasonable to think that motion sickness is basically the activation, bymotion, of a poison-response mechanism,

BASIC NATURE

In essence, motion sickness is the activation, by motion, of a poison-reaponsemechanism. This is obvious: motion gives rises to vomiting.

In certain motion environments, something that must be called "peculiar"happens. Motion sickness occurs. Motion sickness will be despribad here, and thedescription of motion sickness will be based on the assumption that only one peculiarthing happens: a poison response is provoked by motion. Common sense suggesta that twoor three peculiar things do not independently occur at the same time.

There are two currently-popular thuories of why this peculiar thing happens, whymotion gives rise to a poison response. The older of these two theories, the conflictthuury, holds that in motion sickness environments the poison response ocoura because ofL conflict. In a motion sickness environment, the pattern of sensory inputs concerningorientation and motion (vestibular, visual, and proprioceptor inputs) is in conflictwith the pattern of inputs anticipated on the basis of previous experience (6,17). Theconflict somehow gives rise to vomiting. The theory (unmodified) does not explain whysuch a conflict is utt.rly unable (8,9,14,15) to provoke vomiting in individuals who arelacking the vestibular apparatus of the inner ear, The theory also does not explain whysuch a conflict should produce vomiting instead of deep breathing, dischbrge from thenose, or orgasm. The theory would apply equally well if the conflict r oduced one ofthese things instead of vomiting.

The more modern theory, that of Treisman (25), incorporates the conflict theoryand does explain why vomiting should occur. Treisman's theory holds that theconflicting sensory inputs are interpreted centrally as neurophysiological dysfunctioncaused by poisoning. Treinman postulated that the brain stem mechanisms of orientationand motion normally perform an additional function as well as maintenance of bodilyequilibrium, stabilility of gaze, etc the additional function is to detect and respondto certain poisons. In motion sickness situations the conflict in sensory inputssimulates poisoning in those neural mechanisms.

There is convincing evidence uf the basic validity of Treisman's theory. Itseems clear that the brain stem mechanisms of orientation and motion do in fact functionalso to detect and respond to certain poisons. The experiment showing this (13,14)found that, in experimental animals, snirgical removal of the vestibular apparatus of theinner ear rendered the animals defective in the emetic response to certain poisonsinjected intramuscularly. This is positive evidence that the vestibular system isinvolved in poison response. The surgery ancroachad only on the ear and, of course, italso rendered the animals completely nonsusceptible to motion sickness. The vestibularsystem is involved in poison response in circumstanoes of motion sickness and also incircumstances of poisoning with certain toxic chemicals.

Motion sickness is a poison response provoked by motion. It in a poison response

provoked by motion acting (directly or indirectly. on the vestibular system.

SIGNS AND SYMPTOMS

The signs and symptoms of motion sickness can be considered the manifestations ofthe poison response. Although Treisman confined his theory of motion sickness to nauseaand vomiting (25), it is clear that, whenever vomiting is provoked by motion, otherbodily responses are also provo.ked, and sometimes these other responses occur andvomiting does not occur. Sometimes pallor, cold sweating, and malaise occur in a motionenvironment and vomiting does not. Motion sickness is a poison response provoked bymotion, not just vomiting.

Motion sickness is possibly the purest and simplest poison response available forstudy, because it can be produced for study without the complicating presence of apoison. It is produced by a motion stimulus that masquerades as a poison. It isinteresting to think that a person known to be poisoned (for example, by apomorphine)

would think that the poison Is a terrible one because of the horrible nausea, pallor,cold sweat.ig, vomiting, ate; but the reality might be that the dose of apomorphine hadno adverse effect on the body, except that it triggered one of the body'spoison-response mechanisinnr then the body inflicted all those miseries on itself. Apoison that causes facial pallor might not do so by a direct influence on the bloodvessels of the skin, or even by w direct influence on the autonomic nervous systemt itcould do so by activating one of the body's poison-response mechanisms, and thatmechanism could then act on the hypothsaamic centers controlling the autonomic nervoussytem to produce the facial pallor. In motion sickness it seems that when thepoison-response mechanism is activatedl the body then inflicts on itself a variety ofsigns and symptoms, to be described below.

Motion sickness aigns and symptoms are often thought of as, first, nausea andvomiting, and second, all the "other" ones. However, as indicated above, it will beassumed here that only one peculiar thing happens in motion sickness environmentsa apoison response is rrovoked. There is no reason to think that snything else ishappening, and all the signs and symptoms will be considered to be part of the poisonresponse. The 71-qns end symptoms of motion sickness will therefore be classified as,first, those associated with emptying the stomach, and second, those associated withcounteracting or surviving the part of the poison detected (incorrectly) in thebloodstream.

There is a considerable number and variety of signs and symptoms that differ indifferent individuals (1,2,3,4,6,12,17), However, some signs and symptosa appear tooccur in all, or almost all, cease of motion sickness in humanep and only these signsand symptoms will be listed here.

SIGNS AND SYMPTOMS ASSOCIATED WITH hiM1'PYING THE STOMACII

Abdominal awarenessAbdominal discomfortNauseaMotility of the stomachVomiting

SIGNS AND SYMPTOMS ASSOCIATED WITH COUNTERACTING Oi SURVIVING THE POISUN IN 'THi|E BLOOD

MalaiseSleepinessIeadach.oPallor (and/or flushing)Cold sweatingCardiovascular changesEndoorinological changes

Abdominal awareness, abdominal discomfort, and nausea are possibly parts of agradient of a mingle symptom that would have the effect of preventing the furtherconsumption of a toxic food. They would also tund to have the effect of preventing theconsumption of that food again on future occasions (25). They are possibly thqconscious reflectioi. of unusual activity in the central emetic mechanisms (6, 12).

Motility and tonus of the stomach decrease with motion sickness in most humansubjects (7,1?). Oastric (and intestinal) motility has been observed in motion sicknessin humans by listening to the gut sounds with stethescopes and microphones (24)r thesounds diminish, usually to silence, with iotion sickness in spaceflight. X-ray studlesof the gut before and after exposure to nauseogenic motion (16) also reveal decreasedmotility with nausea in most subjects. Balloons have been placed in the stomachs ofhumans subjected to motion sickness (3,7,26),. overall, decreases of tonus and motilitypredominate, but some prominent exceptions are reported (3). In one subject with arqastric fistula, direct visualization of the stomach during nausea was possible, andthis subject together with three normal subjects with gastric balloons was exposed tovestibular and other nauseogenic stimuli; "nausea occurred only during gastricrelaxation and hypomotility" (26).

The electrical activity of the gut has also been studied during motion sickness(6, 19,20) using electrodes attached to the skin over the stom&ch. The electricalactivity recorded in this way is called the electrogastrogrum or EGO. The EGG changeswith motion sicknessr the cban,e is typically a decreased magnitude of the EGO voltage(6,20) and an increase in the basic electrical rhythm from the normal 3 cycles perminute to 5-7 cycles per minute (19,20). This increase of the basic electrical rhythmof the EGG, although it is called tachygastria, is in fact associated with gastricstasis, decreased gastric motility (20,23), so that the Increased EGG frequency isconsisaten-t withe decreased gastric motility observed with microphones, balloons, andx-rays. The decreased amplitude of the EGG is elso associated with decreased motility.

The EGG is an index of interest in studies of motion sickness: it is an index ofsomething underlying motility. There is no simple relationship between recorded EGGvalues and, for example, recordings (in dogs) from force tranducers fixed to the gastricmorosa (18). The basic electrical, rhythm of the EGG reflects *pacesetter potentials ofthe stomach, but not gastric contractions" (20). However, when gastric contractions dooccur Lawy a•m time-locked to the LUU. At che higher basic EGG rhythms, contractione

tend riot to occur at all. Al1so, "the amplitude of the IIIG increases when a contractionoccurs" (20). in motion sickcness, both the increased frequency of the basic electricalrhythm of the EGG anti the decreased EGG amplitude indicate decreased gastric motility.

It in possible that the decreas* in gastric motility would have survival value insomeone who had ingested a poison: it would tend to keep the poison in the stomach,where absorption might be slower and where vomiting could remove it.

Vomiting removes the poison (that is not there) from the stomach. The physiologyof vomiting ham bean recently reviewed (6).

It is not clear how (or whether) malaise, sleepiness, and headache would improvethe chances of surviving poisoning, but they would tend to encourage the poisonedindividual to lie down.

The pallor, the cold sweating, the cardiovascular changes, and theendocrinological changes of motion .sickness can all be seen as perts of a general stressresponse that includes an overall activation of the sympathetic nervous system (814s).The stress response (it is assumed) unhances the chances of surviving poisoning, and Itoccurs in the absence of any stress on the body, for the same reason that vomitingoccurs without any poison in the stomacht a poison-response moch~nism hall beenactivated. It should be noted that moat motion sickness environments do not stresm Lhubody; babies sleep in these environments, Only if the poison response is provoked doesthe stress response appear (in the absence of stressa).

It Is unlikely that pharmaceuticals selected to counteract the autonomlo signs ofmotion sickness would be satisfactory, because no one suffering from motion micknemscares about the autonomic signor only pharawaceutioals that counteract tile rnausea alldvomiting are relevant to the nofferer' s deslies.ý

Pallor ia a result of vasoconstriction in the skin, probably in renponse to anincrease in the leN9 activity to the blood vessels of the skin 16), and it Is a signl ofmotion sickness that: is almost invariably (3) sesn before voiniting. It has been foundrecently* however, that in somne individuals there is flushing ats part of the skin areaction in motion sickness (11). Sweating (eccrino sweating) similarly results from anIncrease in Activity In the SNS supply to the sweat 'Iands1, althouqh the postgangIlioiiicSNS copply to the uweat glands is chelierlgric )r 6). 'Pil C11r'IoCVA0ecnlAJ' uiaijeeII Of InotiUtisickness are also consistent with (in overall activationl Of tho SNS: the pulse rAtsIncreases slighbtly (2,3) and the blood flow tu ekeletal mnusclu i ncresaes (21).

The endocrinological channges withi rtion sickness alan Veuimublw a stressresponse. Recent studies have found that humans IIIi otion s iuknsan have iiict'eaeudcirculating levela of AVII, ACT11. 14PI, NE, Gi1l, awl PIIL 6 ii,2) AVPIllmeanHfltntidiuretiu ho, leone, AL"I'I measn adrenovort inut iphin hormonrl l0i1 moann: nphinph rin, Ni-imneans noredrenialin, Gli means growth hormone, and PHL Insanls prolactinl

Although thise particular collection of' autotiemirk artid nducl'inolog].coal respoinnois typical of it stress response, it is niot cluar exactLy how it wonuld ImI provu thchalnces Of e rv iv ili a Poision Perhaps this I woulei he cl..oar iri'It we lu knowtl what pci 1101the body thinks it has inges ted in tiat-ton sicknesst or perhaps the response isappropriate for several, or evenl momt, poisons.

To the extent that awtiori micknuua,; is n-issar anrd vnilli t-Ing. theA ",-lh'ir- 0,t'i -In' dsymptoms ar" pociliftir epipheollliola, hilt if it Is anhiumed that only one poeculiar thinqhappens ill not Loll aicknues (a poison rosponse is provoked by unnatuiral irut loll), thun allthe n igyni and aymlptollia must he part of that poison reiponee * If the autcniomic ,Žffact~iiwore pecuiliar opiphenomana, it would be difficult to understaind hlow threir iieniiipuiatiotiby cortical control, ustng autogen~ir feedback, could 11ifliunlco the nausea and VoillitiqlgIt would be like pushing on a stri i . However, if the autoiiomic effects are part of apoison response it is iimiodiately underetandihico that a cortical input to tho ,niitonioiilceffectora could take a route (for example) through the poiseon- response mnerhanism dillaffect also other parts of the poison response, such as nauseetan~id vomiitinlg. Autogenicfeedback trainling does, of course, influence nausea and voiiiting, but how it doel so isperhaps easier to understand if it is assumed that mli signs and syisptorrs of motionsickness are ppArt of a poison response.

If cortical input to the autonomic effectors of motion sickness can exert adesired Influence on the nasusea anti vomiting, then perhaps (with trainling) a cortic-Alinfluence on the sleepiness und malaise eight be beneficial alsol thle cortex night,convince itself tby way of the poison-responee mechanism) that it feels fine, that- it isill excellent health, anid that it is wide awaktiý in doing so it miight attenuate thenausea, and vomiting.

Ru 3FE EN CtiE

1. Conaings, P.S. Ailtogenic-feedbaok trainingi a treatmxent for motion and spacesickniess. Chapt 17, pp 353-372, nin Motion and Slpace Sickness, edited by 03.11.Crampton, CRC Proes, Bloca Ratin, rlorida, 451 pages, 1990.

2. Cowings P.S., Suter S., Toscanot W.., iAaniya J.1, and Naifah K. General ,r't,,nonliccomponents of motion sickness. Psychophyaiol. ;.3. 542-551, 19d6C.

3. Cr amplto(n G0.1 i. Srt vdi (m, or nvri'tt sitickn'rs ;XVI I. L'hysmtoicrical clianjeeaccotmpanying sickneis in alan. J1. Appi. Physiol. 7f 501-507, 1955,

4. Crastpton JIl., editor. *Motion and Space Sickness. CRC Press, Boca Raton,Florida, 451 pages, 1990.

5. L'vevsman T., Gottamnan M., Ublicb E_, Ulbrecht 0., von Warder K_, and Secriea P.C.increased secretion of growth hormone, prolactin, anlidiurstic hormon", and cortisolinduced Iy the stress of mrotion sickness. Aviat. Space Environ, Mad. 49t 53-57, 19713.

6. Ilerre D.L. Phytil-ology of motion: sickness symptoms. Chapt 10, pp L53-177, in:Motion and] Space Sic~kness, edited by 0.li. Crampton, CRC Press, Boca Raton, Florida, 451pagan, 1990.

7, Ilemingway A. Review. Studly of research an the problem of airsicknan's i;1 theArmy Air Forces. Projoct 3281, Research Report No, 1, The Research Laboratory, 'rThe ArmyAir Faorces School of Aviation Medicine, Randolph Field, Texas, pp' 1-35, 20 April 1945,

0 1 James W. The sense of dizinyness in deraf mutes. Am1. J, Otol. 4t 239-254, 18102,

9. Keilogg 11.S., Kennedy [3,5., and Oraybici A. Motion sickness eyttptomatoliogy ofSaloyr intt I i.oti e feetvc t tunittovrma Iettitjecti t douringa zuero grttv ity tntn~uone s. Aearosjpa us

Med. 361 315-318, 1965.

10. Kohl 1,.,, 1I~ndocritnolo-4y of space/niotion nicknesa. Cheapt 6, pp 65-86 int I Motionanti Space Sicktte)art, edited by 0,13. Craimpton', CRC Press, Broca Raeton, Florida, 45i pngelt,19910.

11. Otnan C. P. cmin Cootk 4,3. Ityrtarice or skirt italior in imotion a ickneen as setoantret]usi~ng on infrared reflecti~ve technique. Abstract. 540h Annual Aerospace MedlicalAssociation Meetiny, Houston, TIX# May 19U3, -as quoted in: ref 6,t above,

12. Money 5.11. Motioni Sickness. 1'hyelol. Rev, 50: 1-39, 1970,

13. Money K * 1. Notion Siokuses anti evo let rot. Ch'spt 1, pp1 1-7, in: Mat ion antlSpace Sickness, edi~ted by 0,11. Cratupton, CRC Preen, Boca- Hnion, Flocida, ti5l paqes,1990.

14, Money K.F.. and Cireo~ng Bn,4 Another function of the inner oar: foclI litation ofthe eimetic resporuse to poisions,. Aviat. Space litviron. Nund. 54: 208-211, 1983,

l5b. Money 5.E. and i'rieidbory 3. Tile role of the sarsiciruolar canals in citnurtion ofmotion sickness in: toe dlog. Cat:, J, Physiol. Pharteacol, 42: 793-801, 1964.

16. Mcoonough i.E. and Schineider H. The effect of motioo on tho roorttyenogrjrphicuppncrenne of the stonlach and small bowel. ilasiroentarnlogy 21 32-413, 1944.

17, Reason 3.7., antd Lirand T.3. Motion Sickness. Acedemtic 'ruse, Lonudont, New York,31.0 pages, 1975,

Is, Scout AC.1'P.M, Van dot Schee L.0., eýnd Casthuts ,2.L. What Is treasured inelectrogastrogrjrphy7 Digestive Diseases and Scienoer. 25: 179-1.67, 1980.

19. Stern R.M. , Koch K.L., Leibowitz [LW., Linbiad tM., Shupurt Cl.I, antd StewartW4.It. Tachyglastria end motion sickness. Aviat. Space Rirviron. Med. 56t 1074-1,077,1985,20. Stern R. M.. Koch K. U., Stewart 14.1., arnd Vassay M.W. Kleoctrngsstroqraphly:current issues io validlation and meth-odology. Psychapitysmol " ZIi: 55-64, 1987,

21. Sunahara F.A.,o Farewell J.1, Mints U. , and Johnsont W.1H. Pharusacolooicaiinterven:tton~s for motioni sickness: cardiovascular effects. Aviat. Space Enviroit.Med. 58 (9, Suppl): A270-A278, 1987.

22. Taylor P.B.0., [Hunter J., arid Johnson 14.1. Antidiuresis eas a meeseuremeent oflaboratory induced motion sickness. Can J. biochesr. Physial. 35t 1017-1027, 1957.

23. Telander R.L,, Morgan 5.0., Kreolin IlL., Schmalz l'.hn., Kelly K.A., andSzursewiki 3.11. Human gastric atony with tachygastris aird gastric retention.Gastroenterology 751 497-501, 1978.

24. Thornton, 14.1., Linder B.3., Moore 7.2., and Pool S.L. oassrointeetinal motilityin space sickness. Aviat. Spae Envira:. Med SB. (9, Seppli: A16-AMI, 1987.

25. Treisman M. Motion sicknress: an evolutionary hypothesis. Science 197t493-495, 29 July 1977.

26. Waif S. rhe relation of gastric function to nausea in man. J. Clin. Invest.22, 877-882, 1942.

MOTION SICKNESS AND ITS RELATION TO SOME FORMS OF SPATIALORIENTATION:

MECHANISMS AND THEORY

Fred L. Guedry

Naval Aerospace Medical Research LaboratoryNaval Air Station, Pensacola, FL 32508-57(X)

andUniversity of West Florida

1 100 University Parkway, Pensacola, FL 32514-5732

INTRODUCTION

The mechanisms of motion sickness fall under three component topics, which separatelyinvolve distinctive subject matters and together challenge the entire scope of neuroscience disciplines.The components are: I) The process involved in the sensorimotor and perceptual-nmotor adjustment tothe sustained experience of unusual motion. 2) The neurochemical link whereby the neurochemicalprocesses and byproducts of sensorimotor adjustment accumulate to a threshold level that whenexceeded elicits the sickness syndrome. 3) The sickness syndrome, which includes emesis and all ofthe autonomic and psychological accompaniments that degrade performiance.

Motion Sensorimotor Neurochemical SicknessStimulus Adjustment to Link SyndromeConflict

Figure I. Motion sickness involves three component topics.

The three components, though distinctive, are interactive. Etmlesis often gives relief so thatunusual motion can again he tolerated, at least for a while, but the malaise associated with the sicknesssyndrome may reduce willingness to remain in the motion envir-onm1ent long enough to achieveadaptation. A quick summary of where we stand today is that much remains to be understood undereach of these topics but fortunately for the newcomer to this field, excellent reviews and overviews arcavailable (Crampton 1990, Benson 1988b, Davis "tl., 1986, Graybicl 1969, Money 1970, Reasonand Brand 1975, Tyler and Bard 1949).

OVERVIEW

A verbal picture by Crampton (Carr and Fisher 197?) several years ago, presen:ted here asFigure 2., provides an overview of the mechanisms of motion sickness. An hcmunculus, whoreportedly lives in the cerebellum, has the job to receive messages from the motion sensors, thevestibhular nuclei and higher levels, and to operate a switchboard appropriately to initiate fast automaticsequences of motor reactions that will improve the quality of motion control. For voluntary motion,he receives advance information concerning the goal of the movement and he also is aware of the stateof the muscles, in advance. When messages from motion sensors are either in conflict with oneanother or occur in an unfamiliar pattern, the homunculus is confused and with confusion of sufficientlength or intensity, he will sweat or vomit and contaminate the cerebro-spinal estuary so much thatchemical sensors on the floor of the fourth ventricle signal the environmental protection agency tocommence disposal actions.

I'i it 1 2. A carti itI Iustiin thlemechanisms of notion sickness.Above the ho0tMuncUlults are the

L , ,,scisory motor inechantisisinvolved in motion sickness

Swhile below is the neurochemical link to the vomniting

.- uvt centel'Th punip represents tile'all or none' vomiting reflexwhich is part of the complexsickness syndrome, Recently, thelocus of Chemnoreceptor conceptarid the concept of a single

" ",' . vomiting center have beenvit A 1 iM a pop challenged.

~J-~O PrIPAG

SENSORY SYSTEMS INVOLVED MOTION SICKNESS

"The sensory-motor systems involved in motion sickness are those that detect motion relative tothle earth and, by their central neural processes, generate Inotor responses that serve to maintainbalance, to stabilize vision through oculonlotor control and in general serve to improve the quality oftbe control of motion relative to the earth. The vestibular system, the visual system, and theproprioceptor system (tile pressure sensing properties of the skin and the sensory processes of themuscles and joints) are the principal systems.

Of these, only the vestibular system is csQusively dedicuted to: 1) detecting mtrotion of thehead and body relative to the earth, and 2) generating reflexive motor activity that improves tuotioncontrol while motion is in progress. The vestibular system is more like a sensorimotor system thanti asimple sensory detector. Vision, audition, olfaction and touch often serve to locate and detect motionof objects relative to the body. The vestibular system does not detect objects in the environmnent butrather serves to provide 3-dimiensional earth-reference to visual and auditory inmages of objects, slopesand paths its the head changes orientation relative to the envirotment. Fromt this perspective, sensorymessages from muscles and oints and tactile information from weight-bearing surfaces are allied totile vestibular system in the business of controlling motion relative to tile earth lind in detecting thedirection of gravity in order to maintain balance and control mootion relative to the euarth,

A cornerstone fact in the present fund of knowledge oil motion sickness is that a functionalvestibular system is necessary for the occurrence of motion sickness. Elfforts to evoke motionsickness in man and animals deprived of vestibular function, have consistently failed (James 1882,Kennedy t l., 1968, Reason and Brand 1975, p,86, Sjobcrg 1929, Nang and Chinn 1956), Eveapartial destruction of different vestibular endorgans confiers a (hegree of inmmunity, ait least utntil centrtdcompensation for the partial peripheral loss has occurred (Igaralti, 1990). lBecause of its central rolein motion sickness, Utnderstanding of the vestibulhr system is necessary to tile appreciation of tilestimuli that initiate motion sickness.

TIlE VESTIBUIAR SYSTEM

It is beyond the scope of this chapter to provide a detailed description of the vestibulir systemwhich has been done many times before (Wilson and M. Jones, 1979), but an overview of someprincipal characteristics is necessary for discussion of the inechanisnis of motion sickness. Figure 3provides a summary overview of vestibular connections to the systems involved in motion sickness.

The vestibular sensory endorgans consist of two kinds, of sensors: time semicircular canals thatdetect angular acceleration of the head and the otolithie membranes that detect tilt relative to gravity.These two sets of acceleration detectors are located in fluid-filled tubes and sacs that are firmlyattached to and encased in a labyrinthine cavity in the petrous portion of the temporal bone of each ear.The receptors in either ear tire capable of detecting aind setting off reactions to all of the directions ofangular and linear motion that tire nonnally detected by hotil ears,

2-j

SEMICIRCULAR CANALS

The semicircular canals detect angular acceleation and are not affected by linear acceleration orby different orientations relative to gravity. The semicircular canals respond in exactly the same wayirrespective of whether they are at the certer of rotation or at some radial distance from the center ofrotation,

A simplified diagram of the structure of these receptors within one ear is shown in Figure 4."The planes of the semicircular canals lie approximately at right angles to one another. Each canal isfilled with a fluid, endolymph, which, by virtue of its inertia, is displaced slightly relative i tubewalls whenever the head experiences an angular acceleration in the plane of that canal. Displacementof the endolymph deflects the cupula, a structure which behaves like a damped drum because it sealsan expanded portion of each canal, the ampulla. The amount by which the cupula is deflected iscommunicated to the vestibular receiving areas of the brain by sensory hair cells lying at its basebecause hairs from these cells extend upward into the gelatinous cupula.

As well as conveying information about the rate at which the head is being turned, thesesignals also generate reflex eye-movements, whose pritnary function is to maintain stable retinalimages of the visual world, Though stimulated by angular acceleration, the dynamics of the cupula-endolymph system are such that the sensory signal from semicircular canal afferents is proportional toangular velocity of the head. The semicircular canals thus act as angular speedometers capable ofsensing angular velocity in any direction as the head is rotated, when the frequency of head angularvelocity azpproximates frequencies of natural voluntary movement,

OTOLITIl ORGANS

The otolithic membranes, in the utricle and the saccu!e, function like density-differenlce linearaccelerometers. The specific gravity of the calcite crystals in the utricular and saccular membranes ismuch greater than that of the surrounding gelatinous and fluid mediurm. When the head tilts to theright, the utrictilar metmbrane slides right due to the weight of the etnbedded crystals thereby bendingcilia of underlying hair cells. The pattern of cilia deflection signifies rightward tilt of the head. Adifferent pattem of haircell activation would signify different directions of head tilt,

A primary function of the otolithic system is to indicate the orientation (tilt) of the head (andbody) relative to gravity. Notice however that if the head and body were accelcr,,tcd linearly to theleft, the utricular otolith membrane would again slide toward the right ear, even through the headremains upright relative to gravity. The otolith system can respond in the same way for tilting of thehead or for a horizontal linear acceleration so that it does not always signify tilt of the head (and body)relative to gravity. Recordings from different otolith primary afferents show that some units respondmaximally for particular tilt directions and angles whereas others appear to be influenced by movementrather than 9.itin of the otolithic membrane (Fernandez and Goldberg, 1976).

When horizontal linear accelerations are sustairted (as can be done by maintaining fixed headposition relative to a constant centripetal acceleration vwctor on a cenrifuge) tilt is perceived as wouldbe expected by the "steady-state displacement of the otolithic membranes. But when the linearacceleration is brief and changing, then the person perceives linear movement, Movement-sensitiveotolithic afferents may provide information otn the linear velocity of movement during changing linearaccelerations if the frequency characteristics of the change yield continual movement rather than"steady state" displacements of the itolithic membrane. However, how would the vestibular systemimmediately discriminate horizontal linear oscillation of the head from rapid to and fro tilts of the h-,adwhen both would involve continual movement of the otolithic membrane? Here the absence ofsemicircular canal angular velocity signals coupled with the presence of otolith signals coulddiscriminate linear movement from dynamic tilt; dynamic tilting produces both semicircular canalsignals and otolith signals.

AA 3

ENIIII I All MIA1J11 IrS I-

I I N

.I 1 ,A 1.

*1:l,SAAI bA S~ V AlN , SAL IAVIrY

Figure 3. WIneTelat iOnlS of various neural structures associated with the vestibular system.Structures involved in reflexive and purposive behavior elicited by physiologicvestibular stimulation are indicated by heavy dark arrows. StrUCtures assoiated withvegetative effects elicited by unusual vestibuilar Stimla)LlltiOnl 1ar. bounded by the clashedlinle. Modified from Cor-reja and (Iiucdriy (1978),

CANAIJOTOLI'I'll INTER ACT IONS

F unctionally, the semnic ircular canals tell the brain about the rau of'rotationl of [lhe head relativeto thle earth when head movements approximate the temporal (frequency) characteristics of naturalhead motions. At much lower frequency of angular oscillation, thle canal sigivil can be considerablyp~hase displaced relative to the head velocity so that a turning motion may be perceived as stopped anldeven reversed in direction before thle head movement actually stops. The canals locate tile axis (orplane) of' turn relative to hJ hea but they do not provide information on hlow that plane of headrotation is oriented relative to the earth. For example, when the head I s turned from leftward gaze torightward gaze, the horizontal canals provide rate Of turn information throughout the turn and the braincan integrate the velocity information to know how far the head has turned (Blloomberg ". 199 1,Guedry 1974). The predominant horizot'tal canal signal indicates that the head turn is in thle yawplane of the head. If the gaze is change .by movement of the head and vyes from extreme upwardgaze to downward gaze toward the Feet, the vertical canals indicate thle rate of head turn througho~ut theturn and thle velocity infortration can be integrated by thle bratin so thtat the angular extent of the pitchplane movement is known (Guedry s=1~ , 197 1). But the plante of rotation relatiive to thle earth is notknown fromt the canal information; sensory information from the canals would be thle Salleirrespective of whether the person were Standing upright, lying on the side, or Supine or prone.

2-5

"-,4 1" 1

p..

-PA

'".' " --..

Figure 4. Orientation of the semicircular canals and otolith organs (utricle and saccule), Insetfigures illusCratc planes of the semicircular canals and also the x, y, and z head axes (efflixson, .iL,., 1966). Modified from Correia and Guedry (1978).

The otolith-bearing sensors provide information that locates the plane of the movement of thehead relative to the earth while the canals provide angular rate information ihroughout the movement.Whenever pitch (or roll) head movements are made while the person is standing or walking in normalupright posture, the otolithic system produces a sequence of angular position signals (relative togravity) that match the integrated velocity information from the canals. During pitch forward headmovement from upright posture, if at some point the otolithic sensors indicate pitch-forward headposition of 30 degrees relative to gravity, the integrated rate information from the canals indicates 30degree displacement from start position and gaze can be redirected back to start position if the personso chooses, even in the dark (Bloomberg 1991, Guedry eLg., 1971).

Effective vs. Aberrant Interactions

Assume now that, through biochemical intervention or an inflammatory process, the gain ofsemicircular afference is increased to twice the usual signal. At the end of a 30 degree head pitchforward from upright, the otolithic sensors would signal a 30 degree pitch forward position butintegrated semicircular canal information would indicate 60 degree angular displaciement from startposition. Gaze control would be problematic, to say the least. Moreover during the head movementthe = of head movement experienced would be much too great for the angular poition beingachieved. Interestingly, exactly this kind of canal/otolith neural mismatch is produced during a simplecentrifuge run (Guedry and Oman 1990) and subjects are confused, disturbed and dcplore centrifugetraining because of the repugnant experience (Guediy and Rupert 1991/a).

If this hyperactive canal condition were to continue during daily activities, the brain couldimpose a reduction in gain of vertical canal neural inflow at some level before the perceptual-motorreactions are generated, returning motion control toward a state of normalcy but the neurrl-mismatchwould induce motion sickness during the adaptive process and then again when the adapted individualreturns to his normal environment.

IA

Whereas all head movements made from upright posture involve a tight coupling betweenotolith information and vertical canal information, many yaw he'id movements made from uprightposture involve very little angular position change relative to gravity, However, the axis of head turnis also frequently inclined relative to gravity duing yaw head turns (evwn during upright posture) andso the CNS, which is adapted for tight canal/otolith coupling for the vertical canals, may be adaptedfor more varied interactions from the horizontal canals. This may explain diLfering sickness incidcnceobserved for vertical and horizontal canal stimulation on earth (Benson and Guoed'y 1971, Guedry rdAl., 1990) and during micro-gravity missions (Lackner and Graybiel 1984).

Assume now that two pitch head movements arc made through 90 degrees from uprightposture and that the two movements are identical in total angular diplaccment and in the angularvelocity profile during the movements. But one is made by bending at the nectk while the other ismade by bending from the hips. Semicircular canal information would be idontical but otolithinformation would be different. Initial and final pitch positions indicated by the otolithic receptorswould be the same but transitional information would be different, Tangential acceleration of the head(in one direction during starting and in opposite direction during stopping) reaches much highermagnitudes during the trunk movement. Tile head traverses a greater path. Backward displacementof the utricular otolith by tangential acceleration at the beginning of the trunk movement soon givesway to forward displacement as gravity components increase in the utricular shear plane. The morerapid movement of the utricular otolith membrane during trunk movement may reflexively influencethe differing muscle actions etquired in stopping the two movements, Such head movements initiatedvoluntarily are substantially influenced by feed-forward preprogranimed mechanisms but it the gain ofthe otolith velocity information were to be altered so as to be discrepant with the preprogrammedmessage, then the movement might be less well-controlled and accompanied by a report of dizzinessand confusion. ilead movements made in hyper-G environments yield both transient (Gilson i.L,..1973, Guedry and Rupert 199 1/b) and steady-state (Correia JuId., 1968) effects that are disorientingand the transient effects are confusing and nauseogenic, Ilead movements made in the Hyper-Genvironment that occurs during the reentry profile of space shuttle following adaptation to the Hypo-Gorbital environment-. these head movements are likely to produce transient disorienting effects,

Canal/otolith interactions range from those that are clearly functionally effective, to many thatmay constitute either conflict or functionally effective Interactions (advance in vestibular nuM•oscienceis needed to decide), to those, such as the cross-coupled angultar velocities, that are utnmistakablysensory mismatches.

Interestingly, the clear canal/otolith conflict from cross-coupled angular velocities can beresolved into benign concordant stimali by subtle changes in accompanying stimuli. The "Corioliscross-coupled" stimulus is produced by tilting the head during sustained whole-body rotation, 1l'lhsstimulus has played a major role in popularizing sensory conflict as a source of motion sickenss. Forexample, if the head is tilted forward during sustained clockwise whole-body rotation at 15 rpm, thesemicircular canals immediately signal a roll-right head velocity due to cross-coupled angularvclocities (Ouedry and Benson 1978, Guedry 1974, Oucedry 1970). At this instant otolith afferentssignal a pitch-forward head position chamge, a clear mismatch with the roll-right angular velocityinforjatlon from semicircular canals. The brain has been asked to set-off oculomnotor and otherpostural reflexes to compensate for motion in two different directions simultaneously. Perceivedorientation-change is paradoxical, confusing and unpleasait.

The subtlety of canal/otolith interactions is nicely illustrated by the fact that this extrem,ýdisorientation-stress reaction gives way to an accurate and benign motion perceptiotn if the headmovement is made di the angular acceleration of the rotator (or immediately after 15 rpm angularvelocity is attained). The accurate perception is explained by simple physics. During angularacceleration, the horizontal canals sense angular velocity in the yaw-axis head plane. Thus the brainhas an accurate yaw-axis angular message when the head pitch is initiated, When the head is pi(chedforward, cross-coupled angular velocities produce a roll-axis velocity signal to the vertical canalswhich combines with the already present yaw axis signal to yield a vector that remains perfectlyaligned with gravity (Guedry and Benson 1978) Thus the canal/otolith mismatch is avoided, theVOR is appropriate in piane to compensate for the plane of head motion relative to the earth and themotion perceived is essentially accurate, not confusing or disturbing, When the head-tilt is delayeduntil the yaw-axis canal signal has dissipated, then the highly disturbing catial/otolith conflict is fullyappreciated, The immediate after-effects of optokinetic stimulation can also be used to cancel theconflict (Guedry, 1978) because visual motion can simulate, in the vestibular nuclei, horizontal canal(yaw-axis) stimulation (Waespe and Henn 1977, 1978).

2-7

Interactions between the canals and otolith systems that have common (everyday) functionalvalue is a topic that has been relatively neglected by vestibular neuroscientists and it is critical to anymotion sickness theory that rests on the presumption that sensory conflict is important to theprovocation of motion sickness, Fortunately interest in this topic is developing (Benson 1974,Curthoys gLu•L 1991, Gresty tILt., 1991, Guedry 1991/c, Paige and Tomko 1989, Raphan andCohen 1986, Raphan §L.•,, 1979).

Whereas the semicircular canals react identically to angular acceleration, , irrespective of theirdistance, r, from the center of rotation, the otolithic receptors, which are not respQndve to angularacceleration, per se, are nevertheless stimulated during angular accelerations whenever the head isdisplaced from the center of rotation because rotation at a radius yields tangential linear acceleration.For example, with the head fixed in forward-facing tangential heading, but displaced radially fromrotation center, angular acceleration, yields tangential acceleration, r. With continued angulartrcceleration another vector, f 2r, that was negligible initially, increases rapidly as angular velocity, Q2,increiAses.

These two vectors are at right angles to one another and with the head positioned as shown inFigure 4, they would lie approximately in the utricular plane, During angular acceleration, theresultant of these two vectors is a vector that rotates in the utricular plane. Here we are not reallyignoring gravity, as it might seem, but we are attending to that component of the total linearacceleration (gravity, tangential and centripetal compi)nents) that acts in the mean "shear plane" of theutricular otolithlc menbrane,

This resultant vector rotates in the shear plane during the course of the angular acceleration in acounterclockwise direction, depicted in Figure 5, while the semicircular canals signal (in this example)counterclockwise rotation of the head, During deceleration of the head the resultant vector rotates inthe utricular shear-plane in the same direction as during the acceleration but now the semicircularcanals, Indicate rotation in opposite direction, Whether or not these different canal-otolith interactionshave functional utility In natural movement Is not kWown but perceptual effects on centrifuge runssuggests that such differences in eanal/otolith Interactions may serve to differentiate turning-at-a-radiusfrom turning about a body-axis (Guedry, 1991/c). This interpretation differs considerably fromassumning that one configuration represctts neural mismatch while the other represens functionallyeffective interaction.

-t-or - vt hbr

r.. .. I~vector, -- , \ . .

Figure 5. Centripetal and Tangential vectors form aresultant vector that rotates in the mean

S. ,utricular shear plane. Duringacceleration, this vector rotates in the

. /direction signaled by the semicircularcanals. During deceleration, it rotates

9" "L. .opposite the direction signalled by thes,'emlcircular canals,

SENSORY CONFLICT, NEURAL MISMATCII

A generally accepted hypothesis today is that conflicting messages fromn sensory detectors ofmotion prodece motion sickness, This idea, which is not new (Guedry 1970, Irwin 1881, Lansberg1960, McIntyre 1944, Oman 1990, Reason 1978), has gained favor over the notion that vestibular

overstimulation is responsible for motion sickness because very mild vestibular stimuli producesickness when sensory conflict is present whereas some strong vestibular stimuli can be repeatedlytolerated without sickness, A partial melding of these ideas may be called for, viz., very strongvestibular stimuli, in the absence of apparent sources of exteroceptor conflict, may produce sicknesswhen their continued presence threatens the subconscious but pervasive imperative to control whole-body motion relative to the earth. Nevertheless, sensory conflict is a significant factor in stimuli thatinduce sickness.

Some examples from experiences of everyday life will serve to clarify the nature of sensoryconflict and Its relation to control of motion. While in the well of a small cabin cruiser that is mooredto a dock in a boat shed, a person proceeds without pause to inspect instruments within the boat and tocheck the engine, Vestibular sensations from a gentle rocking of the boat are concordant withperipheral visual motion cues from surrounding dock and the visual/vestibuhur interaction aids balancecontrol, even though the vestibular and the peripheral visual messages fail to reach consciousawareness. Suddenly to maintain balance and to allay a little alarm signal, the person grasps forsupport and shifts gaze to find the source of alarm. A fairly large boat has entered the adjoining slipand produced a large moving peripheral vision message, discordant with concurrent vestibularinformation, Balance control is threatened until the person's spatial model and motor control strategyare adjusted, A similar experience occurs when a person places the palm of the hand against at wall inorder to relax by leaning against the wall, which happens to be a sliding panel, not an earth-fixed wall,Again it little alamn, a diverted gaze to understand and a postural adjustment serve to restore effectivecontrol of motion and orientation relative to the earth, Both situations involve sensory mismatches inthe context of an operating spatial model and motion control objectives; they challenge built-in demandto maintain control of motion and orientation relative to the earth, In these examples, the sensoryfeedback associated with motion control would have remained below conscious awareness had theconflict not occurred and in both examples the conflict was resolved on a conscious level, In manymotions that induce sickness, conflicts may be sensed only as slightly confused perceptions and thealarm reactions may remain subconclous. Even for alarm reactions that penetrate conscious awarenessdue to severe sensory conflict, the reason for the alarm reaction cannot be understood by quickInspection unless the observer is very well Infortmed on the role of sensory conflict in motionsickness. This is the nature of sensory conflict In motion sickness.

CONFLICT VS. MISMATCH

The phrase sensory conflict carries implications that do not clearly tit a number of stimulusconditions that provoke motion sickness, While conflict is an appropriate term for "Coriolis cross-coupled" stimulation, a number of nauseogenic motions involve stimuli in which one sensory inputpersistently calls for a reaction while information from another senisor is "abnormally" absent. Such isthe case for sustained off-vertical rotation in which a continual reorientation relative to gravity of theotolithic sensors i.s unaccomnpanied by semicircular canal inlormation (Benson 1988/b, Benson 1974,Guedry 1965/a), information normally present when the head is voluntarily turned about Lhe head's z-axis while the axis of head turn is off-vertical. A brief natural head turn about a tilted axis generatescoordinated canal and otolith information whereas during sustained rotation the coordinated canalinformation disappears. Head movements made durin g earth-orbit missions generate normalsemicircular without the usually coupled change-in-orlentation ilnornntion froin the otolithic sensors(and here it would be nice to have much better basic information than is available on the dynamics ofthe mechanical response of the otolithic sensors to linear accelerations In "microgravity"), Headmovements (pitch or roll) involving the vertical canals (that on earth are typically accompanied byotolith information) are more provocative in microgravity than yaw movements (Lackner and Graybiel1984), More than 66% of astronauts are afflicted with space motion sickness for several days untiladaptation occurs (Reschke, 1990). Here we have sensory messages not clearly in conflict with oneanother but rather sensory messages in combinations that can't be immediately interpreted by the brainnetworks that generate sequences of motor reflexes that ordinarily improve the quality of motioncontrol, From this perspective we prefer the term neural mismatch to sensory conflict incharacterizing stimuli that lead to motion sickness.

EMPIRICAL PROCEDURE FOR NEURAL MISMATCH ASSESSMENT

The vestibular-system always operates as a silent partner to improve the efficiency of goal-directed voluntary body movements relative to the earth, Normally vestibular sensations do notachieve conscious awareness. For example, as the gaze is changed by head and body movement tosee the source of a sound, the person is aware of the sound and then of the visual object and may beaware of pain from an arthritic joint but is unaware of the vestibular message. This property of thevestibular system can be used as a clue to the presence of neural mismatch. Vestibular sensationsachieve conscious awareness in voluntary ambulatory movement only when they are 'disorderly' inrelation to concomitant information from other senses that participate in the control of head and bodymovement relative to the earth. The dizziness that accompanies vestibular disorders is poorlydescribed because the afflicted person is confused and disturbed by mixed signals from the varioussenses involved in the control of motion, Immediate confusion and disturbance from motion stimuliare therefore useful signs that neural mismatch is present either due to dysfunction within the motionsensing processes or due to unusual motion, beyond the range encountered in daily activities,

Awareness of motion and inaccuracy of motion perceptions cannot be used as indicators of thepresence of sickness-provoking stimuli, because vestibular sensations usually achieve consciousawareness during passive motion. Accuracy of motion perceptions cannot serve as an indicatorbecause perceptions may be wrong but not at all confusing, An example is the post rotationalsensation of spinning following a gentle stop from low speed whole-body rotation In darkness. Thespin perceived is inaccurate but not confusing, disturbing or nauseogenic because the misleadingmessage from the semicircular canals encounters minimal conflicting information from other motionsensors and passive body movement minimizes demand from compensatory postural reactions, Thisexample may seem ill-chosen in the light of the sickness provoked by the 'sudden-stop test" (Graybieland Lackner, 1980), The conditions for the sudden-stop test involve an angular impulse thatgenerates a spin sensation of sustained magnitude far beyond any commonly encountered togetherwith an angular impulse to the muscles and joints that would awaken spino-vestibular interplay(Wilson and M, Jones, 1979) despite body restraint in the rotation device, The sudden-stop testprovokes sensations that are immediately confusing and disturbing,

Until vestibular neuroscience advances to a complete understanding of what is sensory conflictand what is functional sensory interaction, the best available empirical clue to neural mismatch is dtepresence of confusion and slight repugnatnce (disturbance) in the overall immediate perception.

CONCEPTUAL GUIDES FOR IDENTIFYING PROVOCATIVE STIMULI

Benson (1988/b) has provided a conceptual classification of provocative motion stimuli, basedon the neural-misn:,t .h theory of motion sickness. We propose another category of neural mismatchin the last colunin of Table I, il'crrud frioni the very different iractions to active and passive motion.The perceptual responses, oculomotor reflexes, trunk and limb reflexes during and after sustwi,,edactive turning differ markedly from theirc(,interparts 'uring and after passive turning.

A confused and rever;ed perception follows active ambulatory turning that is attributable tofeed-forward messages initiated by volitonal motor commands and concomittant vestibular afferentmessages (Guedry CtIl,, 1978), Prostrotation trunk and limb torsional activity, present followingactive ambulatory turning (Correia zLi., 1977), is less apparent when the subject is seated and thearms provide the torsional driving force (Guedry and Benson 1983), It is not apparent at all followingpassive turning, seated or standing, Thus the orientation perception and perceptual-motor reactionsdiffer from their counterparts following passive turning which is dominated by the semicircularcanals, Perceptual reactions during goal-directed voluntary whole-body motion differ from perceptualreactions followirg kinematically identical passive motion.

VI

TlABILE 1: Identificaation of Motion Cue Misluatcli Englendering Motion Sickness

T'ype Visual(A)/ Ca~nal(A)I Vcstiolaulr(A)/Vestibulal(llJ Otoiitii(B) l'mpriocciptor(li)Misrunach Misinatch Misimatch

(A) and (LB) (i) Reading hand- (i) Crows-cuuplcd (I) Phas fe drenceslmuluallcoasly hold niap or text (Coriol Is) during low frequencycontradictory In tuarbulent stlinuhstion vertical linearinforination f'light Ficad Inlovenmlent oscillationi

during rotationabout anotheraxis,

(Hi) Inspection (11) I-lead inovonent (ii) Aftereffect ofthrough bimuxculflrs in abnormial sustainedol'ground or aerial force environmnict ainhulutory turntargets front moving which mnay be stableaircraft (for example, hyper-

or hypo-gravity) orIluclauting (duringlinear oscillation)

Typo 2(i)(A).signals (i) Simulator (I) 'Space (1) Su~dden Stopwithout sickness'. sickness., 'testexpected (1) Pi'loting of IIcald 11ovemuintsignal fixed base hiwoightless

shltulator with environmentmnoving externalvi.SUii display(VP7A)

(I i) lPrc.481r (11) Turning p~int izone(tultenmolaric) during low frequencyvertigo high peO velocity

anrgulamr osci llatioun

Type 2(ii) (i) Looking inside (i) Low-frequencey (i) Null Class(B3) signals aircraft when (<1.5 HIZ) linealrwithout expezted exposedA to m1otion oscillation(A) signal

(i I) Rotation abo~utmIo-vertical axis

Adapted fromi Beinson (1988h,)

Here we propose that vestibular.-induced itiotor response of' thle trunk Lind limbs come intoopposition with motor responses engendered by preprogrammted feed forward messages duringvoltuntary movement and by forces imposed directly on the muscles aind joints by the motion itself.

This class of neural mismatch Is difficult to study relative to the ease with which controlledchanges in visiial-vestibular interactions can be imposed; its imploriance remadins to he detenninvd, Allof the examples in this column of Table I mnay be Type I r Type 2. and Type 2(11) may be a null classfor this form of neural mismatch. The sickness prodced In the "Sudden-stop" test and the immediatedisturbance that accompanies this ye~ strong semicircular canal stimulus may be partially attributableto postural discord with vestibular ad u stme nt demands from this exceptional stimulus. D..~vulow frequency high peak velocity sinusoidal angular acceleration, sonme sub 'jects report a paradoxicaland disturbing sensation near the zero velocity cross-over of the stimnulus--where the semicircularcanal turning signal approaches and vrosses zero signal. During this interval the Weber latio(Stevens, 1951) for comparison of car .! and proprioceptor signals may be optimal--canal signalsa pp roach zero while proprioceptor sigr~is frorn toesional effects on the body approach maximum,although they are niever strong in the seated subject. Similarly during low frequency vertical linear

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oscillation, the perceived reversal point is phase advanced relative to the true point of reversal so thatsubjects perceive hitting bottom before maximum force on the subject's 'bottom' occurs.

STOTT'S RULLS

In an effort to provide simplifying principles that subsume the many particulars of motionstimuli that provoke sickness, Stott (1986) suggests some rules that the brain uses in evaluation ofmatch/mismatch, based on the fact that the overall visual scene is usually stable and gravity doesn'tchange in direction or intensity (at least in the perceptual world of inan),

Visual-Vestibular rule: Angular or linear head motion in one directionmust result in corresponding angular or linear motion of the overallvisual surround to the same extent in opposite direction, Here adequatephase or planer matches must occur or else visual-vestibular sicknessprovoking mismatches are present.

Canal-otolith rule: Rotation of the head, other than in the Earth-horizontal plane, must be accompanied by appropriate angular changein the direction of the linear accelcration due to gravity.

Utricle-saccule rule: Any sustained linear acceleration is due to gravity,has an intensity of 1 g (9.81 /sn2) and defines "downwards."

This latter rule does not overlook the fact that linear acceleration of the head in the earth-horizontal plane yields a resultant force vector that is tilted relative to gravity but rather assumes thatthe sum total of body linear accelerations including gravity, over any short period of natural voluntarylocomotor activity, average to the direction of gravity and 1.0 g magnitude, One obvious deviationfrom this rule is running or walking in a circular path where the average centripetal acceleration yieldsa tilted average linear vector. However when this occurs the vestibutar system assists in aligning the'average" vertical axis of the body with the average direction of resultant force vector, while thevertical dimensions of trees and buildings in visual space serve through visual/vestibular interaction tolevel the head, maintain clear vision and preserve the constancy of visual space,

Frequency-Effects and Stott's Utrcle.Saccule Rule

The utricle-saccule rule, used to explain sickness induced by vertical linear acceleration,appeals to the fact that frequencies of linear oscillation that induce sickness are considerably belowthose normally encountered in locomotion activity so that for example the mean 1 g intensity rulewould be violated on the high side for almost 2 s and then on the low side for almost 2 s in each cycleof a 0.25 Hz vertical linear oscillation, This interesting explanation relates to one of the moreperplexing facts of motion sickness that must be dealt with by any comprehensive model of motionsickness, Motion sickness is dependent upon the frequency of motion stimuli, for some and perhapsall forms of sickness producing motion stimuli,

Data available suggest that 0,2 Hz is maximally provocative (Guignard and McCauley 1990,O'Hanlon and McCauley 1974) and that higher and lower frequencies are less provocative, at givenpeak vertical acceleration levels. The fact that frequencies above 0.5 Hz are less provocative fitsneatly with the fact that the utricle and saccule are routinely stimulated at frequencies above 1,0 Hzduring walking and running. However, if frequencies of vertical linear acceleration significantlylower than 0.2 Hz are in fact less provocative, then Stott's interesting I g explanation Joesn't hold.Unfortunately, data on low frequencies of vertical oscillation is weak because low frequencies requirevery geaat linear displacement to reach the peak acceleration magnitudes evaluated at 0.2 Hz,Magnitude as well as frequency is Important (Lawther and Griffin, 1986), Amplitudes required atvery low frequencies exceed amplitudes that can be attained with existing motion devices,

Data from other forms of cyclic stimulation help but do not clear-up this issue. Cyclic stimulithat violate Stott's visual-vestibular interaction rule dramatically produce sickness at frequencies of .02Hz, far below 0.2 Ii,- but do not produce sickness at a frequency of 2 Hz (Guedry ltal., 1982),

I;

Whether or not cyclic vestibular interference with vision at 0.2 Hz would provoke more sickness isnot known, but here, matching stimulus magnitudes is conceptually difficult. High peak angularvelocities (120 0/s) are required to produce visual blurring for head-fixed targets at 0.i2 Hz whereaslow peak velocity (20*/s) piroduces equivalent visual blurring at 2.5 Hz. With .02 Hz the peakacceleration was only 7.5 0/s2 whereas with 2.5 Hz the peak acceleration was 3141/s 2 . Theinvestigators chose to match frequencies and peak velocities that induced equivalent degradation ofvisual performance.

Indications that flight simulators particularly conducive to simulator sickness have "highenergy" of display motion centering around0.2 Hz are interesting observations that require more datafor analysis than is available from simulator studies, The Guedry, Benson, Moore (1982)experiments illustrate the need for analysis. The 0.02 Hz visual-vestibular interaction that inducedsickness required the subjects to visually sup press vestibular nystagmus to obtain visual informationfrom the head-fixed visual display. The cyclic waxing or waning of the VOR in each stimulus cycle isassociated with ia waning andwaxing of difficulty in visual suppression, ranging from a maximumneffort to suppress VOR of about -70'/s in one direction to minimum effort to suppress a VOR of 0'/sand then to maximum effort to suppress a VOR of ~700/s In the opposite direction, If cyclic variationin suppresion effort is the significant element, then the relevant stimulus frequency was 0,04 Hz,since suppression effort peaked twice in each cycle, whereas if direction of VOR suppression isrelevant then 0,02 Hz was the relevant stimulus frequency.

I lowever if the visual display used is simple, a set of 3 single digits changing ach second, thenver?, little sickness occurs, whereas If the display is more complex, such as a matrix of numbers fromwhich numbers must be retrieved when coordinates are given (Gilson .i1.,, 1977, Guedry andAmbler 1973, Moore eLta,, 1977), then sickness incidence is high, Perhaps cyclic variation investibular interference with a pattern of voluntary gaze-control is the provocative attribute of thismotion stimulus. When cyclic VOR is visually suppressed for even a short time, a VOR gainreduction (not attributable to arousal reduction) occurs. Recent neurophysiologi:al data indicatecerebellar involvement in visual suppression of vestihular nystagnmus and ce'ebellar 'circuitry' in theadaptive modification of the VOR, Moreover these same cerebellar components appear to be critical toprovocation of motion sickness (Brizzee 1990, Crampton 1990/h, Wang and Chinn 1956).

Sustained off-vertical rotation is it form of sustained cyclic otolith stimulation that inducessickness and here the peak magnitude can be held constant. During whole body rotation about arotation axis that is tilted relative to gravity, the otolithic membranes should be displaced in somethingapproaching an orbital path about some central point in the sensory macula. The compoinent of gravitydirected in the mean shear plane of the otolilhie membrane is the effective stimulus. Irrespective ofrotation speed, the direction of this component is continuously changing. Rotation speed determinesthe frequency of this cyclic stimulus, 12 rpm being a 0,20 Hz stimulus. With this stimulus form itappears that about 0.25 Hz is maximally provocative whereas 0.10 Hlz is not, and higher frequencies,e.g,, .37 liz, and above, tire less provocative (Koki,, etLa., 1991, Miller and Graybiel 1973), TheOVR data fall approximately in line with the vertical oscillation datit.

Visual motion stimulation without whole-body movement may be useful in clearing up thisperplexing question as to whether there is a manximally provocative frequency, irrespective of tle typeof motion stimulus, Perhaps cyclic otolith ýtlmulatlon, its opposed to cyclic canal stimulation, ismaximally provocative at 0,2 Hz, It is possible with visual stimuli to simulate whole-body motionsthat would stimulate the otolith system exclusively, or the semicircular canals exclusively or the canalsand otoliths simultaneously. Simulated vertical linear oscillation at frequencies less than 0,2 Hz couldbe generated without the excursion limits that are imposed by devices that actually move the body.Some interesting information may be generated that would relate to whether or not there is in fact acommon maximally provocative frequency across different forms of motion.

To explain frequency effects, one looks for something that might be tuned so as to havemaximum gain at the most provocative frequency. The literature on frequency effects doesn't providegood rationale for deciding where to look. Referring to Figure 1, do we look in Stage 1, 2, or 3?

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PERCPETUAL-MOTOR ADAPTATION TO UNUSUAL MOTION ENVIRONMENTS

Knowledge has been developed in recent years on mechanisms of adaptation to motionconditions that involve cons mismatch among the orientation sensors (Berthoz and M. Jones,1985). Human and animal subjects wearing optical devices that reverse, displace, or change thevelocity of visual motion feedback during head and body movements (actively or passively generated)have been extensiveley Investigated. These studies consistently show adaptive changes in theve3tibulo-ocular reflex that serve to optimize stablization of retinal images during head motion, Forexample, VOR adjustment to optical right-left reversal requires a stimulus-response phase shift ofalmost 180 degrees. A phase-shift approaching 180 degrees developed in about 3 days in humansubjects who wore reversing prisms continuously, even when tests of phase relations were made inthe dark during passive niotion (Melvill Jones,1985). Before phase shift wits manifest, gain reductionwas prominent.

Subjects living in an enclosed rotating room (Graybiel ;LtA., 1960) show VOR gain reductionfairly early (Guedry, 1964). The confusing motion perceptions that accompany each head movementin a rotating room also diminish. After several hours of rotation exposure the gain of the VORinduced by head-tilt movements during room rotation is greatly reduced (Guedry CtaI,, 1964; GuedryWLal., 1962). And for several hours after rotation stopped, head movements produced confusedpeiception, e.g., a roll-right head movement produced pitch-forward motion perception and posturalinstability. After this short exposure, change in the plane of the VOR was not apparent In clectro-oculographic tracings. After three days (or longer) in the rotating room, for several hours after theroom was stopped, a roll-right head movement produced a few beats ut VOR nystagmus appropriatein direction for pitch forward perception of head and body movement (Guedry and Oraybiel,1962,Guedry 1965), The effect that wits perceptually evident after short exposure (2 hours), becameevident in the VOR after longer exposure. A 90 degree change In plane of the VOR in response tovoluntary headmovement can be seen for several hours after leaving the rotation room, when theexposure is of sufficient duration. The sequence of adaptive VOR changes in the optical reversalstudies and the rotating room studies Is tlrst gain reduction and second "recoding" that shifts the phaseor the plane of the VOR appropriately for the exceptional environment, The fact that only VOR gainreduction was reported d" rotation in the rotating room studies is due to thL fact that in theenclosed rotating room, the only VOR component that needed to be suppressed during x-axis roll wasthe y-axis component; the x-axis component was still needed during head roll movements in therotating room. in other words, visual requirements for change did not demand a VOR change in the

lane of the head-movement; rather visual requirements for change demanded suppression of the VURa plane 90 degree displaced from the head movement plane. Also in the adjustment sequence

revealed by the post-rotation results, the perceptual plane was changed substantially before the VORplane change was evident, at least with the measurement available at that time. The spatial orientationperceptual model may change before the control strategy initiates recoding of the VOR.

Along with adaptive changes in the reactions (VOR and perceptual) induced by headmovements in these motion environments, changes in motion sickness symptoms also occur. Early inmotion exposure, symptoms begin to appear and then increase (at different rates In different subjects)and with continuing exposure, symptoms diminish (again at different rates in different subjects),Thus it is reasonable to believe that initiating perceptual-motor adjustment induces motion sicknessand that achievement of perceptual-motor adjustment serves to prevent motion sickness in the novelmotion environment.

While changes in the sensorimotor, perceptual and sickness reactions parallel one another,they probably do not follow exactly the same course. Metrics to characterize each of these reactionslead to comparative uncertainty. Consider that VOR gain change did not proceed at the same rate as'recoding changes' in the rotating room studies or in the optical left-right re•,ersal studies and recoveryrates occur in reverse order;, recoding recovers faster than gain,

Individual reactions during the course of adaptation reveal individual differences in adaptivestrategy. In a rotating room, one subject in the course of a series of prescribed head movements maystop, vomit and then continue on with head movements as though nothing exceptional had happened.Recovery is rapid. Just before emesis, the VOR often becomes disorganized and "unscorable' but itmay return after emesis, Another subject, who may "tolerate" the head movement sequence muchlonger before emesis, finally vomits but is unable to continue for a long time. Recover is slow.Some subjects try to resist emesis more than others, some recover faster than others and these are a V,

J• '. .

few of many differences between people that complicate efforts to miodel the mechanisms of motionsickness.

NEUROPHYSIOLOGICAL MECHANISMS OF PERCPETUAL MOTORADJUSTMENT

Most research aimed at evaluating the neurophysiological mechanisms of adaptive adjusutentto unusual motion has focused on motion conditions that yield 'neural mismatch" but y=1=aijsteneuaLrniiiiaish. Optical distortion of visual feedback always yields the same visual-vestibularmismatch for particular head movements, Pitch or roll head movements from upright posture In arotating room always yield the same canal/otolith mismatch irrespective of heading in the room(Guedry, 1965/b). Many recent studies have been described in Berthoz and Melvill Jones (1985) anda convenient succinct summary is provided by Stott (19W0),

The Marr-Albus model of cerebellar function suggests that thecerebellum learns to perform motor skills both for voluntarymovements and for reflex maintenance of posture and balance.Essential to this learning capacity tire the climbing fiber inputs from theinferior olive, The model proposes that the synaptic connections of'parallel fibers to Purkinje cells tire mnodifiable in their transmissionefficiency and that this modification Is brought about by conWjunctiveactivation of a parallel fiber and a climbing fiber converging on thesame Purkinje cell. This mechanism has received experimentalconfirmlation in a series of experiments by Ito (reviewed in Ito) whichsubstantiate the concept that the clinibiný fiber inputs constitute theinstruction signals that reorganize the relationship between mossy fiberinputs and Purkinje cell output,

Purkinje cell axons project to oculomotor control areas within thevestibular nuclei, Whether the plasticiy within the cerebellum providcsthe sole basis for gain modulation of the vestibula-ocular reflex is notcertain, Miles and Lisberger, from studies in the monkey, argue for thegain modifiable elements to be located in the brain stem,

The ability in experimental studies to control visual and vestibularmotion stimuli and to make precise measurements of eye movementresponses are important factors that have made the study of vestibulo-ocular mechanisms such a profitable area of research. 'T'he multiplicityand variability of the physiological correlates of motion sickness renderthe underlying neural mechanisms of this response more difficult toelucidate, Nonetheless, it seems likely that neurophysiologicalmechanisms similar to those involved in vestibulo-ocular gain plasticityare involved in adaption to nauseo-genic stimuli, The furtherelucidation of the mechanisms that enable recognition of spatial sensorypatterns and bring about adaptive changes within this system may inturn yield principles that underlie the higher mental capacities oflearning and memory,

As stated by Berthoz and Melville Jones, ".,,the adaptive phenomenonrather than being a mere curiosity of brain function ... constitutes afundamental property of the nervous systein, responaible for activematching both between related sub-systems within the CNS andbetween them and their daily encounter with the external physicalworld."

A CONCEPTUAL MODEL

Characteristics of VOR alteration may provide clues to vestibular sensorimotor changesrelevant to motion-sickness modelling, VOR gain reduction occurs naturally in darkness during any

passive sustained oscillation or repeated stcp function or any other repeated velocity waveform(Collins 1963/1964, Collins and Guedry 1962). VOR gain can be immediately reinstated by any of avariety of alerting tasks and can be manipulated, up or down, by imagined visual reference (Baloh1984, Barr rt e1., 1976, Melvill Jones MtW., 1984, Jell QLu., 1988), but without manipulation, VORdiminishes. This everpresent tendency toward VOR gain reduction during passive stimulation maysignify an early and ever-ready level of adaptive change that provides some defense against motionsickness in more variable (and perhaps less stressful) motion conditions than are encountered inrotating rooms or while wearing right-left reversing spectacles, variable conditions in which adaptiverearrangement of sensorimotor response would not be functionally appropriate.

ASSUMPTIONS

From this gail reduction propensity and the early gain reduction in the vision reversal androtating room studies, we propose that gain reduction Is an early adaptive change to sustained unusualmotion that may be significant in highly variable motioun environments, Following are additionalassumptions underlying our conceptual model:

From the presence of optokinetlc nystagmus, optokinetic after-nys~tagmus, arthrokineticnystagmus (Brandt "l., 1977) and evidence for arthrokinetic after-rnystagmul, (Guedry and Benson1983), we propose that the standard operating gain of the VOR is less than 1.0 during voluntary activemotion which is the raison d'etre for the VOR. Voluntary initiation of motion increases VOR gainbriefly, Then an optokinetic component, at lesser arthrokinetic component and possibly a weakaudiokinetic component contribute to a gain of 1.0 for the overall response in sustained voluntarymotion. This theoretical perspective concerning the brain's standard (desired) VOR gain may beimportant (if true) in motion sickness. In short, the vestibular preferred operating gain is less than 1.0and how much gain is contributed by the other sources of gain augmentation may depend uponpreprogrammed feed-forward tnessages related to movement objectives. From this perspective OKN,AKN, OKAN and AKAN are manifestations of processes whose presence is meant to achieve gain inthe kinds of motions involved in natural voluntary movement. Responses generated by sustained off-vertical rotation or sustained active body turning by the limbs are manifestations of auxiliarycontributions to VOR gain in natural movement. The walk-in-place nystagmus of Bles, dtnl. (1984,1979), may play a role in gaze stabilization during sustained ambulatory tunis in circular paths.

From the absence of awareness of vestibular sensation in natural voluntary movement, weinfer that optimal adjustment to novel motion environments provides control of motion in which thereis minimal awareness of vestibular sensations,

Bused on the belief that control of whole-body motion has been critical to survival of speciesand the fact that unexpected motions generate alarm reactions very early in life (Smith and Smith1962, Gud-ry and Correia 1978) we assume that a demand (or drive) to maintain control of whole-body motion is present in passive as well as active motion conditions.

Finally we assume that during initial exposure to a novel motion environment, a spatial modelof the motion environment forms. To permit optimal overall commerce with the environment, controlof motion must proceed toward automaticity wherein the task of motion control is not a distraction.During either voluntary movement in a novel environment or passive exposure to novel motion,motion control objectives and strategies are part of the adaptive process. These are fundamentalassumptions underlying the conceptual model illustrated in Figure 6.

In motion environments, it is important to distinguish between 1) voluntary motion relative toa motion platform that is moving (or perceived to be moving [visual vectionl) relative to the earth, 2)motion relative to the earth by voluntary control of a motion platform that is moving or perceived to bemoving (simulation) relative to the earth, and 3) completely passive whole-body motion with the headand body fixed to a moving motion platform. The different situations involve different relationsbetween intention to move and motion experienced. However, herein we assume the presence of aconstant internal demand to maintain effective control of orientation-change relative to the earth,irrespective of motion conditions. Thus, a detected mismatch in any motion environment begetsarousal and (.orrective actions.

The first stage in the model comprises the motion stimulus which elicits immediate perceptuul-

mlotor reactionis which are compared with pie progr'laltl'ed sets of perceptual-nmitor parad i gis that ilturn depend upon the spatial model, motion control objectives, and previous experience. Even duringcompletely passive motion stimulation postural and motion control objectives are in operation due tothe imperative to maintain control of control of bxoly posture and motion relative to the earth. Figure 6presents this conceptual model.

/ 1111 ..... ' 71 ll7 .. .. 7 1 1 y,, ... ..01

Moin I Pn t.puo j Or *llll - Mlt t . .. iht.l~h

A r u u n a . L i n . . . . . ... ... ... ..

"rrilicnu l lt ' I~ ceplr, I .-. M ...... . l--i . MmIrlltl .d . lig ni !.. ..

Figure 6, Conceptual Model of the mriechanismns of adaptation to Untusual Motion and of therelationship of adaption to the onset of sickness.

When match is detected, the preprogrammed perceptual -motor (PM) paradigmis are, reinforced,the store remains the same, and the selection rate of appropriate sets of Perceptual-motor paradigms isimproved. The spatial model and control objectives detemiine which paradigm sets are itt immediateaccess for comparison. When mismatch is detected, arou.al mechanisms operate through the spatialmodel and control strategy, calling for response change first through gain-control and then it'necessary through gain-control coupled with sensory-motor recoding. Mismatch begins to alter thespatial model so that new sets of perceptual-motor SeLtiLenceS can he stored for comparison withsuhsequent reactions. But mismat h engenders arousal and continued arousal commences the build-up of the neurochemical link to the sickness syndrome, As the matches improve, the model andneural store develop prnmitting more raphi selection of preprogrammed perceptual-motor engrams thatenable the automaticity required for efficient control of motion without arousal, As long as mismatchinduces arousal, the neurochemical build-up for sickness-onset colntinIIes; big arousal con trilbtlthlig tofaster sickness onset,

Adaplation Through Gain Control

The literature on adaptation to cnsisen mismatches induced optically or itn rotating roomsprovides examples of motion conditions int which recoding of sensory motor responses serves torepair highly consistent mismatch. Most of the effort to clucidate underlying physiologicalmechanisms is centered on optically induced neural mismatches. Our cntphasis on gain change waspartially due to our perception that different mechanisms may be involve(] in adaptation to novelmotions that are [lot completely consistent in the neural mismatches they generate. Now we mustprovide some examples of situations in which gain control would appear (intuitively) appropritile forthe job.

Ship motions are fairly variable despite the natural frequencies of the roll and pitch of the shipand they certainly induce seasickness, Individuals moving about on ships increase the complexitiesand variability of die motions they experience. When on deck there is some motion-control advtntagefor stabilizing the eyes relative to the earth, considering the horizon, distant ships and even slowmoving clouds. As indicated earlier, the vestibular system stabilizes the eyes relative to the earthautomatically with some optokinetic and arthrokinetic assistance, in a normal environment. On deck,high VOR gain is needed but arthrokinetic gain for oculomnotor control may need some reductionbecause the leg, ann and trunk motions are appropriate fqr the ship's deck but not for the horizontalplane of the earth. Even the ambient visual information is playing tricks because some very largevisual fields (the deck and superstructures of the ship) are moving and tilting relttive to the earth'shorizon but are the relevant visual frames of refi-rence for control of motion of the body. Laboratoryvisual/ vestibular interaction studies suggest that earth-reference motion cues in ambient vision will

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improve focal vision for shipboard objects when in accord with vestibular information; discord yieldsdegradation of focal vision (Guedry Mui1., 1979). When the individual enters the ship'scompartments, it would be nice for VOR gain to go down while optokinetic gain goes 1p; VOR effortto stabilize visiou relative to the earth is not helpful inside a ship's compartment. Adjustment of thevarious contributors to oculomotor gain appears (intuitively) advantageous for at least part of theadaptation to some forms of complex motions. Similarly, vestibulomotor adjustment considering thelimbs, neck and torso must require gain adjustment as well as directional adjustment. That gaincontrol can be highly adaptive is nicely illustrated by a recent study in which, through adaptiveconditioning, gain was increased or decreased, depending upon whether subjects gazed upward ordownward (Shelhamer etal., 1991).

Expressed in terms of the conceptual model, adaptation to ship motion would involvedevelopment of a spatial model that when coupled with the immediate control objectives and strategywould permit quick selection of perceptual-motor paradigms including relative gains for VOR, OKNand AKN for the interior of the ship. Vestibular sensing of pitch and roll of the ship would benecessary for automaticity of limb and trunk control--some recoding of directional function wouldaccompany dynamic changes in gain control.

DEVELOPMENTAL STRUCTURING OF ADAPTIVE CAPACITY

According to the model, past experience with interaction among motion sensors during whole-body motion plays a role in the state of adaptation to those interactions and hence influences whetheror not particular interactions engender sickness, With this in mind, it is appropriate to consider therange of experience that occurs in everyday life with varied interactions between a) the semicircularcanals and the otolithic sensors, b) visual and vestibular sensors and c) the vestibular andproprioceptor sensors. We include vestibular sensors in each of the interactions because of the centralrole in motion sickness of the vestibular system,

Tho coupling between semicircular canals and otolithic sensors remains very tight throughoutlife. Any particular voluntary head motion initiated from any particular position relative to gravityalways generates the same combination of stimuli to these two different sensors. A particular head-n-otion relative to the body can produce different canal/otolith interactions depending upon the state ofwhole-body motion relative to the earth but a particular head motion relative to the earth alwaysgenerates the same combination of semicircular canal and otolith stimuli.

Here we might ask how the coupling of canal/otolith interaction for particular motions of thehead relative to the earth could ever be altered in the course of development. One mechanism isvestibular dysfunction. Vestibular dysfunction, for whatever reason, could yield unaccustomedsensory patterns. Sustained or repeated dysfunction could increase the range of experience withsensory-neural mismatches.

Another curious source in the develpipment of man lies in early childhood experiences. Thesustainod ambulatory turning that moc:t children gj.njy generates a semichicular canal signal thatproduces the Purkinje effect when the head is tilted, an effect that is disturbing later in life, Thischildhood activity repeatedly induces incoordination that eventually ends with a fall, which the childfinds amusing. Functional value of such activity is a matter of speculation. Is the child increasing therange of adaptive processes that will serve him later in life, should vestibular dysfunction arise?Certainly reinstatement of ability to control whole-body motion has survival value, if vestibulardysfunction should arise in later life. The passive motion experienced before birth and the vigoroustossing and turning that is generated by parents may also be relevant.

In contrast to the tight otolittv'canal coupling in the course of natural life are the more variedcombinauions of interactions between the vestibular and visual systems and between the vestibular andproprioceptor systems. Coupling between visual and vestibular sq'stems is varied in everyday life.Particu!ar head movements jelative to the earth can be generated with cyes open or closed. The eyesmay be fixed on a point in space as the head moves so that retinal images of the surround is retinallystabilized, or the eyes may pursue a moving target during head movement so that the target image isfixed on the retina but background images move on the retina. During linear or slightly curvilinearhead motion, the direction of retinal image sweep depends upon direction of gaze; fixation of fartargets prod)ches high speed sveep of near objects, In modern man, optical lenses demand visual-

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vestibular adjustments. Everyday life demands central processes that handle a variety of visual-vestibular interactions, suggesting availabilty of CNS processes for handling varying combinations ofvisual-vestibular interaction. This may facilitate adaptation to visual-vestibular mismatches when theyare imposed in modem transportation systems. Alteration of VOR gain begins in a matter of minutes,even during passive motion.

Similarly the coupling between vestibular and somatosensory inputs from weightbearingsurfaces andl from muscles and joints is variable in everyday life, The same forward pitch trunkmovement can be made with the head turned to the right, left, up or down relative to the body,Turning movements about a body axis or in a circular path can generate similar vestibular messagesproduced by very different body movements. During walking, head and neck and vestibular systemsare involved in gaze stabilization and their roles change for near and far targets (Reschke tlj., 1991).

From this perspective we speculate that visual-vestibular mismatches can be very disturbingbut that adaptive change should be relatively fast, Vestibular-proprioceptive mismatches can bedisturbing but perceptual-motor adjustment to mismatch may also be relatively fast. This is aneglected area of study. Finally, intra-labyrinthine mismatches are more provocative and disturbingthan the others and perhaps most resistant to perceptual-motor adaptive resolution of mismatch.

THE NEUROCHEMICAL LINK

Neural mismatch, recognized somehow somewhere, initiates the onset of sickness. Ahypothetical sequence is a chemical agent which enters the cerebrospinal fluid in the third ventricle(Crampton 1990, Crampton and Daunton 1983), is tranpsorted to the fourth ventricle where it reactswith a chemically receptive zone in the Area Postrema (13rizzee and Neal 1954, Wang and Chinn1954) on the suiface of the floor of the fourth ventricle. This reaction triggers a nea-by vomitingcenter (Wang and Borison 1950), This sequence has recently been challenged (ablation of the AreaPostrenia did not prevent vomiting (Borison 1986, Wilpizeski 1986) and a discrete vomiting center(Miller 1988, Miller and Wilson 1983) may not exist), but some kind of neurochemical link near thesecenters is likely (Brizzee, 1990).

In considering this link, we must account for tihe fact that sickness onset may be very sudden(emesis occurs in some individuals after I or 2 cross-coupled stimuli-- within say 30 seconds--andnausea onset can be almost immediate) or sickness may be very gradual in onset requiring severalhours for build-tvp with some forms of stimulation (Homich rd._i., 1984), Analogy to titrationprocedures in a quantitative chemical analysis seems appropriate--the chemical endpoint is approachedvery gradually and slowly with very small droplets but the endpoint can be overshot with one bigdrop. Recovery may be very fast or very slow. An alhernative to the titration analogy, expressed asthe model (Oman, 1990) illustrated in Figuc 7, proposes paratlel slow and fast pathways to accountfor extreme3; in onset rates.

The fast and slow dynamric clencrnts in the model may relate either to "orientation-emeticlinkage mechanisms or the dynamic properties of the emetic centers themselves." Oman suggests thatextremely fast nausea and vomiting is neurally mediated, whltreas slower onset dynamics issuggestive of humoral mediation, He suggests physiological mechanisms that might be involved:

The dynamic operatcrs may approximate the action of some humoraldiffusion or active transport process, or could be the intrinsic dynamicsexhibited by a network of vomiting center neurons to direct neural orhumoral conflict signal stimulation, For example, vestibular ,'onflictneurons might work in synergistic pairs, somewhat as vestibularafferent neurons do, and project to neurons (perhaps in area postrema,AP) associated with nausea perception and vomiting. If the synapseswere excitatory and had the character that a burst of conflict neuronactivity produced a prolonged (e.g., I mini) depolarization, "leakyintegrator" dynamics would result. Carpenter etLa. (1990) havedescribed a class of AP neurons that respond qualitatively in thisfashion to a variety of directly applied neurotransmitter agents. Theyattribute the long lasting depolarization of these neurons to a secondmessenger mechanism. Slow path dynamics might be associated with a

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potentiation of the fast path synaptic pathway by a third agentcirculating from the hypothalamus - pituitary or diffusing through theventricles. This slow path is presumably characterized by much slowerresponse times. (Oman, 1990 p 300)

On the 'output side,' die mechanism for fast emesis is in place. Vomiting is a compIzx reflexthat in surgery can be immediately elicited by pulling the gut or by lightly scraping the surface of thefloor of the, fourth ventricle near the Area Postrema. However physical traction on the gut seemsunlikely to be part of the natural eliciting mechanism (Wang and Chinn 1956b),

Considering now the initiation of the linking process, is it the recognition of neural mismatchor the beginning of the sensorimotor adaptation process that triggers the sequence of events thatculminate in nausea and vomiting? Triesman (1977) proposed 'hat toxins induce neural mismatchamong motion sensors and that vomiting provoked by neural mismatch serves to protect species,Morec vet, the unpleasant experience associated with the source of the toxin would provide beneficialavoidance conditioning. Thus motion sickness is a biological accident attributable to the fact thatunusual motions generate neural mismatwhes that simulate mismatches that toxins generate (of Money1990),

Money (Money and Cheirng, 1983, Money 1990) provided inferential support for this idt, awhen they found that labyrinthectomy in dogs reduced emesis from several toxins. Based on thisidea, it is detection of neural mismatch in the motion control system and not the beginning of theadaptation process that triggers the onset of the motion sickness syndrome.

Fast Path, A single conflict stimulus produces

Insteneo0U nausea.

might be neurally mediatedneural nlLuseamismatch magniludesignal estimatesensory .,--- + ...

contlict Cotilcic telast path

fnctltiont-o-tnreslrold

- [slow pth-,* powor law

other omutlcSlow path: inrputs, og:, Seta overall nausea threshold G /vag l ttllorence& gOAin ot fast path

. Slow dyniamios suggesi humoral mediation

Figure 7. Schematic diagi'am of model for dynamics of nausea symptoms. Adapted from Oman(1990).

Onset of sickness may be slow because of a slow passive process or in some situationsindividuals may actively 'titrate' exposure. For example, in earth orbit or in rotating rooms, theindividual may restrict head and body movements that are the sickness-inducing stimuli. In suchsituations, adaptation may develop at a rate sufficient to prevent the onset of serious symptoms ofmotion sickness, In studies of exposure to continuing passive motion, emesis incidence levels(Guignard and McCauley, 1990) for passive vertical oscillation reached 80% for the provocativefrequencies around 0.2 Hz in about 2 hours and only about 30% for a higher frequency. Someindividuals who did not reach emesis in this study undoubtedly experienced nausea, neverthelesslengthy exposure to some motions is required before awareness of symptoms occurs in manyindividuals,

THE MOTION SICKNESS SYNDROME

The motion sickness syndrome consists of autonomic nervous system reactions associatedwith motion stress, somatic nervous system reactions involved in emests and a range of complexmental reactions including fatigue, drowsiness, poor motivation for work, and depression.

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AUTONOMIC-STRESS REACTIONS

It is hard to imagine any perceptual-motor function more crucial to survival of the species thanthe control of body orientation and motion relative to the earth. From this perspective, any threat tothis function must elicit alarm reactions, The perceptual-motor mismatches involved in initiatingmotion sickness are signals of threat to the control of motion relative to the earth. However, themagnitude of the stress would be related to the spatial model of the motion environment and thecontrol objective. Stress and control strategies would differ between a disoriented pilot suddenlyperceiving imminent impact with the earth and a ship's passenger whose perceptual-motor mismatchesare detected but not perceived as threats to survival--except perhaps subconsciously.

"The general neuroendocrine response to sressful motion and sensory-rearrangements includeelevated levels of adrenocorticotropin (ACTH) cortisol, prolactin, growth hormone, antidiuretichormone or vasopressin (ADH or AVP, respectively), thyroid hormone, epinephrine, and

nrinephrine" (F-arm 1990, p158). However, individuals considered susceptible to motionscnss do not necessarily manifest greater autonomic activity than Individuals more resistant to

motion sickness. From a review of findings, Harm (1990 p165) found support for the idea thatsympathetic nervous system activation provides some protection against motion sickness and thatshifts in the balance of sympathetic and parasympathetic function underlies motion sicknesssymptomatology.

EMESIS AND TIE SOMATIC NERVOUS SYSTEM

Nausea with its visceral concomittants and the somatic act of vomiting are distinct functions ofthe emetic contiol mechanism, (Borison, 1986 p4). Vomiting is usually preceded by nausea fromautonomic actions but can occur without nausea, Curious characteristics of motion sickness are I) thequick relief from nausea that emesis often brings as though whatever the neurophysiologicalaccumulative process that accounts for feeling sick were suddenly set back to a 'better' state and; 2)the very slow recovery that may occur following brief exposure to a highly provocative stimulus.Nausea, stomach uneasiness, fatigue, headache, and drowsiness may persist for 12 or more hoursfollowing 60 seconds off-vertical rotation at 15 rpm, or following 2 head movements while rotating.

Rapid relief may partially be attributable to the Tact that many of the autonomic concomittantsof nausea such as salivation, gastric stasis, respiratory and heart rate changes are also part of theorganized reflexive chain of events that comprises the somatic act of vomiting. The reflexive demandby the somatic vomiting sequence for change in these physiological concomittants of autonomicallygenerated nausea may account for the sudden change in perceived well-being after vomiting, Asequential model (Davis eLtI., 1986 p73) as opposed to a "parallel" activation model has beenproposed to explain the effector sequence that makes up the all or nothing vomiting mechanism--mouth opening, salivation, gastric relaxation, respiratory contol, abdominal musclecontraction...controlled by the somati.:c nervous system.

Ideas relating vomiting to survival of the species center on levls of defense against toxins.Specific smells and tastes associated with nausea produce avorsion and an initial level of defense, It ishypothesized that the first levels of defense are so effective in the rat that the rat has ,urvived throughavoidance of toxins even though the rat !innot vomit.

In considering changes in the physiological meawres associated with motion sickness it isnecessary to keep in mind not only that the -"niting sequence and the autonomic aspects are distinctfunctions of the emetic control mechanism but also the fact that changes in orientation end stmtes ofmotion produce changes in respiration and heart rate associated with changes in energy demands ofthe body. The vestibular system is an efficient dletector of these demands during natural movement.The paramedian reticular formation appears to be a site for the integration of cardiovascular andvestibular signals (Yates and Yamagata 1990). Vestibular function is apparently important inadjusting heart rate during Hyper-Gz exposure (Matsunami and Satake 1991). Frequent and sustainedexercise, i.e. higii levels of aerobic fitness, seems to increase susceptibility to motion sickness (Bantatljj., 1987, Cheung ctal,, 1990) possibly related to neuro-chemical changes associated withexceptional exercise regimens.

L4".•; ." ]

• , . 4',; .. ,

2-21

Does willingness to vomit play a part in the magnitude of symptoms experienced in motionsickness? While the act of vomiting is reflexive and not under voluntary control, willingness to vomitplays a role in how different individuals adjust to unusual motion environments. Possibly quicknessto vomit and hence feel better is partially idiosyncratic. Individuals who reflexively vomit with littleeffort and with little disruption of performance may be willing to vomit whereas those whose act of

'e I p U the subconscioust strategies that brnante~ rceta-vomiting is a major event are less willing. Whatever the cause, willingness to vomit plays a role in thestrategies individuals adopt in adjusting to a motion environment, Here we refer to strategies that are

more on an int ellectu al level th a the p rtal suInsi u srtges that bring on the perceptual-tor djustment our conceptual model, Individuals in rotating rooms or in orbital fli~ht can electtavid ead em h a not absolutely necessary, maintaining a sustained malaise that may

h may opt for a more active approach that may result in more emestsbut perhaps more rapid adaptation.

COMPLEX SIGNS AND SYMPTOMS OF MOTION SICKNESS

The range of signs and symptoms that comprise the motion sickness syndrome, as describedby Benson (1988/b), is presented here along with Figure 8, which depicts the neurophysiology ofmotion sickness.

The cardinal symptom of motion sickness is nausea; the cardinal signsare vomiting, pallor and sweating. Other responses are frequentlyreported, but in general these occur more variably. Typically, thedevelopment of motion sickness follows an orderly sequence, the timescale being determined primfirily by the intensity of the stimulus and thesusceptibility of the individual (Money 1970, Reason and Brand,1975). The earliest symptom is, commonly, the unfamiliar sensation ofepigastric discomfort, best described as 'stomach uwareness'. Shouldthe provocative motion continue, well-being tsually deteriorates quitequickly with the appearance of nausea of Increasing severity.Concomitantly, circumoral or facial pallor may b6 observed, and theindividual begins to sweat; this cold sweat is usually confined to thoseareas of skin where thermal sweating rather than emotive sweatingoccurs. With the rapid exacerbation of symptoms, the so-called'avalanche phenomenon', there may be increased salivation, feelings ofbodily warmth, a lightness of the head and, not infrequently, quitesevere depression and apathy. By this stage, vomitingis not usuallylong delayed, though there are some individuals who rmain severelynauseated for long periods and do not obtain the relief, albeit transitory,that many report following emesis.

If exposure to the motion continues nausea typically increases inintensity and culminates in vomiting or retching, In the moresusceptible Individual this cyclical pattern, wita '/axing and waningsymptoms and recurrnen vomiting, may last for several days. Those soafflicted arm commonly severely anorexic, depressed and apathetic,incapapable of carrying out allotted duties, or caring for the safety ofthemselves or others. Their disability Is also compounded bydehydration and disturbances of electrolyte balance brought about bythe repeated vomiting, Apart from the charocteristic features of motionsickness--pallor, sweating, nausea ,1nd vomiting--other signs andsymptoms are frequently though more variably reported. In the earlystages, increased salivation, belching and flatulence are commonlyassociated with the development of nausea. Hyperventilation isoccasionally observed, while an alteration of respiratory rhythm bysighing and yawning not infrequently precedcs the 'a'ialanchephenomenon'. Headache is another variable prodromal symptom,usually frontal in distribution, though complaints of tightness aroundthe forehead or of a 'buzzing in the head' are not uncommon.

Drowsiness is an important, yet often ignored, symptom commonly

-;A,:.,

2 22

associated with exposure to unfamiliar motion, even if not necessarilyan integral part of the motion sickness syndrome. Typically, feelingsor lethargy and somnolence persist for many hours after withdrawal ofthe provocative motion stimulus and nausea has abated. However, incertain circumstances a desire to sleep may be the only symptomevoked by exposure to motion, especially when the intensity of thestimulus is such that adaptation occurs without significant malaise(Graybiel and Knepton, 1976). The soporific effect of a repetitivemotion stimulus on infants has long been recognized, It may he, that thedrowsiness observed in the adult when exposed to appropriate motionis a manifestation of the same mechanism, though it must beacknowledged that the sonnolence in an individual who has sufferedovert motion sickness is frequently of abnormal intensity andpersistence. (Benson p.319)

RECEPTORS CENTRAL NERVOUS SYSTEM SIGNS & SYMPTOMS

CEREBRAL - NAUSEACORTEX ..- Dizzinnas"Somnolence

Headache~ HYOTHAAMUS Depression

Performance decrement

V., it iBU.LAR _f- . increased secretion ofEREBELUM PITUITARY ADH,ACTHGH,PRL

Motion VETBUA ýVESTIBULAHI

stimuli APPAATUSO *. NUCLEI -

.-- C1Z ' CENTRES '.. RECEPTORS " PALLOR

------ .. . . . M Mot-N ityDecreased gastric

I CE RE IMotility Cardiovascular &roepiratory changesVOMiTING

Figure 8. Neural structures in motion sickness. CFZ Chcmoreceptive trigger zone. (FromBenson 1988b)

MOTION SICKNESS AND SPiATIALi DISORIENTATION

The combination of sensorinmltor systems involved in maintenance of spatial orientationawareness and the systems involved in bringing about the onset of motion sic:kness arc the saime.Motion sickness may increase the probability of failure to maintain adeqluate o'ientation awaretess as aresult of the distraction of coping with emesis or the depression and malaise associated with motionsickness. Enthusiasm and confidence of the student pilot in learning to control acrobatic maneuverscan be seriously degraded by the drowsiness, malaise and discouragement that aire part of the motionsickness syndrome. If these symnptoms are not accompanied by vomiting, the student and instructoralike may not appreciate that the ,i;udent's 'poor attitude' is due to airsickness,

Many flight environmettts and especially aerobatics generate niany mismatches that cloud theperception of the maneuver and that also tend to induce motion sickness. Trainees adjust to thesenismtlatchcs atd in so doing overcome airsickness. Indeed the motion perceptions of actual flight are,;o much a part of controlled flight that the experienced pilot disturbed and made sick by flyingsimulated maneuvers in a flight simulator. I-lis perceptual-motor store for control of motion in theaircraft is violated by the feedback from his control actions in the simulator, The beginning flightstudent, without comparable stored perceptual-motor patterns, is undisturbed by flying the simulator(Guedry 1988, Kennedy eta1., 1990, NRC conference 1990). From this perspective, motionsickness and spatial orientation reactions of pilots are related,

2-23

Many flight situations that induce pilot disorientation involve stimuli that are minimallynauseogenic. A pilot in formation flight and keeping station on a companion aircraft may be in acoordinated bank-and-turn but believe the aircraft to be in ldvel flight. The turn sensation from thesemicircular canals is absent because time since commencement of turn has allowed the cupula torecover to its null position and alignment of the resultant force vector with the 'vertical' axis of theaircraft elicits a zero-roll signal from the otolithic receptors. Thus the pilot can be dangerouslydisoriented but unaware of his disorientation and also undisturbed by nauseogenic sensorymismatches. In fact this is referred to as Type I disorientation (Benson 1988/a) which is responsiblein the fixed-wing military aviation communities for a greater loss of aircraft and pilots thandisorientation types in which pilots are aware of disorientation.

Type I1 disorientation, in which the pilot becomes aware of his disorientation, may involvemismatched and nauseogenic sensoq input. Type I1 disorientation accounts for a higher incidence ofaircraft and pilot losses in rotary wing aircraft than does Type I (Vymwy-Jones, 1988). However,incidence of airsickness is lower in rotary wing than in fixewin communities, The frequency ofoccurrence of nauseogenic stimuli plays a role in the probability of sickness and pilots wouldobviously avoid repetitive Type II disorientation,

While the physiological mechanisms of spatial disorientation have a commonality with those ofairsickness, practical solutions for the two problems and even research into those solutions Involvedivergent approaches,

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2-29

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3-1

PHYSICAL CHARACTZRIBTICS OF STIMULJI PROVOKINGMO0TION SICKNESS

Michael J. GriffinHluman "actors Research Unit

Institute of Sound rind Vibration ResearchUniversity of Southampton

Southampton, SO 55111Eng land

Toe physical characteristics of moti ni stimuli responslble formotion sickness are reviewed in two parts. The provocative stimuli arecatego0rlesed and their nauseogesic propexirtes discussed qualitativel~yin terms o1f the sensory conflict theory of motion sickness.Qua nt it ative information available from osperimentel studies withspecific types Of Imotiol is then nunestarised. 'Tho motions of the b~odyconsidered in this review include translational oscillation, swingmotions, rotation about a veiticel axis, rotation about an off-verticalaxis, rotatilonal oscillation and' cross-coupled (l.o:. Co I ~o IlIs)stimulation. Conditions produc.ing visually-LttduosJ m~otion sickness at~ealso sotnmnarised,

1. INTRODUCTION

motion sickness is studied primarily because of Lbs ptobiosus It, cýa-non h, jopouhtravelling in a wide variety of environments (see labia 1) . The rnotoions dazgy'lalei wAIt,sickness in the various environmients are difierent and often complex and eo H.ti, Inotimmedialtely apparant wit ch mull ons are priimarilty roapons Iblo for: nAckiesu. LVow ýi Ituii I in>conducted it. reul environments have mtade, useful measuremeints of butt, rie tmu. Ion and 11112ýct)sequent sickness so as to estaiLish cause effect relationships.

Table I Some examples of enviroranionts, activities and devices, whicit call caunnsymtloof motion sickness (fromn Griffin, 1990).

moats Caetul -IdeoShips Eliephintt rides

Hlydrofoils .:atrHovercraftiiwiniminq Eel rrjrouncl devices

Vised-win nq i rc ar af'CtItip rashIleId In p ca '19n inverIt In/i In n .Il I tI I I'-!;Spal.' k. mi 'ic::rfi cd" re-tdotlt

13 L n c:; ~Im -Ii I tIt -, uklicy 111 Lins it'll mil

lixponlment-al studios have si:t)wn Ilthato loivci:y lijil: mt ntis cart oaunt' okim hIouoratury condirtions. 'ttose motl itrill have h oor: tso-l In c runLn y r) a inr) nI o 1-j I 21 ip!-;yvhoi oq1:a5 iarorrplal.es wirti I twIjvi'.e,I i iSCOlIt 1111 lily I~ C1i11t bi(t sjic.knessJý. itr'1y lttvi'tort, uttncc to tent. n tturtttivo 111ti-111tcinti Eil uktiHW1 rtq;, nr hIanrat.tr'y i iivteostill iitt3ti-vv' inotttIf led a rnia~t inn betwt'eit the t y1io of 111tit011 nwXt' tot ' .1d tho' (orno:IFcnL1tt Into i ninlics itetzis

EV idnlice tof the calustint oi an1t [ot slckttrss come-5 fromrt Ial'tat tory iexpthe-' nta1(91it lu, I.-'Liutdy, antalystist ft ttteoretircal I idtels al(d phtlosotphicatl tcti~its dotiut j 15 (ItII tIc" JId lW. 110:1 .inliris't "he rt tJ'tul 11)0 in lentriot- 0t , l atar~t ftott lalt:.ratotry !ulot

1.1 The causes of motion sicknessStun soitetinq e It on nmotiort uS rokttoit tlhter Int a t~onroetn:y hnt ptoiihit to at ti Ii hutt I' I lie It

irnctli ti tot fc actora it ho.r tltact ito m tnt oti o~~'ra t'. til' Inion clthlitItI ' 11ti' 1,t11tyni ther nont-rot Ian factortrs are Ilaiiato ft>r 1221125 tj i kobese. Mcd t.,tt ir'kttu.'it- 'ii ,thell; h ivasnilv atittribitd orLo astol psychologiucal weakness.

'V['- no ld 0st ilaul I iospottit ble for aickritos cantnot be out. I Iy (dent IIlr': Ity Itton oto~perornt. itt transaport oriv irotiutttolt titore Is mu!.o bitn maniy di roctlults and tihe I ravelhlt (it

'isable to. att~ribute t he s ickness 4,n mot ion In any onie direotion . tstian- vony gentleItuovoenetla ire (:aabtltl of proclucitY sickn~ess - li itoce toICCI~ln thei r (of ltttt31Ce stay sIcnt a a ttL1

of weaknvtotts . For sosie-,onvcrunmntnnts so lent. ((t study has yet to identity '-Ite antL )itprncnrpa Ily riaspottAiblo fur sI okitens ,I

rho 10I00SO 1:el atL i nish [fis entab iti shoed btic worse toot i ott rinc mot joi an icriretn a I I ow t.o fIt e-I n

iderit Iif jltioo of Culres. 'There are mtany, unpr~oven rettedies off-ered for moot lots zri:itittrr

1.2 Signs and Symptoms of Notion SicknessA consido ta i ott of the pthyticL- s tntimtoli IcautiLog tnoottoin sirckneni atlso InvolIvets ,

c7.oortifeat ott of Illeans of quantitfyinrg the effect a. Vomit rino i.; t~he mi-itt! obvioitr aign cifriol jotisiecktortas but. itý its tro t he only effect t vomoititng may ito neither the must. serisai lv'snor 0io soot. I importantr conseqtuencte of motion siLcknetss. Whet-re the Intri deoce of mtoirlostvckt~irtit s low, t-he recording of stotne leotiq drunati-c effetct Whith Irt iav i)1:, ptsentst fits rji oato

tinaritilty WillI be a more nietnsIt Ie lindicator. The various a gtrand oymptsoms rof motiLonsikor mltirayrts differ itt their dependence on the characteoristilcs of moti.onr and ot~hetr Iat soI's.fHowever, studies at tiea reported by Kanda et al ()9771) atnd Lawt~her and Gtilffi ti (987)ouclclest: witlid and todorlrotis ymptorns of sticknerts macy bo predicted front tthe rel~atiot. betweenvoritLt i g riotidenre and ih ip toot~iono nagoitirdei

itrvtrti~garora ot motion sickness ha-,g oftetn chosen to usn rating scales which givesorte weight to ef fects other than vostifti tag. 'tants sutch an 'nausea' arid ' sickness' havedIffereit. mroanitngs in differerit atridiet no It In attractive t.o niandardine ott t:he ratltinscale. One of the most used nttalett in that pr-esented by Graybicil et; ni (1968) is:. which Uiteacut~e effects are given poinlts (Tabl.e ?.a) which are thert aggregated and Waed to artItVU- atai lovol of sevority of mrt otio sickrnaci ott a t iv pci nt sctale fromt "alght: malaise'l t~oIf tsatrk sickrtesstt (aee TLable 2ttf , This treeI " has beetit usedi to categorise the syriptoing -,f

mtotIiotn unicknect In sante. of the Peaper otot-itt treII~trItra d no n itject tona' . to 9 bet iw.

Tahi 2I 1 i ilaituost ic ciateyor I at-iort of di tfr ettt leve ic of severit~y of acute,- toot iotnnir!ktsesn ts dlefinled bn~t tirtyisil cit. a, .1968. (Po ints accosnulated frots the aignisandi ,Iymptorni in thtis iabf arts usied to detertitino the, to tevast degree, of niet ottsicknoss sevotinty givent by 'labia 2b).

Category pattonrttoitottic Mta jot Mit n or Minimial Additional

Ii frolIni!I A p~ointsfr A polntts 2 pitonrts QusaIifyte rg

Na utrca rirririt. i og or Nause t 1tr 1L, Nausisea I E.4r ija St r Lto Np igcantt 1to onytindrorti ret cit I nrj III dis.cotritort awarenness

Skint colour - lPallor III Pa~l or 11 Pra 1. isi)r I PI oSIrI rig

Cold - III it:,weal-I i

111ictrea a -d - JII it Isaliuvatiotn

itrows.irtess - III I

P'at! it - -Ieadacrh-j~

C' t i ) I 1 1) - -ý It i I rotor

tyrit tarta Ž1 I I

iT'ilu 2bs Ivolti itt tttrverit.y ort rtute, rtit. rut sicktuein:t art fttitr'.Lic by tiraybloL ut i.l., 19gill.fPolir t e 'I ut isirtiat ru frittit T'ilab l rt2 utile tsr deter ittI~ itie t o o 3r1 ri ot tons o ini tri Ink~: teIr nvon If.y utlowt Itt t itl it .airo i

ttjit.stl~ Iýo itf roverIt V Sickttetris t'atetqory

? Ii (InFankr suu:lrrt-ti

H to .15 Severe Maliseia M 111

'I Mndsirttat Miftlo,ris A Mt ILA

I to 2ratlq Mcilaine 13M ]I

I~~~ itIIh W c s

3-3

2. THEORETICAL CATEGORISATION OF PROVOCATIVE STIMULI

2.1 The role of theoriesA complete theory of motion sickness wopld give a method of measuring both the cause

and the effect and indicate how they are related. Various motion sickness theories havebeen proposed but none is yet capable of providing quantitative predictions of the degreeof motion sickness to be expected frost a range of different motion stimuli.

For a few types of stimuli, presented in restricted circumstances, it has beenpossible to determine empirical relationships between the motior. and its effects tseeSections 3 to 9 teloi) . These relationships may contribute to a general model of motionsickness hut they are not, in themselves, motion siokiless theories,

General theories of motion sickness are currently qualltativa rather thancjaimuntltatl ve. 'They provide a rationalisation of existing information but make no precisestatements of what degree of ection sickness will arise in specific circumstances. The'sensory conflict theory' derc.rbed below provides a useful quaJlitative introduction to thecharacteristics of nauseogenic stimuli,

2.2 The senesor conflict theory,Several theoprles have been based on the idea that motion sickness arises from a

conflict bntween the-' information received via two or more sensory systems. However, sincethe mean:!nq of sensory information is being continually re-learnt, we vary our responsesto stimuli, There is not conflict between the stimulation of the sensory systems, onlyconflict between the interpr,,tstion placed upon this stimulation. Any measure of conflictbetween the physical stimuli wiii be fixed and so such conflict will not explainhabi tuation t.o nauseogonic stimuli or the after-offeuts of exposure to such stimuli, Theextr.nordinirsy adaptivs 'apabliities of the human body are involved in both causiing andoverc:oainq motion rickneas.

A conflic' between signals received from different Lenses is more easily considereda conflict with what is 'expected' than a conflict with what is 'correct', The combinationof s51gnaLrs %dhich is expected wril be largely that which has been learnt from previousexpor:lIIce!rt. The concept of sensory conflict has therefore been extended into a theory ofnnle 1ry tI'lai ransnieleit (sec RSc ron, 1970, 19171) ,

The aerruory rearrangement theory of lw- ion sickness states thatt "alJ oituations whichprovoke motion sickness are characterised by a condition of sensory zearrangemrert in whichtUre mrrtion .iignmIs transerillttd by the eyes, the vastibUldr system and the tion-vestibularPro 1r boci'ptor's are at: iatirarice either with one another or with what is expected C'roaprariorrn erperieco" , Reason and Brand (i9g35) suggest that the conflict may becoxvesrliuntly sald sufficiently considered in two categories! inter-modality (between theeyeii and the vestibular receptors) and Intra-modal ity (between the semi-circular canals andctulithis within the vustlbolar system)s. For both categories it is possilhe to, identifyth4,c' typos of s ituatio[nin which uorifl i:t may occur (seer Table 3)

'tabL I Tyi' esl and cuate orieo s of serliar r itt

Type of Category of conflict:

conflict Visual - Vestibular Canal - 0uoltth

Type I Vldr ,qt 111rr'r V'rIr ibtrl1. ,r mr) r Cunal,3 and otoliths .tLmiLrtaneouslySilill iar,'ronly r lr l flrretrt signal lifferent (i.e,(i ,,. r: nil ' "Idlitorly ,r conrl.tradiCt.ory Ol unrcorroiated)

Urrrortr irnli" erd) [iuforiat o la Informatilon

Type Ila Vlitual systemlr signals in the Canals slyr-al in the absence of anabiuon el. airll exp.cIed vesLtibular expected otolith Signal

Type lib Vest iutrlar aytI..eri slgrnjrrrl In thie IOt~ol[t.hr s ignal In the absernre ofabherlco of all rr oxpc

t ed v.sta l rOin ap,'otied ctanal signal

Mrrt. iih ,tievi ornntipn's car, rnvolViv rorste r ira one cont Ili t r there is genierally sore:Ul. Iir rit y lit drfr:idinrrr wh(!r,' the varilous cni ronsients sliour d be enit red than whether thoyC'.lrr Iho tlteoron withlLn Lhis Tab.iteogotisation 'fable 4 ilutintrates the division advocated byAoi.rirnirri (1984). Thrie tollowIng 'x'sp an,;ttIons are derived fSor s rriffin 1990) ,,

C .'

3-4

I~l II 1i'~'rI2 I ~o ii oic .iorol l~ .10-1.1Cd hý' van-ili! I.tCVe- Ilo o ii - N I' ihIllii. (Adotpt (,it

from Hfenson, 1984)

Category of motion cue mismatchVisual (A) / Canal (A) /I

____________Vestibulai: (a) Otolith (3)

TYPE I Watchirg waven fromn a ship Making head movenientei whiiutA and 2 rot~ating (Co,:iolis or cross-simultaneously give Uae of binocuiiarsi n a moving colprlad stimulat~ion)Coantadiacto:y or vehicleunoortelated Making head r~ovomelit. in aninformdtian Making head mnovements wheni abnormeal acculeration

vinqion As distorted by environment. which may beoptical. device constant. (L.g. hyper- or hypo-

gravity) or fioctuatligq (e.g,'Pseudo-Coriolla' tatiiiulat.iun linear oscillati1on)

Space sickiness

Vestibular clino::dors (e, g.Mftncire' n dlseatie, acLe.lahyrint~hit is, tr anerilabyrint heciornyl

TYPE Ila Ci~noraini 1ackleoq: Poe titional aicohol ri'rl.agmiun

Asignals in absence0. expected B signals SIiieiuietor nic~knoine Ciloric !tAr iisuat~ion of an11il-

Hauntad awing"'iclr ait

Ves~iI.iular Uitiorcduts to~g,Circu,tar vlhitoiori pronsure verl io

Type Illb 7oonkiý insjide a movli t~ow-ftieqlikoncy (<0.5 IN.)3sgignala in absence vehicli, without. exi-.Lcmnat rtzl~~ I raeitccte In lilt,.onot ex~ated A signals vliuaim ref~era.lnci-1, uq bel ow

dvok in boal.) Roeta tingi I.Aiknor ar.rrtivocLar (13. 0 h-'n-e;'

Reeding in a m1ovingj vCehJL o roULIe.ion, rol-at. in abhit enoff-vartical agisl

2.2.1 Visusel-vestibul~ar oonflii'tType I

Wi.toh leg cueathy Waves F romn a ,heh ItomI-il 11 In n~aol. Vow1 I hut or and nacne. 1,otnat -fonsoneylecp Ion of fic meot.ion of Lteu etip reaidlye 1.o the g~ravil~tationla Hinld (it (Ai 1at';ar

wh ile nlel~lili( only7 tho uloi rort aititn mo1(112101 ill thu wave~i rit at Iv( tri 0 h 1 tic- i ll'(. 'I'll a!.9 [t eltýIori may he rulcdtI y placed eia, a typoi iLon I L [i.-t It i t-d. 11,111 b-! nelillllelJ 0t01. Uri-

wi)', 11. -ll a N! 1e '-1ott byi wo,111 ln i. l, tot.i r ~ v hin w t ,:._ l.11 A

nu It b e 11u n Iud ad i c-it t hy l .a 1 i ll 11110 u n c-l i Loau : 1 lo l n j iki u a1th I ii iA 01 o I- Il , I id t VI :111.1] t ' .11r11 ill 110111 tii hc-to 1:;Lll~i 1 11' 10111. II llh11i'' I'l llllll lIt't l~l 1 in (1111y.11:j h.on .1Til

vi11.1clciitIorl tr c ot ic taune 101111- ma n ic -I 11 c-tl .% i )lw h Vel Wli Ii. uli:; t1 leuvIlli

Jti ho 011.11)1 1111C. Vii.a 10111 ncld t W ic-r %f. tiotlyt r mo at, ~ l, I inodo itum t" cvil and lboI-t III .011von

Type Ilb

Ma-il ny o tl m11 l it n ' 1 1mava allokove' Ihu1 hloo i: Il- ti il y rImiiltl-' In1 11o !;il' vut~l- ~ call101

ilatc till111. inhie byI H i Ai M e on li -11 00( llh vil I111(1 11011 ,: ou a v c .l 1110 ii'IýJ 111) i 0lll1 VOIl l -h-ipito.ucvi111k a s od in ii Il hu viti tiol 111

Type Irb

Many folill f ' rav l. a ckn arr may be t lvist 1,-rt'iil~y itt'r butmi 1,, h,,vn4.-ib laiI~~~~er~~~~~k'j~~~~~~~i~~~~tl~ ~ 'I lx''"Wi e 1i ltljd 1 t O? LL! Ilit ol 1e s i cry 7~tl~ rt o

3-5

2.2.3 Canal-otolith conflictTypo IThe cross-coupled, or Cornolis, stimuiation which occurs when the head in rotated

about an axis other than the axis of rotation of the body is said to be a Typo I canal-otolith conflict: it is usually assumed that the atoliths tend to signal the correctinformation while the canals provide a false signal - see Section 8 below.

A different conflict occurs if the head is moved during exposLure to abnormalt~ranslational acceleration, such as high G aircraft manoeuvres, zero G in spacecraft,acceleration and decleration in cars and oscillations aboard ships. In these oases a til.tof the head will not give rise to the changes in otolith signal which normally occur whenstationary on Earth during exposure to 1G.

Space sickness has sometimes been considered to be a Type lie canal-otolith conflictsince head rotation will produce an appropriate canal signal without the normal changes inthe signal from the otoliths which occur when they tilt within the gravitational flael ofthe forth (Reason and Brand, 1975). However, voluntary head motions which are associatedwith space sickness are thought to produce accelerations sufficient to stimulate theotoliths and so it may be more appropriate to identify apace sickness As a Type I ranal-otolith conflict (see Benson, 1977).

Some disorders of the vestihular system caused by disease give rise to symptoms ofmotion sickness due to unexpected Llontributions of signals from canals and otolitha, andso say ais,' be classed as a Type I conflict. One example is MNinltre' a disease in whichboth balance and hearing caln be affected.

Type IlaA signal from the semi-cIrcular canals in the absencs of a signel from the otolitha

can arise from tre convection currents set up during caloric stlmulation of the canals byirrigation of the cuter ear with warm or cool water, Similarly, a difference In thespecific gravity of the endolymph and cupulae which may arise from the consusiption ofalcohol, or 'heavy water', results in the cuplase being deflected by gravity, Both ofthose situations can produce nystagmus, dizziness and nausea with the greatest stimsulaolnwhen recumbent with one ear down. In this position there in a strong feeling of not beingmoved from unchanging otolith signals and somatic senses but maxiteal stimulation of tho,normally, horizontal semi-circular canals.

Type 11bConstant speed rotation of the body about an off-vertical axis results in a change in

otolithic stlieulatios with no change In the signal from the canals (see Section 6), This,is said to be a Type Ilb canal-otolith conflict. With rotation about an forth-horizontalaxis at about 10 rpm on a 'barbecue spit', nausea many be produced in a few sinhtoe, Asimilar conflict, occurs if the body is oucillear in translation at low frequencies, suchas on a swing, in an aircraft, of abnard a ship (see Sections 3 and 4)

2,2.,3 Signifi•mnce of the theoryWhen providing a qualitative explanation of the causes of motion sickneos, the sensory

conflict theory is, often sufficient: all known causes of sickness are accommodated by thetheory and it suggests some useful preventive measures. Its greatest value appears to bethe identification of the relevant sensory systems, their interactions, and the foundationthat this provides fur the concept of sensory rearrangement.

Mhe sensory conflict theory dooe nor indicate how sensory conflict can be measured endAt therefore provides no quantitative Information. TL cannot be used to Iden'.ify which oIacveror posuible conflicts' in an onvironment is miost significant. The sensury corf lotAtheory might be used to ant to) pate whether some combination of stimuli is likely to benine•oqenitc but it canoot be used to predict the extent of. any symptoms, or how they dependon the m.agnrit ide of motion, the type of motion or the duration of motion.

A d(relopment of the sensory conflict theory, employing control theory asid based onthe means whereby the visual world appears to be stable despite movements of the head ande,es (i.e. 'efference coppy'), has bebn elaborated by Oman (1.982). He proposed that thesite ot visual percepticon receives a 'cupy' of the efferent signals sent to the eyes andcontains a model of how the sensory pathways operate. If the model fails to account forthe received sensory information it eventually adapts but, initially, 'reports' conflictand produces signs and symptoms of. motion sickness. A separate system model of motionsicknesas was evolved by Riedel (1980) and is also based on sensory conflict,

2,3 Other theorieeSomo mot ion sickness theor les have incriminated somatosensory proprioception of joint

or vlsceral movemeht while others have blamed the 'sloshing of the blood' or theflucLtuat ing smechanical pressure of blood or stomach (e.g. Wollaston, 1809) . Suchuuggest ions are generally discounted by evidence that an impaired vestibular systets impartsimmunity to sickness and the tempting corollary that the vestibular system is 'responsible'for sickneas. 'Overstimulatron theories' attributed sickness to excessive stimulation ofthe vestibular system and orientated the discuaaion towards whether the otoliths or thesemi-circular canals were responsible.

2.3.1 Otiolith tilt reinterp etation theoriesA 'tilt-translstion reinterpretation' hypothesin (Young et al, 1984) and an 'otolith

tilt-tranrlatios reinterpretation' hypothesis (Parker of al, 1985) have been advanced inthe context of space sickness. The absence of a gravitational field in space means that

11....jf[

3-0

otolithic signals only arise from translational head movements - unlike on earth, whore themost common cause isi assumed to be the roil or pitch of the heed through the gravitationalfield of the Earth. Roll and pitch head motions In microgravity will give signals from thesemicircular canals, and relative movements of the perceived visual scene, without theexpected signals from the etoliths, Astronauts have commonly reported that, early In aflight, pitch motions of the head provoke symptoms of sickness. Immediately postfllght,astronauts who have adapted to microgravity exhibit decreased ponturat stability with theireyes closed (Young tt al, 1984) and decreased ocular counterrolling during tilt (vonBaumgarten at al, 1984) Both observations are consistent with adaptation to microgravityresulting in a failure to interpret roll motions of the head in a gravitational field asrotation. It has also been observed that immediately following spaceflight some astronautsperceive roll motion as horisontal translation and that roll motion induces more horizontaleye movements (Parker et al, 1985). A 'prophylactic adaptation training' procedure toencourage the appropriate micorogravity relationships between otolithic and visual signalsprior to spaceflight has been proposed by these authors. These hypotheses may beconsidered as lending further support to, or refining, the al.l-embracing sensory conflicttheory.

2.3.2 Ratlmn-rssponse theory of motion siclnesuIt. has been suggested thr" the causation of motion sickness might bd partially

explained in terms of inappropriate (i.e. unnecessary, unnynchronised, delayed, oropposing) reflex responses to movements (Griffin, 1990) . Reflex responses normally arisfrom the interpretation nf signals from the various sensory systemis capable of detectinqmotion. The standard interpretation of these signals will. be incorrect in some situationsand new reflex responses wLiI, need to be developed. Motion sickness is assumed to arisefrom the 'conflict' between inappropriate reflex responses. * The theory is thnreforecentred on response conflict rather than sensory conflict. It is suggested that whilesensory conflict cannot be measured it may be possible to nmeosure indicators of responseconflict. Nevertheless, the suggestion appears to be broadly compatible with both thesensory conflict theory and the otollth tilt reinterpretation theurles, ' The reflex-response theory may contribute to understanding the time-dependant nature of thedevelopment and recovery from motion sickness. It may also suggest some measurableparameters of both the motion and humnan response. This theory does not discount a role forsomatosensory perception in motion sickness,

2.4 Application of motion sicknehs theoriesThe sensory conflict theory cannot be tested by experiment tiinoo, while It provides

a framework for what has been observed, It makos no preclse predictions, Since the theorycannot be diasproved, it may be assuniod to be eithor broadly cDrrect, or irrelevant, Thetheory does not make qunLitative prodicions,. indeed, it Lmplies that such prodictionscannot be made. The effects of changes to the quantity or quality of motion stimullicannotL, therefore, be inferred from thu sensory conflict theory.

Any explanation of motion sickness in terms of the sensory conflict theory istherefore qualitativo and does niot pruvide an explanation of the physical causes ofsickne•ss Although some latkr theories attempt to move the theory forward thoy are alsoinsufficient to make conftident predictions based on physical measuresients.

In the following sections some of the available quantitative data are presented. Theoccurtorece of motion sickness with the individual atimurL should be accommuodated by theseinsory con I Iict theory, arnd all other theories. flowevre, currently, onlty the exporimcentaldata show quantitative r'' aticrh-ihie between the .'hynicat oausesol ot anickneus arid Him,various aylgtis and aymptoins.

3, TRANSLATIONAL OSCILLATION

3,1 Vertical oscillationt!:udcies havo shown that 1()w ru'l(tmlr'cy Vcodl I r:a] o, ri ],at lotr, :oni 'tune u 'Iaunno (iti ( In Ii

anr arid arrlmalsa ,

3.1,1 Human studiesMorton et al (1947) report exposIng f[vs subjects Lo up ard down si,)tion ri a I ift; 'ver

a distance of about 5 metres with an accelert ion of approxistatiily 2.1 sis ' and a emaxismimspeud of 4I mst. The exact charaete(ait lcs of the motfion were not sitatad but It wasripot tend Lhat four out, of the five siubject a became nick In a period of 10 t ) 30 mnilil.ens

The first, major ucries of systemiatic lattoratory stui,lrcs Of the t productl ait of Itl otilin[cknesis ins man by ver Lcal itscl cLatlon wet e coridu1l-ed wit neveratal hiindred Naval ,,tdet.5

and are aor'times referred to an the 'Wtleleyari Univerasity attudiru' An a)1rvatn, # or ifft.capable of 5,5 Isattret n f di spit lacesinit (peak to poeak) wa usaited no Lmt art" 2)0 tiLnit. '3 eX(l tiCa

to all ernating periods oi oorisitantL ascelerat Lon nild constttaot w4evity at that the risil u:lttngdispiactleerit waveforms were, ve4ry approXintat.ely, UnitItiudal . ''e I fret st.uAdy investrigatedfour different frequencies (0.22, 0,27, 0.37 and 0,51 Hz) and 'roduced the citthiusion thatthe hlhoer frequencies resutted in less nicktesa (Al.exander of al, i945a) . Th' sectndsnundy showed that I:teresa ing the manuytiItUde Of the motion (at. about 0.37 lV) increased theitcidertce of sckneuss (Alexander et aýl, I945b) . The third study msed similar frequent uLto I-he first Study bitt coh1Kt t'qe a the per Inds at constant acceLe rat. Lon aliowed t.he.generation of d[ffe1rent Lmagnitudus of motli0 , The data again showed greatest sicknes, wilthlowest frequencies. However, comparison of the results with those from the earlier studiesresulted In the concl union that moderate magnitudes of moteon produced ithe seat tiottionsickness and that the highest magnittides produced least sickness (Aiexander et al, 1945c)

. ., , .,

Tbs I:Ok rub at Iidy incest !gatc( t.11 Qo tli cit kl irusysseo1t rind~ w acevu I.ris (AlexKanrderi et asI#I 945id) .A Iliter Study produceod furthot dJata with1 the same frecluoentoea (Alexander et al,1.947i

'The above results f:rom chit Wouleyss y am tlng Irtoldenoe (%)Univen ally studies have been rioasalysod !to as 60-to express the crustriltin iocit dunce as 'a fun tAoriof r~m,,e. accelerationr for eac;h Freqriescy (see - 0,22 Hz l 0,27 HzF'upurni 1 and Lawt-her and clitt E fit%, 1.987) Wh itethfe re i ts sca t tarj. Isn t he result1.ts I.t Is nappa reont 40 - 0.37 Hz ~0,80 HzIthitt vart: Ins) acn-e (oraltioe at 0. $3 I-IV. pruduIOerlless v ornitin L.s han the asenre acoref r et ori at0 .37 liz, rin I bo(.h f rusquintu. is p)rodnoed less uvomitting th.ban s~ons s at icr. at U,21 tV_ Otllher UpehllI nattonri is thm serl[(is tepo ut ntis abitnuts~of s rel lab]. effort of I [sue of day ono si okritesel5153 I ho lt levat or', a1 crtcloin etwoeen 20nil cikoi3Sa or rte Iia ucILator arid npresto inaquet fonrmoual ji- h Lstoayy o f mlo Louio suelonoesu, asatemLrplt lo find effects of motioon nil c-krisse on 10task per rita rie nii d t how the absetrie ciif ai 1rrig ai t I atj ofcJ o1-1:1 f temyrrnpratti ro on sottori31 !knti cuts Isn t he LIoi'nafcrct, Stiu d Is ma of t.h1eolfinairy of ani -unr1-it on ri..cokrionst drugs wereslo inn rde rtikon. 0 1 2' B 4 8 6 7 8

furoi re hrt tboonu otnly rine u)1111 inajour no l Acceleration (ma'-2 rma.)I lahborrr- VCt )lYiI Itcvoart. i qat t.rrint olFho I n Olq rat;Jýl riueIVii~ui il ottn

iteitwuri pbytilcat itlin arsd or.s Inni.ts of cod t'sfiurt in:llttr i oiilrtint ,utii aind sot inn slinkri 'r iii htiuains. Th urn) dunce Witlli acaole ratt I e 1rargnri I.licitr

A ~ ~ ~ ~ ~ ~ ~ ~ o Ica:ia i uei wroirrckŽub tiunWtoe tur f requ encie o 3 lf di stortedH.nriven rch ti-run (up a2, inst(aler by aquran Ftol ned C nsta .crtice1ai mtiori, (Daute from

etilmicepportred by ani iiydtraill motit I oni nyuratv Alxwior tsb197uailiirit- of I,. sirtrtos of v~irit ma I dtifiavresert,1 ii deyjres~i of roil enrl Ii'i dorgjroos of pi c~it (thle axjes totaltioe ware ipprom.i maturl1y 0.4enotre3 1urlow cic ( lterof 4. Llieiii T11031 (I it1 ul tidy uXPisJUcI cgrnnfIS of 21) to 33 subjectst~o easch of 14 oxperinisnlol onirudltiosri Iscolincl nuq ¼rrnuu ragnitmlode of. cent (cat siniusoida Iiiotioii at 0,1)83, 0,167, 07133 arid 0.1500 (0,1 i'lettrio end NiCtsuliry, 1974) , Sealed soubjar.tler111t ci th LAioSr ()ii M 1H.Ocirrrrsi ciiriricr on_,slpciinof. up co 2 (inurei withr rio oxternici c~le'w.

Vnrlcjta tie qrolLeIn~o at-rri fron 01 fililte xlriii hieti l uaiit'uduet flof artls eatiortý hol innriron' t i.'od I to gene d tn Ic cI Ik u .ao~s Iti nqwo Inht i req use is atqn Lu a oh "il r :ucfui Y til cuy mat x cli IIn

meri~titt ity tinrot t70.ori nickrsumci won ticitnI i~ ii hr.f 161 (ltit *The urotho rs proponed a forirt (cfor it urial li: a~nymt ion slckreiai, uncidoacci IMS'11 icer. 2 (tents hasert1 on h~is ititegriil of a o4mcmiwl 1lind.! liii it lridrlr clfro ioll. This writoi calue of rthe I irwil: inn arefiint ted the awccoleroniort

tncqti (red -At cI partti c'iiii Itcol~.uwlttity to ouituniitoa jillý comtrii: Oug(se Seotnt (3err L7 i (nnltw).

t'lCiauu fey of alI YV ( 7) inxtruridiii the Ltii t tot. tudicilu to trifroueiirtlrte] uboccV 0,5$ lie.,canl vlicgl.atd r.0815i0l11a tr . 13 litl anrd in). unito aitnrd exsiruiti d habitusat iotini Ce i'Pt a Sled u it'r

wuit (Ji", 0.6* '1 sari itI tis sowed I Iurii iiiot (cii lo lire ii i mi dormsCIU CoittinrueditI o decrease air the

Va0inm t Intqr ig%i v'10arn~t~ng (%*) ____

900- 2.2 ma~jnrm,s3. go -* 1 h Gaposutite

at) r .,Gi me-, tint. 00 - 2 It axposresie

70o 70 -- Alter 6 day Interval

60 - 60- Allte 6 day Interval

60- 60

40- 40

20 20

10 10

0 1 2 0 4 5 1 2 G 4 bI

Day of exposure Day of exposure

trigur* 2 Ilais 1I tat btui lii two gucuitpi of Frigure 3 (ubitti I cia ci ill ~wii cliinuli ciqutilincAtte expuriurt on I(vs ecarlne ie nubt Jcots expueauc to 1 .2 liz cutrvrt Icuri Itlrtiep exposed Ina 0,25 lIt at: 2,.2 ins r *rna. al tniuoidl m not tort at. 1.3 ins i -ni-, s. onr 6and tle thurr rrrccup exponen t u (1.235 Ilz at. tiornnIt (niir , N~omt.t I rig iiIti~enie shown1.7 sirE' rsin mm (tilati fr-inil W~ailsuy sit sliceir I ti tf nint~lorn eapoautre, Da.ls foiner

ar I (9711, Hurfxuliiy en al.*, t9lt).

3. K

frequency was lircreasec it1 tee accuiet o... a, is1,ýqtil mdk Was iiitcl..ttiijo. -j11 y I jjcI -:1 . t41-) became sick with 0,7' HL ve~rtical, molt:! at-. 55O ms' tins. a.With roil or pitch motion:(at OttO5, 0,230 or 0,345 HY, with miu!'-.,dss of 5.5 to 33.3 deg o'? romss) addted to avert1ical. Motii onftL 1. 25 1 -it 1,.1 n~ rm.ts,3. thle. ircidernvof ut sir~ktess wa s not:

1. Lgtiicsaz.tLI y d Ififfear e jt f ree s ic Ano' e .! thLI thev e'sr t ical motion aloneo. Ni subject vomitedwit~h roll. motion alone (33.3 d5(, , at 0,345 Hz) but two subjects Vomited with thismaynol ute of pitch. 'teauthors infor trhqt the results support the conclusion thatvertic.al mnotion is tile cause of seasickness Ard imply that bract ccc Ion duri:ng vertical.osclillation cay not contribute to sickness.

'three osxerl[mental studies of. huih ituation Vomiting I%)areo reported by McCauley of al (1916) Tb" 100f irst rw-poritscent involved exposilog 20 sal''subjects. an fi~ve occasions to 0.25 INi vertica'l 0.8 -4-cnot itotl at: 2 .2 inn r in. it, 'The sub j-ct s had allpros I eta.). y vomniter) when exposed to ,1e tie Sot Lont. 80 4- 0.25 H7TtheI iiic donce of nict Ion sickness tell doiring 70-tite Fiveg experitlontal sassoions ft rot l5% to 30%. - 0,333 Hz'the soccttr and I: bird experiments wittt siiqhtiyulitfereot exposiures involved ants ii groups of 60' 0160 Hzisa Los and fo! i.t I 'ýSo stid shlowed Ialsmila r 50.habkultAtoo si trot but, after a pecriod of 7daIys wit but co1t Ion, slu:i~ci~pf liiI Ity i ttirntised - 40-t-u'jyetti~nc that: its Inilerval was stificlentito r scuhj i ct nts ro ltise settle protction firosi 30.teclIon slckoleso i'igttre 2 sitawl; that the nitoof liiabtt 'at lri wea- qrnetar in oxpe r tenKn 2 20-(withi 3.3 Inn' , thenl in expotltinict 10-(wit) 2.2 inte -' ýs.na.s) - the autltor~s aitytosted 1-othat tiin lit tyc, lhobrcetiso haitn uij tios Isý rooster r)~-''-'---'-----when tioe atlaiulus Is ttore teuneogenic. DFigure 0 20 40 630 80 100 1203 ahotiws littat the ra

t:o of habituatiott was Exposure timne (minutes)

utrnattlt (In tie f'i s-s hour: of eltporilcilt 2 (21it1.1r exposttri(3 iLicnitn oxpor' litont 3 (1 houreýxposuyesf . "'hos ra~tant io was als.o greater: In tligur. 4 Increase Int the n umiber o7ýaftue (tum xpi cJod to 2 (touot oil' iioto Iottpe d-ty, pm r'tors to have votmited xliii. increasling

Aqiln, the tio.C 'C tiS uqtl!Oi'! ic exaoXPO Strsto-'lt i L duratiott of exile eite. La ted11 t rOqttelitci(Irat-r ~dunte-nof von btAci siinuucidat ntotion. Wets'

itt irear~rhuh suris .frost Mccati itty or al. 19716).

Ii igtr 4 i lititiratn lhu t .hr is i ri theIttuIlkt-t: .k1 Co or1 cItiort rkin.1ch tossnn w ilI I tirt rett'tlttcg du rat ion enfl exposu re toa four rtrtsritienoi orn ofrsilotI ottill r; tpoi- tii bIy M'c-.aule y of (Li I I 1'316) , They retuosi that thet custutative miotionsilctknont Iit Inoiieiittt ektl a ftttctfinn of. expissil o tirne call boeoxpressoei In tories oiý a log norttalIcliii ti but] tie All nmet] ottl is ot~fetuiito expte.its motion ttlckncoot as .t futnctioni itI requoitiry, Ftituc rt t nd expcisitro L ltite (stteiSoctiott 3.,3.1),

thin '- m-t do utjic I loiL itli Fnt'(uititcy r't, snot. let ttickttcus in ,diowti Iti liuiqartt !) For 2. houir-Itpottiii i-I In Vi -I -ite.~ It'~piago o () hus [tniot, I oil . 'liTtr'e dalia show a rtioat dttcrcaso hir rtev"idst[ I itItj I nut iiiets uc' (itodririld by vort ittiI l niunltto cic lcit lorittbitn with Incrcas lnrji tiiusluticyI miii i I2..' 0,'ti lie . VI" uruQ 6t !lir.wt-i Ithat. dt treritiinIino hot~woet 0 .1I)' aend 0, 0 Itie t hoIt1'.1 -tsnt' 1i 11 ussl I Iu iii' 1 -- l'ir'iioe w 1.1 it 11" itir iit lI flict' aq. turl'- ofi t hor mot lots wer' tont i Iy

10 Vo---ri IOU-- -iltn ------ - - ------

rnlit5

r.mn.t.00- 0.55 90 - -'-0.10? HA

-l.i- SO -In

4.44

30uso

2(1-- 20

0 )2 04 00 0.8 1 - 1 i 4 8 aF euny(Hz) Acceisretlon (tns-2 r~me.s)

Frigurile 5 Vat I at Itotn it vosltnitn iq aictidence Friquxe B Variatilon in volisit innl I nic JdetteeWit t.1i iteIri'(~ittii.:y cOt Scti:S anUncr'idi whith the miagnitude iof vertical sintusoidal

nlo],ii tot 2 (oira Ibspoourea to Variouls motion for 2 hour exposuiresi toi varIous""ljtII i]el't t (D:lii lat~a [ruil tMciatily freriuettoiea of motifon . Utat:a frrom. ¶lal,!T/) McCauley elt at. 1976t,

3-9

linear, 'Tie iidlil-!r ins which voalt]tilg incidence varied with buth the ntagiLtude ar;.h thefrequency of vertical sinusoidal motion is shown in three-dimensional form in Figure 7.

Inoidence of vomtling (%)Guignard and McCauley (1982)

investigated the effect of addingharmonics (at 0.33 or 0.50 hiz) to afundamental frequency of 0.17 Hz verticalsinusoidal oscillation. The authorsreport no statistically significantdifference in the incidence of vcmitingptudu~..d by the five conditions studied, 0The motion sickness incidence varied from50 to 78% in the five conditions and are 40reasonably consistent with predictions of40 to 58% using the motion sickness dosevalue procedure defined in Section 3.3.3. 14 II

While studies with artificial stimulihave involved sinusoldal and pseudo- 0,08 al,1 0.16 0,20 0,.5 0,83 0,42 0,6 0,6 0.7

sinusoiddl stimuli, several investigations Frequency (Hz)have been performed with reproductions ofrecorded motions from versels. For Figure 7 Variation in vomiting incidenceoxAmple, Malone (1981) and Anderson et al with the frequency and the magnitude of

(1984) summarise results obtained with vertical sinusoidal mctlon for _2 hourreproductionj of motions predicted for a exposures. (Figure derived from Grirflfnsurface effect ship travelling at various 1990).ape eds.

3.Si Animal studiesSjbberg (1931) made dogs motion sick using vertical oscitlatton getierated by a seustaw

arrangoment, an elevator and a crane, Studles were alno undertaken with human subjects(aste I tiberg, 1968). After trying a four-pole swing ind a complex turntable givingcontinuous rotation and pitch oscillation, do Wit (1957) found that: vertlcal csccilat.loliof 'egn in a cage euspendod by a spring (0,33 I-hz, 2,5 metre oxcuusion,1 4 Illsm'r ll,) Wesmorc effective in causing sickness in dogs. Exposures of 20 minutes were s8inticienlt tocause sickness,

Using a scans of, ostcillating cats vertn toally, McCabe and dilingha (1964) woere ib.hto cause siclkness in all anhtnals with en approximately sinusoidol accrLelartion of about 4mia ; ,•"s, . (frequency unknown) , There was no apparent di f oretince ii siLckneesi between thosefree to move, those who rested the]r heads en the floor and those whose heads wore fixedby a 'tooth bar'.

Suri et al (19719) reported that 0,65 1Hz vurtical sinusoidal sciliatiuou at 4.3 In;'

rm~s. produced sickness inI catst 22% vomisited wi.thln 20 minutes, Boriso oir l otniI t(1986) produced sickness in cats w)th 3.5 msat ra,.s vertical osd1ltation st Ahoul 0,5 liz,

Twenty ui nutes vertical silnusoidal 0,6 IcZ oscillation at 3 Mi n rm ,, has also been showsto produce vomItitng in cats (Fox ot al, 1987) . These authors found that thLs frequency cioscillation with a displacoment of 0, j1metrsa (2.,,! mis ;' rut,s.) also caused vumilting,

Usilig vertical sinusoldal osc)llation it1 tlIe r.nltqc 0,17 to 0.3'3 itz, wii-h ackc:ehratiuntiiI n the ratige 0,23 to i . 3 ins- t'its,, W.lpi zeski VI a I ( 1 'Ta) fuenid 'qt i [rr m1l01kr-'tir tn uilstllnt tin motion si0!ti ,,.1, t 1 tI lhonkeys] 1 ti(liy f;Lt'.ie)I)t Itle. to) nit lt toll o, il aterL(ccl axis, only 1 vomited whein exp:qntlteho y' r tata c[te) tletn'e. fliTh. oilier! wi-rI,oxposeid to 2 hours pet day for up to I0 daysj without 1igm ii of snicktens . Wi pl z-ski et i 1( lt31b) report that vort.tcýal s niumnutoid l d ,tiaci i t. t ait 0,2 (hi lItuugh ,'l din(ilf'+, lI t 'ni ,t

2,1)0 metresmsIe . ,Ilt,) p'roduced iAkli'htlOsl i only tea iqiuiutitle ioriket'ys t withil tW.

The house imuik shrew appsailrs .+ tie leas auscLpt ible to rotl, oni ,i c•tkies: with verticoiosci[lolatio than htoritintal carti'.ittlon (Kai, et: ai, 1990), I'Lfileeti llimo1ta VxpioSiU!a ioLrequencites between 0,25 and 2,0 Hz with a di placeilsts of 40 Isis reslilted isr . t.l]e or lilOvusiitl'ig at 0.25, 0.' and 2 Its, but signi.flcarn: problems with I iii veALtcaJ ost:ct atkline,Nevertheless, the overall effect was less then with 5 Ininutu exp-,sras to slhtnl tatmagnitudes of horizonital oeachilatboln (see flect In '1.2).

3.2 HUxizontal osillatiaonAnty suostantLlal studles of tihe extont t.o which horlztrectal oi:i 1st]ot 01 huotans caulesj

siotiJon sirkness have yet to be publi abed. It has bueeni report ,d LIla' the house musk ihrew(Seceun niULinuie) caii be made to vomit by 5 inorlnte exposures to horlzmnitaL onic]•[atbit of25 stm dinpleceinent at 0,5, 1.0, 2,0 and 3,0 111 Ueno eat. ad, (988) , About 20% of aitim'.L.-voultetd at 0,5 Oz while 65% to 80% vomited at tie three higher Wirtqhenc a, i 1i (Isuacnllaui~t, a sliliilar purcentage vomited when tl-, asuIcLatlion :spiaceomentt was reduced iU10 mm but aii an iials vomited when the dispiacuniemti was increased to 40 ma, tt hfert waq a ''thabituat Ion to motieon with rapeeced exposures anId nsome dretgs aerm found to teduce s.otLi,,snicknessn in thin anmlaels, Other :itud les showed that with a displacemnent of 40 sin ind atrequenrcy of I tIw, the house tasPn shrew was cmittilarly aiffcted by fot.et'luld-aft mciliet,lateral motion and a circular motion (formed from the stirtusation of the otller mtatlons witha 90 degree phase shift:) . The anliel was more susceptlb.pc to horizontal esmclitit lon thasVerfI- I l o :)JItaLtnto (KiJi ef al, 1990).

. x ,.- ,n!J., 4.tQ', 4't

3- W

3.3 Standards for evaluating translational oscillationALI cururent etandair tie ory ovoluatin i no ot ton with r'sorrcet:l 10 tit tr ICKlIOCli -31

restiricted to the asasesseer. of von-t jol Ott i.l Iat ion occujr r'tri in ,ur zi-ox is of thte bodly(e.All fihe rientr-to-hend Or' foot -t' c-hood ixtIs) .i rinco i:r ttislttiiioncral tnr*d ii it Itor in cubt~l

axes, Cooit tetrouo rotot tori (wl tii or without- head iw -veownta,) , oosrlar. Irhe Vi trodt 3 'rleetc. cart cause motiror si,'knosq It. ehOlol 1tot he arterimed hovt the uric o(f heieo oten~lairde isýa sufficient mieants Cit prellii rI Iq rtimluso ritkotes rIna ti cuivirorrrnttcrte. 11t iAs trit. ele-ar,wh ith environmeants can be aerir'asu0 a tr these ci artdtrds but they oire main]ly applied toboeto arid ships.

3.3.1 McCauley et al studiesFrom the results of laboratory studltee of rmotionr sicknaerri causeed by vai -11r20A1a

ocillation, a series of formulae tot predlicting notion sickness incidence ISf) wtorepropolieo by 0' llanion and McCauley (19'74), MrcCauloty anti Kenneidy (19316) irA, I'rutautny Lt. al(1076) . The method applies to motion Io tire frequeinoy range 0,08 to 0,63 H7 il. tt mraximrumerie .1-ivi ty to accoieratfon at ahoot: 0. 16 11-c. The a'issrepf on t'hut MflI wi . very .41 h

acceleration and with tirme In ogivat tors (i.e-. a curiulativer toriral diet rtbthiosrn( resul tedAin bomiwhhar complex mathemratical. operations. [lot' cin qit .. ktwior itroidence (MINS 1 cxprearaodais a pretgIs assiumed to bu the product of a terrr ir.pieleot~i eg thcr I rfltrner ofriotiton ilagrtitrrde arrd frequency, P,, endl a to 'itt expresaing thbe ofet et of, mtotion duirailon,

M"1 1 170 P1 PT,

'The tarts 1P. in caicuici 'sd ftoer a ~erilt, ztm qoanti tyi ng the etffect ct mflqsitudo and t reCqrilncyarid a toerm dericribieg tliii fotrm of a c~uxulattyc liormati d;.et ribt. torthltl Lin pracLi-ju tsites. sta~yhe obt aiErred froum statijr.toutl teibA ccl ,The 'iffort, of: magnItude arrd ft cifuoticy wan doterm ifnodI'' rm a aurse doenrileting 1.[th accrr (rita: i er retquiu toOI C producei ioreltmg atit. viarlAottltttt(ciCOlerti Itt 571% of porsotrin do r iny iwo (torir expwirilresl

L-2.1,3 og,,rl12 i~il 5.81 (iog,,f'l. ii

Whero 1 ire fHie r *nire a1cocierstion in q/ f is the treqoency En Hy.. Tho tiorit Iii isjouetite ueif urt to give a? voiceo tot ;fr

Where 1: 1.8 the eopowsit c titele in 111.1frtotee

Valuna cit Ph arid 11r Itt out) ')t. 1 frie byIcoiief iin taboi cir. of ir rnormttel. dovi.t'o v, coeleroflson (m.9' tm. e.

-it the valirrin if '.,~ end e re.spect fcc ty.1,- 10 'rl illi~p In, aN. Ii.b a 61) isnr *. 71. xporiti re to &I -ac-Irrydoo: toe 'atf 2,) Irisl I rrifIo. 0.21 q

r*,t.,verticlc s1winraindejI rmotions at. 12]I;?, z., - 0.19 aInds. 1 J'( tnlro i', "- 0.5't, aridP:. -- 0.81 Yiv irq i (It ''ti tied IttI' Intill lltk e'r-I rtr'dc'nc" cit 46%,

3,3.2 International Sitandarid 2621 Wart. 3 10 - miln----(I1.35)

Prý, I 'I I, I n rt itatd ru ct :1l a ittItt.q t. Itt I ' I"tit-' , F o 11 ellrA. ( trI , i ý l ia it t I t11 1 I ie( 2 housl 8 --

17,1l' I),,A t t, ý . I l6 ] oIiV. 'CI I r t 1,1 t -' 111)1T I w I dert lit Ll If tal, i.tiitt fin : It. I 10.7 ot

ote nidinrq t It. Vttliit tllet oielt 10.l titii t; " Ii rrtti, 8 hotira * -t-11t.10 NOcuY, ail 8 11 ex)'orutr'. '1'ttestaqrt.tllonlci ettd drrr'ei uns are Ln art Anvriet.i.3neiquine t:l jult ir'. rit (p eci flt'' It A i tttitjtt It tiilr'ttot 2 tutoirs ire double t:. 'ci o frii st0 ci. 0.1''ll, - trtsct'u Iutulids. I i t :,II t r~~ Ei- If 10,V"1tttt I , opl In 0.01 0.11'11 tIn lln lttt ji ;`S h, i It Andit 8 lu ýio'ttr : art sown Alll."i' 3lire rt * 'bertIt . it~y Io tjl!InAkiiri ti1 lti Frequenny (Hz)q.'cafieet. trot ,li 010t 0.315 IN', [irist I at F~igure 8 Maqrit odes vit ye t]I cal 'iz-a xisItii'titrn t.fr nquertu L es Fio t.hat1. avccete I irt (tilt n ec i -'I tadtiort eXPrcted 1_t centrMc 10% Anirrotiencrnay lit ut.itt aceqe fred it' pr odiwi le aInk e cart at vm~n neparo f3 iue,ý81,6 Ic7 are 31.15 t ienet gonteir thinir t~hose Nofl cumn ii tei~ ltcs~tiOau r6 hof 11 s lutes, 2iI i'tl~niro' 1.0 produce nrlrckr'css at. 0. 31Slr [.Incld tlo nttrs artd, tar .it.Ively, rd 2bi Piaiortl riat loweo re enl', The rcontente cit this (toiter nat i 0Ia I Organize I:ionl for11 oti r 01.d wesI e fi refs publ i. s hed usn Adde ndust 2 it flo tl I i a Ll. nt, I1)115

toU.K 2631 in 1982.

Gel n Acceleration (ma-2 r.m.6o) ___

S- asymptolin weighting

-realisoble weighting8$ (3841

40 %

20 %

01: 0

160 2031 Pt 310%~

Frequanoy (Hz) irrequenoy (i.

Figure 0 F~requencoy weighttlog W, tis &tFLned rigure 10 Voo..cani. z-uraitn oonci llt1aiAmiii British stai'datd 6(11 (19611. (Graph expect'ed t.o callse 1 0%, 2C% Prod 410%nhow,. 138.1qritý .1Line as uryrrIp t f) I ( Ircideolci of voinit:n dulyritn. o 2 h oxpoaurcIonapproxinat.Jtmi.ý' I- t 1hao I I ucaI.at. r~id a cora rd i riq to 13tr it I1s St~andarrd 634 1.v!,*i I 13301.1e wet ghtriny dio r Ieti ky Itle incidetnce will doubt e !L' manlrit ode fiHLAl ld ir'f Foi: 31.338 1i1 Iti3113 prta31101ti,3rin). double at81 nxpo X~30no dura tri.ron is Lnriealrl',

hy a Earitor of' four.

3.3.3 Br~itish Standard 6841. (1987)Britlish Gtanct...d 6041 (198'1) duresici a 'lotin.o toi ocknoerr dcls value', MI3DV, Latr".t no3

a frnequmno1(.y we .itI133 (ie. 0.I f3iltur)'i 83d a t:1l 3111iopLdrrdInu . "to f301'.~ requencywtalghtit q, WIT, can fie lroprrln.initd by im a13ymIplot 1 approxirrintlco haiv ing all afttenuat )Ifwhiroh y r lem with frequency At I6, 0, and -IP.:'it per ou Lavo , Table 13 1.1 ~at Lh at L rLoiuat iriii,of tihir;asnymptotic approx~imationr an3d Ilytrre 9 coilparae ttii malymptot;,Lo -ird reur.Itirirlpefrequency we (ghtriqnc, "' hi ertalidard fully clofilo 3313 he con3311 lable wel gtI rtg tot-Imp Ioveiot a tic n by a ourlogtio o3: fiqt.ia.i tI.ern~, T'he qreatntoiit 3303,1 ot 1vity to accolllritt (un.1,3 ], then rangeqi 0,1P5 tou 0.25 It., WWIh a rapid todircit.orn .0in ll~ Icmt iv ty at. higherfrequonulos 08 he 13gX108LtrC do rittion, t roeocridul, andt thr3 [1 rcqU(Jay wcniifjit rid ( 11J1300korot ion, a,,,, iWrco' 1.333., many ho3 iised to :omrputo 0h m.33rot. lon sickreonr d11311 vaurnho

The1. iare tertage of uondapt-odal uroita wh~o haty vomit i.e ItIhen gi von byt

ill10C~t :~.la ( 111 Who may1 vol 11ii -, 1/, 3.1S)V,lti:1 relation La1 blindc on uxpo'itrro.nr Lar11t1111 Li~ aO r ihoit 2t0 i.Ein to abon-. 6; 11 with .rpruiveloerre of: vomit~ing Lip to '10%. * Iiqtro 10. 8ho)wr tile preddmnrod maj~ tpituoll of vert ii:,osncil lation iequrirind for 101,3 20'(. rind 403% ul pIr1troolu Ic, voitilt 3witIn:13 2 htiolrv,

w I i3 t~re mot1. 03 ar n,1:ktlearr Ii n:!I 1c'rrnce (MS I ) Irvfttlýd mllI.3i3 t Jnod L.3 Ie.t1 t ori .1:1. 1 . 1It wom1 ii,.wrthllt IthElO 1qolririnv WE. ght: 11111!1 WeIn e13 :f3 11itI11,I1n' that L.3ho dnmll'on,13,10o3 111l 831 1 1 ml 'I, I If,,I1t1i13111 t nlrde arid duta Ira r L im mo1l,[t 1133 WOI :3 f

trI tarI. tfo, vIlugli dll 1111t. k~ip,I Ibollrt III3 .13 ' .11 1. and1to ill '11 ini lip3 t I , > 1 .?r llt 63 1,31131

I 13"15 ']if,) fil tvr cga.if of friujuefiCV "y w lytl. 111 Wg Useigd ffor 1aM : rrri. Ig ly V k I a0003' t.331tlii wltlhtmutr 1331110 3,1 ilt.o n31lickrio.4ml am1 dcivfird iry lfl: itt I sr1-inidardt 8,91311967)1 ( Values shrowni A111 103 Life afllyrllptot Ic .134300w mat:1113tiit o3 Vimnivi 3.3311

Wriu~lny, lIN, 0. 100 1 T0 0.3 Oh7O 1.3 0 o7-(, 3711 0.0 )i.

1.10111~i001 0,813 1,1 1.100 10,00:0 E1.0113 "T 11. 7 131 O

4. OSCILLATION ON SWINGS

Vetr Iniousi I vl3Vs tlIgat31 I o 3llV'13- dlli~ldid that %.he rmlons.i ofl 31 :wi.r-n may 13e a 11031V313leilt13183111iii of elerattn moug r 1111.01 0103083. 'iwo princi pal calt(310 3133 of aw.t ig have beer,1 urredi 3I)liroie secunred 10 1 Lirt. tire pLatort 313 sIPPU;.. t 337- 1 ht. hbonY 0Wligri5 F,3 a !3[110 ltjpenlLI 133311133 3d(ccL1.-108 cIritdOL the a311'lo of: tile aptil ted fotcea (e.g. 2 pole 13winrg.) and (il) parallelr9wilign whlich are Locoed at eIthei 'v331 so thrat they rei31313 trot .izoita 1 131 rigy swinrging (e .g.I pole swinqu)r . Pflgure 11 ill untrateir typical 2-poLI' and 4-pole Swinge. T'ito motions0rroxpenricineod by obeiervere on the awitil are different-min 3 the two 0338831 ant] 318.31103 i.31dr1.r1a unidi rectional trarrslational accelerat. Ion. For d simple swling of rauluir v, the u1iting

J I

WhereI q i~s rho1c ac'!eturctrniiim duo to Irciv 1Ay (9,t01 iris

0n5 I iWopoi I.cnw i rig It: eei19 heassiumed that: thu e irtijoIi I: I I.s WIfith rho plIatfort:ila~lt-hough tti.b may rlat. be trueC ioi~ thu bueId Ullii ns it. In r.Lurttaiiiod by at hedesThesubject iii oxposrrd to rotcit-ionat. ilcctolratiitii at thu awrirrg frequency iii add] 1'ioh totrarenlat(ioria I accelortrrIioe. In tho abifrinrire of niochlanlcal IMirpor fecrcons, Like icoiuoratLort1pairallel i~o the plat-foiii (bilt Lho x- or y-axisi of a seared ioubiect.) i~s zurir since thr.a''ceteraiftiot Inl thii li roctAIon fni oqtit antd ottio:'tito to -be, acteul orat ton comp . onet, duo tograv it y atis Inrg rout the t i trigq or' I.ic ho 2).13.toti. 'The iic~o I rti: [Lott pcr(iorpclcuat: to iii'plat-formIin (i-ti 'so-axsi ,I' a seated stihbjettt isl pri'(mat .1 y 'huto to theO 'iltih a iolorttiIi it.aIweays aIcts 1ii thIl post Itivo dii oc t t.oe (keofti og 1'11' rillI P ten onlI the ;ist fois iidosctiatos ait tltice tile froquorrc:y of ttiutt witig.

or, a tooi:-pois liwirg rio pist fortsurea Itilf ho ci .:oei ~at arnd i~t. iulmi ho tsuriulm)I1:haft L h (in 1 subject neitia J.e1n . in t Iil o fauteorioiittiti-oit t-rotighortilt? 1'iOar of swingi flf(alt bough Inl (2 ot. .ica h hia say riot be t.hot

case wi tiiout hued restraliiiti . 'Thorn IsI:tierefo re n0 tcttatloriiit E.'ce Lerat-Im tr, Illthre (tori sorith at direct ion (i . e. pa raYlotl toti-'I' lit [fnitS and tin the x- or: y-axis of aiseat~ed iiutjuct:I ther is IIs)L0 itgiriloant(14racornI erat iloc witIicii iis floei-s InuitEoli al I, 'file Two pole swing Four polesew~ngv (If i ca I tio~thon I s a .1 s3orioa:i s3dcI

Figure 11 t)i ags.aiiiat Ic 1.1 jlao ire o of 2-(inpol is oi Snirino ctudivi' dou riot polo sod 4-pcl to w irngni

clearly describe tho f.ormn ct wng u n sodanld it1.:il cV irti a] ways rie co r.rect. tcccairnulattthe so 11t ions expel i oriccic by siiibjoi.-t if btiect On ic c1t: egOAjr i tlatitort 0rid 1.t11'mniti11t bitp ttciijlt.ud holow,

Ilttid icim Ill rawilog t Irao Wuren coiidt IcuýI t c fori two Ilisa 01 pi t:pottt'C. ifI to cfi 5055is it hu fuct ivuensa or- drugs or ilovitto a (:oocitdurir ttct: oi lt.it tiit.1tj lstiveupt U.:( poritStiS wititti hn IigIXoCl cood tet till I Itay aurv~i 'to A la-zw situdio (iS v (tmeoiigitt Ito det~oltiltito t.h 11 utbeof t.1tieIA/fin lit) I d "ct I r ot t ot f ittor cit. oli iiiotu iott nl oh totoiti

4.1 Two pa1e swings

JaW11. awin 0Iot bItj .IuijrUoctti Ih'stbtigwey Ii9'I, b1946)1 Iticotctaijated riot.ios sicknrots In stir. INtttri)upti of .x 1s ortij jitd a ootil: rot group dorn rg 20 rtt itlev nxottflittI'i Ill the ,!olit rol group'Y0. oectttmt ItI I arid 24 ., o t titone votti teId. Amongq uirie g toutpl oft a]ic low known t.o hit,

tqit Forliri ft ol mot tort sic-kness Otrero woet o9 'iit) ttf 1 LI1 wit tt 3117. It, 6511 oi tit'25u voirliti II .-'r t(mc 201 titr~itti en. T'he r1/ !hitimi cIi en in tit crow riot. r~ultilltn I ric frtom riot101t,101t1 ~

lWow cit i i ott- It itor. I wt'I Wictlit It11. t" t P.0 V '11ch1in l ( - tiit Is', In it It hir, no ic

wi ittd vi raiitr !11111r i( .29 iotrtt iqiciteg,1 a I rtytec oaoti"'ui',J C,2.-il') ('It "id lo swiltil ac:A 11t ý .i~u

wit.il l tb - lttit t wt-p iee ,[) Lioln t It W1-1r1 u a "t 1irth I~ - 1 i t n'j cttp i'ri cit 1 Ii 'It 1)'1 cillc' r u' .0t :1wil t II ib Stlm '.~tte fltilt t.110 11 tttý Itici ii t ite : tit out httill-1~ y o14f nvit . p t iloti ilie lyl'sy (ctr'tI c~)l d id

tatt yptIll I m'tyI~ ciikoimno ~tti r vi-taiod Ii ,i -t Il by ie'1'iltn'in: d"Inton Ill Pvt),IT~Il, t'I -111- wt i I V i ov10 I,- Itc 'it Iw , . ltrV' ti os i i inaI tls mt i' ft'iIot i

t't il ITVO Itq ot:tiii. I ci hr lii I~i t icpt m I: le mini lt I, i~i -. dinrwi, oit w~ I I e -iinw y I wI WIi itlm q'i I ,(i k i tI.1tw an~ 110 it' d - idetit t o I tittlitittiiai( .1y,1-uT~ttit o1h 'Liti1 rt aip l 4lest: t r itet sll W al 1 111iti' t 'i I

wc itt . 'ci cwi hirt 'ill bi t fto rk I eidii t ott ':tI' c o ii r it yli itet o: a't~ im i rit r ilriti t't( ul nwt 7 t it itt

6n9 1 ...t I Iil os, cI t I- (fitt~ riatic in ot derý2ict III rtao isec st id ct'.tiii-I vi tii( 5ii toni 'tt( I ii im l i:,

WliVttll :% 'I ),),i; 'lrjttj i el/ W('t - imoti an boragh tlie~ raditic t W itlrlil~ 5 t' wolie meit pi'ilar

nyI(t cil wa cstioWhentoil by short 2,O imetes IImitt ejl rig .arid Si ciwa f ew. lt rIhol I Ii TI I "tai l :I I'trenIII

ttI rit. it I iliti I~ y qI-ti- t Iiect oi i m whe Ilt -ir ditig " .'tir to t hors 011 1 onht l c ha !YI n tir 'riir"d Itm t 1 ('1 W1 1

:III-IIl 1 )]11 111y cotk lm 1 11 I 'SlIIIti 11 .1 :t(1t -. A.2 h t ' ol a 1"). )~ i

3-13

:;ý inlq. :t •]1l'•:; I tIh ' ' i,!ot,, i or[, t[ I,,-' :; I i "ln i ' I - ] Iýý a I I' lh !; W ith 1 -P ;•p I" - I h • i '' I

.'I m 'tl* i - 11 -;''v i'k I , minW ;I) ".t ' s t•.g W¢IWOI) ,.1"c o'l' It V,- 1"1t'•: 1-11.1; ,lt 1 t inq] it) tho pl.1no of IH tlio"

vertical semicircular canals".' They recommended the supine pozilIon, or any other: positionin which the 'vertical canals' are horizontal, for the transportation of air-borne troops,

Uting a iwo-pole swing, Fraser and Mannitng (1950) systematically Investigated theeffect of swing radius and swing angle on motion sickness in seated men during 30 minuteexposures. With a 90 degree angle of oscillatlon, increasing the swing radius fros 1.8metres (giving a swing frequency of about 0.37 1-1) to 3 metros (a swing frequency of about0.28 I-z) increased the number of men with signs and symptoms of sickness from 4% to 501,A turther increase in the swing radius to 4,9 metres (-0.25 HI) increased the sol:oness rateslightly further to 58%. With a 3 metro radius (a swing frequency of 0.28 Ftz), inct(easirtg(he tugle of swing from 50 to 90 degrees Increased the incidence of sickness from 22% to50% while increasing the swing angle further to 130 degrees only produced sickness in 46%,'Tlhe authors give some consideration to the accelerationts received by subjects ont the swingarid conclude that rotational acceleration was not Important since sickness increased whenrotational acceleration decreased as the radius of the swing was increased. 'They concludethat the 'tangential' component of acceleration rather than the vertical acceoleration mayhe necessary for Siokness, or that at least two forms of motion ire necteesary for sickness.Using a simlple owing with a radius of 4,6 mLetres swinging through 70 degrees at a frequencyof 0.26 tiz, Nitnson at al (1951) found that the greatest incidence of sIckness occurredaemong subjects making the greatest head movements.

Other studies have been conducted ont swings of various types. For example, Babkin etad. (1946) produced mnotion sickness in dogs using a swing with a radius of 2,4 metres whilhswung through about "70 digrees at 0.33 Hz. This was reported to produce definite signs ofmorion sickness in about 609. of dogs tested; the use of a shorter swing radius produced alower -Incidence of sickness, Babklin and Bornstion (1943) had earlier found that bilateraliabyrtnthoctomy abolished symptomls of sui.kness in) two dogs previously susceptible to owingsickness, Johnson (1951) reports that fIve dogs who all vomited on a swing within 30miniut ites did not totl t when their heads were fixed, Chitan arid Plotrlk off (t953) fourtd nitthtusing it owing with o radius of 4,3 metres (a swing frequency of about 0.25 Hz) with a voingcrc of 120 degrees, 60% of dogs vomited within 30 mittutes artd 25% off men vomited in 20trltlttte, Some drugs were able to reduce the Incidence of vomiting. Wang and Chinn (1954)tietd the sanmte metionr and showed ,a conniddorabi.o reduction itn vostIlting among doqs aftr theauctrgical removal of r:heir 'cheittoceptl.ve emetic trirgger zott'

Money and pIrlOdborg (1964) produced votoiLing .In rentrained dogs atanoing on a two-poloswing of radius 4,1 metres swinging through a '10 degree arc at 0.25 Hz. Of 57 dlogs tested,17 vosnited w th.ln 25 intadtLtes In thelr initial teat and 16 of these vontiLed within 25minttes during three subsequent ftists. Surgical procedures to itlactLivate the semi-circularcotials while ieavring the otol.itha inlact, greatly reduced tho ausceptlibility of tlhe dogsto motion sickniess on tile awing Later investigations with dogs involved surgtccl removalof the astipullao, toe utr~nl.a atd the tsacculo (Money and Chioong, 1983) . The same two-poloewilht tost restllted J1n seven out of ,nltght. dogs vomiting within 25 rIti.nLtes '•ot four separateoccaslons prior to the operation. Following surgery none of the dogs vomited during theswinIg test , Th-o ellsetic respon1se to sontie drugs was also greatly dirllnished by the surgicalretnoval of tie vestibular system,

Usllug a two.pole swing w(th a radius oLi 3.7 met-res osc. ilst-Ing through art arc of 90degeroon, Uramptolr and Dauntoni (1983) produced motion sickness in cats within a clearplastic bno, Mean duratiotts before retochildg or vomltting are givain as approximately 16vi nutes. toti.)auon et ad (1984) reprirt experitments in cats exposed to various motiont sIrcliuding those generated by a iwo-pole swing with a radius of 1.8 metres swinging out

itltlt 60 dog re rs with a ftrequettcy of 0,317 Ilz arid a vert0ical. displacement of 0.9 met •r.TIlli awlttg wan placttd witl.tii a stat. iitit y il.uttinatred bto so that. during switugi rig there wastraib) itcti vi.sual and vestibilat riciieu1lat ion, St itiulati.on by vitisal movemSent only wasprocvidod by swlinging the box (0.25 li.z, 6Ii degreres) over thr stati)onsry animal.s, With tLieceintbioil visual and vest lbttl.ar dtillilal. ion, 25% Of cats vomlited whereas only 10% vomiterlw I t I t Io ulit ll Ell imultit. Iott al nir, (:oi lechl iont ll) ,

It1 i-;.ttuniat Iotu with the trall].,.ttiotial studites reported Inl Sectioni 3 It catn be shownI Itll t hIoI ablovi swong atdn cil as with tie•+t. eotad peatriont htvey prodruced a groa tot hienidence of

itt- lI I -kiesr titan would be predicted frosm the it-axis accolerat ion ( i e. rad alict:uh ilttat iont prodtiod by a combiltation of centripetal ar:celeratlon and a jrt-avittiiioal

.."111p,1I'lt ) . (,'wo--pole iwirign produce Z--cais accei-.ratloni of seatned sub.(ect-s at twice theowing freqetincy so, for this axis, the frequencies quoted in the text above should bediolltltr.) - I'liT Weal yan Univer•sty satudles and the Humiunt Factor Research Incr studies

ti'uw,,-hl (l nlotkieel- • tic.ildence decreased with incrueaslng frequency. In order Lo obtatnIi:kI, nu (t lc idenlce of 50% within 30 minutes, the z-axis accelcrar.1Ion would need to be

-jr'-aii, than that Occtirring in the above studies. This could be achieved with larger,inlot!t -tf ewieq arid lower trequeno las of swiag - both difficult to achieve, F'or exasple,th i mtitt, t Hirknoss done value procedure indicates that a freqguency-weighted acce Lerattlon",I t.1 Iti tt I . wtritt would bhe requtired ill older to achilevei 50% vosi.t i t n i 30 minutes, Thl I a

WtiUld t -gulrc ,k clitgery. tiwlng than has been used in the sttdlest a taditis of 15,9 in.tets(ow Ltrigig at. 0. 1-25 l, so an Lo give a z-axis accelerat ion at 0,25 Hz) wlt.h an angle ofnw iq tt ot ...ulti 145 deglrees would be needed, It Saeetis ressona'Io e.o conclude that A-axis"! - lat II)iti! "tI itt'W l'atLion are not alone the cause of wickutesa on twu-pole swIngs,

Ftl ,it •'tnll rcmii- ralintd to a two-pole swing, the only other motion is the rt at .ioealIci lat I oi, ThItoe Itttli t.udes ot toll (or pitch) oscillation used in the swing t-tudles are

larger t tan t hote lound toc produce onLy minor motion sickness in the McCauley et al (1976)

. . = = = . . . . . . . . . . . . .

3-14

I .I~n -'-o It Ito I- :;I e, -I tI tNt -tot II . I ft

seesaw was not affected by tlieo annA io of oil no -,IItt.tition of op tc 25 de rnotellt (It Wallassumoed t:hat th11 ve r.t ica I notiAon, notr Lire p.It ch not i on, in fItire seesaw act.s toapofrir Lb e foiritI kna'iserr - pcassAb)ty booauair' thle gJrrolq- I i CsaItni I and i-i1 cit nretr orntiIII it- rItild st. lid ion' ft .I,1 leval o r Cont fi rtnoed that Icart ICal toot.leo -1 coocrn'n mot. loft El0 cklor'Ia) I t- therefore rcttrrontl~y

inomsns it u nce rtroin oh ich characterlstlcs of rhe not. loon (on toe-polo awno I nqn ar p rfitnril15reffotfoslble for clcknnrcto Icee. tiect ort 4.2 tel owl

4.2 Parallel swingsA serlas of stunle IOn f dregs foot prevetitiig rootloot scki ekss Iin dogti and tarl want

rtottdvccid on n porrn lid awing orf rtoniltro 4,4 ttet trt qjivlg nj n fterqueoncy of- uros-liatlor titf theltorc--arrd-'tt axis of t 0.25 Ic. (Nabohi, 1945,a, 19451,,, 1946, 1 fi48j . The heodoi t of le mnot troro~1). ,tlnotroof abhtvo thne ntw Iitt t rs.cirdr rductst and tree well-! tirade s ick b o1tgieL-itt nrtgt 90 deniroet angiles bctwionet 55% and 60% of 369 mori vomtited Lnth i n'soofrae of 30 mnrlttteaxpntitron Leo thin motiont *It Wart totted that, looser dtfgtoi OF noing oere sufficient toCautin' VomtnintgIt amtotrg c-ite. trtrn0 tircjt ie1 doayt rind tree. Mt titht tft (of t on tinrtncop~tb ti menritvoini ted l'notn the olctoer two wtetre very' taisoat'di wobo exposed to 30 degyree swivns Willt artice rage ti[ntr to n'omitirng of 14,5 tot ~t;to comiptared toI M e 1.5ttilttnt wI ith tjte 90 dt-tor'e. ff0Illtr

Johitsric cad TIay lor I1961) fom~parteri tire a to1nos yottnjto rat ad by 2-pete an cr '-p0 e row If s- bethl howlitg a rad~irir Of- 4.*6 01t (to the heads of atrh-joots( , ore rtno (laoti(ot frnreq teny of0.2 211ti. anid a 50110 arc of "to deqrncea, Usintg 9300 yotttnra 11Ic, crubjocts flacl on tito HIic tort Iorot. twitirf (no as too Produte) intlootirrn the foro-and-afl axfis anti LIP to Ilix ntilittifittt of nrltn toriI. bony invotlriatad tire differences between the colenga, fire, effe~tcts tof H.81.110 the itoiani rittdthe effect% of cloning the eyesa. NItP grer rotti percottaoge nrt sickness :,ytsptointtatO 'no stlthOleo inootri fto and tito oyesrt oe (itcalI35% feli 111 off tite 2-pocrI aotffn and 207. fult it1 1. nil lteh4-polo tswlng) . Resrtric~t inn the Itead, opeit. not rho ey-on, or nottlt racicoci ict ong Htio h.,-:d anirtipetting thle yerretsulted fit a ~omaI nierab~ inp-erntjiseto Litti ntkttass tint I nioco lor hot.),o rot ttqo'['h c ut hor to or. t Atdad thai t: nkto-o oft weao cat nor niy iv '' ,'totngt tO- CIIý. 1 a to J rt lft toS t f ft; to otntltftft'ffftrt nod trlon'efitetf of firo hiotid'" VToe Loiater i CII tn ff'oct ott. viýIiof (tor 00 at I. r lbrilrod to'-ttttlreitm brolnff abltf to usico riqlit to ttsslsi Itt LI-o itairttanatton oI ri rotnorirfy head. TheoOctcurreonce of tip to '1% siokirntaof wt- rho heatd fixedo warte t rlibtrori to Iertniop IniteIttnoobiiisnatlon of the head.

4.3 Other devicessA floorrist whee~l olvirte bat' benor urrnod t.0 ptloroko! itt0triOtt f tc-kitntt Itt tcclri iflnfotmtolof atit'i

llotto , 1985; Peaox adt intl' 911 fi1f00t andt trlffiptcoit, I 961,I( .tnttn rt al tfi Cranilptoti aittiUr10tet, 19911 , (lal-ri Wore P3ini aen Nr Or ci oar -runes ohich'l hnrnq l-tt 0 eifithe efld of 1Faicolttin0 rotatved about. a ot i icoitical I xi iijttfsi tarotjq' t ViI-frl 'Vitoe tjo.j.ijr ftlir aIQ1tto owoti t o o)ffr0LtAOtti to thi-t pci ff1 of tfupartt(iI[ott Of taclt Ito)X Wait (1,445 lto. CrOftI ttttttftN Irtll n1t 01 f tiff-'froirte caurnoti iteo otticpneitailot of. nCttf ibox to0 rttev'o itt a vont'o -Itntn'ko] i' W It f1t ho tft aoi y aitapetildnt, t Iny hilt itono -nitnfd to noitig outwtao rds ttndtr rhtn tort: (Ift of: canitf r pi ft-l

a ctt ort icen-a thtey afire rlinn t"Ind neat'.0 tded.-'' Thne tll km tor0xoi-o tolloot rc by t hur~ oci IsWat innstoredly voct1 a utttuttoldal. c00cA 1-61ti1t11. Unitnt-I (ltit-t [tttt I .1tf tt to.wo-olri 0.10 ll l111/ 1 0.tn I Stt lintall. md Itoful.i cautned vibone i~ontkrer btit 0.*28i IN (l0 rpln rrti~ totfutot fIt-l cit, i Iar lost- tttt o rt. lsA ofI I ottI)lotivttrn'rot onid Iit appoiarod tchat. 401.tn ofn: .!, t . oulIr votrll t 01 ithlt 301t ml 1tritror wittoir om'xorortr lI1:itI.a ft 0ron ent'fc-y

5, ROTATION ABOUT A VERTICAL AXIS

5,1 Constant speed rotationtrornin g is (i19014) dofiotrlioeot ftoitrr 0t trt tf Ill whit h It-i i' Waso tint 1' I 'it ft to lf':IryultttIot toot f

Itt, Itim tot lit Wirinoto ' If "ot Witihl t ioot t f 'o-ffr' fftrrrt ito ttft'f ltI t 'tO'-i

"OffId t'j torim . td ' l i ttl "11.1 oot,-' tor t , It.' Ii 'I-le t y "f 11it l lit for ot tfr forl roto too, trtoc-krto-ro it'i

r oe e r irt' Itr l ifotftt ti) to .po I. iri ft i 1tt'o.'11 n ft oti tt tt totit t it ffno ftl ~ If'l Itrr I .'w t ort -:Ir &'' :'l ItO'llilyIt ll~ritp0tt 'Itlotr of Ilo tit i-fito oil(rift .o it'ti w '' lttr l l Wit' i ttrrf'rj I ro lt lot f lol ''dl royffot 'ottt

l'If, tjn-'tc of . I" 11 41 1.) 10 'notitr I Itl rro t lr-t 1 l'I ,:ittt o dtt waft, mitt. , otetttrr ir rfftr I fof 0 'tor roforti tttt itt

tnt 0 fflf t ot .1 otti ff l lt'mott nidV-oI tc,tl mot f-i t t wttt ttt d 1qtot jI bi ilf ottott e tyt Iot-ttftrto of rit'''Lo )0Ivia T rttontci- ify d oit~tt 0tyrtttttrtt fin-tot-'ir thi l't .torlo siotc-tot 1 irco ~l d -- tt t't (f i - it(' toI ' f t 1irtrr' 1

tr I fiff oV.1o a I (19114 17oto'o-rroMeriti f itt fll ttn:1l ritlot t fct rtf itoit ro1 tl'tt ,1r1et[ot i i ojt I f In to ori 'o

I ' l f t efl u -t c l i tt, e ttoa I ' n t f 4 1r (j tc ~ t ' ( ' i tr itn ' l . I M It t o tl , ; n o f1 I ot I o r I ti t I o k l i no ~ l r t I l it I t o i t l i mto r tQiff 'ill tr I* it-i (t f-tt li(tood I it nt ril I on alolti' Ii fit' , tioc-Ilrt 11w1 1 . i, j II, ,k-'ttY

Wi h WI rot1 v:ak it -if I o( r, ftl t 'rri't tor tftrt'oo otafoo Jrot oti rt wit ol oi tfi r)1 i ' rtrik-tt 11lil I t . fctl ttt fr

Wiittintak I onto eo ottr t o i it I ( owtitotctl 1i (otrt

31,, ric titor wintIt a~jl ttott mmo' oi t Iyý ltt'whn;ic lt'',sqn m I r w .to irtpttetr io-o ntt naId it ott t''tt -r tt -I -m I I titrttrtIkTiortt Wh naIlowtt ed I ,'sir or-nnrt I 'tirco rn-rII ft e

w It I)IIri 2. I~rr-otc- . It. I titllotinIl I itn oqtn',tt I y I itirtieoc I hto I [It:itrtoe ot trtt I rrf "-1t111 ,t';tf t ni ''5('r'ttd1ittlttoitted Itlti, I itr l rot ft I'm I nt" l y a Io ow tt itttif1. s v it o' -In-i W I 11n limntrk I nc t aI, I I'laf~,LbI

iDaurnot r arid] (-'x I 198!)tol t n-rtirtet Itth coinfrett nto f mtroll ontt it kteadnI itt ruIgor rreI mnkeikytiooxlo.'(nnrnt tot bodty n-rnc looft Iton tntl rok itriefIt' f nr ol~t Inttsnnot a vo. rt'.l townIaxs W It In vat- root onitwi vIv rig

3-15

conditions. Nith 10 rpm rotation of the visual surround around stationary animals, 82%became r ck within 30 minutes. About 77% became sick when only the animals w,:re rotated,95% were sick when both the animals and the visual surround were rotated together and 45%became sick when the animals were rotated in the dark, With c, higher rate of rotation (25rpm) the sicknoss rater: increased for all three conditions involvi n'y motion ofT the animalsbut decreased for the condition Involving only movemeant of the vinual field. The animalswere free to move within a small cage during the motions.

The effects of various restraint conlditions on motion sickness in squirrel monkeysexposed to 30 rpm for up tu 120 minutes has been reported by Wilpizeski et al (1985) , Witha clear view of the laborstory all of the monkeys exhibited motion sickness within 120finutes when they were allowed to move. When the torso was fixed, sicknens full to about50%, and with both torso and head restrained the sickness fell a little more. With torsoand head fixed and a blindfold, no animal exhibited signs of motion sickness.

furing continuous conotant velocity rotation about a vettleal axis, the sensation ofrotation diminishes and nystagmue does not persist after the onset period, On cessationof rotation there is a sensation of counter-rotation and nom- horizontal nystagmus, Motionsickness induced by the above exposures to constanip jpeed rotation about the vertical axismay have been caused by the apparent movement of the visual scene (see Section 10),movements of the head (see Section 8) or the acceleration and deceleration before and afterthe period of constant velocity (see Section 5.2).

5.2 Rotational accelerationSevere, or sudden, rotational acceleration about a vertical axis can produce moi.on

ricknesa, A test for pilot susceptibility to airsickness developed in 1922 tic 14l4 hasbeen reported by a former Director of Medical Resrearch for the hcy~i Air Porce (Pluck,1931), With ayes open, subjects were spun onc a rotatcinq chair through 10 rotations in 20seconds 30 rpm) . This exposure, which is reported to have been capablo of causingvertigo, nausea and vomiting, involves acceleration and deceleration in additi-on to theperiod at constant speed rotation.

Lackner anrl Gravbiel (1979) describe i 'sudden-stop vest.ibulat-visual in.eractiontest' in which subjects are accelerated at 20 dog s" to, 300 deg a" (50 rpm), maintained mlthis velocity for 30 seconds and then brought to a stop in 1,5 seconds, The procedure wasLhe:' ,speated until a motion sickness end point was reached or 50 stops had been completed,'or 10 subjrrcts rbceivJng their first exposures with eyes open during the test, an averageof about 14 stops wns required before slight nausea occurred. With eyes closed an averageof 38 stops was required, A similar test with aubjects viewing within a stationary stripendrum was used by Graybiel and Lackner (1980) . 1u has been found that susceptibility tosickness with this test increases if the gravlto-inertial force level is decreased to zeroG or incruaasd to 2 G (Lackner and Graybiel, 1983).

McCabe and Gillingham (1964) placed cats within a mould, so as to restrict movement,and subjected them to rotation about a vertical axis followed by high rates of deceleration(up to 38 rtd s '; 2160 degrees &3't None ci the cats became sick with this stimulus butclho-y were made sick by vertical oacilatlon (see Section 1,3 . J) . Yhis led the authors tocon 'lade that the otOlirths rather then the semicircular canals were responsible tor motiontsickness.

Osseikopp and Odseskopp (1990() concluded that 20 minutt, periods of body rot ation on, LUtnritble at ')0 rpm with 15 seu in os n rand I seconds off caised motion sickness In guciricapjigs. Corcoran et al il(10) c'mpared succept 1l]Ity to si(ckness o•f rhesusnc moikeys and:cqi• irtel monkeys wlhen cc;pcsed tu corni irious rotation (45 mLnutes at 25 rpm) and when,.,ijcrd to sudderi-stotp corat.ior (45 minutu s wiLth sudden stope every 30 :econdri). Nonec of

hc. rhesus monkeys hecame sic-k in eltor cocidlt Ion but a1

I of the squcirel monkrysl hijc:=rme:[k1 in boI h corditirosa. (The squicri,1 ircrnkcy is in the same taxonomic ordor nit man cndlia; bec,i used is ci scrrouate for humans in scany exprimental studies.)

hu monot|io bscknens arising from rotation;, acceleration is greatly Influenced by theeirual field (see Section 10) . Head movement may have also contributed to the reportedsigns and symptoms in some of the above studies (see Section 8).

5,3 Co alem rotational motions'Double rotation' has beer, used to study" some behavioral responses of rats which are

thought to be indicative of motion sickness (Morita et al, 1988 a, b), Rats are unable tovoidt arid so some other indication of sickness is required, The expostures to doablebrotatiuon were qeneraLed by placing the rats on a small turntable 25 tei off the axis outsecord turntable. While the smaller tipper turntable rotated continuously at 80 spin thelower turntable alternately accelerated to 25 rpm and then iecelerated to a stop tiheresponses of the rats suggcsted that this double rotation was more nauaeogeni, than -pinrotation of the ripper turntable alone. Removal of the vestibular system appeared toprevent the rats from experiinciiig sickness,

Another complex form of motion used to provoke sickness in animals has conrbineticonstant speed rotation abc jt the vertical axis with vertical oscillation (Ordy andBizzese, 1980), Using a sinusoidal 0.5 Hz vertical oscillation with an excursion of 152mm (about 0.5 ms' rm.s.), squirrel monkeys were rotated at either 10, 25 or 50 rpm for 61mientes, They had a clear view oi the labiratory and were able to make small movementswithin their cage. The 25 rpca cinditi.on caurpd the greatest sickness: 89% vomiting at 25rpm compe-ad with 21% at 10 rpra and 71% at 50 rpm. Covering the rage to eliminate visual'cues reduced sickness and there was some evidence that., mn'a mr'keys suffered slightly more

3- 7i

from sickness than females. A separate experiment indicaLed that ablation of the areaiostremn of squirrel monkeys ibnh bited their motion slokness response to this type of

t.)tion (Brlizzee et al, 1980).

6. OFF-WRTSCAL ROTAT ION

Rotation about an off-vertical axis produces a 'rotating linear acceleration vector'from the force of gravity. Unlike constant speed rotation about a vertical axis, thisproduces sensations of turning and nystagmus which perniatst throughout the rotation# butlittle ot no post-rotation effects. Rotation about an off-"ertical axis can also be highlynausuogenic. When rotation occurs shout a horizont axis, the term 'barbecue-spitrotation' is soaetimes used. Jchnson (1,954) found tha hne use of this type of rotationcombined with head movements in the covoral or sagittal plane could produce sichknss in upto 95% of persons within five minutes and that sickness could ue induced within 15 secondsin some,

Pennor. and Bodin (1966) reported that rotation :,f subjects on a stretcher about ahorizontal axis for 3 to 4 minutes was likely to produce nausea with rotation rates of 40to 60 degrees per second (7 to 10 rpm). Using 120 second periods of rotation about ahorizontal axis with rates of 10 and 3G rpm, Correia and Guedry (1966) report that twelveof 20 subjecis were unable to complete the experimental sequence due to imotion oickna.a,

Graybiel ard Miller (1968) rotated normas subjects and some with labyrinthine defectson a chair tilted by 10 or 20 degrees from the vertical, All but six of 66 normal subjectnreached moderate malaise A (M t1A) (see Tables 2a and 2b) with a 10 degree tilt and asequence of rotations incrementally increased to 25 rpm over 65 minutes, More then halfreached this end point by 12.5 rpm over about 30 minutes. None of five subjects withlabyrinthine defectn developed symptoms of motion sickness. Graybiet and Miller t19)0)report similar results and show that there was a high correlation between susceptibilityto sicknes& with this test and susceptibility to sickress as indicated by the Co.iollsSickness Susceptibility index, CSSI (see section 8..),

The effect of varying the rate of rotation (from 2,5 to 45 rpmn) about a 10 degree off-vertical axis, and the effect of varying the angle of tilt (from 2,5 to 25 degrees) at arotation rate of 17,5 rpm was investigated ii a small number uf blindfolded subjects byMiller and Graybiel (1913), There was little or no sickness with either a 2.5 or a 5degree tilt and some subjects were insensitive at rotation rates above about 30 rpm.Greatest susceptibility to motion sickness occurred in the range ]5 to 2C rpmr with all foursubjects reaching 'moderate malaise A' (tie, M IIA) within 15 minutes with A 10 degreetilt. The authors note that this tange of frequencies is similar to that giving greatestsusceptibility to vertical oscillation, As the angle of ti.l increased from 2.5 degreesto 25 degrees an increased susceptibility to sickniss was shown by reductions in the timeto reach M IIA,

Graybiel and tackner (1977) found that 60 eilnuteuj ot rotation about. all narthhorizontal axls at 30 rpm caosed sickness but that r,tating the body 10 degrees head-up or10 degrees head-down did not differ from tGtation in The horizontal position,

Lentz and Guedry (1916) describe the "I'll riti-Aki it Rot,itlion Test' (TAkT) in whc•chblindfolded atandinit persons are rotatetd bnutitt Iheir z-axis whi ir, they (and the axis ifrotation) are tilted at various angles. Ii t lie inltiai trh.aL, a vertir-ti nob h ect wutsaccelerated at 25 dug.' to at tipoked If 60 dcl,-1 jt00 rpni) in the ci, cki1aqis. ii ruct tori.After 90 s at cisltani velocity hit, ulh)eci was tec,'1ii•[iau tt atA p, at. 25 d.kqu, ", I' i ;second trial the rotation was thu sanie exc-•pt, st. ion was it tLhe counteurctockwise i(itiect.tori.In htie thi id ar,, rourth t11ials Ihi axhit wii W I t It-,ito 0 M { i'lreoo ittf-voi-t.[cal. in ih,11 flit 1icnnd sixth tlrial the device was acceilrratd lt a !') Og, ' tkI 102 tiqes ' (Vl trpm) . 'PIhnt( wastart ' iit'arval oit n minates between tit a t uen d (iiiiuei ,y stateý that. it. wan riot. titcoitstttOllf a , subj)ect-F to terminate ti hit ht l, pi {. itt o , i.',titi l a i i'

Leger em al 1:981) exposlet suijects to '0 is tuti peritts (i f 20 rpim with rnt ation Ibo,,ui-a horizontal axis throioqh the three axes oif thie tody (thl x-, y. , anid s-axes) and wLtnthree visual conditio.ts (hi indfld, intt at e fIhri , itf o ) r oirt'ieevo arid uxt urnri fr~imm ,ohr,!reti'e) . There, were epporta of i nfat:e as thin ii 95% of the ;q condittuna ,ciperienned by11 subjects. There was rio signi [ir!anw. di[et minc ,.,', rtiiLiij to whethe:" itsh rttation aboutthe horizontal axis occurred about. the x-asi., the y-axis, or the z-axis of lt,, sutbjoct.Thare was less sickness with the external visamu it i am of referertc,.

With totutton rates between 4 and 1'; rpm, Mowrey and Ciayson (1982) use•d thepruvocation provided by 6 minute uxpouuiret hit acin icl med nstatling chair to assess t.hyeffectiveness of gitiger as an anti-moti,)ra rikr.eas age't. They state that nrtne of the '16subjects was able to stay In !-he chair for 6 mrinutes when cliven a placebo whereat; half ofthe nub (euts so rvived 6 minutots exposures after c'onruminq Irgowdered* ginger,

Otff-vert. lat rotationn (25 r'pm :or 30 or 60 minuteu at ati incl)inatill of 20 dicirees tothe vertical) baa also Iteen used to study unutiton sickness On thise at. rsae Sutton et al,1988). .

Thee percept Inns of z Ay moveriment during rotation about an axis inclined to thevertical are dimcussed by Denias et al (1988) . These authors reported that using arotation ilete of 7.5 rpil 1-iith inclinations between 5 and 30 degrees, most subjects reportedsickness after a del.y ranging from less than tao minutes to more than 45 mtniltes.

-': C.4 >

- '',---' •,..-"A'-

3-17

Cheung at al (1990) tumbled subjects head-over-heels about an earth-horizontal axisat a rate of 20 rpm for up to 10 minutes to determine the effects of fitness training onmotion sickness susuepttbility. They found no difference between males and females but anincreased susceptibility to sickness after fitness training,

7. ROTATZONAL OICZLLAVZON

"7.1 Oscillation about a vnrt•.al tuaaMoore et al (1977) describe a 'Vlsua±-Vestibular Interaction Test' (VVIT) in which a

seated subject is oscillatrd in yaw (i.e. about his z-axis) sinusoidally at 0,02 Hz withi peak angular velocity of t155 deg~s'. (This corresponds to a rotational displacement ofapproximately ±3.4 rotations). furing rotation, the subject identified the co-ordinatesof numbers shown on a visual display within an encloa-d cabin, Lentz and Guedry (1978) saythat the motion itself, when experienced with simple visual displays or in darkness is notdisturbing. They say the problem arires when the motion-induced nystagmus is superimposedon the sacoades required during shifts of visual fixation and that nausea tends to buildup slowly on successive cycles of motion, Lentz at al (1977) repcrlad that a five minuteexposure to the test was -ore provocative of sicknesa than the Brief VestibularDisorientation TL.. (•.u±, - uw-j Section 8.2,1. There were significant correlationsbetween the results obtained from the WIT and the BVDT. There was also a low, butstatistically significant, correlation with results of a motion sickness questionnaireindicating experience of sickness in various forms of t:ansport,

Guedry et al (1982) presented seated subject.s performiig a head-fixed visual searchtask with 5 minute exposaras to two types of sinusoidal yaw oscillsi Ion: 0.02 Hz at ±155deaga'" per second or 2.5 Hz at ±20 deg~s., 'hile oscillation at 2.5 f-i produced noconvincing signs of sickness, the oscillation at 0,02 Hz was highly nauseogenic, Six of51 subjects failed to complete the 5 minute exposure to 0,02 Hz and 4 vomited) 75% of thesubjects reported some relevant symptom, The authors also exposed the subjects to cross-coupled (i.e, Coriolis) stimulation producedl by ten 45 degree head movements during a 5minute exposurn to 15 rpm and found this somewhat less nauseogenic (see Section 8,2,1),

Igarahli &I al (1966) provoked sickness in squirrel monkeys by oscillating them abouta vsrtioal axis (at 0.25 Hw. wi.th an amplitude of 90 degrees and velocity of 141 dogs'')whhie they were within an optcIinettc drum rotating with the same motion but a 45 degreu_hnase lag. When the motion occurred about a vertical axis there was vomiting in 13.3% ofthe anllmals, whereas when the motion ocrur:ed about Che horizontal amis there was vomi.tingin 50,81 of the animals,

Lackn•r and DilZio (1989) exposed subjects to 40 dego- constant velocity rotationaltout a vnrtloal axis with the direction )f rotation changing (at 300 deg.sa1) every minute.When tusted wearing a helmet which doubled the inertia of the head, ail eight: subjectse:!prr!enced nail!'a, but when tested without the helmet there was no nausea,

7 2 Oaaillation about A horizontal axisMorton et al !194") used a 'roll-pJ.ch rocker' to expose subject a sli11]1 tanously to

roil notion ('trouuh 25,5 degrees) aiid a combined pitch an I vertical motion through 1,6tl'etree at the end of a 4,9 itrnte irrm of a see-seaw, Oscillation on the see-sew alone at

'25 IIz rvulted in 40% of subjutsri "romltinq, wiltreanli wiLth thLs mnlieir corel'end wit), •tomzic'r. at 0.08i R., 33') r t stb ': vomlited. Tho Hi lrnlt rte en were nim)l.• H i both

rotidit.i['l.J ,in) the authors 'our Lute.d that venrt i,,a mot ion from the sgovsaw was rum calii', ofth." oickneon, A,snioii, ., stvinidil vert ical snot on, thei notion 1•t•knoSt It d.11?i vii lJ'IIo'eodii.' -#ouI d ,t) p r I(Iul about I6 W o I prei nliTl imc! lonlilitq 'ick d'o I'[I1J ,. 1 h(ou t (MJ)t u ti1, tul .(a ui

mot ion. Ilrkness wis si lqhtIy qreater whenll t(Ii n ..ilaw )aniI le,1 ) Fi It -'iatalblu ). I ( Ill., ,lhdIoWe.l whieii I o ci.1j Iat ed aIt aboul 0,09 iv,. If the iul I 3,b minrot ru of dinpML,:- e ieiit Wa i ls-.d.i all ifeqgue'irles, these changeu: wl h frequency arte connI .tri.t, with ll),totio ilckrlen Ol m Iut!iLjclal asd by Ve t-ici l r oScillatinti and pussibly coniLsteel- the moti tin aircktif.ns 3losi, value

Igaushil et a] (1987) exposed squirrenl msionkeys ro usrL Itlatory stlotion about in "nuthhorivontal axis while viewing within an opLokiticerio drum oslliastiug ita the same axis endby rho saeme amount but with a 45 deqren phase diifcrence. (.me litilon at 0,25 fHz wilth aLninmp litue ot 90 deqree,, provoked slcrknuss in ni. rtnal mio°ikeys bit w in de•or-used In those withinuriiieal removas. of otolith end organs.

McCauley Lt al (1976) [lnýesetiateId response to pitch acod roll moulern at 0.115, 0,230or 0.340 Hz with magnitudes irt the range 5), to 3.3.2 deg.s" r.m.s. Mlien the rotationalmiitLons were added to a ver)csaL motion .)f 0.25 ih: at 1.1 es

1 r in a,, the Incidence of

!51 kiest was not siqnficartntly different from the inciJe.ice of alckt)2ss with the verticalmi-tion alone. No subject vomited with roll motion atone (33-3 den .as at 0.345 Hz) buL twosubjects vomited with this magnitude of pitch. The authors conclude that the resultssupport te view that vertical motiona i threuse Of seasickness and infr t.hat headmotion during vertical oscillation may not contribute to sickness,

Yhe effects of rotational oscillation about an earth-horizonmal axis ac 45 degrees totLh x-axes and the y-exes of seated sub.Jects was investi'ated by HoleJuk daid Blea (1989),Over 35-minute exposures to oscillations (iO degrees peak at 0.025

1)z, 0.1 liz and U.025 Ot1 0.1 lIr), iubjects performed varinur tasks and rated subjctive symptums. No subjectvomited but symptoms increased with exp)osure time and were greatest when there was nocuts ide view,. The provisio of an artificial horizon reduced motion sickntrss syoptctna.The ticks included a requiteiment to maks 45 degree head movements and tme authors speculate

" V;' .,: .: :•. : .. i------------------------------------------------- .' -', .,r.i.4'

• ft'r"J

that CuriolLs eJtects may lave contributed to sickness.

e. CORZOLZI, OR CROBS-COUPLUD, STIULATZON

8,1 Principlos of axoss-ceupled stimuliIf, while the body undergoes constant speed rotationt the head is rotated about an

axle other than the axis of constant speed rotation, nausea and other classic nymptoms ofmotion sackness nmay appear, Moat commonly, the subject is rotated on a chair about thevertical axis and required to make pitch or roll movements of the hnad, In the sensoryconflict theory this is assumed to arise from the otoliths sending the correct informationon head movements while the semicircular canals give a false indication of huead movement.

The 'false' indication of head motion produced by the semicircular canals arises whena canal is rotated so so to change tne extent to which it is within the plant&' of theconstant speed rotation. Consider, for example, n vertical canal with constant speedrotation occurring about the vrrntical axis (Ie. in yaw) so that the canal is not in thepine of the rotation, Assume the canal is then rotated forward in pitch, so as to becomehorizontal and in the plane of rotation. The rotational velcoity of the canal will havechanged from zero to the velocity of the constant speed rotation, The fluid within thecanal (i.e. endolimph) will need to accelerate to reach the or .d of rotation. Until thisspeed is roached the endolymph will deflect the cupula and so indicate that therre has beena change co rotational velooity in the plant of the canal (i.e. in the yaw axis of the bodybut in the roll axis of the head, for pitch head movements). However, the only movementof the head containing the canal his been in the pitch axis. So, while the semiciroularcanals indicate pitch and roll rotation of the head, the otoliths and proprioceptlveiJnformation indicate only a pitch motion of the head. In summeary, when a person Is Sxposedto continuous rotation about onu axis and makes a rotary movement of the head about asacond axis, there is a veeling of being rotated in a plane approximately or thogonal. - thetwo true motions.

The above illustration it only a simplified intrcduction to the cross-coupled effect,tor example, it Is also necessary to dotialder the signals that arise from cmnais that leavethie plane of rotation. For a canal orientated horizontally and exposed to rotation atconstant speed for about 30 a or more the endolymph in tile canal will ne rotating'with thewalls uf the canal and will then cause no deflection of the cupula. Suppose that the oanialis now iotated in pitch whiLe still undergoing constant spead rotation about the verticalaxis of the body, When the canal becomsa vertical there will be no rotation in the planeof seits~iivlty of the canal . the decrease in rotational velocity will result in theendoly.mpi daeflcting the cupula,

For pitch head motions while exposed to constant speed yaw rotation of the body, thebehaviour of canals in the roll and yaw axes of the head may follow the above generalexplanlation. A canal sensitive to motion in the pitch axis io thu head would remain outof the plane of rotation at all times and would indicate head movement as If there was noconstant speed rotation, Tf the head were to be rotated in roll while undergoing constantspeed yaw rctation, the 'erroneous' signals would arine from canals sensitive in the pitchand yaw axes - a canal sensitive in the roll axit would give the same roll signal as in theabsence of constant speed rotatloni, In practice, the semicircular canals are not trulyorthrgunal and aligned in the pitch, roll and yaw axes of the head, Consequently, somechange will. be indlcatird by all three canuls during must head motions. It is assumed thatth', adapl.ive processang of slgnali from canals allows for the resolution of the signalsLnLe plIth, roll and yaw mTotions o. the head (see Section 8.2.2).

lhv sensnory :ongl iot explanatLion of sickness produced by cr05s-capled it-(molit-IonuinallIay nniulnen tfhat the olto}.ithn rilve a signal dependent otl their orientation wiLh lrespectto gravity and are urnaftect.ed by the conetant speed lotation. However, as the otoliths00051 away I ein Lhte centre ni roLation there will be centripetal orocen and translational

Iie •raltion. Thene mnghl qhe -itgni.firnt in nome canes.

Tiho direction of the illuaory sensation inttt'-duced when the semi-nilrcular canals enterand leave the planri of rotation can be envisaged withouit mathematical derivations, Supposethe constant apeed ruoatiluo is In the clockwise direction (looking down on the subject) andthe hlad h rulled to the left. An 'ideelimed semi-circular canal' orientated in the rollplane of the hi ad I1i not. in the plane of conseant speed rotation at any time during thelie-id niovement,•t Th,' signals given by th.!o canal are therefore the same as in the absenceof constant, speed rotation, A canal orientated in the pitch plane of the head enters theplane of totattoo when the head is rolled to the left and will Incicate an increase inpltch velocity. Signals from thi- canal would tot occur with this head movement in theabsence of the constant speed rotation. The yaw canal which leaves the plane of rotationwill indicat,' a decrease in velocity - again, a change which would not occur In the absenceof corstait .o;peed rotation, Tile overall impression couneo by a pure roll movement of thehead is a combined movement involving roll, pitch and yaw. Figu, s 12 provides adiegrummnatic illustration of the signals that may be expected from canals orientated in therol I, pitch and yaw axes of the head Then making a roll movement of tile head duringcontstant speed lotatlion. 'The Bemi-circular canals are not capable of detecting constantspeed rotation: in Figure 11 it ir assumed that the head has been held stationary duringe•rIstant speed rotation long enough for the effect of any previous head movement (and theoriginal acceleration of the turntable) to have decayed, The decay in turning sensationafter the roll movement is shown in Lhe figure.

:""Lh : * I II j I

3-19

8.2 Nature ot practical crose-ooupled teats - Angular velocityVarious purpose-built devices and proprietary Angular

rotating chairs, often designed for vestibular veloolty Turnlng aeneatlontunction teste, have reisn used to generate cross-coupled stimuli. The teat is usually condvotec'. with t,qeated subjerta rotated about their vertical axis I oll canal(i.e. yaw rotation about their z-axil), Theprincipal variabler involvud in the teat are:

%i) rate and direction of rotation;(ii) direction and angle of head movement:liii) frequency and duration of head Piton

movement: (%[ can.liv) visual a onditions: I(vM gravitational force;(viO end point of test. 0

The full influence of all variables has not been WIS-exhausitluly studied but some general conclusions Yawcanalaplpea r poL s .sibwcana

,2.1 Bifect c rate and direction of rotationThe nature of the cross-coupled stimula-ion is

nuch that qreater rates of toration would be expec;tedto produce greeter magnitudex rnf 'ilusory mntlnrimand, presumably, a higher incidence of sickness, Time

DUiny 90 degree movements of tha heed, Mil terand Graybial (1969, 1970la, 1970b, 19i0c, 19'4) fl'U9 12 Angular velocity ofinvestigatnd aicknas a as a funution of rotational semi-circular canals and 3ensationvcloolty from I to 30 rpm (i,.e 0,0166 to 0.5 Hvi 6 of turning produced by Loll headto 180 deg.s'l) . BLindfolded subjects maisd movements motion during constant speedto th, front, right, backl left, front roturning to rotation about the 2-axis of thethe upright between eia:h movmmentt and holding each body, (Idealised canals in thehead position for I a, After completing this roll, pitch arid yaw planes of thesequence ol' 5 head movements in 14 a they paused for head, After Benson, 19841,20 e before repeating the same series or headmtions. There were larn•e Inter-iubject differencens with aome subjects giving usefulresults in the range 1 to 10 rpm while ot•otis could be tested over the range 5 to 30 rpm,Never theless, for all subjr,:!ts the number of head mcvements required to reach both 'severemalaise' (M 11t) and 'sioderate malalse' (M 11A), dacreased as the rate of rotationinrctuaed, (The system used to identify and rate the symptoms of motion sickness was thatdoveloped by Graybiel et al, 19681 see Tables 2s and 2b). Presenting the data onlogarithmic scales showed that there was at leant a 10:i difference in the number of headmovqrments required for moderate malaise by the most and least sensitive subject at a fixedrate of rotation, Different subjects Oiaowed similar raten of decrease of the logarithm oftie number of nead movnmentn with the Ilgarithmn of the increase In the rate of rotation,'ITh average slope appears to have been such that there was an 1hnv•erse rlationship betweenthe .number of head mcovementa, N, before moderate maisise and tne rate of rotation, R,ralsed to the power of 1.7.

Ml Iler and Griryb Ia dotermI rnd t} Ii 'average stressor effect' (E factor) of a singlehoed fovrmorit at cach rot'atIconil vIorirj'y tot, both moderate malaise (M ITA) and for severeti-.I [,I'it! (M .II , V-.i lun 1"I olrlint dcgrruoo ot! ma lei e wotre ailso deterl•mined (MLler and,'h;ybito], 19"7c, I ( i1c" , rIo lojo.di L ri latL ,,iishjp betwween tliu P: factors and chairVt- rIC) Ii I c1131 lV 1 ,v I,,' C i icrinot n si• krlim aeverity Are. nhown In Figure 13,

Tihn ' Iiti ,,in ilki :u Fhi oltIO l d r I ii t ry [nd's, >',1t31, was doft[neid anr riLt prudul. of I lt,,rCV r'I ii , ,in4or e• to-i of 't tiq lo wid i 1i nillvitrili (i; fact.or) W itLh the number of headilvtCi~ ii-t . [;l t I- I k i ltl r l ti I w ri]•i I i d ,it ion ýiri:kriesoi atdpi oit:

'Thi V i 1lI of I rait be obca.[l nod 1'ruin P, iq.q r •? I-3, Alternatively, C. 3 values can bevrl olorlltt fd rotm the fellowilog injuat otto:

Sl Ihit malaise (M [): )(,8IM S 0, 0053Ce ' W x N

Moderate. m,1lale H (M ii1 131) I ,S:IM , , - 0.00.104 R'"' x N

Mdiderate Inal aise A (M IIA) : C"s,9N li 0 ,010201 R''" x N

£nv'olW ri,,lale ti C(M 1ll)1 SiL: , U,UU104 Rl'" x N

PV.,is A a :kinios ('C1 I CSt r•,. 0,00045 RH'"' x N

Ih-, Tindrx was a r ranged ii,) that pr act lci] ClSl values would fall within the range 0 to 100,w. Ph Jcr,Ees I 1crerslog for less susceptible nubjecta, A value greater than 100 would beci iloried by a subjoct who req±itad morre than J50 head movements to reach moderate malaiseat a revutucini rate of 30 tm. High CSSI values indicate that a subject is resistant tomot on sickoesir while, low [',,!3' values IridLraLe high susceptlbillhy,

The Cornolls Sicknoess susceptibility index provides a means of quantifying individual

" .i ..... .

3-2o

E Faotor E Foctor1,4 ilOOo

2 M1 MIM III 1 --00 - M0I0

-4- MIIA / MIIA"_40 M 111/ -40- M III

- -0100 -16 - P1

04

0,00100:

- 010001a a Io Is 9o ga s0 oa 1 10o oo

Oheir Veloolty (rpm) Chair Veloolty (rpm)

iguroe 13 Relationship between the r, factor and ohuir velocity for fivn lovei;; ofmotion sickness severity, the ti factor indicates 'average streasor effect' of asingle head movement at each velocity, (see Miller and Orayhlel., 1410c).

6sinseptibility to sickness by determining the number of head movements required duringrotatlon at any rotation rate between 2,5 and 30 rpm to cause a defined degrae of iraldiae(oil the scale shown in Tables 2a and 2b, Graybiel et al, 1968). If the CSSI value for 'Asubject Is known it becomes possible to predict the rate of rotatorn that will be requiredto cause the required motiorri s.cknes; endpoint within a defLned number ot head mOVemLts,M llor and Craybhiel (1970c) muggeeoted that moderat-i l aIaise (M [IA) yilnIld-.d tho h'mnebalance between subject acceptability and test confidenae.

The CSSI values reported by Miller and Graybtel (1969, 1970a, 1910b, _910!) werodetermined with b lindfold subjects and the pasternr of: 90 deugree hoad movomonts d-sctbhedabove, Other visual conditions or other types or patterns of movement may not provide thesame values.

For severe malaise IM III) , Miller andGraybiel (1969) found a high teat-retest Percentage with 0881 valuereliability when C0SI values were obtained on 100

two occasiono, Using 250 normal subjects(mainly aviation students and flight crowl thoyfound that the distribution of CSSI values was 80highly skewed auch that while) the mean valuewas 15.3, the median was 10,0 anid the mode 7 to8. Fi'gure 14 illuatratoe the cumulativedie tribur:on of CSSI values In the group. 0Millet and draybiel (19'4) repert aImcostd0t loCal ciiLstIibuitionnS far cii tour levels Ut

malaise (M I, M I11, M IIA, M II1). Calkirn of 40aJ (1981) used a logarithmic t.ransformatlaon tolusd1 co the skew in the di.tlribution of CSSIva Iues. They also showed that after iheappi ication of hils transformaLlon there won a 20' eoapactable reliability' in CSI values asIndicated by two successive exposure:; ofstubjects to the test. Mi ler and Graybiel ,r(ig1lOo) showed that there was a high 00correlation between the CS81 values of subjects 0 2r 0 40 S0 e o 100across five motion sickness end points. Oorolls S1okness 8usoepifty Index

The CSSI index implies that a doubling of Figure 14 Cumulative distribution ofthe revolution rate will have a greater effect C118 values in a group of 2S0 aviationthan doubling the number of head motions. For studenrts and flight crew. (Theexample, a three fold increase in the rate of distribution is highly skewed - mean:rotation is approximately equivalent to a sx- 19.3; median: 1d0. model to 8, atefold increase in the number of head movements, from Mt lir and Graybiel, 1969)

Kohl et al (1986) defined a procedure for calculating the value of the CSSI whensubjects have been exposed to a sequence of motions in which the rate of rotation has beensystematically increased.

The application of cross-coupled stimulation requires prior judgement of the rate ofrotation which will result in the desired symptoms with a reasonable number of headmovements. Miller and Grayblel (1970) explain how responses to a questionnaire may be usedto determine both motion experience and susceptibility to motlon sickness and hence select

S....... .•; :• Z.:•:

3-21

an .appropriate revolution rate for each subject, They s'ate that when M Iil symptoms(severe malaise) occurred within 40 to 166 head movements, the ig.qns and symptoms developedgradually without the hazard of provoking frank sickness (vomitio;q), Consistent with thedata in Figure 14, they found that 50% of subjects reached severe malaise with a CSSI of10.

The dependent variable in cross-coupled vestibular stimulation studies can be eitherthe degree of nausea produced by a predetermined stimulus or the stimulus required toproduce a predetermined degree of nausea, When the stimulus is predetermined, some scalosuch as the scale shown in Tables 2a and 2b (Oraybiel et al, 1968) may be used. It theendpoint is predetermined, some measure of the at imulus severity is required, This couldbe the number of head movements required when exposed to a constant rate of rotation.However, with the wide inter-subject variability in susceptibility to sickness, it is oftenconvenient to increase the rate of rotation as the test proceeds ao as to be sure that mostpersons will produce the desired symptoms. A cumulative measure (such as total number ofhead movemonts executed before reaching the endpoint) can still be used so long as allsub jects receive the same sequence of conditions. Ancther advantage of this type of teatis that it is possible to prevent subjects developing severe symptoms by terminating theexposure when the signs or symptoms are lees severe. Consequently, some studies havechosen to use fixed rates of rotation while others have varied the rate according tosubject response.

some studies suggest that the magnitude of the effect (e.g. perceived t.iCit) whenmaking head movements In a rotating environment are linearly related to the rotationalvelocity (Guedry and Montague, 1961), Studies in a slow rotation room showed that morehead movements were required before subjects habituated to Coriolis stimulation sti higherrotation rates if the rate of rotation wan increased by fixed steps (see Section U.3 anldReason and Guaybiel, 1970), More head movements were required to habituate to the ohinigefrom 9 to t0 rpm than the chanqe from 3 to 4 rpm. Rnason and Greybiel (19'lU) recommend thepercentage st total head movements appropriate for each rotation velocity from 2 to 10 rpmwhen using I rpm increments in rotational velocity, Using this information, Benson at al(1971) deviaed adaptation schedule! in which the increment in rotation rate decreased asthe rotation rate increased so that the number of head rotations required was similar ateach new rate, They provided experimental support for the method for rotation rates from3 to 5.95 rpm. Gelding (1989) compared results obtained with fixed and variable incrementsas proposed by Benson et al (1971). He concludes that the findings from both methods atesimilar if the severity of the stimulus is expressed as the integral over time o0 therotational velocity experienced (equivalent to the product of the number of head movementsand the rotational velocity).

The Brief Vestibular Disorientation Test (BVDT) described by Ambler and Guedry (1966,1968, 1971, 1978) and subsequently employed in many studies, used a fixed rotation rate of15 rpm (90 degrees per second), After 30 a at constant velocity, a seated subject withclosed eyes makes 45 degree head movements every 30 a in the ordert right, upright, left,upright, right, upright, left, upright, forward, upright, On comnlet.ion of the sequence(330 a) the motion is stopped and the subject opens his eyes after sensations of movement

have ceased, Guedry (1968) says that the results of testing 500 student pilots with thistest showed that observers judged that only 5% of subjects remained unaffected after sixhead movements. Ambler and Guedry (1971) show that the test could also be conducted witha lower rotation rate (10 rpm) with the benefit of lean subject disturbance, Banta et al(1987) describe a modified version of this teatt the subject is exposed to coiLstantclockwise rotation at 18 rpm with eyes closed and the head tilta relative to the plane ofrotation every 30 s for a total of 10 minutes or until the subject tutmirnates the exponul:odie to symptoms of motion sickness.

Studies using variable rates of rotation Include a series of experimunts ill which th,responses of the eutonomic nervous system reaction to motion sickness have been studied(e.g. Cowings et al, 197'7, 1986, 1990). The procedure is oimil.ar to that proposed byMi Iler and Graybiel (1969) : blindfold subjects are Initially rotatod at 6 rpm andincremented by 2 rpm every 5 minutes up to a maximum ol 30 rpm, At 2 s intervalsthroughout each 5 minute period, head movements are made at 45 degrees in each of fourdirections in response to recorded voice instructions. A subjective scale of motionsickness severity was administered at the and of each five minute period while the headmovements were stopped but the chair continued to rotate, The time to reach severe malaise)M III), or the number of rotations to reach this degree of severity were used as thedependent variable. It appears that the exposure durations before reaching this endpointranged up to 55 minutes with a median of 19,5 minutes among a mixed group of 127 males andfemales (Cowings et al, 1986). Stott at al (1984) required subjects to make 45 degree headmovements while exposed to a rate of rotation which increased at 0.1 deg.s' uitil 15 rpmwas reached (after 15 minutes)l this rate of rotation was then maintained for a further 5minutes, Subjects who had not taken active dritgs required the motto:, to be stopped afteran average of 11 minutes.

There appears to be no particular virtue in using clockwise or antiolockwise rotatLion.Varying the direction of rotation has sometimes been used to reduce the chances of subjectshabituating to the motions (e.g. Miller and Graybiel, 1970). Guedry (19651 exposed ninemen io 10 rpm of counter-clockwise rotation in a slow rotation room for 12 days, Thesubjective effects (vertigo, naunea and stomach awareness) caused by head movements whileexposed to counter-clockwise rotation decreasrd. One hour after the end of the 12 daycontinuous exposure, the effects of head movements while exposed to clockwise rotation wereunchanged from those while exposed to clockwise rotation before the 19 day exposure tocounter-ulcckwiase rotation, Two days later, responses to both directions of rotation were

A.

3-22-. p

dl mn it•Lsthd, but J monuiihs at itr t uponies were similar to Lhose before the 12 day ewl 'sun e

6.2,2 Effect of frequenay, direction and angle o@ head movemantAs the snmicircular canals are not truly orthogonal and aligned in the pitch, roll and

yaw axes of o-he head, the effect of roll and pitch movements of the head do not haveequally provocative effects and the greatest effect in not produced by a 90 degree headmovemont,

Whereas the Brief Vestibular Disorientation 'est (SVDT) u-eio 45 degree head movementeat 30 a intervals, the Coriolis Sickness Susceptibility Index (CSSI) involves 90 degreehead movements at I a intervals, In some tests the angles coi head movement have beenmeasured precisely whereas in many they have been based on loose verbal instructions,

Lent., (19716) described a chair in which headrests posittu.ned the head either in anormal upright position - with the lateral semicircular canals in the plane of rotation -or with thu head rotatod 90 degrees forward and 45 degrees to the left Ao as to place apair of vertical semicircular canals In the plane of rotatior, This chair was used tostudy turning nerinations (not to produce motion sickness) . Subjects maintained their headsin one of the two positions throughout a 2 minute exposure tc 18 seconds of acceleration(h dg.a'(), followed ty constant velocity rotation (90 degro-,s,st 15 rpm', followed bydeceleration (at 5 deg.s'•),

lavlor at al (1911) describe a test in which blindfold ntubjectr were strapped In asupine position ,.ri a turntable rotating in the horizontal plane at 30 rpm. The head wasmoved miechanically through a vertical arc of 36 degrees and back with a cycle time of 24seconds. The authors state that this teat produced nausea and vomiting within 2 or 3minutes in subjects unaccustomed i:o the motions of aircraft,

2,.23 INfeat of gravitational forceL.acknor and Graybiel (1984, 1986b) found thst the strength of symptoms induced by

cross-coupled stimulation were dependent on the gravitational force. When this was reduced(during flight manoeuvres or in space) the stimulation -as less effective, When thesteady-state force field was increased the effects were inr-teased. 'They suggest that theefiect may be partially due to reduced effectiveness of semicircular canal function whenthere is reduced otollth signals, Additionally they suggunt that the changes in motoc-control and sensory feedback required with different acceleration fiIlds may be relevant,

8,3 Slow rotation roamVarious studies have been conductld in which subjects have been placed in rotatinc,

rooms rather than onl a rotating seat, 'Slow rotation rooms' 15 or 20 feet, In diameter and'I or 10 feet high allowed the provision of accommodatLor end the ability to expose subjectsfort periods of several days, The r-ooms were constructed to provide information for- Mantedorbiting satellites, lraybiel (1969) said that rotation at 1 rpm gives little or nodisturbance of vestibular origin but "at 10,0 rpm it is comparable to exposure on rough

It has been found that there can be adaptation to the ouculogyral illuslon in m slowrotat'ing room over a few days Graybiel at at, 1961). There is evidence that hahituationto motion sickness acquired while standing parallel to the axis of rotation transfers- tothe orientation with the subject at rignt angles to the axis of rotation (Graybial at al,1968). Orayblel et a) (1969) fetind that incrementing the rate of rotation by I rpm per dayup to 10 rpm resulted in no overt symptoms of motion sickness whereas sudden exposurej, to10 rpm Invariably led to motion nickneas amonq subjects performing set tasks, Attempts totintl.tuate to in rpm over shorter periods wor.n unsuccessful, UsiJng rotation rates of 1,5and 20 rpm ilraybiel (1970) found no dl f forpence in siesre'Btibi Ib ity to mot ion sickness betweienii, icd and normnlly sighted persons - although sighted persons tended to be more suscept iblhwith theoir eyes open, Oostervehd et al (19'72) found that 19 sub-lects were more onusceptibleto nrilckrmen when making head movements irn a rot'ating roomi with eyes open, thrvee wer- nmoresusc-'ptribl,' with eyes closed and two were equally ausceptible in the two conditions,

The slow rotation r,-m hap also been used to evaisate the effectiveness of some .antl-motion sickness drugs (e.g, Weod et at, 19661 Wood and Graybielt 1968, 19701 Graybi,-l at.al, 1976, Grayblel et a1, 1981), In a typical experiment, subjects seated away from thi,centre of rotation, were required to perform tasks requirirg head movements in roll, pitctiand yaw. In a control condition, the rate of rotation was increased (from I rpm up to 27rpm in I rpm steps) until subjects experienced severe malaise (M III) within about 40 headmovements, The number of additional head movements possible with this rate of rotationafter the consumption of drugs was used as the measure of drug effectiveness, Graybisi andKnepton (1910) reported mixed success in providing habituation to motion sickness among asmall group of aircrew in a rotating room.

9. OTHMR COM•L•X NOTZON CONDZTZONUThe motions in many forms of transport are causes of motion sickness (see Table J).

In moat transport env.'.ronments there are motions in several axL.s of translation androtation and the motion occurs at more than one frequency, For many environments thedir•ections anr frequenclea of the motion primarily responsible for sickness have yet to beproven beyond reasonable doubt,

Seasicknfesa I.s often primarily caused by low frequency vertical motion (see Griffin,1991), However, the vertical motion is partially caused by the pitch motion of ships sothe incidence of vomiting and illness is usually highly correlated w0th both the ve*!tical

3-23

iiutLiul. alid Liiu pitch lrluliuri At Vu njjlij * i..I aui coirdittiliti which iniLrease the pitch adrdthe vertical motions of vessels also increass the motions in other axw,, there can bestatistically significant correlations between the incidence of motion sickness and thevessel motions in all axos, The trrveller suffering from saaslcknesm may not be able toidentify the axis of motion causing the problem,

The 'ride' in road vehicles, and efforts to improve the comfort of person in roadvehicles, is dominated by consideration of the effects of vibration at frequencies inexcess of I Hz, However, there is no evidence that oscillation of the human body atfrequencies greater than I Hz Is a significant cause of motion Lickness in such vehicles.The motions causing sickness must be at lower frequencies. It seems unlikely that verticalmotion i.s normally Lufficient to proluce the high incidence of sickness that occurs in road .veiicles. Accelerations in the horizontal d~rectiovs are more likely causea of motionsicknens but there are currently no dose-effect, relationships.

The physical causes of ai.rsickness have receiuved ioss investigation than the physiculcauses of seasickness, The complex motions cn aircraft vary greatly between aircraft enddepend or the flight condition. It seems probably that some forms of airsickness are dueto low fr!, quency vertical oscillation, but dose-effwct information is not available,

Various studies of motion sickness in gravitri-inartial force fields other than i aihave been undertaken, In studies during paraboiýo flight in aircraft it has been foundthat at zro G, movements of the head in roll, pitch or yaw increase motion sickness and

ehat the symptom' ert- greatest with the eyes open (Lackner and Grayhiel, 1984) . Pitchwovcmhnts of thu head and trunk through 90 degreea with tire eyes open bted the most severeaeLeciti. Similar results were obtained when the study was repeated at 2 0 but the symptomstnided to be more severn (Lackner asld GraybiLi, 1986a, 1967), 'Space ontion sickness' isoft en provoked by head motion and was not a problem in small apanacra't which allowedIttlu or no movement,

10. VZISUALLX-ZOUOED NOTZON $IZIW01B

Movement of a largu visual scene gives the illusion of self-motirn in the oppouite(ot.rection, Thu 2! i'nrl,'4 may be produced by translation of the visaul field past theohbsrvor (linoer voction) ou- "tration of the visual field around the observer (circularv"otcu.non) 'These I ilusiona tay not, in themselves, cause sickness but the occurrence ofotbor mlotions (especIalII heati motions) while experiencing an illusory motion can belauseogenic, Circul.ar vection is more easily simulated and hae been most studied,

101. 1oseudo-Cool.,ts effectThe Coriolis effect oucurs if, while the body is rotating about one axis, the head Is

r otated about another axtis (sae Section 8). Di ohganrr and Biraedt (1973) used the telm'paseudo-Coriolis effect' to describe the similar consequences that ariae if heart movement'iare made during circular veorion.x

In the hicihgans and Sra,,dt experiments ,.ubjects sat at the cent re of a 1,5 :i diametercylindrical drum with its nmX-t vertical end having inner waels wit.h alternate white ondblack vertical stripeL each subtanding 7 degrees at the eye, (Tilis appa'. •,s is sometimescal.led asr 'optokinetic drum') . Using 45 deqree head movements to the right and left duringroteation about the vnirtoal axis at ¶5 rpm, they compared the number of hled movementsrequired to produce motion smickness in three conditionsi rotation of the drum only,rotstion of the uhai r only an!d combinod rotation of the chair and drum, All threerondit Ionn produced sickness with thie 'drum only I rotatlor, tending to require most head,iovimnnits and t1ie combirn-1r ruriat Ion of chair aod dusi requiling the least head movementstaruve aioknenn, Thte nnrem'• eAnt-l oros 'er, experienced by nubjects An, all threesonidiL t LOis,

i•ALnkni-r arid T0,),olr.a (1977) found ULitle difference in the motion sikness symptomsuxp'oiI luocel whel nutibjeit I hull.J :Ire rhed ntaLtionary uo moved the head from shoulder tosrhoulder whi he viewing withiri ar optoknretic drum Wlth ratea of rotation increasedIncremental Ly from 1.66 tn 13,33 rpm. There was a trend towards fewer symptoms when thehead was hold start.irary Tiriy repo.t that symptrona were not the same as tho.se experiencedduring Coriolii stilioulatiorn - possibly because the incremental charges in the rotationvelocity rkeulted in only a few mubjeotr expertencLng the pseudo-Coxiolis effect when,nov rig th heead,

Using rtndomly posltionod black doto on the interior of a white sphere, Yang and Pei(1991) investJgated the severity of motion sickness in seated subjects arising with variousdirections of sphere rotation (at 7.5 rpm) end head rotation (f20 degrees). During rollmotion of the drum, freed movements in roll reduced motion sickness while pitch and yaw headmovements caused no significant change• relative to the condition with no head movement,During pitch motion of the sphere, head movements in roll, pitch and yaw significantly .reduced motion sickness zympt-ms. During yaw axis otation of the sph,.re, head mcvem-nts .in roll and pitich sign.iticantly i, ncreased motion sickness symptoms while yaw axis headmotions ned no effect. The effect of head motiun was most, detrimental with yaw rotationof the sphere and most beneficial with pitch rotation of tht sphere. This may be explainedin terms of the strength of the illusory sensation of turning (circular vection) beirngstronggest with yaw rotation of the sphere and weakest with pitch rotation of the spheresee Section l0.2t,

KI, i• ,.'•. ' t., v...

3-24

10.2 Circular vectionVarious studies have produced motion sickness iwithout head motions using a drum

similar to that devised by Dichgans and Brandt.

Daunton at al (1984) compared the incidence of motion sickness in 271 squirrel monkeysexpoaed to constant speed rotation about a vertical axis with A view of the laboratory withthe sickness that occutred within a rotating optokinetic drum. With a rotation rate of 10rpm, 70% of animals retched tr vomited when they were rotated, while 74% retched or vomitedin the rotating optokinetic drum. At 25 rpm ell animals retched or vomited when they wererotated and 81% retched or vomited within the optokinetic drum.

Using drum rotation at 10 rpm, Stern et al (1985) found that 14 out of 21 subjectsdeveloped symptoms of motion sickness in a 15 minute exposure. Five subjects requested thedrum motion to be stopped before 15 minutes. HU et al (1989) found that symptoms of motionsickness increased appreciably as the rotation rate of the drum increased from 2.5 to 10rpm but fell when the speed was increased further to 15 rpm, Using a rotation rate of tOrpm, Stern et al (1990) found that symptoms of motion sickness could be greatly reduced byrestricting the subjects to a 15 degree circular field of view or providing them with afixed visual target. Hu et sl (1991a) found that exposure to a circular vection drumrotating at 2,5 rpm end 5 rpm for periods of 4 minutes reduced sueceptibility to sicknessduring subsequent exposures to 10 rpm for 16 minutes, Using 10 rpm rotation of a circularvection drum 0,76m in diameter with alternating 5.7 degree black and 9.3 degree whitestripes and a fixed head position, Hu at &I (1991b) found that symptoms of sicknessdecreased over successive exposures of 16 minutes duration,

In studies reported by DobJe at al (1987, 1989a, 1989b) most subjects toleratedappreciably less then 20 minutes of exposure to drum rotation at 10 rpm before symptoms ofmotion allknLss resulted in withdrawal of exposure. Dobie and Mey (1990) report meantolerance times to this test In the range 3 to 6 minutes compared to mean tolerance timestn the range 2 to 3 minutes fao subjects given Coriolis stimulation (chair rntation at 10rpm with 45 degree tilts in the frontal arid latorAl planua uvery 40 seconds),

In a study of optokinetic and vaestibulo-ocular reflex responser to pueudo-randomstimuli, Peterka at al t1907) found that no subject complained of sickness when the seatedsubjects were nscillated in yaw in a darkened room but 20% of subjects producad symptomawhen a visual Ltlmutlui, was rotilted abcu t the stationary subjects., The provoostion wasgreater with the optokinetic stimulus even though the magnitude (.f the visual mot.ion washalf the magnitude of the rotation when the subject was oaoillated, The two motions hadsImilar, though not identical, spectra with all energy below 1.5 H4,

Using rmndoedly positioned black dotes ol the Interior of a white sphere, Yang arid Vol(1991) investigated the severity of motion sickness in seated subjects erising with roll,pitch and yaw rotation of the sphere at '1,5 rpm. The strength of the illusory sensationof turning (circular veotion) was strongest with yaw rotatioln of thb sploire and weakrl,with pitch rotation of the sphere. However, in the absence of head movements, symptoms ofmotion sickness were strongest with pitch rotation and leant with yaw rotation, Thefindings are explained in terms of otolithic signals reducing vaction for rotation abouthorizontal axes, at the expense of introducing 'conflict' between visuaL ,nd vestibularinformation. Pitch head motions are assumed to,be worse than roll head n[otions becausepitch head motions are more frequent and so more closely associated with otolithicstimulation - consequently pitch rotation of the sphere produced the stronqeni contlact,

10.3 Other mootionsfrom studies Involvinq the swinging of oa'dts end the totaLtion of monfkeyn, i1aUiLtou] Of

al (1984) concluded that these animals could be made :ýilck 1y visual st.iniulation alone andthat arnimals most sueceptLh] e Io opookinet Li Ot iulr1sat)oll tend to beI t lose moist. cept [Ii.Ivto motion sickness with bodily imtovment, 'r'hn tWo oploknrirtic mplot tin i w, oil( tiwiiniqi rg abox (at 0.28 Hz) over stationary c.ats and plancInq nti Lioriary i~riitrre] nuonkoyum wILhin arotatiteg optokinetJlc drum (snen Slotltor 10.2).

10.4 Distortion or degradation of the visual fieldBenfari (1964) obtained subjective reports of motion slcknuss symptoms while subjects

viewed four types of film projected with a wide angle lens within a 165 degree dome. Itwas found that the combination ol peripheral flicker with a poorly structured visual fieldgave moat symptoms of motion sickness, The presence of flicker alone or a poorlystructured visual field alone were noL sufficient. to cause significant problems,

The wearing of left.rlght or up-down reversiny spectacles while walking or lmtakilygother voluntary or involuntary head movements can induce symptoms of motion sickness (eag,Kottenhoff arnd Lindahl, 19601 Sock and Oman, 1982), ackner anid uizio (1991) report thatsusceptibility to sickness produced by 0.5 Hz pitch head movements with visual inversionwas less in a 0G environment (a parabolic flight profile in an aircraift) than in aterrestrial I0 environment, Ambulation while wearing left-right reversing goggles has beenreported as considerably more naussogenir. than ambulation with up-down reversi.ng gogglesiTakahashi et al, 1991).

10.5 ltisulateo sicknessThere are manly reports of motion sickness in simulators, some of which may be

attributed to distortion or other deficiencies of the visuel simulation. The presence ofinappropriate lags between subject responses and movements of the visual scene and themotion simulator may also be responsible.

141 1,"

3-2.1

11. OTHMR NON-MOTION STIMULI CAUSING SICKNESS

oymptoms indistinguishable from some motion sickness symptoms can be produced byvarious non-motion stimuli. These inclide caloric stimulation of the outer ear, theeScesmive consumption of olcohol, the consumption of heavy water (deuterium oxide), somephysiological conditions and physiological disorders, radiation and variouv h[ugs,including poisons, tome of these may also accentuate susceptibility to motion sickness,

12. DISCUSSION AND CONCLUSIONSMot1on sickness arises from a wide variety of physical stimuli. Experimental results

provide a growing body of data from which predictions can be made. General theories ofmotion sickness offer qualitative explanations of why motion sickness occurs in eachcircumstance but they do not allow quantitative predictions of the physical characteristicsof stimuli required for sickness. General theories do not indicate which of two stimuliwill be more nauseogenic or provide prediotions of the extent of sickness with any form ofmotion,

Head motion appears critical to the development of sickness with some motions. Thefailure to control, or adequately monitor, head motions in many experiments limits theinterpret.'tion of some results. the motion imparted to a person at the floor or seat maynot be the same as that occurring at the head, The transmission of motion through the bodymay be attenuated or amplified and there may be phase lags, MIotioa in one axis at tin seat(e,g, fore-and-aft) may induce other axes of movement at the head (u,, pitch) , Thesub~lect may make voluntary or involuntary movements of the head in response to the motions,With the extent of these depending on the type of restraint and the visual field, Theinteraction between these head motions and the imposed motion may be a cause or sickness.

Ucudies of the efftets of head position and body orientation o" &ockness induced tythe drug spomorphine, revealed that vomiting was far less when subjects were supine(lasaos, 1957) , The benefit was shown to arias from the supine posture of the body end notfrom the changed orientation oý the head, While head movements may be the cause ofsickness with some motion stimuli it does necesmarily not: follow thai the often reportedbenefits of a recumbent posture in transport arise from the changed orientation of Phohead. These studies also suggested that the action of apomorphine was additive, orsynergistic, with the sickness induqed by vertical motion, horiszntal motion snnr raloricstimulation,

Visual conditions are also critical to the nevelopment of motion sickness in somesituations, Different degrees of sickness can arise with eyes rinsed, eyes opon vi4ewinga moving environment and oyesý open viewing the outside world, When viewin(g the movingenvironment (e.g. the interior of a moving cabin) the effect may depend on the visualsoarse. A task which requires eye movements may hav, a parhioularLy detrimrntal efsct onsubject well-being, 'fhe pieseritation of a visual scene which moves within a cabin (os withsome simulators) may ba expected to increase or decrease sickness depending on the eye andhead movements that arise and how both the extent and the phess of movements of. tht,projected visual scene correspond with movements of the cabin or the pcsitLion of theexternal world.

Future research will extend the set of relevo,.t experimental data, This will allowIncreased understanding of the effects of ihdividual physical, physiological andpsychological variables, It may then be possiblle to of ez more confidunt predictions ofthe physical causes of motion sickness in specific environments.

13. MYEERZNCUUAlexanrdir,S.J., Cotzrr M., fIiil,C.JT , Riccluti, i,A. , Wendt, G.R, (945a) , We,,, I uy,inUniversity studies of motion sicknusit I. The etfects of variation of time Intervalsbetween accelerations upon sickness rates. The Journal of Psychoiuqy, 19, 49-62,

Alewander,S.J., Cotein,M,, Hill,C,j,, Ri.ciuti,S.A., WendtG,fi, (1945b) WesleyanUniversity studies of motion sicknessl I, A second approach to the, problem of the effectsof varlatior of time Intervals between accelerations upon sickness rates, The Joulmnsl ofPsychology+ 19, 63-61).

Alexander,S.J., Cotzin,M,, Hill,C,J,, Ricoiut I,E.A., Wendrt,GR, (1945c). WesleyanUniversity studies of motion sicknesli: 111. The effects of various acuslarations uponsicknsas rates, The Journal-of Psychology, 20, 3-8.

Alexander,SJ,, Cotsin,M., HillCJ,, Ricciuti,E.A., Wtnrdt,O,R, (1945d), WesleyanUniversity studies of motion sickness: IV. The effects of waves containi.ng two acneleýeaionlevels upon sickness. The Journal of Psychology, '0, 9-18.

Alexander,8.J., Cotzin,M., Klee,J.B., Wendt,G.R. (194'1), Studies of motion sickness: XV1,The effects upon sicliness rates of waves and vsr4rn,- frerpimnn/ePs ho- 1"H•dri'acceleration. Journal of Experimental Psychology, 37, 440.-447.

Ambler,fR.., GuedryF.E. (1966). Validity of a brief vestibular disorientation teat inscreening pilot trainees. Aerospace Mediciine, 37, (2), 124-126.

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BAbkih,BY.i, Bornatein,M.R, (1943). The effect of swinging and 6ff binaoral galvanicstimulation on thle mnotilit.% Of the atomuch in dogs. Revue Canadianne do Bioloyle, 2, 316-349,

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Udrens,, Natsuki,N., Saito,1l. (1988) * uncos Murinus as a new experimental model for moiction,iekrress. Life scipnces, 43, (5), 413-420.

Wsantr,S.C.,,Chirin,F11, (95)Ftimnta o o sickness in dogs: functional importancerof camoeptvo mutQ tiggr tne, mercanJounalof hyriolgy#178, 111-116,

Wtlpineski,C.R., towry,L,0., Contrucci,R.2., OreenSI.J., Goldman,W.S, (-L985). Eftfect..i ofhead arid body restraint on experimantal rnotion-inducud sickness in squirrel monkeys.Aviation, Sparce and Enrvironmental Modicine, 56, (111, 1070-10)13.Wi gpizealcl,C.R., Lowry,LLI)., Greenr,S.4, Smith,I1D,E, MeInirik,Ht (1987a. Subjective06ricuritants Of motion SiCkOSi`69 quintifying rotation-induced illness in squirtul monkeys.otoa~ayngrology - Heed and Neck Surgery, 97, C(5) 133-440.

Wilpi .{ufli,V. H,, Lowry, 1.0., Nil lar ,1IA. , Smith, B.* [,, lie idmarir, 1) 1987h') . Adaeptati(on anrdhabit natio.n of motion-induced vomiting In squirreil mronkeys, Aviation, :.Pace andEnird ,irmer'tul tMedicine), [is, (9, Muppl,1, A22-29,

W,; L G dn, (1957) . Some arrimal experenrtri on ic t Looi sickneaca . Acta otolsryiiqo.Lirs, 48,112-181.

tlo] Iar) on, N.H(. (1809) , Tha Crooni en Lect.ure, Ph ii onophia (o)'ran-.act .1ons at', tic Royal.Soc uty, London, Part 1, -1-3,

Wod GD,(raylrihv1,A. (1968). Elivelut(ion nof sixteen rint t-moriori nicknosan druqn underc~oririullud larboratory conditions. Aer-omapce (4cdvioire, 39, (12), 1341-1.344.

Wo-'rr,C[,:, Qrabil (19'10) bviuluza;±ui- oh. artimotior a.) ckniies driiqrii A now ehffeotivoerý,mxdy reveja~l d, Ar,'p cMdic) nE, 41, (8), 93P2-933,

Wurrri't-.),, Graybiel,A., Kennedyp,mS. (1966). Coreperison of ettectivenorse of~sors antimotio:,s teknmss.n o1rug. Using recommenided and larger than reesoirrrrenderd dunee me toested in the Mlowrutnjtuoii room. Anrospac-o Neirdine~o, 3), 13), R59-262,

Yang"'S., Ved,,'. (11911 Noti onnii'vr novertLy rrrnror tn rrtori t virusuii andM (enamoveiment, Avlaiti on1

0 pac,- arid aevi ronruentali Much) dire, 62,' (2) , 141" 144,

yournq, 1ý 14. , ')marr,rC2 ,N Wit~tntt,D. 1 Noeb. Moy,h?.Nt., I LIchrt.'nbr'rq,FB. K. (19)14). upi t i ao rierntait.ion I n we tqht Ietnaý-ireon nd rxarirpt-iarIon t.o v crL 1 rtrg crlrv I ty .r 1r' 22 5 0, 2011-28.

4-1

I11CINIVICATION OPURATIONNICILI DU VlCPIMMM POUR L'AliEo ,11UPACE R IA EURVIREN MRL.

A.LEGERDivision, Visualization Interface / Etudes Averted"

SEXTANT M~onique33166 St M~dad on Salles Codes, MR

IiLMhi Sur un plan purement mnldical, Isi nal deu The testimony of representatives of the Groundtransports ou drndtase to pose g6nilrallement quo dos Formes the Army Air Forcms and the Navy andproblinios binlns dana Is vie cocranta. Er. rovayrhe, let reports from England and Canada suggested thatapirdtlono airlennies at spaidales dornnat un. touts auitr the incidents at seasickness In amphibious trainingdimension t cott. affection relativement friquente. Do and combat operations had been high, resulting atmime, Is syndrome do cintituse a une Influence sensible sur time in serious losses of efflelencyt that airsicktnesslIs conditions do .wrvie on mar, had become a problem of some magnitude in the

selection, training and proper elimination of MirLA perspective historique issue dos reeherches mondes lots force personnel particularly navigators, bombardiserdu dornier cunillit mondial permot do mists mituor Ie and gunnors; sod that operations then anticipated,problime. Colte distarolts conduit entuit. k analyser les lin which very large numbers of troops would be

*reIntions complexes qui ortisitnt intre In drintoses at Ia carried by air and by small surface craft, might be*performance psychomotrica dea opirateura. attended by at serious doegre of incapacitation from

motion sickness" Bard, 1948.Llmpact dos cinitose sur len opirstions militsires

*ai~riennes comports do* aspncts classlques, rolativemont Ceal timolgit bion des prioccupations qul pouvalentbien fiudl6& sut le plan ilpidimfologlque, Let problimes alister Ii calts 6poque, La question qua I'on poutl ids it Is formation Initial# et t I i'ntralnismnte des piloto& ligitintoment so poser ait: "qulen est-l maintensont?". Laonsntituent toujouis oft print Important. Do mime, los but essential de ce document sort done do tentor do Maine IscLdtome pouvmnt 6vrontue~lhernnt tonrilbusr h accrottre as point sut las usepets actual& do I& signIficationvulnirabillti da mile k terra dos combattants uircportis. opdratlonnelle dos cindtoses.On relboe par autocrast dos upon@s nouveaun, risultant deli'volutikn tochnologique du Warnot& ot dos systbrmos. 11 faut bien so rendris compte quo, dant Is vie couraite,Moils, l'introdcction des "yifmel d'side k Is vision nocturne I'appsrition du syndrome do cinitaow eat cartos diplalsanto,et du suiv de, terrain automatique amline des conditions do mats quo son netentissemfent Bur Iii conception dos myoynsvol propics soa divelopponient dos cinitosos do transport at tour mise en oeuvre demeure gdniralement

asses ilmit6. On pout, par exemple, so demander quell sera

La retentissomentt du mal doa lespace sun le operations Illmpact dos cindtosu. icr ia dciclon dos passagers dospatale noso pss it u tut d I&mim faqn slonquo ciolsir Is bateau, lavion ou Is tunnel &out Is munche pour

aunt gonsidinis des i~jouns courts (navette) ou longs i udoo oam nmi 1etpoal u ot

(station spatisae habltable). Las rdsultatA dc loexploitation question demeurs duc second ondre par rspport suitcontslddnatlons tarlfalroi, On pact 6galoeont voir contalins

doc Sy~tbmo do Transport Spatial (STS) constituent Is constructeurs automobiles alintonrogor, Iots do Ismelilecre source do doiindes sur co sciot, conception dos vihiculos, sur Its interactions vilso-

vostibulaire. toutefols, cette dimarche demosreEnfin. is& consiquenices physiologlques at pqychologiques hobituollement rolativomont ponctuollr. It oil postant blondo syndrome do clittoso, tell.s qu'aggravation do Is connu quo Ito mal do volture" constitue un fluau pour te&dishydrntation, assthie, sont lot principsux factours, f parents de Jesnes enfants mals qul , gindralement at fortprondreoen compte pour Is survie on mer, heureusoeont, affecte plutOt Is moyarkno honaire dos

I. INTIODUCTON dilpiacaments quo tour sicritil.

En tall, ces quoiques rnoifelor anacdines, nasocios auLei ccnsiqcenicna opdrationnollea des ciniltoses ont 4t4 consildirstions tsistoriques, ant pour but do soullgnra quo 1sporticuli~krement itudlies dens I& comniunautiti millistai au problfina do Is signification opinationnefle conatitus rsncourt dic second conflt mondial at dans leia nitie qui ant moleur extrimomont puissanit pour touteslIa ituciesoclvi. Pout comprandre cot mindrt, on pout delto un sttrait maniesa dansa le domains dos ainitosaso. L~inpsact ourdu rapport do I& premillra rilunion du soue~comlti US Sur leafficaclti des opiratocrosil stI&uriti des opiratlens, donelot clnitoxes, daspri Renasn (22): Is cobt humnin at matlifiel, constitue uno dli fonidamentalo

do It progression dos connalsaancea giniralas done ccdomain. (somemi damn beaucoup dlautme dalleur~lt),

4,.44I

4-2

Ainsi, clants lea annics 60 A 70 Is perspective dos vole Australia,,. font tAm do probilmen qui sambiaspatisux at dos problimes d'orlontation spatiale pouvant on particulihrastent algd pour [am tiavigatotais.ddcoulor a mans aurwi douto largamant contribul I l'anorImportant dos Cludes do physlologic voeelbulolro, on samucoup moins do donndea sont disponblbo pour leaparticullar sun Etats.Unis. opdrationa do combat adrian, Los estimations variant an~ta

S at 19 % aeon lea sources, mali I'interflrance dos cin6tomoComnmit Ia, note Bonson (1), Ia port. do blon-Atra risultant avoc l'ut6cution des Wihom opirationnoitot eat

*du mau dot transport&, mmem moddrda, pout conutituos one halbituslloment rolaties comma trio baue, pulaqus no

sourco t~o prablimu pour on piloto dont Is ticho oat par dipossont psa 0,3 pour 10W0 hommo/mIsalon, 11 oxslte paravanco -onipluas 11 taut copondlari roconnaltro quo coite ailiours dos Interactions recomn nuro a n~s o conditions du 1parts d'olflcacitd sit souvont extrimant diftfile, i quantifier, combat at Is performance pouvant porticipar It on tauxsurtout thut dus pilots@ antraindsl, habltuallament p~o roistivomant bas par rapport A, Il'inddnco global@ du

*porti star Il'ntrospection. Do plus, los relations ontro Is syndrome,performance, prise so "eno gdntrai do terms, at iencinkntsa no ripondont pa. & des lols simplas at sont Les itudes do temps do guorre font une place Important.connoss pour Wte bldlnectlonnellso. su problinm. do transport do troupes par vole adrene,

Ma~4r at Purd, 1949. Dirren, 1949; Hemingway, 194S;Apris avoir brllvitmont 6voqud l'historiquo du problimo, It Chinn at Smith, 1953), Tous i'accordent pour constater quoconvIant don; d'onvisagor lei Interactions qul existent ontro Ilincidwon dim cintoss dons lea troupes adroportiot wsclnitoso at performance aft do poser Ins boase d'un particulibroeinnt 6lavia tora dos phase do transportrillelon star as signification opdrationnalle acloolba du tactique. On rouby. sinai des incidences do l'ordro do 25 itsyndrome, 80 96 salon io typo do vol. En revanche, II no sombla pit

Waster do mention particullhro pour llnterfirence ayes lot2. FEISIP213M' HI#TORIQUE opirallons do combat Immidlitoment sprbs 11aroportags,

Comma Is souligno Renasn (22), avoc qualquos anecdotes En fall, dons lansombia dio m tudes do terrain on tampsdapuls Cicoron Jusqulk TE, L.awrenco, lea cindtow aont do do guorro, Il'nfluenco dos cindtomes star Is performance deslongue date prioccupil Ia commonautil m~llitalre. Cos conibartants, on debtors des phas. Wlga. do syndrome.prdoccupatIons ont Iris cortmlnoment culnilni eta coort do samble oxtrimament difflcilsit quantifier, cc qol eut sawusecond conflit mondlal, avoc It nicaulti do transporter do facileomnt coniprihansible. Coltta constatatlon amino donstrils large. contingents do troupes, appolia A Aire A onsiddror let itodu do terrain eta do Isboratoire, qul ontrapidoment engagE. dons des opdrationts do lirands Eel aplcltlquament oonasecrio sux Interactions ontra loaorevorgursr, Co moud, blen traduit per Is citation do Bard cinitoses atbs porformenco do Popirlatur,prdsentile plus haut, concernalt asntiollsmantP'entrafnomant adronautlque, lot opdrations marltimas at'Ia 3. CINWIOSE IT PKRFORM&.NCEtransport da troupes, Lot travaux offactuds trits t6t dens Iacours do second confilt mondial ont surtout donn lisu A Plusiours revues do is littdraturo abordont lots relationsuna estimation do Ilincidengs does cinitosot sans toujours exitent antr, cindlowsa at performance (11, 20, 22). Commatripondro diroctomant ata problime do bs signification pour Roanss (22), on pout dgabament 6voqoer l'upecttot op~rations. La ravue do cetto question flgurknt dans bidirectionnal des Intaractions antrc cinitosot atb1ouvrogo do Renasn (22) Conaltto tnan baes do donnica parformance, &t savoir loo orftts des cindtgoa stur Iapankul~wlroment intirsassto k cot Allard. performanco atlas offal. do Ia parformonco aur Is syndromeo

do cindtoao.Chaton pour m~moir. des chiffras concernant los opirastionsamphibles, qui vont do 11% par petit lamps jusquih 60 & Pour cc qul concerno los dtudos do terrain, I& plopart am70%6 par gras tamps, Four co qclo concerno lea opdrations sont lntdruosdsil sox cindloses provoqucas par Ia navigationadriennes, trois thimn. assantiels mont distiigula, maritime, mals quoiquas rnatltata sont dlsponibles pour desVentrabnoment eta pilotage, los op~rations de combat aWrin situations adronautiqcs.m 1 OII eLa par ailleara doat les opdrstionso aroportiles. nombrausca ilod.s do laboratolro consacrios & letfet da

diverasom atimtulations provocatrico our I& performanceL'Incidonco pendant lontralinoemnt, rapportle dons ine psychomotrice at Intollectuollo. Comm* to souligno Monteytitudot du temps do guerro, oet roliativemant modesto pour (20), lea Etudet do laborsatoro introdulsont un blalalo& plotos (10 & 139% scion Hemingway), mole beaucoup Indritabia dons i~valuatiost do Is performance, car Is aujatplus iuiportante pour boa navigatours (jusqu'k 65% sclon cat consciant ditra obsoesv at connalt gidnralament I&une itlod d- McDonough publ~s en 1943). Le dodE. do b'dprouve. cod eat donc fortamant msaceptibia doratantissomont opdratlonnal to plus Cividant des cindtoses modifior son comporteomnt at sm motivation par rapport itlora do IPanirsinamant on Icola do pilotage cat I. taux do tnae situation opdratlonnalie prolongde. Cot daxuptsaeota dodisqualification qul pout lour Itreo ttribtad. Salon Dirron i6vuabtaston do Is performance saront euccaaalvemaont(1949), Co taut MISr on fonction dos aoorces d'Informatlon aborddt,antre 0,15 at 6,5 Va. D'une manuire plus qualitative, dessources allides divarees (Afrique du Bud, Etato-nis,

4-~3

3.1. rEludes eozprinoatuooti do terral. porormanot; Intallectuolls Cii Pa~himotriet~o -Mnt rivtAGAl:6rs, Clem Is an pour does tshn do saloul mothimatique

Bien qu'obtenuma avoc dus stimulationsa t on (blen quo coo solt cantrovorad), dootimotlion du temps otonvirannomant relativornnt Aloip6 do ce qui sot renontori pour diffirontso tithes do poursultsoau do tradding. Onon waronautique, In donateso provonant dos 6tudu itaI mer note soum ludustonco do digradotions, Iona d'prowuv$ont Intdrooaontee A oonaiddror, Dos riaultstsaoncient mottant on Jou Ia vigilance suditlve.avolont dJAh soulignA Is difternce antro.I performance doroutine at Is porformance do points. Coo Signi&l quo, M. CHM do Is porlibrinest sut In dlndtomom~ime toat on proie gu sy'ndrome, ian lndivdu qui trauveune motivation staffloant dens Ilaocomplluoomont do a 11 Weiss on certain nombro do donnies, I& plupamtihos oat capable do Voifootoor pratlquomont tans ansodotliquo. qul diabliuiont on lion ontro Is ndoonaoll vitulsdigradation. Las d~radatflona obinrydo. our diffitsonts toits dlaccomplir une tich. at Is sodvirh du syndromot provoqu6do performance a011 ouantiitlomont pgsnto. C1211 too par dos stimulations nauaooginlquo, 1t oat habituollomentproandbro. hourso deupoaltton & Ilarnvironnermont, On a shu obioM un* forts diminution, voireoune dispoartionpu observer on* diminution do. performances sot dos complits, dos qvnpt~mo lonque 1s sujot as trouvettheks dleuatrctlon do dontlon, do ualsonnomont bnaaquomont don. one situation critique ou ozorgst unogrammatical at do tracking ot, d'un. manibre plus forts domands &our Is plan poychomotsof, Flusolmrs itodesprolongko, un@ digradation do copacit~i do traeb do Is oxtpklrmsntaloa offoctudour mar coaujot (22), tandentroute (titho do navipltion). Co typo do r~oulitat oat monitor quo too Lichas dirigesont Il'ttontion von In monderottouvd dant phuoloora Atudes (tI), on condition ttell. ou asttrieur diminuent Isacinkoso, aloft quo Is conoontrationan simulation. our to. syipt~mes a piut~t tondmnce & Inu acorottre. La

question oat copondant loin dlAtrs totoloment tranchdo,Parmi lot raroo dtudo. r6alisdes on onvironnomont puloqus Lentte (19) observeoun accrolsoomant do Is idvdritdadronautiquo, ii foot chato Is travail do Kennedy at cotl dons dia ayndromo provoqu6 par on toet d'lntoraction VIsuc-do. vola do pdndltration do cyclone (14). Do. digradations voatibutatro on fonation do Is compleudt6 do [a tWhoalpnlfloatives do Is performnance ant ainsi 646 obsorvdoo our vituallo.one tich. do vighlonco auditivo,

4. AMPCIV ACIUKIJCertain.. itudeo ant Agailamont 6td mennesaon miliouspatial, malo rfarmont avac do. donnosa quantitativemant L'onmnmbio do. donntes Isuuos do. observationsosfftoctudoodtablia.. Alint, Reason (22) rapport. cottaina 4liments on situation do guaor atilet dlvorooo itudes our I'offst do.d'analyso subjoctive our is performance do cooononautoa cinitouso our Ia performance pormettont ddtibtlrt qo'lfsovidtiquoa montrant one rNduction do Is performance on ali~t. un risueo potential, tint asi niveou do. opiration.vol at san acoroioooment do I& difficuMitA offeotoor ICt tithes militaires quo dent Is domaino apatilIdemamnddoa. Hettinger (11) inentlonno do. r~aultatoaxp6rimontitux r6oonts r~vdlant uno alt~ration do temps do Dana Is praninor coo, coat vdiriabioment Ia probibmo doriaction at do I& capacit6 deastimation do tampa, sombiant Picacfloolt, on troms do roumito at do odoriti do.lids A l'sxistoncs ddpieodes do mal do lospaco (21). opdrations, qot oat an iou danm do. situations ott Is ourviis do

combattant va ddpondro do is ospaocit k mottro on oeuv.o33.. Motiono on liboraloiro dos armaments do ptus on pius complexes it co~toox. Dana

It second, le probibme neast habituallomont plot aoaai vita,Los 6tudo. our It d~gradation do Is performance rtialidea malt, comrsta toots do colt earitrdmemnt itovi do.dons do oconditiona do laboratoire smont wrmamomnt optirations saptial*#, i1 &segt pltas d'un aspoct do rsntobilithnombrcoosn, Au regard do. diff~renta onvirosnamoento quo do odouritd. 11 taut copondent toter quo, dons Its douxutilaoU, Ica Cutldot cia11uiq do Wendt sour loffot dos goo, on so trouve biosi confronid avoc un probibmo qol, turacc~ldratIons varticalea, ainal quo cellos qui ant tuivi our c0 IC plan do Ia signifliction opdrationnoiloe Impliqus is notiontypeo ditaimulaiotto, ott largomont contribud A augmenter do coilt humoin at niat~rial des cindtosos,lot consajsaauncoo dons Is domain. do Is performanco. LAcoambre do rotation lanto do Pensaola tufnt dgaloment une En gardont on m~moir. Ias donnua.. .riotntoo, it conviontplace partiosaitbro quiat It I quoltiath1& itIdiondoo doo maintonont d'offeosoor une analyse do problims do I&ostpdrimontationa qut y ont t 6 monde&. Enfin, dioutro siagnification opdrutionnoilo dos cindtowe dint Is contest#onvironnsnortla rotatirs (oriantis our Io. Etudes on mlieou adronau~tque it spatial actual, Los carwitristiques proproasaetial) ott 416 uttflsdo (11). I1 foot stoual tatt d'aooo out op~rations adironnes, so vol saptial ot oux probitimo.nsombrouaoo Etudwo. n slimulatossr,,dont cortolnt Ilias It Ia soulavias par Is survto on mew wanrst sucoooolvomentsimulation do combat adrtan (I15). aborddsso

Effectuft i l'lsoao d'dprouvo. provooatricus, diffironts toot 4.1. Opirstln.. mordon...physiques at do coordination motrico, cormin Is course, tolancer do fldcokttoo, I10~ Isirhasorbinos, we sont z~vilds nont Danm Is cadro gdnoral does opkations sariafnno., i coosvtonttsipiiatlliivomont affoot~s par Is syndrome do cinito. Bit do diaulauguor do. aspects iaeatooo.ee cwnmo Ilontralnomentrovsncho, "trout dina Is phase 0. ~ o do Lpotiltton aus t Is. transport oddest tactiquo, mile sues, dot Moscatostlznolationo naoatoginiques, dlffdrants toots do

4-4

nouveaux I16zamu contexts do I'ivoiution des armoments at mat de Pair, soft 19%, Wonr quo Is taux d'echoc Woobal dudot techniques do combat at decntratnement, coon sot do 33 %, L'autost note toitefois quo parm]t fee 40

616yes qul ont cocault6 pout mal do Vitro lIs tauxtLas thus prornibtes questions psuvmct itt. abordiot d'611mitution (touts# cause coftfond1AW) attaint 70 W. LO

companatlvament I des situations connute antiriouroment, citiffre do I %s rejoins Womansnt Is caux d'attrition svan.6terrain automatiqlus ou iua probiltmsa His It li vialonique do Force Meanienc Beige (251).

""wqu, dolvsnt Mtre ivoqui. en time do poptva t dopotentlalti, puisqus, en fait, Hl mists Itr psu do docnsos 3dml, pour termicer cstto ravus des donnis rdcontu aourdispontibles s ai ci ujot. tincidenedes dhi t iosos Ions do l'antratnsmoct, 11010dB quo

Hbwin at cog,. (12) ont rappond Ito Amtitato N di s oncqim4.1.1. Appietlasqp at sntralnsmesat loitgltudtttals portent sue isns population do 796 6livia, k

partir des ulocciga cotleatds Ions do 28.4183 sortiesTraditionnsilsment, lbcoool do pilotage a toujours prisonti sffscttsha cur diffirnta typo d'adronfta pondetnt Is courtun content$ prW6i0gl pout IW ddiVs'ppmont do. cintitosca. d'OM*Iota do l'Aironaoutiqus Navals (pormoels navigantA quolquus diffirecns prita, lifes It livolutlon des matiicla non-pilicu). Solon Is type d'apparalati d1 umersie,at des techntique. dontranrumoct, cn ool retfolativcment lhMicdncb dols cinnuotos va do 9 It 23 %.. 14w vndusmimntsmxast. En Wat, It lucite setualls, Is signification survioccztec dant 4 It It % dos sc ati10 performance sotopirasinomell des sindioacs on deals so ans diouts It considhris comma algnifloatlvemsnt digraudse dana 3 Itconaldirsi on termu do coOt direct at Indirocto, mel& aussi IS %. dos casrolatlyarmont k Is situation via It vim du rocrutcmsnt dosdlbvwapiiotu. L'uamsc do mo chifrtiro montre bimit quo Is ptobIlma posd,

an temps do palm, par In cinhtoaos dint to da cls@ doParmi In itudes modern*& contomrant Il'ncldecce dos pilotageseat laod, dens l'abaotu, diAtro Catav;rophiqus, ducindtonsc lots do i'entratnomect au pilotags, Iea "Ietata moms pottr ao qul concern. Is taut d'attrltlor qul pout tourrapportis par Resson on 1096 (22) donnent ins estimation &itt. dirictemntc i16. LA codt diuect, sur Is bsim dos #chowtifi Moavie, pulaqus, salon cat autour, 76 % Amduch6lantillonk at du dMaln dant Is progression, deosnuto tant cloutsddlbywapilotom do Cranweli a souffort da mal do l'air igalument rolativeomnt modirh, bloc quo, gaickeloment, itpondant I'ontralncnisnt au vol. Dana ci groups, 1S %. oct no soit pa. slairocuint indilqui, Ott pout ivoctuir copendlantdid attaints au point d'lntcrrompre pthmaturiment in vol. Is cofit indirect dus citnhtos on icoli qol consists on

I'ilmication d'isdividus qul, aills avalent aurmocti loutEn 1972, Lagusy at Coill rapportent, d'aprbs ins ocquiti handicap, sursiont tons dloute pu &le des collects pilotem,

oftsatuU dana ons 6cots do l'Armd do IAir Franp* I neut commeoen timoigccnt lot risuitats abler. As par Stott atincidence giobale do 30 %., stutemuent S 96 des 6iliss aysnt Bagehow (23), On pout sinai considdrer qu'k terms coococaulti Is midecin du Porsonnil Navigacnt (18). A In mimo Allminations, mime pou, nombrousot, pourt &enet condlutro Ittipoque, Dowd (S) dmst Is jugoniccnt quo let cinhtomes in rslatIf appauvtlaamect do Is quagliti doss pliots& qul, pardomeurent encore un problimto Iris Important dons t1US alliours, dolvent igfalsment ripondre It buiaucoup daoutesoAir Force, particuiliromect dic. Is manoouvtoo daytiona I critira physique$ et intelloctuelt.haute performancce. It citi Ins riotaitats do Tuckter (1965),rapportant quo 10 617 %. dob 6Iiviapilotes t oct i attsints Cadi awine i cocalddires Is problims din. It perspectiveeta main& uint lois durant liur ectratlnement, 5 V. d'un dc- poialbilitias do recrutoment. Dana in pays comma Ismacibre, rip6tttlvs, aycs un taus d~liliminatioc dil sox France, Is prestigeoattasht I in carribts '1s pilots mduitatro,"cntowso do 0,7% on particutior calls do pilots do chats. s at monore Irbs

grand. En sonuiqusnce Is combre do aindidastosaoulitaltntDoblo (4), in sa fondant air let oommontatret dot pilots. &cchcr It cocte carlibro oat tris, hlsvi at tend miem ItInstrua~ours portant aur uni population do 577 l6yoa, a'accroltrs aim rigutiiromont. Tact quit coil. situationddtorminlo ucm incidencce do 24, %. de miaI do lair moddrd durera, ts problinno dot cicitoss Ijout itt. cocsiisir6at do 14,6 %. do mit dc lair &Ms~v . 11 ant Intirosaunt do comma rolativsmsc: minsur, En revanche loraquiunowunaid6rot quo, dint colts 6tudo, Is jugsment do adyiriti du pinurle do pillots. cat recontri., rimultant, par usemple,syndrome italt itabli en tenant sonupto do it digrudoatioc d'une attrition ilovil,o do pilot.a quslilnia Nol au ditffrssitialdes ~srformances obsarvia durant Is vol, LUnmtor aoulignc do rimrcunration avec In sartlibros cvillas, Wlort it dovientquo catle estimations~t tomcn& doute utm prudinte, putoqus macs douts plusa Intircomant do teniter do ridluirle imPicidince des malaise. fltgers ou mime mnodirha a pu M~rs ilimlnetiosan schols do pliotaile.soua-ostirnis do fait do Ia mnithods divaluation cmpicyio,rvur autre ýMtd, ten ctuiffrcc, rd~ultanl Jc cults itudo act one Pour Wie cociplet, 11 faut par ailliona osiviasger is contentsvalour importanto sur Is plan do lit signifloatlort particulior du tompa do guerre. Dana uc cosiflit majsur onopirstioccoile dot cinitoosta, pulaque ivaluant dirwoteont pouit sappolor Io esrarieus do peratl dievied,loffeat tur In parformancc, En 1977, ayes ins mithodologis vralsomblablemont diefiles. It combler rapidemeont. Snralativiment Iddctiquc. Osilo.ToymensAu (8) eatims quo 30 offet, In compludthi dot evions do combat modcmssniSO V0. des ilivwtpilots. souffhont do anal des transtports It implique in sntrahuciontwt rellativimeci long t, At auppowades dogma divers durect lowr entralnemont en #ool., quo I* matrial pulses itt. rompisal rapidomon4t on poutCoepndant saulament 5 ilivasi cur 492 oct 616 dlimtnu pour doistor qus to cthcinlmsn dioI Is itrtnatioton icaloos pulsea

jouor orticeenont ot quo ]a Mal do l'atr y sit un r~lo dons I& population do pilotos do chauc (16), au momns 25 %silinflostif. des pflotoe nonnalomont Adakptes ant Unan sumoptiblilti do

buse qui pout INs rondrs sonsibles it des conditions do vol41.1J. Vladrorbillltl do masi A tom. inhabituelles ¶LA miss It teran do troupes akroportoa oonatltuo ilgelemnst L~e sulM do terrain automistique comports doux types dotan contests favorable aua cddclmchoonet des ciatososs. Lea ceractirlatiquu propicos ata ddclenchemntet du syndrome doconditions du transport pedokdat Is largags seat, bon sAr I& cindtose Tout d'abord, If pilot* Wesnt plus dlroctement onsource asuontilell do problimes mooonuris. Poor Ochappor conktrill des dvalutlons do Vavion ot so trouvo done damait I diteotion, des radon et bin~iiforo do Mofet do surpriso uone situation do pasloger. d'autro part, ien 4olutiona, donicoumdark Ifl riussits do i'opkation, lea vipporall do laopparoll, constltusos typiquarmont do successionstransprts taniques sont ameands It ioluor & trig baow daweddration Os pouitivos ot negatives at do viragoes, sontaltitudo, pendant dam duroe relativomont longues (1 6 2 par ollosmilmos hautoment susceptibins us provoqluerhourso). Dama cui conditions Is taux do saijots souffrant do l~apparition du syndrome. Coo doux conditions Mant41114106 Pout Issintdre 8096, COMMo1 on tfimoignent INo rdualoa. ont pout done penser quo t'sppartlton inslidleuse durioultats exprirmontaux: obtonus par Clalban ot coil (7), met do lair themo tn ploto opirationnoll eyant par sillours

Unan tide. coiplass 11 otloctuor, connatitue una 0oll0 Mongol11 soa, on gdndrai1 roeiatvomnnt diffloiloa do obhifrr Ilimpact pour If qualltd at is sdouritd do Is mission, du moins Jusqulkexact du mil do l'air subi durant Isyto volutr lolflicacisd dusa cc utano, habituation It cam conditions do vol alt prim place,combattants aua sal, Compto-tonu des observations du temps En failt, on debars do rapports do pilotes ayant offoctud iotdo parrro ot dos rdsuitata esdrlmentault otar Is performance oasio on Yol do co typo ds systilmo at des donndoasat I"o caintoses, on pourralt ponsor quo lolefft direct anhodotiquos, ce problimo no somable pas rdellosnont avoirdomoure relativontment moddrd. 11 toaviont cpepndant da 6t4 docummnt6 d~une msnllro sdrtouss,poussor Ist riflation plus loin, En Wet, los& opdrations dotransport do troupes quo Pon pout attendre do contextso En revancheo, II caxsto quoliquus dldments ooncernant leehautomoent tochnologilqta du combat modomoe en Europe diaspositlf Wedald it I vision nocturne, Ainal, Comuni at Coll.sent relativemoent peta propicos atax trio pondsi mouvomonts (3) ont rapparti loxistence do problbmos do cindtose donsis soldiant par des "Yomlssmemnts do masse hlstorlquue. leontratnomont at iiutllloation opirstionnoill dom sysibmus

daldo 11la vision nocturne do Ibliclloptilro d'attaque AH644En revanche Io dipisoomont dim menaces it Iemadriour du "Apache". Los mtcsnismes on cause &ambient gtrethilitre *uropian pose is problime do lIntorvstition Vl'dstsltce do problilmos do paraflaxie, reals on poutponctuollo our tan point chaud do troupes didli1to amend.s t igaloment siappoaer quo Is restriction du champ do visionongiagor to combat trio rapidlomont aprits lout Miss It torre, ontrataio par Ilutillsotion dsn systimoo pout dgismont11 ne *segt plus lI do 101st hsold do real does transports jousrttan r~le don# liopperitlmn des syrept~mes, 1Aoipris un vol tactlque do quotqtaos honsea minis bion do celui signiastion opirstionnollo do cow troubles, an dlebars dodu stress comrbin (fatigue diun vol prolongE, perturbations lour incidenco star lontratnemonw, sot oncore mat connue,circadionnos, changoement do "lnat) olt IN, olnisosos On pout capondant aupposer quo Imistence dma syndromepouvont contribuor it augmenter Is vulndrabiltO do reiss It dons dos conditions opkdrs onnefll, pout affectortonfe. sirioseimont touti bion lloftlacit quo Is "oArit diuno

missicin d'ittaque nocturne, dEJA dllfticll an alloenilme,4.1.3. ZdMeIatS nouveaux

11 conviont onfin d'dvoquor tan demulr point rolstivomoentPar rapport aug donnils, cluasques &our Ilncidonce dot nouveau qul st Ilutillaation Litstsiuve des slreulatours encindtonss dama los opitations adriennos at lotw slgnifllation panietalier dee simulatours do combat marten, Doivontuelle, plumiours El6ments nouveaux so3nit &consldiror. nomtbrouses Etudes oant montril quo Nnlidonce du met des

simulatour Atalt relativoanont ilovde (2, 10, 1I, 17), PourEn premier Uota, aussi blen le& machinste quo lW systmas lKonnody(1 cc probtime va, susceptible dlentrainar mned'orm. et Is& mAohas accompllos par lee Equlpages sens certain* r~pugnance A utilmer co typ do slmulatours, 11 nodovenus esstrimormont complexes. D'une ntanilk coroitlaro, sombis toutefaisi pss quo insoafiots socondalres descomtts omplusltd oat assoocido I un coOt trio dlovi des simmalatoura do combat puissant &itr offectivenoietadronots do conmbat at do Ia formation doe iqtialpsa. La intpliqtsill dons des problimini dAofseohdt ot do sdardtwd. Itformation dion pilot* apirationnol oonsitue tan sfoht coepodiant duot problibme sulflsaniont mignifllctif starinvestiasement iris Important, tout coreme laopparoht lquila to plan ophationstel posut quo I# comrmademont sondolt mattve ont oeuvre, inquilta tnt pour at qul concern leifloacltd do

lentratlnemanet quo son arganisation.Omitsro e considdrations, do nouvoltes, conditions dosmplolsont mpparuoos, hautemesmi suscoptibloe do provoqluer 4J. Opirations spOIstaei'spitriflon du syndrome do. indiosan tnmediii s doepilot#& adaptide ami Avoltations Modrone doe avions do Los retontlsasoet **sdrtonnal du real do Peqiac sfor leacom~bat modernos. Co sent an partiesllor lot shfots dt suM opiollais spothlao .octsstua tn point drlntird lanportando terrain outomatiqueaa t las problitnmo lis I Ivlutiluotion tent pour leImplctin do "rentbilWIC .11lio poutdes dhapei"M dlad It is vision nootusmo Ot, It opparaft quoe mosployer ac teram qoo pouw ls edatotd Co lt intb a dii

4-h

rccornru assiez t6t dens to d6vcloppoeont des missions dohors do cas particuliets, comme lett incidents do transfort.1spatillem habitilo at a dirwoomont all indireotemont matinS do t16quipago d'un vatissau veto utto station orbital.i, to mall

do nombrous. dtuds. do loopac pose rolativement poll do probilimes damrn os6jaurs do longue dune., En rovanchs, Ins vol& courts

Laos donn6wa connuoa I at jour font dtat d'une incidence comportant un programme trio chargi montvolinno do 50 %, tuskt bion aw routs dos vote ettettaux partlicoumaiot suscopi~btms d'kro, affectiei out Is planamfirclmlns quo aoviitlquu (26, 6). 11 ediats dus doutes opdnttonnall. I1 Wait coptandaint rectonnoftre quo, aurquont It Is *Advat respoctive deo syndromo. prisontili par boaauoaup do plans, Ion promilir. hour.. pusodo. onlost satronautes amintoaitu at Io. caunonautoa soilitiquos. Imlrnoontour sant gliniratomont In plus critique&. En os doPout ea& dornilors, toentralnontont vostibulatro intenal! croonutanoes vSidabtoment eoooptionnolltu mnottant on jellouquel Iits ont soumtia evant Is vol pournalt contribuor it Is odcuriti des opdrattans dan& lIn 36 prndmhiae houros doriduiro Is oliviritil du malaise provaqtuh par t'odaptatton otuo mjour, on pout toujourm ligitimament so posr is questtonconditions do micralproviti. En falt, at ton pout avoir uno do l'Impact quo pourroit store avoir to mul do tospaca.uses bornno We do lincidanco globolto dit mat do lupine.dani tIo iqulpagee, Is oiviltiti des uympt6nma andurda ase 43. Survie on merun point beaucoup plus diltoat It ilvaluer. Pout Inopinotilona do I& nanette spatWal amrnIrtalne, uno estimation 1t oat notates quo li. condittons do survio on met sontcourantit donna tudstaence d~un malaise a"to ot prolongSl pmfttstaitiriniont proptc aa m d&VOloppoiMant do$ dkiltoon(done rolatIvemont tncapacitant) chat un astronaut. taut to. coming Is souligno Roaan, nitant Liman (1955), avoc destrols Vales chifino. do 60 % d'incidoncoo dane to. dqtapatin abattus an

mer, Sant fourair do donnelas statistiques prdint.. 11 avancoLa sig~n~cation optirattonarolto du mat do tlospaco, at tan quo, dana cotta situation, to mat do mar paurriat bion aovatsoan ttont mux incidents qut ant ditl rolovdi aul cours do Volt contitbud It It mart on hitant to proceasua dospatisuit, nest pa. errtrimornnt "vdent@ it Ovuluer. Homick dishydratation,(13) a risomment sxpoai Vi'tat do Part exitetnt dama codomauin. otto letmpltcattonsa ntraltnio pourt Is conduits do. L'ivonrtuati: d'obsorvattan dijoctions on mor ltoropilrations do ts navoito adirtatlno, Pium qu'uno d'opilrattana cambinios adromaritiinos au aironavals eallIncapacitatton total@, Is manque d'Initiativo do. atajots loin ditto nigollgeblDon Dana cotnditions,. Idiot do Is morattatntm pout reprilsontor un probtlimo, Los observations vo conotltuer un point Important dam na chances do murvlooflactudes par Thornton (24) manirent quo lon aujote des personnel&, La rocheorche Mrs. d'autant Pium dtffictlo atkttatnts acsomplisaont giniraolmont corroctonient lin solon touto prababtilltt tongue quo lei conditions do mettichos quIltour sont asepigni, matl ant tondanco it so waernt matialwatms Las angina do sauvotage Individuals montlimiter utrictoment It Vtnlaulponaabt., En fait, H otatoalto gidnirallomont stalitnquat o ism comportmnt sommo donaturotloiomnt tame sortei do compensation, au soin do viritablos bouchona stir to mat, go qui taovoniseli'quipago, do lantivitil dus plum attoints, qut aboult It & onaidirabteomnt toapperitian, du met do mor. Losl'occamplissemnt do lenseomble des abjoctiro at do. ticho. consiiquonnos woit on gintrol triplem (9)i ratontismeemnt sunprivums (resnhka), lea baoisom hydra-mtndraux, attatnts du poychifamo,

aggravation do. little patholagiquos intorcurronta,Sur to plan prattquo, an rellive un cortain nombre do cia alato mat do loapacot a itetrfiril diroctoemnt avon: do. activitiat Labaiuttasoment du mat do mer oat l'apparitlon deopirattonnolloa programmine, Aitno, lots du programmng vomissemenito tncoorstbloa qut augmontont do fagonApolla. pltamioura incidents mtnours ont ItS notias dont to considdrabto In portea hydro-mtniralea. La probilime dopius slgniflnatif, lam du vol Apollo 9, a motratnid un report ti6qutI~bra hydro-mlnilral dent Ia sutvie en mer oat dittod'une boumS. dent to programme. On note igsaement quo toutes In conditions extrimemaut critique du fatt duIliquipage do Skylab 3 a ditS amnionS It ndutre rattotnnoemnt do l'oau, La dialhydrotation avoc hilmo-slgntflcattivermnt usc acnlvttia pendant lei 36 prommbros concentratton oiat aggravino, dana to cus des vomiussemnt parhoures du Vol, Pout ce qut conicerns lei upinationa du lea portes toantquoa qut pouvont abouistr It 'itntaltanton d'uneSystimo do Transport Spatial (STS), divert Incidents ont abateos. miltabolique,igolomont 445 rapponti attigomont do programme doSTS3, report d'uno sortie uttra-vilhlculalrs lurm du vol SIMS Sur to plan poychique, it oat blen connu quo loos cndtaose5 (13), Do *6ti Sonliltique, to. dcanue sont mains stins, aiviroa ontralnent uno viritable prostration avion une portemats Reaon (22) rapport. qu~on 1967 line millotn plus itu malins Important. do t'litat do consorvation, 11 oatsovtditqtse pourrait sovat 0t6 annulS. en rataon d'un renonnu quo ta vatonta do aurvivr canstitue un itidmentiproblime do mat do flospacn. Important dana lot situations do naufrago maritime at

l'apparitin, dut syndrome do cindtooe, en dohors do woUn 6liment dCmportanco dona to probibino do Is riperoatsaons physataogtques, oat toujaursa esrimomentsignification opirattunnalto du mill do tlospac eat it durie difaoarable, D'autte pan, Is nopirago d'une embanatton,does oapietona onvilsgioas. 11 taut btmn itr# consotont quo ito. monloplano dana un onvironnonmont hostile sonstitue unoilvontsolios difilcultia ronuontreosutvtonnent denato." tiaho ditfilcta et Ia coooseatian du noufragil conotituepramuiros houro. dua vol Spatial (26) at quo done is mojoriti sauvent un 6*wmnt dkWal, Lapathbo oqtondri. per to Matdes an Phabituattan rnauosonsololto it Wa mlerGrault oat do mar pout. done is rivitr critique dane un muomentmsquiso dana to. pronitirsa 72 hours& du vol, Abut, an thest pour Is rivaalto doIs misoban do sauvetago,

.. . . ...

4-7

Enfin, Ii no tout pie oublior qu'un pilots pout Wet bicss au 1 Benoson A. J., 'Motion, Sicknss'," In "Aviationcours dun abandon do bord so quo son that no pout alors Modicine" 2nd ad., J, Emotiing and P. King,qlulltre aggravOd par Ilapparltion do mal do mar at do ass lotterworths, 19M, 318417.offal. ddbiiitanta, 2 Chappelow JI.W.,*8Slmuiator Sicknesa in the Royal

i.~~~A CFCUIN orest A Survey In "Mellon eaus in FlightWr. ONC.1.1110NISimulation and Simulator Induced Slknias',

AC3ARD CF 433,Soptember 1937, paper 6.Loneemobie does donitoea do Is Booktorure at dos perspective* 3Cornunn R;,Ludwick R., Wayne C., 'Motion Sidmess -dolcoulant do Ailments nouveaux lis I Pi'voiutiont do# Old Syndrome, new clitcrnsarmat ee proceudinspmatirielh at des tiches des Olquipigee do Il'aronaulique 38th International Congress of Aviation and SpaAemaflhtaire pearmottant do shotua Is& conaliquenoas medicine, novamber 199, 41opitationnellus doe aintomsi dark Is contexts actual doe 4 Dobie TOG,, " AjrcideIs in Airerew",opirations a~ironnie. at spatialls. AGARDograh .177,1974

5 Dowd PJ., 'The USAPSAM selection. taut, andULnaidnos dus cinitouee an dole0 do pliotage "notble rehabilitation program, of motlon-alci pillota", irkrallativeniont stable it soft unpact sur Is progression des "Predictability of Motiont Sickness in the Selection of6i6vee mee relativomront bien mattrili. La rioi probihmi eat Pilatae, AGARD C" 109, usptmbes 1972 paper 7,cetut do i'effort qu'll tout coneantir pour aisiiorso, Is taos 6 Eborov A. D,, [ouganov B. NM,, "Ist mcicnlamasd'attrltlon 16 aso miii do P'air. Las nature do cat effort sit k labyrinthiques at extra labyrinthlqssaa dant Isilhauro actuollo itroltmemnt h~s iax poulbilltils de d~voloppement du miii du mouvement enrecruitment at It Is philosophic gindrale idloptle. apasantaur", Koamitcheakiala Bioll I Avis, Mod,,

1985. 19 2, 44L1LA aurvenos do manifestations do cindtoso chra deo& pilots& 7 Galban 'P., Gouars M., Gulflirmln, MI, hlifas J.,openationztsio metlant an oeuvre des systiomu d'armos 01 Contribution A 110tude do 14 capacitil opillationnoilodo& mlissons complexes constitus sins aucun doute *onednlaartanpteaoedemuoatciqssituation priloccupante, Ce point mdrIte tris cenalneament &ba.attd" eu o op oSnidone surveillance psrticull~re, Ia sulvi do terraint automstlquoe o .m altitu19e8, Reuede Crp d 13,l e01 l'otflllatioii do vitlonique montho sur Is caiue do' pIlatle 8 Cndalui6ssn s 9,, 1968 b23,6ato13,odat do dlspositift d'aldo biti vision nocturne comportent des8iieTysneuIP,,"apyhptooi editiments partlcullbrement propiges auO d~clenchoment dos lbya. phlotos at W~ surveillance midico-

c~n~tea&,paychologlique on dcolo do pilotage."ACJARDograph 227, Aout 1977

tL'Incidonce opirationneillo do snal do l'oapacos contiltue 9 Oisv P, "La survisaon mer', Cours do i'Scoistoojours un point dl'ntirilt soutenu. il les (alto montront dlAppllcatlon do Service do Sati pour Is Marine,quo dans beaucoup de cab Iva consiquences 1983,nouro~aenorloiies de Il'daptsatlon &t ia microgravitE 10 Glower DWA, Lilienthal MA., Kennedy P.S,domourent modirdes, lea risques potontiols dana dos Fowikee I.M, "Simulator Sickness In US Army andsituations critiques surveriant daens lox premlitrv hourca do Navy Fixed and Rotary -Wing Flight simulators", Invol persistent La duris des vois constitue on dilment "Motion cusa In Flight Simuiation and Simuiatord'importance pour Is rateritlssonent iur lic opidrations, Induced Sluitlnem", AGARD CF 433,Siptenmber

1987, paper 8lEnfink, lea conAdquenceat tics cinituses &atl Is, aurvicon ano me Hettinger 1.3, Kennedy RIS., McCauley M.E.,aont blen connues at rcpiluranent toujours one monanm 'Motion Sickness and Human Performance.", inimportante pour Ia dovdnir din dquipage.s ctainsstor it 'Motion and Space Sickness", Ed. Crampton, CRCl'abandon tie hard ors tie survol maritime, preom, 1989, 411-441

12 H-ixion WC,, Clocdry FE., lgr.4z 3M,, "Resusits of!ongitudinal study or Airifrirneas Incidence duringNaval Flight Officer Training,., In "Motion Sickness:

Renorieroemnti: Lasutour souhelte romercior Martino Mechanisms, prediction, prevention andKerguseien do Laborstoire do Midoolno Adroapathale do Treatment', AOARD CP 372, May 1984, paper 30Centre d'Essiu en Vol pour son side doen Is pr~puration do 13 Homick A., Reachkre MAF, Vsstdorpioag 3M,,cc document. 'Space Adaptation Syndrom/ Incidence and

Oporatlonnat Implications For the SpaceTransportation Program", In "Motion Slickneu:Mechanisms, prediction, Preventlon andTreatment", AGARD C? 372, May 1954, paper 36,

14 Kennedy RS, Moroney W.F., Bake R.M. GregoireHO., Smith 131.0. 0 Motion SialknessSymptomatoiogy and Performance Decrement

Rifi11rensici 1111bitilographiqoes oceasonnea by Hurricanes Penetration& In C-121. C-130, and P-2 Navy Aircraft.,, Aerospace Med., 43,1972 1235.

is Kennedy RS., Berbaum K. S, Allgood G. 0., Lane 20 Money K. E., "Motion Slcknsu", PhysioliogicalN. E., Lilienthul M. G., Balaztlcy D. R,, "Etiological Reviews, 50, 1, january 1970, 1.39.SiW eanoofl of Equipment Featoie ond Pilot 21 Retine, D.A., Repperger D.W., Goodyear C., PotorHistory in Simulator Stckes&, in "Motion cuea In G., Rodriguez L.U., "Quantification of ReactionFlight Simulation and Simulator Induced Siskness", Time and Time Perception during Spaw s huttleAOARD CP 433,Septomber 1987, paper i Operation.". Aviat. Space EnvironiMad,, 59, 19U8,

16 Leger A., Lejeuneo d., tMWd 7. . Kerguelen M , ii 220tem vastibulalrat done Is We~laon at Ventralnemont 22 Reason JST., Brand JJ., "Motion Sicknoess,do# cosmonauteu", Prooeedirp 4n0 Internet, Conf, Academic Pmu,1975on Space Physiology, WA Sk'.^7, Favovmber 1;85, 23 Stott S.R.R., Degehaw M., "The current Status of tho143-.148, RAP programme or euensltlzation for Motion Sick

17 Lager A., Sandor P., 'Etude Hiorikaomaae do AIrorWW, in "Motion Sickneas Metchanisms,Vincidence doi Mal des siniulateur am d Inse Forces prediction, Prevention and Treatment', AGAIRDAilorknen Franpisea, In "Motion cues in Flight CP 372, May 1984, paper AO.Simulation and Simulator Inlucod Sialkneu", 24 Thornton WE,, Moore TTP., Poole S.L.,AOARD C? 433,September 1951, paper 4 Vanderploeg JR. "Clinical Characterization and

18 Legusy C., Hadni I.C., Oouars M., Gaily R., Olbert etiology of Space Motion Sickness, AvIat. SpaceA. R., "Pouibiliti6 do privoir Ia prlilslposition au Mal Enviton.MedJO5, (9), epplement At, 1987,des transports lore do I& adlection des p"ilottea, In 25 Tribal S., " La Select1,on at as suiveilliance du point"Predictability of Motion Sickness in tha Selection of doevue du Mal doe Pair des dlbves -pilote& do la FA4Pi'lots", AGARD CPP 109, september 1972, paper 3. Belle: Rleultats dos dix demuires anndes", in

19 Lonts LM., "Laboratory Tests of Motion Sickness "Predictability of motion Sickness In the Selection ofSuscoptibllity". In "Motion Sickness: Mechaniams, Piots", ACIARD CPP 109, september 1972, paper 8prediction, Prevention and Treatment', ACIARD 26 Vandler ploeg JM. ,Stowart D.P;, Davis J.R., "SpaceCP 072, Miy 1984. paper 29. Motion Sickness", ESA SP.237, lOSS, 137.1 42.

5-I

Factors Influencing Susceptibility: Individual Differences and Human Factors

Fred E, Cluedry, Ph.D.

Naval Aerospace Medical Research LaboratoryNaval Air Station, Pensacola, Florida 32508-5700

andUniversity of West Florida11000 University Parkway

Pensacola, Florida 32514.5732

SUMMARY

From a conceptual viewpoint, individual differences in susceptibility to motion sickness aredetermined by differences int initial reactivity (receptivity), ability to adapt to the motion, ability toretain the adaptation during abstinence periods, and ability to reinstate adaptive-responses upon re-exposure to the motion. From a theoretical viewpoint, the adaptive adjustment involves alteration ofthe timing, magnitude, and direction of sensorimotor reactions so as to increase the efficiency ofpostural control in the motion environment, However, the threshold linking the sensorlmotor adaptivepiocess to the processes that ct-off the signs and symptoms of motion sickness may also be anindividual characteristic. A conceptual model is presented to organize the discussion of individualdifferences in motion sickness susceptibility. Factors that have been reported to influence incidence ofmotion sickness such as aSe, mental activity, anxiety and fear, perceptual style, physical fitness,active control of the inducing motion, concomitant visual stimulation, quility of the initial exposure tothe motion environment and conditioned motion sickness are discussed,

INTRODUCTION

Motion sickness is a significant problem in every major form of modern transportation,including space travel (Homick 1979, Homick eLaL 1984). Inpassengers, its effects range frommild discomfort to severe disturbance, and in crew, effects range from lowered enthusiasm for workto incapacitation for any useful activity, Extreme prolonged sickness is a threat to survival, In flighttrnining, air sickness is a significant cost due to increased training time and attrition of some otherwisewell-qualified individuals. Operational significance of motion sickness is reviewed by Leger (1991)in this volume,

Motion sickness is a normal response to an abnormal motion environment, and it is likely thatanyone with a functional vestibular system can be made sick by any of several fonirs of provocativemotion, However some people succumb to provocative motions much more readily than others, anddifferent environmental and personal conditions can Increase incidence of sickness engendered by agiven motion stimulus, This chapter deals with individual differences in motion sicknesssusceptibility and with factors other than the motion itself that alter the sickness incidence. Thechapter by GriffIn (1991) deals with characteristics of motion that influence sickness incidence,

The Scope of Individual Differences

The magnitude of individual differences in reactions to provocative motion can be clearlyappreciated by exposing each of 20 flight students to a sequence of head tilts during whole-bodyrotation at a speed of 15 rpm, It is probable that one subject will describe the experience as"absolutely dreadful," to use the scale of Lawther and Oriffin (1986), while another will find theexperience interesting and not disturbing as indicated by requests for repetition of the experience withstronger stimuli, Amongta group of individuals who have chosen a career in aviation, similar in ageand background, a few a bhor and are visibly incapacitated by a motion stimulus that a few enjoy. Theimmediate reaction to such a stimulus foretells subsequent sickness If the exposure Is continued,although prediction from initial reactions is far from perfect, Nevertheless immediate reactions aresignificantly correlated with subsequent problems in aviation (Lansberg, 1560, Ambler and Cuedry,1966).

Immediate reactions to provocative stimuli fail to reveal the scope of important dimensions ofdifferences In reactions to motion, Some Individuals recover very slowly from a given level ofsickness while others recover more quickly, A very important category is chronic sickness where

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despite prolonged and repeated exposure, severe sickness continues. This category is most easilyidentified in seasickness, where ample opportunity to adapt fails to yield imnprovement, While tmembers of this class are rare, they should be studied in detail to answer some questions that willarise in this chapter,

Nature-Nurture

From earlier considerations of mechanisms of motion sickness (Guedr, 1991), we Infer thatmotion sickness susceptibility (MSS) would be dependent upon the Individuals history of exposureto unusual motions but if individuals are somehow Intrinsically different initially, then not only willthey have controlled, to some extent, their exposure histories but their current state of adaptation willdepend upon intrinsic differences in adaptive capacity and adaptation retention. Thus, immediate MSSof Individuals Involves the classical nature/nurture problem of understanding human behavior.Because motion sickness is a specific and fairly measurable aspect of behavior and because exposurehistory Is also fairly measurable, advances In the understanding of MSS may also provide an approachto the greater problem of understanding human behavior (Mirabile, 1990),

MOTION SICKNESS: AN ENDURING TRAIT TTHAT CAN BE CHANGED

Based on the conceptual model presented earlier, tnissmatch between perceived and expectedspatial orientation reactions initiates two processes - one that alters the adaptive state of the individualand another accumulation process that leads to the sickness syndrome. In turn, the adaptive state ofthe Individual depends upon 1) history of motion exposure and 2) how the individual reacted to andhas been shaped by the motions experienced. Figure 1 deplots factors Influencing individual motionsickness susceptibility to a particular motion of stimulus. Adaptation achieved in a motionenvironment depends upon the activity of the Individual In that environment - what the individual hasbeen required to do or wants to do and tries to do. Adaptation to aviation In Individuals whoseexposure predominantly Involves piloting and learnin to pilot the aircraft differs from adaptationdeveloped by Individuals whose exposure, though equivtlent In hours, is that of a passenger, Pilotssometimes become sick when they are in the back seat, History of exposure is thus not a simpleaccounting of type and number of hours of exposure, It Is complicated by the fact that the Individualpatrtially determines the history and the history changes the individual.

In addition to the individual's long temi motion adaptation capabilities, other personal factnrscan alter immediate susceptibility to a particular motion envimnment, Examples of temporary

Motion History

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Constitutlonal Factors

Figuie 1, Factors in ivdividual susceptibility to sickness with particular motion stimuli,

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redisposing factors are temporary gastrointest~nal upset, inner-ear inflammation, alcohol Ingestion,eadache, and perhap- savere emotional involv .ment in family matters. More enduring predisposing

factors inclnde tfie psychological characteristics that determined the individual's selection of pastmotion environments, Individual adaptive strategy and effort to perform within the environment, andperhaps individual fear of the environment itself.

Evidence that motion sickness is an endurina tam has led to much speculation about personalcharacteristics that caure this "weakness." The evidence consists of the fact that individuals whobecome sick with one kind of provocative motion also ltnd to become sick with other kinds ofprovocative stimuli, i.e., susceptibility Immi to h'e constant over different motion conditions (Gtraybiuland Lackner. 1983, Crampton and Young. 1953, Kennedy and Graybiel, 1962, Hiximn tlIL 1984,Lentz, 1984). Individuals susceptible to motion sickness early in life ltnd to be t'oubled by sicknesslater in life. Motion sickness is an enduring trali over time and type of motion. Motion sicknesshistory questionnai-es are perhaps the beat current available predictor of sickness in new motionenvironments (Kennedy u&aL. 1990, Hixson CLAL. 1984). Part c-f this section deals withmechanisms that might be the basis for idiosyncratic reactionp.

The evidence that suggests that motion sickness is an enduring trait also suggests conisiderableindependent variation, The correlation coefficients over different provocative stimuli are not veryhigh particularly when large samples are studied, Motion sickness big= correlates significantly withprovocative test scores (Lentz, 1984) and also with sickness in operational environments (Hixsor. UaL 1984), but again there is much room for independent variation. While some of the "weakness" incorrelations is probably attributable to reliability of measurement of the predictor and the criterion(Kennedy utL. 1990, Reschke, 1990) which limitn the prediction correlation, almost certainly someof the weakness is attributable to changes in some individuals, and not to elastic measurement. In ourstudies (Prewitt 1975, Lixson elAL.. 1984) somn Individuals were highly susceptible to one kind ofstimulus but relatively unaffected by another, even though the provoking stimuli were equal induration and equivalent in provocation incidence. The fact that "desensitization procedures" areeffective In returning airsick aviators to flight status shows that adaptation can serve to change theindividual, The flight instructor who experiences flight siulator mickness, while his beginning flightstudent does not, also illustrates changes that occur through experience with particular motionenviiJnments. Part of this section will deal with factors that would serve to change motion sicknesssusceptibility In individuals from one time to another.

A CONCEPIUAL MODELANt) FALTORS TIIAT ALTER SUSCERIfBILITY

Figure 2 will serve as a g'uide for reviewing mechanlssms of the reaction to motion thatcontribute to idiosyncratic reactions as well as to changes in reactions of individuals over time andover different stimu!i.

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Figur• 2. Conceptual Model of Mclmhit'nis of Motion Sickne•i

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The Motion Stimulus

On the left side of Figure 2, is the motion i tfmuluA The fact that motion sickness llda to bean endurlig trait over different forms of provocative stimuli seems to lead some Investigators to theidea that, as far as motion sickness is concerned, all peovocative stimuli a'e qualitatively alike, i.e,they differ only in regard to how much sickness they generate. This idea, if wrong, leads toInappropriate interpretation of experimental results, Modon stimuli that are equally provocative can bequite different in some aspects of the total psychological and physiological reactions they generste.DifTurences ir, particular aspects ofthe total reaction could determine whetho or not measures of some"predisposing" factor such as trait anxiety achieves significant correlation with reassures of motionsickness generated by a particular stimulus.' Experiencing the obviously safe off-vertiCal rotation at12rpm In a laboratory differs considerably from the Initial experience of acrobatic maneuvers In highpennrmance aircraft, Differences in psychological impact of motion am more subtle than this examplewould imply, L.e., differences are not necessarily ascertainabl from a 'common sense' evr.Juation,For example, off-vertical rotation in the dark at about 15rpm is not at all unpleasant initially. Subjectsfind intemesting the fact that the path of body motion they perceive is quite different from the true bodymotion, For those made sick by this motion, the pleasant reflection on an interesting experience givesway to stomach awareness which can progress fairly quickly into nausea and vomiting. Before thenausea begins, however, these subjects would be quite willing to repeat the experience.

In contrast is the effect of head tilt during whole-body rotation at 15rpm. Within the firstsecond of experiencing this cross-coupled stimulus, a number of subjects are aware that they do notlike it and are even immediately fearful of the experience. Both stimuli involve canal/otolithmissmatch. both induce sickness in many subjects but the immediate perceptions of the two sttmullhave qulie different emotional overtones - even to those made sick by both stimuli. It is curious thatonly a few individuals find the cross-coupled stimulus sufficiently interesting to want more of itwhereas most subjects find the off-vertical stimulus interesting and want to observe it, until sicknesssymptoms begin. Differences in the total reactions to different motion stimuli may explain some of theinconsistencies in this challenging arcs of research.

Motion Sensors

Because absence of vestibular function confers immunity to motion sickness (reviewed inReason and Brand, 1975), measures of vestibular function have been explored for their potentialrelationship to MSS. Thus far, vestibular functirn, as tested, has not shown a clear relationship toMSS, other than the immunity that complete loss of function confers, With very few exceptioos,measures of vestibular function in these studies have been limited in scope and low in reliability.Kennedy etaL (1990) provide a convenient tabulation of relevant studies. Bies etaL (1984) foundthat rates of decay of canal-mediated responses to impotlse stimuli, the often-investigated'cupulogram', (Reason and Brand, Chapter 7 1975, Dowd, 1973, Dobie, 1974, Mann and Canella.1956, Reason, 1967), failed to discriminate seasick from controls, but labyrinthine imbalanceappeared more frequently than expected in caloric tests of the seasick group as did unusual visualinnfuence on body sway (see 'field-dependence' below),

Results of Bles CIAL (1984) suggest that adaptive capacity may be depleted by the recoveryfrom partial loss of function, leaving some individuals, whose capacity may have been marginalinitially, chronically motion sick, when exposed to a provocative environment. Following suddenloss of vestibular function, motion sickness is generated by ordinary voluntary body movement forseveral days and weeks, until adaptation to the loss (or partial loss) o.curs. Physicians would like tohave tests that forecast individual adaptive capacity when the treatments they me considering threatenthe loss of vestibular function. Some, individuals never adapt to the loss successfully. Inputs fromthe visual and somatosensory partners in the control of body motion induce sickness while relativegains among these partners are adjusted to compensate for the reduced vestibular component,Adjustment continnei u,,til atitonnaticity in the control of body motion relitive to the earth is achieved.

Failure to find clear and itrong relationship to MSS is to be expected considering the numberof causal factors and the problems faced by investigators in measuring vestibular function quickly inlarge numbers of subjects. Some scatter plots that comprise cupulograms more closely resemblecircles than ellipsei and finding the cupulogram slope is more imaginary than measurable in manyrespomses. Measurement of vestibular futwtion and its Interactions with other sensory motor systemsis improving and technical advances will enable assessments thpt are far more adequate than werefeasible in the past. Exploration of this area, particularly regarding interaction measures and theirchanges with repetition, is far fIom complete but it is still a formidable challenge.

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, ~Percptual.Motor Adaptation

Reason, in the course of a well-organized study of motion sickness (Reason tL.L 1969-

1978). proposed that a large part of individual variation in susceptibility is attributable to individualreceptivitX, a, and reention of adaptation. Receptivity, which refers to idiosyncraticprocessing of sesoy noratoniferecp~esin ofsensory In ormatlon by Viae central nervous system, was inferred from studies (Reason,1967a) showing relationships between motion sickness history and the slopes representing therelationship between response magnitude and increments in intensity of different sensory inputs. Theidea Is that some individuals characteristically damp down stimulation whereas others characteristicallyamplify it, Irrespective of the stimulus condition. Receptivity, which is a broader concept of how theindividual interacts with his environment, should be considered with perceptual style, discussed later,but it is included here because of its relation to perceptual-motor rLdaptation. If in our conceptualmodel we assume that those who have high receptivity also am strong reactors to sensory nissmatch,then the model suggests that those with high receptivity would be more aroused to commence theadaptive process and also more liable to rapid titration toward the sickness endpoint.

Reason also presents evidence that adaptation capability is not necessarily closely related toreceptivity (Reason and Graybiel, 1972). For example individuals who exhibit extreme reactions tocross-coupled stimulation may be fast adapters, fast enough to reduce micsmatch before theneurochemileal link achieves threshold level. While our studies show some relationship betweenitmimediate reactions to provocative stimuli and subsequent airsickness susceptibility, many individualswith extreme reauctions adapt quite successfully to aviation (Guedry and Ambler, 1972, Hixsort ALaL1984). Reason also found Individual variation in retention of adaptation. Thus receptivity,adaptability and retention appear to be separate factors. Again referring to the conceptual model inFigure 2, if missmatch magnitude diminishes and If adaptation retention is sufficient then likelihood ofsickness with successive exposures to ship or aircraft motion is diminished. In Figure 2, the largecentral area represents hypothesized components of perceptual-motor adjustment whereby missmatchmagnitude is reduced which in turn lessens the chance of sickness.

Autonomic and Neurochemnical Adaptive Change

In recent years several procedures have been successful (Bagshaw and Stott, 1985, Jones ctIL, 1985, Stott, 1990) in treating airsick aviators. Most procedures employ repetitive exposure tocross-coupled stimulation incrementally increased in magnitude In daily training sessions until theaviator tolerates stimuli considerably stronger than were initially tolerable, During this cotditionlngprocess, changes in perceptual-motor response to theprovocative stimuli occur but there is reason toquestion that this is the primary source of protection for the aviator. A recent summary (Stott, 1990)shows that a range of procedures have been successful with airsick referrals in different branches ofthe military services and in different nations. In recent years, the most common adaptation stimulushas been incremental cross-coupled stimulation although in the past others have been used (Gibsonand Manning, 1943). Adaptation to vertical linear oscillation appears less readily achieved thanadaptation to cross-coupled stimuli and tolerance gained to either stimulus form may transferminimally, the one to the other (Stott, 1990, p. 378), From casual observations in our laboratory wesuspect that adaptation to off-vertical rotation is also difficult. This is an important area for in-depthstudy. Hlow can adaptation to incremental cross-coupled stimulation transfer to the flight environmentif adaptation is minimal to low frequency vertical linear osculation or off-vertical rotation? Theeffectiveness may depend upon improved control of the autonomic aspect of the reaction in the flightenvironment. vhich is actually less provocative than the sustained unrelenting stimulation that occurswith off-vertical rotation or with steady-state vertical linear oscillation. The flight environment, evenin acrobatic training, offers many fairly sustained recovery periods between provocative maneuverswhich are anticipated before they occur.

A procedure called autogenic feedback training (AFT) concentrates on bringing the autonomiccomponent of the response to motion under volurary control. Cowings (1990) proposes that AFTdoes not involve percoptual-motor adaptive mechanisms but rather increases the tireshold to theneurochemical link. In other words If the autonomic aspect of the total reaction is suppressed thenthe arousal due to missmatch would be reduced thereby reducing neurochemical build-up and alsomotion sickness. We might a-I;o expect that if APT reduces misematch arousal, then perceptual m.toradjustment would also be obviated, if the task and environment permit effective function withoutperceptual.motor change. Because the adaptation procedures used in treatment have not been optimalfor perceptual-motor changle, this may be an appropriate view of tei effects of some of theseprocedures, Including the APT of Cowings'. On the other hand, it is clear that environmen.s that

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demand perceptual-motor change for effective function (Melvill-Jones, 1985, Guedry, 1965, Guedry,1964) yield dramatic perceptual-motor changes that parallel reduction of sickness and are probablyinstrumental in preventing sickness. Conditioning with optimal conditions for perceptual-motoradjustment may yield beneficial transfer effects by improvinll 'learning-to-learn'. Perceptual-motoradaptation appears quite stimulus specific when tested soon after the adaptation procedure but afterseveral days, more general adaptation becomes apparent (Guedry, 1965). Intensive incrementalexposure to cross-coupled stimulus seems toyield more general adaptation (Grayblel and Knf-pton,1972). It is likely that both perceptual-motor learning and the threshold to the sickness syndrome canbe altered with conditioning procedures. Both may be somewhat idiosyncratic in the first placecreating Individual differences in susceptibility that can be altered by conditioning procedures, Asidefrom the excellent comparative series carried out Reason, wherein adaptation and adaptation-retentionwere observed with systematic variation in visual-vestibular conditions (Reason and Brand, 1975),and the studies mentioned by Stott (1990, p.378), we have insufficient data-base for furtherspecifying or amending the conceptual model represented by Figure 2,

Both mechanisms, adaptive perceptual-motor change and adaptive autonomic control, involvesomething akin to learnink. However, Oraybiel and Lackner (1980), who found no evidence forcorrelation between signs ot sickness and physiological Indicators of autonomic activity, challenge thevalui of AFT, a challense discussed in some detail by Cowings (1990, p.354). Since Graybiel(1969) proposed a "facultative link" between the perceptual-motor adaptive process and the onset ofsickness, we seem to have a concensus for a linking threshold in a conceptual model. Whether thethreshold can be modulated through conditioning, the exact nature of the threshold, and where thethreshold should be located in the chain of events is somewhat debatable (Oman, 1990).

That the threshold linking perceptual-motor adJustment to the sickness syndrome is subject toconditioning is suggested by evidence for conditioned susceptibility to motion sickness (see Fox,1990). Money provided a convenient summary of evidence for conditioned susceptibility:

"There t.re reports of 'sea sickness occurring at the sight of a ship [or] mounting thegangway' (180). Such reports are frequently heard as anecdotes about persons whohave been sick previously at sea (82, 253), and such sickness can be considered anordinary conditioned response in which the primary and associated stimuli together dogive the same response as the associated stimulus alone. Everyday reports of this kindof sickness usually do not mention vomiting, and it is reported similarly that 'withchronic administration of emetics to dogs and cats, there (was] observed no instance offrank vomiting as a conditioned response; on the other hand, conditioned salivationoccurred in a number of cases.' The authors refer to other studies in whichconditioned vomiting was achieved (41). Again, although mmny repetitive swing testsof dogs have been reported (27, 213, 230, 294), only one animal is reported to havevomited as a conditioned response (230). Ordinary conditioned vomiting of this kindin man is also rare, but it has occurred (253),"(Money, 1970, p,16; reference numbers are thise of Money).

Psychological Aspects of Motion Sickness Susceptibility

The Idea that motion sickness is a byproduct of a protective mechanism against neurotoxins(Money, 1991) does not seem consistent with consideration of motion sickness susceptibility as aproduct of disturbed psychologic function, but the question of psychological correlates, causal orotherwise, has been a persistent one in this field, The presence of psychological correlaes suggests thatMSS is, at least in part, an enduring psychological trait. The autonomic reaction to tiotion stress isindividualistic (Cowings, 1990, p. 356)in that ... "no two individuals produce precisely the same stressprofiles..,, as indicated by differing patterns of physiological indicators of autonomic activity, Highscores on neuroticism, anxiety, feminism and introversion scales correlate with high motion sicknesshistory. Considering results of a number of psychological tests, Collins and Lentz (1977, p.593)concluded that nonsusceptibles "appear better prepared to cope in a nonemotional manner with stressfdsituations, whereas susceptible individuals may be more likely to manifest emotional responses in thesmane situation." These authors were careful to point out that their findings were based upon extremes,susceptible And nunsusceptible, In a very large sample. Put in aviator training perspective, scalesdesigned to measure theme personality traits yield statistic ally significant but !ow correlation to motionsickness as rteam'mrd by questionnaires; and motion sickness history questionnaires yield statisticallysignificant but low caritelation to measures of air sickness In early stages of flight training; and measuresbatted upon an entire early stage of nlight training have a correlation of about 0.6 with the next stage atflight training (Hisson UAg, 1984). This means that a number of individuals with high scores on

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ne'roticcsm, anxiety, feminism and introversion will have little trouble with airsickness in flight trainingand if a representative sample of all flight students, not Just extremes. Is evaluated, then correlationbetween any of these measures and MSS will be very low. The number of factors entering into MSSdoes not permit any one measure to be highly correlated with measures of motion sickness susceptibility.

Fear and Motion Sickness

Physical characteristics of motion stimuli and factors other than fear and anxiety are the ptincple Ideterminers of motion sickness (Reason and Brand, 1975, p.192) but some of the symptoms thataccompany fear and anxiety also are associated with motion sickness, In some motion environments,like that of the student pilot, anxiety and fear may heighten arousal to the point that subconsciousperceptual-motor adaptive learning as well as the learning of flight tasks is impaired and in our modelincreased arousal may hasten sickness end-points. But fear is not a primary factor in motion sickness,many motions that are obviously not dangerous are extremely provocative. The views of Wendt (1948)remain valuable today:

"When people speak of psychological factors In motion sickness, they usually refer toone or more of seven different classes of factors, more or less distinct from one another.Let me state these with special reference to airsickness.

1. Expectation and suggestion. What the traveler has heard about airsickness,the attitude he sees others adopt, the observed effects of rough air on others, and hisexpectations from his own past experience affect liability to sickness.

2. The specific conditioning effects of past experience. Sickness in autos, boats,amusement park devices, or airplanes tends to condition nausea to whatever stimuli werep resent at the time, These include sights, sounds, odors and, most important, the stimulifrom motion itself.

3. The specific habituation effects of past experiences. Experience ordinarilylessens susceptibility by eliminating the unexpected, leading to a more correct estimate ofthe chances of sickness, and by setting up some barrier against elicitation of nausea suchas occurs whenever stimuli are repeated.

4. The effects of concurrent activity. Airplane pilots and auto driversinfrequenty get sick; navigators and passengers more often do, No helpful explanationof this has been proposed but it appears to be well-authenticated that the nature of one'sactivity can have a considerable effect on proneness to sickness,

5. The effects of concurrent emotional state. Apprehension, fear, anxiety andgrief are often present when passengers become airsick. Opposing emotional states ufconfidence, satisfaction and well-being are regarded as preventing sickness.

6. Airsickness may be a motivated symptom which frees a student by wash-outfrom a situation which he wishes to escape.

7. Airsickness may be a weakness associated with certain personality types, e.g.,anxiety neurotics, who are more susceptible to the effects of the psychological factorsinvolved in flying,

In the brief space available it Is not possible to review all of the evidence for theeffectiveness of each of these seven classes of psychological factors.

The effects of expectation or suggestion, conditioning and of inexperience areauthenticated by laboratory experiment, by the general testimony of those who becomeairsick, and by statistics of sickness rates gathered from flyers. It is clear that these areimportant contributory factors."

In 1948 Wendt was attempting to correct the idea that airsickness is primarily due to fear but heclearly included fear and anxiety as potentiating factors, Wendt contrasted findings of relationshipsbetween personality traits and motion sickness, where both were measured by questionnaires withrelationships between personality questionnaire measures and sickness as measured in flight training,The following partially summarizes his findings:

"The addition of all the personality items predictive at the .25 probability level orbetter to the I per cent scoring key served to raise the cort'elation Ix.tween questionnairescores and the airsickness scores only from +.43 to +.45, From these data we concludethat airsickness was to only a slight degree associated with such personality traits as weremeasured by our questionnaire, (Wendt, 1948, p.28),

Wendt clearly includea several psychological factors as potentiators of airsickness. In thisconnection the simple preventive measure of an introductory lecture, explaining airsickness to flight

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students just prior to commencement of flight training, seems to provide a substantial decline in the

incidence of subsequent airsickness (Roth and Rupert, 1991),

Perceptual Style

Much of the interest in perceptual style and its relation to motion sickness stems from the work ofWitkin (1949-1950) whose studies of spatial orientation seemed to reveal two classes of people, thosewhu:,e perception of the verticality of a line seemed to be controlled by surrounding visual frameworkand those whose perceptions were more controlled by body cues so chat judgements could be madeindependently of the surrounding visual framework. The former were referred to as fleld-depedent(meaning visual-field-dependent) and the latter were referred to as fleld-independent. Observations werecarried out in a variety of conditions wherein a rod, pivoted at its center, was manipulated to apparentverticality while the rod itself was centered in a tilted square frame or in a tilted room. Subjects wereeither seated upright or tilted relative to gravity or relative to the resultant force while enclosed in a roomwhich could be tilted relative to gravity or to the resultant force (generated by a centrifuge). Thepronounced individual differences seemed to be enduring characteristics as Indicated by high test-retestreliability, for both men and women, on the order of 0,87, with a year intervening between tests,

Witkin found marked sex differences, women being exceptionally field-dependont, and mentending to be field-independent. This parallels differences in motion sickness susceptibility of men andwomen, He then correlated Rod and Frame rest (R1T) scores with a variety of non-orientationperception tests. Significant correlations led to the conclusion that particular modes of perception"represents a deep-seated characteristic of the individual," Proceeding on, Witkin (1950) examined

relationships between the P.FF and a broad range of personality tests, concluding that there is an intimaterelationship between perceptual style and the basic personality structure of the individual, Potentiallyrelevant to motion sickness susceptibilit was the conclusion that those who depend upon visualexperience in their perception of the upright tend to be characterized by passivity and anxiety, lack ofself-awareness and inability to organize coping responses (along with other seemingly undesirable traits)whereas field-independent (Fl) people, "who rely mainly on postural experiences", tend towardself-assuredness, activity, self-awareness and body-confidence.

These remarkable conclusions have led to investigations of the relations between perceptual styleand motion sickness susceptibility, a number of which, as tabulated by Kennedy et. aL (1990), yieldsignificant correlation with motion sickness scores but the findings are not consistent, Reevaluation byFrank and Casali (1986) suggests relationship between field-dependence and motion sicknesssusceptibility, rhe spatial model in Figure 2 may be subject to some 'deep seated characteristics of theIndividual,"

The following differences between studies probably generate apparent inconsistency in resultsbetween studies of relationship between field dependence (FD) and MS?: 1) Studies that involve onlysubjects with minor differences in FD. 2) Studies that Involve only selected extremes in Fl/FD, 3)Studies that involve provocative stimuli that are minimally provocative. 4) Studies that use stimuli thatare inimediately highly provocative. 5) Studies that differ ,onsiderably in the qualitative aspects of theprovocative stimuli. To ignore the qualitative aspects of provocative stimuli seems unwise whensearching for personality correlates. The least attractive possibility to those pursuing this area is that theideu should be discarded.

Continued exploration In this area may be fruitful particularly if interdisciplinary teams areinvolved that include ,aembers with substantial backgrounds in each of several key physics of motionstimulus areas viz., motion stimuh, motion sickness, vestibular function, perception and personality.Individual differences in thA dynamics of the response to some motion stimuli are very impressive.During deceleration from a 3 G, centrifuge run, the otolith system can be stimulated so that It signalsessentially upright posture relative to the earth while the semlcurcular canals signal high-velocity forward-tumble (0 iedry and Oman, 1990). With subjects in complete darkness, a typical perception Is that thebxoJy pitches forward to approximately a 90 degree nose-down position where it remains despite apersisting paradoxical and confusing forward tumble angular velocity that Is supeulmposed. It is asthough the canal-mediated angular velocity signal can induce only so much distortion of the otolith-mediated angular position perception, However this typical perception is not the only perception becausea few subjects report head-over-heals tumbling during this same stimulus, as thoughl their otolith (andproprioceplor) position information were completely overcome by the canal information. Howard 2(I 990), who has excellent "Pitch-vection" research devices has indicated similar individual differences -most subjects seated upright relative to gravity, can be displaced in perceived pitch position relative to

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gravity only so far, el., 45 degrees, by visual pitch vection, but a few experience pitch tumble throughseveral revoludons, Exploraion of reladons of these individual differences in relation to adaptation to theaviation invironment and particularly the aerospace environment may prove interesting.

Sex Differences

A consistent finding is that women are mor susceptible than men to motion sickness (Money,1970, Reason and Brand, 1975, Lentz and Collins, 1977), recently confirmed by Lawther and Griffin(1987, p.986) for ship motion (sea-jolng ferries). Incidence In women appears to be heightened near tomenstruation and during pregnancy, suggesting a hormonal factor (Reason and Brand, 1975) In motionsickness.

Considering the recent increased Interest among women in physical fitness conditioning and Inconidering aviation as a career, It would be interesting to determine sickness incidence among womenacc¢ording to physical fitnes level, Several recent studies have suggested that exceptional aerobic fitnessin men increases susceptibility to motion sickness, possibly due to hormonal changes (Banta "t el, 1987,Whinnery and Pumell, 1987, Cheung, inLAL, 1990). if extreme fitness in women has hormonal effectswhat will be the effects of exceptional fitness in women on motion sickness susceptibility?

Motion History

Every aspect of the vestibular-medlated physiological reaction to motion seems to be modifiableby previous experience and it has even been suggested that the nphical reaction to acceleradve forces ofthe vestibular transducer may be modified by changes in stiffness of the cilia In the transducers (cupulaeand otolithic maculae) through vestibular efferent control, a mechanism that is reasonably established forauditory outer hair cells but doubtful for vestibular heir cells. The modifiability of responses byexperence tends to cloud detection of endurina idiosyncratic responses because responses of individualscan be changed and the changes can be long lasting (Reason and Diaz, 1972). As Indicated earlier, themotion environments that constitute an individual's motion history are ales, to some degree, determinedby the individual's The environments entered, and the activities In the environment are

rtlonalit of the individual. Thus exposure history and personality aretertwurrent t of the individual

A number of questionnaires have been developed In efforts to obtain quantitative as well asqualitative information for motion history and motion sickness history; see reviews by Reason andB rand, (1975) Kennedy a (1990), Collins and Lent7, (1977), Many questionnaires were developedin pursuit of the idea that motion history reveals perceptusl~motor and autonomic-response ndaptationopportunity and sickness history reveals idiosyncratic sickness susceptibility. Another idea (Prew.tt,1975) Is that the individual's motion exposure history, particularly early In life, has been critical indevelopment of many enduring characteristics including personality characteristics.

In early infancy, motion is predominantly passive, and its quantity andquality depend on the exigencies of life. The possibility that early differences inexposure to motion might have developmenta implications has been a matter ofsubstantial interest recently (Peto, 1970; Ornitz, 1970; Prescott, 1971;Ouedry, 1972), although the Idea .I. is not new (Peter1en and Ralney, 1910).There are several basic ideas which can be considered in this connection: (a)Deprivation of passive motion early in life 'M y prevent normal neurologicaldevelopment of motion control systems. The effects of sensory deprivation onneurological systems such as the visual system (Kolata, 1975; Greenough,1972) could be expected to apply to this system as well, nonsadeiRng its closeinterrelation with both the visual system and motor systems. (2) The quality ofearly handling might condition idiosyncratic arousal reactions to motion whichIn turn could iniluence neuobiologlical ,,nd behavioral development. (3)Differences In development of skilled control of motion could influence manyaspects of human behavior.

... it has been indicated that passive, gentle oscillation of prematureinfants improves general motor maturation, visual fixation and pursuit, and Ingeneral, overall health (Neal, 1968). A seris of studies (Korner and Thoman,1972; Pederson and tar Vrught 1973; Pomerleau-Malcuit and Clifton, 1973)offer general support for these finding and suggest that regimens of vestibularstimilation in eaMy life may have mori developmental significance than specialregihitens of auditory or cutaneous stimulation. The possibility that readingdisabilities and some psychiatric disorders may Involve anomalies In

Yj .,Th

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vestibulocerebeliar development has also been indicated (Frank and Levinson,1973; Holzman et al., Hallpike etLa], 1951) but not without some controversy(Stockwell etAL, 1976). The stereotyped rocking behavior of psychiatric casesand of monkeys in sensory deprivation experiments and the instability and"swimming feelings" reported by mentally disturbed individuals have been citedas evidence supporting the general idea that deficiencies in equilibrationsystems, either genetically or environmentally determined, may somehow beinvolved in the etiology of behavioral disturbances. While a range uf evidencecan be adduced in support of these theoretical positions, more specifichypotheses and neurobiological experiments relevant to these are needed."(Ouedry and Correla 1978).

The topic of motion sickness susceptibility in relation to behavioral devation and psychiatriccategories Is being studied by Mirabile (1990) whose views reflect those of Witkin. Witkin foundtendency for shiftsin field-dependence with age, and from evaluation of perceptual styles of young adultsin relation to a batter of personality test, he concluded that those who are Intermediate between extremesof Field-dependence and Field-independence tend to be better adjusted than those who are at eitherextreme (Wltkin 1950). Thus, good personality adjustment is not associated with either extreme,according to Witkin, but this seems at odds with some of the recent findings of Mirabile, (1990)concerning motion sickness in psychiatric populadons.

SUMMARY OF FACTORS IN MSS

Several factors, proposed by several authors, are summarized in Figure 3, along with indicationof how they might interact with components of the conceptual model, History of motion, from natureand nurture perspective, is shown influencing idiosyncratic receptivity, perceptual style, autonomiccontrol and hormonal state, Receptivity, the idea (Reason, 1967a) of idiosyncratic tendencies thataugment or diminish all sensory inflow, is shown Influencing the gain of .aatixV s.tatiU which is alsoadjusted for gain and response patter through perceptual-motor adaptation. R influencesthe spatial model which now includes mismatch aaesment (perceived tumble relative to the earth maynot violate the motion control Imperative of some Individuals), Control of autonomic reactions has beenpreconditioned and can be further altered through adaptation procedures such as AFT. The hormonalstate is also subject to nature/nurture history, fr example aerobic conditioning (discussed below).Hormonal state modifies the neurochemoial link. Arousal from vestibular missmatch (Intravestibular,vestibular/visual, vestibular/proprloceptor) remains a focal point for both the pathway to perceptual-motoradjustment and the link to the sickness syndrome. Autonomic control influences autonomic arousal fromvesdbular missmatch which together with hormonal state influences the nourochemical link.

Fig i P3rceptuold Mot or w iu sslN I iv Adaptation Th e hl9 state -•"

F1 symdr--.

Maonleudon]

Figure 3. A sumnua'y of proposed (Actors with indiction of possible Interactions.

,•-II

Figure 3 provides a convenient overview of suspected factors in MSS, some more understoodthan others, and serves to illustrate the complexity of predicting MSS. Much more specificity is neededfor this conceptualIzation to become a true model, testable by experimental observation. For examplefunction of the hormonal component (Kohl, 1990) must fit with current information on anti-motionsickness medication (Wood, 1g90). As Indicated at the beginning of the earlier chapter (Guedry, 1991),the mechanisms of motion sickness challenge the entire scope of neuoscience disciplines and all levels ofneurosclences are challenged by and must be used to challenge any conceptual model developed.

FACTORS THAT ALTER POPULATION INCIDENCE

Other than adaptation and idiosyncratic factors a number of factors and conditions influence howmuch sickness occurs in a provocative motion environment and whether or not individuals In thatenvironment wigl experience motion sickness.

If the job of the individual permits, selecting a location within the motion platform may serve toreduce or avoid sickness, The magnitude of linear accelerations experienced varies with location within aship or large aircraft. When the entire ship or aircraft rises or falls, location makes no difference buttangential and centripetal linear acceleration components increase in magnitude with distance away fromthe center of any angular motion such as pitch or roll.

Supine body position is effective in altering sickness incidence (Manning and Stewart, 1942,1949, Reason and Brand, 1975, p.94). Even the very disturbing effects of deceleration from a Hyper-Ocentrifuge run are reduced when subjects are supine (Leger, 1984) for reasons not completelyunderstood, When in the supine position it Is probablT helpful to locate the horizontal semi circularcanals in the plane of maximal angular velocity of the platform (usually the roll plane of a ship), as thevertical canals seem more productive of sickness (Benson a,,d Guedry, 197 1).

Fixing the head and body relative to the motion platform is helpful in reducing sickness (JohnsonhaL 1951, 1953). While this point has been challenged, there is no question about its effectiveness Insome motion environments, such as rotating rooms, or continually circling aircraft or during Earth-orbit.Head-rest flxation is helpful In avoiding inadvertent head movements that occur; even heavy breathingInduces Inadvertant head motion, Frequent head movement relative to any moving platform increases theprobability of discrepant otolithic (Hyper-O, Hypo-O) effects and cross-coupled angular velocitysemicircular canal effects, all of which are nauseogenic,

Location on ship can also reduce nauseogenic odors, Anyone who has been on a ship driven bydiesel engines during a following sea will recall the efforts of experienced crew to find locations awayfrom the diesel fumes that tend to envelope the ship when prevailing winds are from the stem. Money(1970) provides a convenient summary on uffects of odors. Reference numbers in the following arethose of Money (1970):

"Tobacco smoke, unpleasant odors, and even food odors have been considered tobe promoters of motion sickness (12, 39, 50, 54), and since motion sickness occursmore readily in the presence of nauseating drugs (22, 34, 240, 249), it seems reasonableto expect that it would occur more readily in the presence of a nauseating odor, Odorsassociated with previous bouts of motion sickness sometimes promote motion sicknessvery effectively (253), It has been reported that the odor of pyridine promotes motionsickness and, surprisingly, that the odor of toluol suppresses motion sickness (302)."

Ambient temperature has been found not to be a contributing factor in the genesis of motionsickness in a number of formal etudies, Typically, in these studies, air exchange was carefully controlledto avoid effects other than temperature (Wood and Grayblei, 1970), My experience, in studyingvestibular function over the years, is that when ambient temperature In the chamber or capsule cont•ininithe subject is uncomfortably high, Incidence of sickness increases in vestibular experiments not intendedto study motion sickness, Possibly odors associated with increased temperature are the predisposingfactor, The following quotation from Money (1970) Is consistent with this Interpretation:

"The time of day and the interval since eating a meal have been found to have woInfluence on average susceptibility (6, 27, 35, 192), except in one study (91) in whichthe incidence of severe sickness increased with time after the last meal to a maximum at 3hr and decreased. Ambient air temperature has been found repeatedly not to influencesusceptibility (75, 135, 152, 155, 192, 309), although persons suffering from motionsickness frequently express a desire for fcnil f'esh air, and many susceptible peraons

K~"~

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consider excessive heat a contributing factor (50). It is possible that the odors thataccompany high temperatures in some situations promote motion sickness."

Visual conditions influence sickness induced by particular motion environments. A view of thehorizon from the deck of a ship can influence interaction within the brainstem that lessensintralabyrinthine conflict that would otherwise require resolution by higher centers (Guedry, 1978).Vestibular reflexes that stabilize the eyes relative to the earth only potentiate sickness when the individualis enclosed within a ship or aircraft. Closing the eyes can reduce this potentiating effect.

The layout of visual displays and the visual search task within visual displays also influencesickness incidence. Displays that demand frequent and large head-movements wouldTiotentiate sickness.Several studies show that tasks that require visual search within a cluttered display potentiate sickness(Guedry,&Lal. 1982) even when the head is fixed relative to the motion platform and the display. Inmodon-based simulators it is possible that peripheral visual motion Improperly phased to vestibular Inputwill otendate sickness when the task demands focused attention on cockpit displays (Guedry, etaL.1974)

The task of the individual in the motion environment not only affects the rate and form ofadaptation to the environment but it also Influences sickness susceptibility in the envimnment. Mentallydwelling on motion sickness symptoms or envisioning motion of the body in space seems to potentiatesickness, whereas, mental involvement in an interusting task has preventive effects, if the task does notinvolve a nauseogenic visual display (Reason and Brand, 1975, pp. 71-73).

A number of personal factors influence susceptibility to motion sickness. Age whichunfortunately Is beyond our control is a factor in motion sickness susceptibility. It has been reported thatmotion sickness is rare before the age of two years, that it increases to a maximum by about the age of12, declines between 12 and 21 and declines still further before the age 40 years (Reason and Brand,1975 p87),. Beyond the age of 50, motion sickness was reported to be rare in civil aircraft (Lederer andKidera, 1954) but Lawther and Griffin (1986) reported that 22% of those suffering from sickness onChannel Island ferry crossings were over the age of 59 years. Age does not confer immunity to highlyprovocative motions, but declining incidence with advancing age may be related to declining vestibularAfferent Information with advancing age. Lawther and Griffn (1987) use different values for constantsIn their equation for predicting sickness Incidence, depending upon the age as well as sex of the subjectsthat make up the group,

Other predisposing factors that have been Indicated are fatigue, alcohol (and of course a variety ofdrugs) and emotional state, Dowd (1975) found evidence thnt sleep deprivation altered the vestibulo-ocular reflex to the provocative cross-coupled stimulus and theorized that fatillue reduced the motion.sickness suppression that pilots had achieved through flight experience thereby rendering them moresusceptible to the cross-coupled stimulus. Clearly more information is needed in this potentiallyimportant, but difficult to study, area. Consider the problems encountered in finding experienced pilotswho will agree to congregate for the study the effects of theirx sleep loss on Lb• tolerance of purposelyprovocative motion - an Important consideration for those interested in conducting research in this topic.

MYSTERIOUS VISITATIONS AND A GENERAL PRUDENTIAL RULE

Anyone who has worked In motion research for a number of yenrs becomes personally aware ofoccasional heightened susceptibility to motion exposure in laboratory devices, Reasons for thesevariations are not clear. It is natural to suspect that immediate motion sickness susceptibility would beinfluenced by conditions and activities that induce some of the many of the signs and effects that are partof the motion sickness syndrome. These signs and symptoms as described by 8enson (1988), are listedat the end of the chapter on Mechanisms of Motion Sickness, Until specific studies have been conductedto show that conditions that induce headache, etc, are not effective in potentiating motion sicknesssusceptibility, a general prudential rule is to avoid conditions that prod'Joe symptoms like those that arepart of the motion sickness symdrome. Because of the difficulty in conducting studies of motionsickness with human subjects, prudential rules will have to suffice in a number of areas for some time.

In closing this chapter, I wish to call the reader's attention to the very substantial work that wascarried on in this field in Canada, England, the United States, and Australia in the period between 1940and 1965. Much of this work Is referenced In Money (1970), and Reason and Brand (1975). Intensiveand extensive study in those years forms much of our knowledge base for today.

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Wendt, G. R., Experiences with research on motion sickness. in "Fourth Symposium on the Role ofthe Vestibular Organs In Space Exploration", NASA SP-187, Penscola, FL, 1968.

Wendt, G. R., Of what importance are psychological factors In motion sickness?. J, Aviat, Med.19:24-33, 1948.

Whinnery, J.E. and Purnell, M.J., The effects of long term aerobic conditioning on +43,tolerance. Aviat Space Environ. Med., 58: 199-204, 1987.

Kl~din, J. M., and Meddis, R., A note on personality correlates of motion sickness. Dr. J.Psycho!, 63:619-620, 1972.

Witkln, H.A., Orientation to visual and postural vertical. in Psychophysiological Factors in SpatialOrientation, ONR symposium (N~AVEXos P-968), p. 18.29, Penscols, Fl., Oct 1950.

Wilkin, 11I.A., The nature and importance of Individual differences in perception. J, Per$., 18: 145-170, 1949.

Witkin, H.A., Perception of body position and of the position of the visual field. Psycho!. Monog.,63:1-46, 1949.

Wood, C.D., Pharmacological countermeasures against motion sickness. Motion and SpcaceSickness, O.H. Crampton, Ed., CRC Press, Boca Raton, FL, Chap 16 1990.

Wood, C.D. and Grayblel, A., Effects of brief exposure to hot and cold environments onsusceptibility to motion sickness. NASA. Navy Publication 1104, Pensacola, FL, March 1970.

NW,-#~4

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by K.E. MoneySenior Scientist, Defence and Civil Institute of Environmental Medicine

P.O. Box 2000, North York, Ontario, Canada, r43M 3B9and

Payloa4 Opecsalist, Canacian Space AgencyOttawu, Can•ad

ABBTRACT

Motion sickness in spaceflight occurred only rarely in the earliest apace flightsin small capsules, but in the larger Space Shuttle the incidence is fully 70%.Apparently, in larger spacecraft the requirement to make head movements and bodymovements in weightlessness increases the likelihood of space sickness. Typically,after its appearance in the first day of a spaceflight, space sickness is made worse byhead movements and by disorientation, and it is ameliorated by renaining motionless.The sufferer gets better slowly and usually is entirely well after three days. Anti-motion lickness drugs have been useful in dealing with space sickness and biofeedbacXteuhniques might be helpful, but attempts to prediut Susceptibility (except by assessingsusceptibility on previous spaceflights) have not been successful.

INCIDENCE OF SPACE SICKNESS

Motion sickness did not occur in the first American spaceflights, probablybecause the spacecraft were very small, Only when larger spacecraft were used, and whenthe astronauts' obs required them to move about in weightlessness, did space motionsickness appear in the American program. (It is said, however, that on the secondSoviet sptaeflight, in the small Vostok spacecraft, violent notion sickness wasenCountered). The incidence of space motion sickness is shown in Table 1, taken fromHomick and Vanderploeg (7).

Table 1.

*INCIDENCE OF SPACE MOT1IO SICKNESS IN U.S. AND U.B.S.R. SPACE MISSIONS (a)

United states (as of October t984)

o Number of Crewmen (b) Incidence of Motion Siokness

Mercury 6 0Gemini 20 0Apollo 33 iiSkylab 9 5ASTP 3 0Shuttle 48 25

Soviet Unkon (as of 1981)

Procra Number of Crewmen (b) Incidence of Motion Sickness

Vostok 6 1Vookhod 5 3Soyus 38 21ARTP 2 2Salyut 5 6 28slyUt 6 27 12

The incidence of space motion sickness in the Shuttle as of 1981, consideringflights by 125 astronauts, 91 individuals some of who flew more then once (23) in thefirst 24 Shuttle flights, is 7il (S),

SPACE SICKNESS 10 MOTION SICK4NEdU

Motion sickness in specs it, apparently, motion sickness, although in space thereis. no sweating, flushing is more common than pallor, the vomiting has been described as"brief and *usually sudden ... without nausea or other prodrome", and after 3 days orso When the sickness disappears there is a peculier nonsusceptibility to even the mostnaussogenic (Coriolis) accelerations (0,24). It is possible that the reportednonsusceptibility to Coriolis accelerations resulted from the lack of a reference "down"

*(e) Reports of one or more symptoms of space motion sickness are included. No attemptwas made to categorise by severity of symptoms.

(b) Includes some crewman who flow more than once. Table taken from Homiok andVanderploeg (7).

X -I

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in Ipva:•f Lyht, or fromn the nma 1 mluliber of exporimorntaI utilijets qtud ot,, but theSoviets also mention, as a "peculiarity", that once the habituation to space motionsickness in complete, there in then a "clearly defined higher resistance to cumulativevestibular loads" (1). In Soviet cosmonauts, unlike American astronauts, nausea islisted as a "typical" complaint (1,12). In the mrotion-sick cosmonauts, pallor and coldsweating are "typical" signs accordinq to one report (12), but in another report pallorand cold sweating sweating were omitted from the list of "typical" signa but werereported to be present "in a number of cases" (1). In both the American and Sovietexperience, vomiting is usually followed by an improvement in the condition(at least fora while).

MOTION SICKNESS IS A POISON RESPONSE

In motion sickness the body behaves as if it had been poisoned (6,13), Motionsickness is a poison response provoked by motion. more specifically, motion sicknues isa poison response provoked by motion acting (directly or indirectly) on the vestibularsystem (14). There is now evidence that the vestibular system is involved not only inthe poison response of motion sickness, but also in the poison response to certainpoisons. Experimsntal animals were found to be strikingly defective in their responseto poisons after surgical removal of the vestibular apparatus (15). This involvement ofthe vestibular system in poison response was hypothesized by Claremont (4) and byTreisman (25). Of course, those humans or animals who are lacking vestibular functionare also completely nonousncptible to all forms of motion sickness that have been triedon them. A recent study of Jabyrinthine-defective humans found them to be entirelynonsusceptible even in response to a purely visual motion sicknesas timulus (3). Motionsickness is a poison response provoked by motion acting on the vestibular system.

TIlE PECULIAR NONSUSCEPTIBILITY AND LONG-TERMI PACEP'LIOllT

it is important to note what follown logically from the observed peculiarnonsueceptibility to the sickness in response to Coriolis acoelerations in spaceflight.To the extent that available evidence supports conclusions, this nonsusceptibilitysuggeste (hints) that a rotating spacecraft could be used for long-term spaceflightwithout serious vestibular/motion sickness complications. On the basis of the (sparse)evidence available, it might be anticipated that rotations starting after a week or soof spaceflight would cause no motion sickness problem. Rotation could of course stopfor short periods during a Tong flight, and for a week or ao before landing to allowreadaptation te, a nonrotating environment, At least it can be said that, as of now, itwould be premature to rule out the use of rotating spacecraft because of anticipatedvestibular/motion sickness problems. It might be that no such problems exist. Befotelaunching a rotating spacecraft on a long flight, however, further inflightexperimentation could be required to see whether the nonsueceptibility or ability toadapt could hold in spite of the variable-strength "down" (the linear acceleration)produced by the rotation. Earlier experimentation in slow rotating rooms (includingwalking on the walls) suggests that any problems encountered would be readily overcomeby habituation.

THE SEVERITY OF SPACE SICKN9S8

There is little detail available concerning the severity of space motionsickness. One analystl (Davis et al, unpublished data cited in ref 23) of 57 Shuttleastronauts who experienced motion sickness in spaceflight, describes 46% of the sickastronauts (26 astronauts) as mildly asck, 35% (20 astronauts) as moderately sick, and191 (11 astronauts) a severely sick. "In this rating scale, even those characterizedas mild could have at least one episode of retching and vomiting. In the severecategory, the crew person had to express several symptoms of a persistent nature, havemore than two episodes of retching and vomiting, and remain ill beyond 72 hour* intoflight.*(23) The above numbers are reasonably accurate, but it should be rememberedthat, in general, an astronaut does not want to be known as someone who was sick inspace and it is part of the culture of astronauts to be positive and healthy andcapable. If asked about the degree of sickness being expeeienced, an astronaut'sculture would incline him to believe and to say that he was OK, and this inclination ispossibly responsible in part for repurts of vomiting in spaceflight without noticeableprodromal symptoms. There is even one report of an episode (5) in which an astronautvomited and then got the agreement of his fallow crewman that they would all keep theepisode secret. This cultural factor has perhaps acted to reduce the reported incidenceand severity of motion sickness in space.

THE INFLUENCE OF HEAD MOVe'NLTS

some astronauts have expressed the opinion that the incidence of space motionsickness would be almost (although not quite) 100 if in the astronauts had to doconsiderable moving about in the spacecraft during the-Urat 3 days of allepaoeflights. On some shuttle flights there are some crewmen whose jobs allow them toremain strapped into a seat for almost all of the first three days. Another influenceon the observed incidence of spaOe motion sickness is the pest practice ofromedicationt until recently, some Shuttle astronauts took antimotion sickness drugsusually scopolamine 0,4mg and dexedrine 4'.Omgl bcore launch. (Prs;ai NASA jwu1Liy,

May 1991, is to refrain from premedication and to inject promethasine 50 mg intra-muscularly if motion sickness in flight is troublesome. This policy was adopted partlyfor the reason that antimotion sickness drugs taken prophylatically can impede thenatural adaptation to the now motion environment.) A4 a guests perhaps 10oer so of

II V

• " .. . +" •i ; " ' '•+>,¢•+ ,,.+% 7,.

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unmedicated astronauts who were obliged to move about and do a lot of head movementsduring the first three Any@ of a spaceflight would be utterly unaffected by apace motionsickneas.

DURATION OF SPACE SICKI•ESS

When motion sickness occurs in spaceflight it gradually gets better but typicallyit persists for two or three days. The astronaut can get some relief by takingant motion aickness drugs, and more relief can be gained by remaining motionless (17).After a period of being motionless the astronaut starts to foel better, but when hestarts to move about again the nausea gets worse again, and if he persists in moving,vomiting can result, After thrae or four days, when habituation ie complete, theastronaut is completely free of symptoms and can move about as much as he wants and evendo gymnastics without provoking any syptoms. In one Soviet cosmonaut, however, motionsickness in space lasted two weeks (arthough vomiting occurred only during the firstweek)i this cosmonaut also experienced motion sickness, including vomiting, for threedays after returning to Earth (Matsnev B.I., personal communication). In &cat, of thefirst 27 Salyut-6 cosmonauts, 9 suffered significant sickness after returning to Earth,and 8 of these 9 had suffered sickness in space at the beginning of their flights (12).The sickness asesociated with the return to Earth is analogous to the 'mel dedebarquemsnt' experienced by some people upon getting off a ship. Its occurrence inAmerican astronaut, has perhaps been prevented by the relative brevity of theirspaceflights, and in the longer Skylab flights tt could have been masked by seasickness,since the Skylab astronauts were recovered at sea, Even so, two cases of motionsickness after rotur,, to Earth have been reported in the American program (23), and itis possible that motion sickness after a long flight could appear with disastrousresults upon stepping onto 14ars, or ujon stepping onto Earth after a long flight(perhaps after a Spaoe Station flight).

PREDICTION Or SUSCEPTZBILITY

Available tests on Earth have not allowed prediction of susceptibility to spacesiokness (18,23) although, since 7?O or so of people who fly in the Shuttle doexperience space sickness, a prediction that all future flyers will be sick in spacewould be correut in about 70 of oases. There is no significant difference in theincidence of sicXness between men and women, and the likelihood of being sick in spacedoes not correlate significantly, positively or negatively, with susceptibility tomotion sickness stresses on Barth (nor, probably does it correlate with the amount ofthe right stuff possessed by the astronaut).

MOTIONS THAT CAUSE MOTION SICKNESS

Motions of the body that cause sickness are, at least usually, notions thatexceed the normal frequency and/or magnitude ranges of the viatibular reueptors, so thatsome of the vestibular roesptors are reporting false information to the brain in motionsickness eituation (22). Vision and some proprioceptora continue to report correctinformation. In such motion sickness situations the brain says, in effect, 'Myvestibular system ts giving me false information# therefore my vestibular system hasbeen poisoned by something I ate, and I should vomit.' Motion sickness is not asicknamse it is the normal healthy response to poisoning, triggered by a stimolus thatmasquerades es poisoning.

In spaceflight there are many sensory inputs that could be interpreted as falseinformation in the vestibular syatem. For example, ' hogah9ut weightless flight thevestibular receptors probably tell the brain that the body is alling, wherease vision,and the duration of the "fall", contradict that vestibular Input. This falling versusnot failing is possibly the most important provocation of space motion sickness. Also,the vestibular receptors tell the brain that there is no down (no gravity), althoughastronauts usually do perceive a (visually determined) down. The conflict between"down" and "no down" could also be important in space motion sickness, especially inview of the possibility (11) that people vho maintain the logical visual indication asthe peroeived down (instead of taking the "feet are down" perception are the ones moresusceptible to space motion sickness. The vestibular receptors also tell the brain thathead tilts relative to a perceived down have taken place (according to the semicircularcanals) but have not taken place (according to the otoliths), as Benson has pointed out(2). It is seldom considered, but static head tilts relative to the down direction arenormally (on Earth) reported by neck proprioceptors, and the abuenoe of gravity's pullon the head in certain tilted head postures in spaceflight could well be an importantcontributor to space sickness. It has been shown on Earth that motion acting onproprioceptors can cause motion aickneua (10). Similarly, the absence of gravity on anextended arm, in an astronaut who perceives himself upright, is consistent with anangular acoeleration of the arm and hand in the "don" direction, and since the sameangular acceleration of the head and bndy would have to be taking place together withthe arm (because no ruwtion of the shoulder in taking place), denial of such an angularacceleration by the semicircular canals could create further conflict. This would beempeci'lty so if the hand were holding an objent kmnwv to be "hmsvy".

AVIUINU 1ROVOCATIVIO MOVEMENTS

Perhaps astronauts should be told that, to avoid motion sickness, they should notonly avoid pitching and rolling head movements but they should ales avoid, as much ae

Z .

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possible, postures Li which the spinal axis is offsst from the direction of theperceived down, and they should avoid static tilt positions of the head relative to theperceived down, and they should avoid extended limbs at right angles to the spinal axis,and when moving (translating, floating) about the spacecraft they should maintain thespinal axis parallel to the direction of the perceived down and not soar "horisontally'like Superman. When the body's spinal axis JA perceived to be "horisontal" (at rightangles to the perceived down), then of course yawing head movements should also beavoided,

THE ADAPTATION

It is thought that there are probably three main aspects of the centraladaptation to the unusual vestibular environment in spaceflightt first, a generaltendency to ignore or suppress inputs from the vestibular apparatus, especiallyotolithic inputst second, a tendency to interpret all changes in otolithic inputs aschanges of linear acceleration rather than changes of tilt angle relative to gravity(called variously "tilt-translation reinterpretation", or "sensory rainterpret., ton or'stimulus rearrangement", reft 19,29,30)1 third a substitution of other sensory inputs,especially visual inputs (26,31), for the previously used vestibular ones. Anotherpossibility is that the cupulae of the exquisitely sensitive semicircular canals do notnormally have exactly the sam density as ondolymph (16), a complication usuallyovercome with the help of information from the otoliths, and that habituation toweightless cupulas also takes place. It is also possible that different cupulae havedifferent densities so that asymmetry of oupulse produce the kinds of problems that havebeen ascribed (27) to asymmetry of Otoliths. The space motion sickness is thought tostop when the central adaptation has proceeded sufficiently. Again, the proprioCeptivecontributions to the motion sickness and to the adaptation have been largely ignored butcould be important. It is known that propriaceptive function is altered inweightlessness (20,21,26,28.29,30) and that proprioception on Earth can be important inmotion sickness (10).

PEFNRENMOC

1, Atkov 0. Yu. Clinical aspscts of weightlessness and hypokinesis. Lecture givento the International space University, York University, Toronto, Canada, pp 1-17, AugL990,

2. Benson A.J. Possible mechanisms of motion and space sickness. Ina LifeSciences Research in Space. ESA SP-130, European Space Agency, Paris, pp 101-l08, 1977,

3. Cheung B.S.K. Howard I.P., and Money K.E. Visually induced sickness in normaland bilateral labyrinthine-defective subjects. aviat, Space Environ. Mede in press,1991.

4. Claremont C.A. The psychology of motion sickness. Psyche Ili 86-90, 1931,

5. Cooper H.1;!. A reporter at large, Life in a space station. The New Yorker pp34-66, 30 Aug 1976, and pp 34-70, 6 Sept 1976.

6. Crampton 0.H., editor, Motion and Space Sickness. CRC Press Inc. Boca Raton,Florida. pp 1-451, 1990.

7. Homick J.L. and Vanderploeg J.M. The neurovestibular system, Chapt 8, pp154-166, in space Physiology and Medicine, edited by Nicogossian h.E., Leach Auntoor C.,

and Pool S.L., Lea and Pebiger, Philidelphia, 1969.

6. Jennings R.T., Davis J.R., and Santy P.A. Comparison of aerobic fitness andspace motion sickness during the shuttle program. Aviat. Space Environ. Mod. 59,448-45L, 1988.

9. Johnson H.S. and Dietline L.F., editors. Biomedical Rusulta from Skylab. NASASP-377, NASA Scientific and Technical Information Office, Washington, 1977.

10. Lackner J. and Di Sio P. Some efferent and somatosensory influences on bodyorientation and oculomotor control. In. Sensory Experience, Adaptation, andPerception. Spillman L. and Wooten 5.R.. editors. Erlbaum and Associates. Clifton, NowJersey, 291, 1984.

Ll. Lichtenberg B. Human behavior and performances personal insights, Chapt 9.Study material provided to the International Space University, pp 1-4, 1990.

12. MerSnev 3.I., Yokovleva IY., Tarasov I.K.. Aleksev V.N. Kornilova L.N., MateevA.D., and Gordiladse 0.1. Space motion sickness phenomenolgy, countermeasures, andmechinisms. Aviat. Space Environ. Had 54a 31 -317, 1983.

13. money K.E. Motion sickness. Vhysiol. Rev. 501 1-39, 1970.

14. Money N.E. Motion sickness and evolution. Chapt 1, pp 1-7, in ref 6, L990,

15. Money K.E. and Cheung B.S.K. Another function of the inner ears facilitation ofthe emetio response to poison*. Aviat Space Environ. Mod. 54. 208-211, 1983.

'q, . ,,

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16, Money K.E, and Myles WS, Hielvy water nystagmus and effeots of lcoo1_ NHatu'e247 (No. 5440)s 404-405, 8 February 1974.

17, Money K.E. and Oman C.M. Medical nmnitoring and therapy of space '.otiirjsickness. Prevented at the 33rd Congress of the International Astronauti.--il Feducrti..,Paris, France, 27 Sept - 2 Oct 1982. Published in Space 2000 edited by L.3. ,*l.tanicAmerican Institute of Acronautic9 and Astronautics.

1I. Omatn C.M., Lichtenberg U.K., t.)ney K..,., and McCoy R.K. M.I.T,/Canadianvestibular exparimento on the Spavalab-1 Missions 4. Space motion sickn"em sympt.ms,Etimuli, and predictability. EKp. Brain Res. 641 36334, 986,

19, Parker D.C., Reschke M.F., Arrott A.P., Homick J.L., and Lichtenberg O.K.Otolith tilt-translation reinterpretation following prolonged weightlessness,implications for preflight training. Exp. Brain Res. 64s 3L6-334, 1986.

20. Parker D.E., Reachka M.P., and Aldrich N.G. Performance. Chapt 9, pp 107-178,

in roef 54, 199g.

21. Proceedings of the 7th Interiwational Academy of Astronautics. Man in spaceSymposiums Physiologic Adaptation of Man in Space. Aviat. Space Environ. Med. 58 (9)sSeptember Supplement, 1967.

22. Reason J.T. and Brand J.J. Motion Sickness. Academic Press, London, 1975.

23. Reachke M.F. Statistical prediction of space sickness. Chapt 14, pp 263-316, in

ref 6, 1990.

24. Thornton N.E. Moore T.P., Pools S.., and Vandorploeg J. Clinicalcharaoteritation and etiology of space mition sickness. pp Al-AS in ref 21, 1987.

25. Traisman M. Motion iscknessi an evolutionary hypothesis. Science 107s493-495, 1977,

26. von Baumfgarten R. at al. European experiments on the vestibular system duringthe Spacalab D=- mission. Proceedings of the Norderney Symposium on Scientific Resultsof the German Spacelab Mission D-1, P.R. Sahn, R. Jansen, and MH. Keller, editors, pp477-490, Norderney, Oermany, 27-29 August 1987,

27. von Baumgarten R.J. and Thumler R. A model for vestibular function in altered

gravitational states. Life Sci. Space Res. 17s 161-170, 1978,

28. Watt D.o.g., Money K.E., Bonder Rd.., Thirsk R.S., Oarneou M., and Scully-PowerP. Canadian medical experiments on Shutt(le flight 41-0. Canadian Aeronautics and SpaceJournal 311 215-226, 198s.

29. Young L.R., Oman C.M., Watt O.D., Money K.E., and Lichtenberg B.K. Spatialorientation in weightlessness and readaptation to Earth'm gravity, Science 225t205-208, 194.

30, Young L.R., Oman C.M., Watt D.0.D., Money K.S., Lichtenberg B.K., Kenyon RV.,and Arrott AP. M.I.T./Canadian vestibular experiments on the Spacelab-1 mission: 1.Sensory adaptation to weightlessness and readaptation to ons-gi an ov.,rview. Exp.Brain Res. 640 291-298, 1986.

31. Young L.R., Shelhamer M., and Modestino S. M.I.T./Canadian ex ,rimonts on theSpacalab-t missions 2. Visual vestibular tilt interaction in weightlessness. Exp.Brain hee. 641 299-307, 1986,

Acknowledgement

The author thanks Dr. C.J. Brooks for helpful discussions.

8IMULATOR SICKNESS

by KE, MoneySenior Scientist, Defonce and Civil Institute of Environmental Medicine

P.O. Box 2000, North York, Ontario, Canada, M3M 389and

Payload Specialist, Canadian Speas AgencyOttawa, Canada

ABSTRACT

Sickness in a flight simulator can compromisa training, and it can also give riseto effeats that persist afterwards and create hasards for the train**. Generally,simulator sickness involves moss visual disturbances, more dizsinees, and moreafter-effects than in other kinds of motion sickness, and less gastrointestinal adisturbance (although a few instances of frank vomiting have been reported, both in thesimulator and after leaving it), Simulator sickness can interfere with, and discourageparticipation in, simulator training. Its aftereffects could cause accidents, and toavoid these accidents the trainues are often grounded for a while after flying thesimulators. Different incidences of simulator sickness, most between 10 and 60%, havebeen found in different simulators &nd depend partly on the criteria for the "sickness"and on how the simulator is used. Procedures for minimizing the problem have beendeveloped.

INTRODUCTION

The use of simulators for flight training reduces the costs and the risks oftraining in aircraft. In modern simulators that include a wide angle visual display,however, there are problems with simulator sickness. With technological progress, itseems that as the simulation gets better the simulator sickness problems get worse(4,7,19). These problems have been the subject of symposia and the sabject of someexcellent reviews and overview papers (l,3,tll, lS,lE,20) and they are being addressedwith some success. The present paper will attempt to summarise the field briefly andindicate where further information can be found.

INCIDENCE OF SIMULATOR SICKNESS

The incidence of simulator sickness is usually higher among pilots with littleexperience on the simulator, it is usually (15,21,111 but not always (19) higher stillamong pilots with extensive experience on the real aircraft and little experience on thesimulator. The incidence also varies with the individual simulator, with the kind ofmission being flown, and with the criterion for recognizing the presence of simulatorsickness, In a survey of more than 2500 "fligh-,." in ten different simulators,"simulator sickness incidence varied from 10 to 6"4" (15). Other surveys h,viw alsoproduced incidences in this range (S,6,9,10,l1), including studies of air combatsimulation (5,21), but another survey of (mostly) air combat simulators found anincidence of 671 (18), and the air combat simulator at Williams Air Force Base at onetime had an incidence of 879 (R.S. Kellogg, personal cominunication). Overall, thefraction of pilots who experience nausea in simulators is roughly IDS, and the fractionwith "eyestrain" is 251.

It is not known whether there are comparable problems during and after flying the

real aircraft (L2).

SIMULATION SICKNESS IS ONLY PARTLY MOTION SICKNESS

The gastrointestinal symptoms encountered in simulators are, in all probability,symptoms of motion sickness (1,15) Theme include stomach awareness and nausea, and theyare probably produced by a confliLt in the pt.ttern of sensory information concerningorientation and motion (l,l5). In addition to the motion sickness, simulator sicknessincludes other, separate, visual and vestibular phenomena.

Primitive simulators without viasal displays, or with visual displays that aresmall or night-only, produce almost no motion sickness, Only when large dusk and daytime visual displays became available did motion sickness become a noticeable problem insimulators, The large visual displays produce sensations of self motion in the pilot(13,14), in all likelihood these large displays also stimulate the visual system in sucha way that the visual system provokea the vestibular system (17) to produce both thesensations of self motion and (in some pilots) motion sickness ( pg 321 in ref 1S)."Stimulation of the vestibular centers by visual inputs" (pg 17 in ref 22) can producemotion sickness, presumably because the stimulation creates in the vestibular centers apattern of activity that includer aspects of conflict or mismatch.

Modern simulators include also a motion bass (2.24) and the mechanical motions ofthe motion bass can also be suspected of contributing to the motion sickness, especiallyif the motions are of the low froquenoo variety that are known to provoke motionsickneoss in other environments (1V).

Kennedy's a'assifiuat ion of the symptoms of aim ulator sickness include v I- -,vestibular, and vagal (-gastrointestinal) Symptoms. Only the vogel (gastrointestinal)symptoms are properly considered motion sickness. In addition to the motion sicknesssymptOms there are separate phenomena in simulator sicknesse the visual symptoms ofeyestrain, difficulty focusing, and sensations of visual distortions, and the vestibularsymptoms of dizaineoss postural instability, and false sensatione of bodilyorientation. The visual and vestibular symptoms can occur for many hours after leavingthe simulator, and they are possible sources of accidents both on the ground and inflight.

In addition to a pattern of conflicting sensory inputs, flight simulators inflicton the pilots visual inputs that are imperfect in apparent depth and that vary with thelocation of the pilot's eyes as he moves his head. There is also, usually, a very highworkload in flight simulator*, sometimes for several hours, and the crew is often beingtested. Simulator rides are often check rides in which many emergencies are simulated,and if the crews do not perform well they can be subjected to rerides, failure,tamoorary disqualification, or even permanent disqualification if unsatisfactoryperformance persists. Simulator rides can be long, stressful, unpleasant, andfatiguing, whether or nof motion mickess or any other part of simulator sicknell occurs.

The headaches associated with flying flight simulators could be caused by themotion sickness, by imperfections In the visual display, or by the demands of the task.Similarly the drowsiness could be part of the motion sickness or simply the result ofprolonged hard work.

MOTION SICKNESS Is A POISON RESPONSE

Notion sickness is a poison response provoked by motion. It is a poison responseprovoked by motion acting (directly or indirecly) on the vestibular system. The motionsickness that is part of simulator sickness is a poison response provoked, for the mostcart, by motion of the visual field acting indirectly (through the visual system) on thevestibular system.

DEALING WITH SIMULATOP SICKNENS

Simulator siaknese can compromise training (4,15). Some trainees sensitive tosimulator sickness will avoid the simulator as much as possible. Some will adapt to thesimulator by adopting habits that would be counterproductive or ha•ardous in the realaircrafti for example, simulator sickness might be reduced by minimsiing head movements,but minimizing head movements in the real aircraft would degrade Lhe lookout. Theaftereffects (4) of simulator sickness (postural disequilibrium, false sensations oforientation, and visual flashback) can appear several hours after leaving the simulator,and could cause accidents on the ground or in flight. Because of the aftereffects, sameday flights in real aircraft are restricted in some organizations, with a loss ofoperational availability of pilots by as much &e St (15). Also, simulator sickness ismi aerablel this kind of misery can be inflicted deliberately in order to induce desiredkinds of adaptation (8,35,26), but managers with responsibility for pilots should takesteps to eliminate it.

To deal with simulator sickness, current recosmendations are (15,23.)t

1. Avoid creating simulator sickness by suggestion. It can be contagious if one pilotsees another nick. Pilots, should, however, be warned about the aftereffecte. Noone should go directly home to repair hiis roof after a simulator flight.

2. Do not fly the simulator when you are hung over or have an upset stomach.3. Adaptation is the strongest fix for simulator sickness. Try to fly the simulator

every day until adaptation is complete (but do not fly ih past moderate naussa:stop for the day if you become nauseated). In some simulators adaptation occursmore readily if hope are every 2 to 5 days.

4. Do not fly the simulator the same day as a flight in the real aircraft.5, Got seated and organised before turning on the visual.6. Keep to a minimum the number and magnitude of turns while taxiing or while flying

near the ground.7. Keep to a minimum the number of steep turns, abrupt chAnges in speed or pitch, or

turbulance in flight.0. Keep to a minimum the number and magnitude of head movements, especially large

nodding movements during turbulence or during changes of aircraft heading orairspeed,

9. Use mostly Instrument flight in layer cloud and not too much clear hood flying, anduse night flying rather than day or duek flying.

10, Use the free&* mode and resetting mode as little as possible,It. Ensure that all projected channels of visual imagery are corrctit aligned.12, Turn off the visual and turn on the simulator lights before exiting.13. Whatever is seen or perceived to be the cause of the sickness should be minimised.14. Be awere that the initial flights are more nauseogenio than later ones, and that

some particular missions are much more nauseagonic than others.15. When adaptation is complete, most (but not all) of these rules can be discarded.

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REFERENCES

I. Benson A.J. Aetiological factors in simulator sickness, pp 3-1 to 3-8, in rft 12,1987.

2. Bussolari S.R., Young L.R., and Lee A.T. The use of vestibular models for designand evaluation of flight simulator motion,. pp 9-I to 9-10 in ref 12, 1987.

3. Casali J.0. Vehicular simulator-induced sickness, VOlume II an overview. NavalTraining 5ystems Center, Code 711, Human Factors Division, Orlando, Florida 32813-7100,92 pages, 96.

4. Casali J.a. and Frank L.H. Manifestation of visual/vestibular disruption insimulators, severity and empirical measurement of symptomatology. pp 11-1 to 1i-18 inref 12, 1987,

S. Chappslow .W. Simulator Sickness in the Royal Air Force, a survey. pp 6-1 to6-11 in ref 12, 1987.

6. Do ileyn G., Do Graph P., and Vandenboach P. Enquets sur Is mal dessimulateurs do vol couples a une etude nystagmographiqus. pp 13-1 to 03-3 inref 12, 1987.

7. Ellis 8.R., Grunwald A., and Velger M. Head-mounted spatial instrumnentsalsynthetic reality or impossible dream. pp 14-I to 14-8 in ref 12, 1987.

a. Frank L.H,, Casali J.0., and Wierwille W.W. Modelling operator controlperformance and well-being as a function of simulator visual and motion systemtransport delays. pp 12-1 to 12-7, in ref 12, 1987.

9. Gower, D.., Fowlkes J,, and seltaley D.R. Simulator sickness in theeH-47 (Chinook) flight simulator. USAARL Report No. 89-28, US ArmyAeromedicsl Research Laboratory, Fort Rucker, Alabama 36362-5292, 69 pages,September 1989.

10, Gower DJ, and Fowlkes 3. Simulator sickness in the UH-60 (Black Hawk)flight simulator, USPARL Report No 89-25, U.S. Army Aeromedical Laboratory,Fort Rucker, Alabama 36362-5292, September 1989.

l1. Gower D.W., Lilienthal M.O., Kennedy R.., and rowlkes i.. Simulatorsickness in U,.S Army and Navy fixed- and rotary-wing flight simulators. pp8-1 to 8-20 in ref 12, 1987.

12, Guedry F.E. Jr., organiser. Motion Cues in Flight Simulation andSimulator Induced Sickness. AGARO conference Proceedings No. 433, AerospaceMedical Panel, AOARD, NATO, (includes L7 Articles) October 1987,

13, Howard I.P,, Cheung B., and Landolt J.P, Influence of vection axis and bodyposture on visually-induced self-rotation and tilt. pp IS-I to 15-8 in ref 12, 19k87

14, Howard I.P,, Ohmi M,, Simpson W., and Landolt J.P. Vection and the spatialdisposition of competing moving displays. pp 16-1 to 16-8 in ref 12, 1987,

15. Kennedy H.S., Hettinger L..J, and Lilienthal M.G. Simulator sickiýs,. Chapt 15,pp 317-342, int Motion and Space Sickness, edited by ,1H. Crampton, CRC Press, BocaRaton, Florida, 1990.

1i. Kennedy R.S., Berbaum K.S. Allgood a.o,, Lune N.E., Lilienthal M.G. and OaltaleyD.R. Etiological significance of equipment features and pilot history in simulatorsickness. pp 1-1 to 1-19 in ref 12, 1987.

17. Kriebel J., Kornhuber A., and Lang M. Motion cues in everyday life, pp 10-i to10-8 in ref 12, 1987.

18. Lager A., Sandor P., and Delahays R.P, Etude horizontale do linoidence du maldes eimulateure dane lea forces aeriennes francaises. pp 4-1 to 4-7 in ref 12, 1987.

19. Magee L.E., Kantor L., and Sweeney D.M.C. Simulator induced sickness asmongHercules aircrow, pp 5-1 to 5-8 il ref 12, 1987,

20, Mc Cauley M.E., editor. Research Issues in Simulator Sicknesst Proceedings of aWorkshop. National Academy Press, Washington, D.C., pp 1-66, 1984.

21. Mc Quines* J., Bouwman JH., and Forbes J.M. Simulator sickness occurrences in2Z6 Air Combat Maneuvering Simulator (ACMS), NAVTRACQUIPCN 80-C-0135-4500-1, SO pages,February 1981.

22. Money K.E. Motion sickness. Physiol. Rev. 50, 1-39, 1970.

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23. Money K.E, Flight simulator sickness in the Aurora CP140 FDS. DCIEN TechnicalCommunication No. BU-C-44, 6 pages, October 1980.

24. Mooij H.A. Technology involved in the simulation of motion cuess the currenttrend, pp 2-1 to 2-15 in ref 12, L997.

25. Norre M.9. Cues for training vertigo, providing suggestions for the managementof simulator sickness. pp 17-1 to 17-4 in ref 12, 1987.

26. Parker D.I. and Reachke N.V. Preadaptation to the stimulus rearrangement ofweightlessnless preliminary studies and concepts for trainer designs. pp 18-1 to 18-9in ref 12, 1987.

7-I

BR1A 810=~l88

Michael J. GriffinHuman Factors Research Unit

Institute or Sound and Vibration ResearchUniversity of Solithamptin

Southampton, So0 5NHEngland

1uwAnM

An historical illustration of the prevalence of motion sicknessrt sea is followed by a review of experimental studlies In which bothship motion and sickness have been quantified. The mot-ions responsiblefor sea sickness are identitied and aiternative methods of predictongsea ,Ikness from measures of ship motion are defined. The influenceof causal factors other than motion 'are also considered.

1. INTRODUCTION

Sea sickness may have been the first form of sot ioon sickness experienced by marn andanimals - it has probably inflicted more persons than any other form of travel sickterss.Nevertheless, while all who go to sea have something to say about mot i.on sea sicknessl,scientific study of the subject has been meagre. There have been remarkably few systesit:attempts to determine the motions resFonsEble for sea siokness and little ser iouascientific effort to minimise sea sickness.

1.1 T'ypm of motionVarious terms are used to describe the

motions of ships and people, with several VIRTICA.different terms being used for the samemotions. Vertiual motion of a ship may becalled scending (or heaving) or identified bythe conventions for vertical motion of seatedor standing porlonsanz-axis motion. The aseni ( a)used to describe human motion are shown inFigure I. When a person is sitting or MOLL LATERALstanding facing the front of a vessel the x- (r.axis of tire body corresponds to the fore-and-aft axis of the vessel. Similarly, rollmotion of the body corresponds to roll motion aeý (r )of the vessel. A person who in free to turn FORE-AND-AFTmay stand sideways so that the x-axis of the WO-W@)body Is parallel to the lateral axis of thevessel and roll of the boat will cause the Fiigure I Axes of motion.body to move in pitch. Lying down willrender the z-axis of the human body horizontal. These variatorlis may attect huearrsensitivity to vessel motion. Most studies of ship motion and eoa slckri'rrr have lclritnrdthe:e variations and describnd vessel motions using axes of the boat. rirther than axns ,fthe exposed people. At most, the orientation of the body (upright, o rocinlbetl t) I itindicated.

Three a) ternat ive co-ordI rbat n systems rdigilht le r110d L.0 din crt Lb(r Lite llioti iti:i I Wiii :hpeople are exposed on thips: a co-ordinute system cent.red oel ile person li.e. a ilodyo..url Ic.coordniraLe riyatoem), a co-ordinate system cenhted on the ship, oz i l,.i-irdiniti ,ystimllcentred on the Earth. With people moving around on ships, bludynanmic co-ordLtrite ll nte'pirrare I nconverient. Earth-referenced co-ordinate ayst.ema are technicaIlly drft itil t Lrrrneusethey require that the axes of measurement remain vertical rind horin.ontal as the ves3oLrolls and pitches. Although some measurements have been made with emarth referericed axrtsmost tmeasurement, s related to motion sickness have used ship-referenced axes. Inconsequence, measuremitrio in the 'vertical' and 'hurizontal' diroct, ton are only tnrilyvetLical and horizontal when there is eio roll arnd no pitch, Measuremorenil of 'horiczontallmotion (i.e. fore-and aft or lateral motion) using ship-referenced aces can be verydifferent trom those obtained using earth-referenced axes due to the grayvtatitonalrompornenta detected by transducers au they tilt in the graviLatIonal field of the eari.h(see Se,tLton 6 below).

1,2 Effe•o•t of motionVomit. inrg is the most obvious sign of motion sickness but it is nut the only sign of

sea sicknersit Vomiting may be neither the most sensitive nor the most important.corivsequence of sickness. Where the incidence of motion sickness is low, some less dramatic,,effect say lie a more sensitive indicator since it may be present in greater quantity,Additionally, nausea may be a mrue accurate indicator of performance arid mood thanvomiting. Monly studying motion sickness have therefore chosen to use scales which givesome weight to effects other than vomiting. However, various scales have been employed socomparisons of data from different studies is difficult (see scales defined by Fenda et al,1971; GraybLel et al, 1968, Lawther and uriffin, 1986). Terms such as 'nausea' anld'sickness' have different meanings in different studies. Some rating scales have been

.4 .* ,<,•. \" .

dessigneoi for xprixanial studies in the laboratory and are less suitable for aplication

Lo utrarodtraellrs y mansof a questionnaire. Consequently, it is currently onlypnsiibio to compare the results of a wide range of field trials by using vomiting as thedependent. variable. Fortunately, ntuuiiea at sea reported by )Kanda at al (1917) arid Lawtherand Griffin (1981i auggest mild and modaraiu symptoms of sickness may be predicted from the

relation between vomitinq Incidence and ship motion magnitude,

2. AZ8TORICAL PERBPNCTZVI

Most reports nf the intoldenoe of me& sickness give little information on the , yaicalcueof the aickness but provid~e a background view of the extent of the prcblem, Seao,

studier of tire efficacy of Alternative anti-motion sickness drugs 'have often includedcontrol qiOUPS taking no drug (or a placebo) and provide a imajor source of information onthe underlying extent of motion sickness at nea. other information comes from m fewexperimental studies and from medical records.

During the years 1909 to 1931 (excluding the period 1916 to 1920) 2.3 men per 100,000were invalided out of the Royal Navy through motion sickness, while 10,4 men per 100,000were olaced on the nick list ýKoevil, 1935). These figures werc interpreted Is showingthntt most persons develop an "Immunit1y' to motion. From a questionnaire of 100 sailors,Kuovi 1 foun]- that 40% admitted to having experienced motion sickness - but in no case wastihe problim ý-rifficirrit for it. to be entered into their medical~records. Of the 40% whoreported having been seasick# J13% had beern sick on destroyers and only 10% on batties(.ps.

ti'urps for the rrnumbers ,f passengers and crew tineekIng medical attention on the UnitedFauit Cormpany Steamship Service between 1915 and 1923 are given by Desnoea (1926) . P Hout().St Dt approximatnly 30,000 passengers, and a slightly lower percentage of about 1_ 000crew, suiffered sufficiently severe motion sickness to seek medical attention, There werenio rooo'rded de-,the due to sea siokness,

l1olling er a) (1944) ruport a study using soldiets on two minesweepers sent to seawheanever there was a prospect of sufficiently rough weather to test the efficacy of.l~r~.riat iv ant~i-motion sickness tdrugs. With the vessels at sea for between 4 Arid 6 hoursthe, Iinidence of sickniess in control subjects varied between 22W and 61% on different

.tpwi'h most. of these vomitting before the end of each trip.

it,, obtained from 1385r tronpa undergoing assault exercises in India, mainly in smallldigcraft, qtiowed that 12.41 vomited (Hill and Guest, 1945). In other studios with

,r,,1diers iii lending crart, Tyler (1946) found that about 35% became sick and about 14% weremeverely alck durliry tirtee hour periods. The sickness was found to depend on posture (see!l.tot Ion 3.4.4 below) nod medication.,

Chin!. r't al (1950) conducted a drug trl~tl aboard a 16,000 ton troop ship on a two-wayctoneqinq of the Atlantic 0ýoan during which 20%L of a control group vomited on t he e"stboundjoutriey and 41% of a different control group vomited on the westbound crossing, Chinn et,it (1952) report a drug itudy with troops aboard two further vessels crossing the Atlantic,Somte of tire troopi had made the crossing previouslyi of these, 36.9% on one ship and 38.8%on the other ship said that they had been seasick previously, In the study, among thosewho were adm'ini-itered a placebo, 38.0% vomited on one vessel and 37.,6% vomited on the othervommol. The incidence of vomiting declined with increasing agei when including those whoreieived active drugs there were 33,611 who vomited in the age range 17 to 20 years while14.2% of those iii the range 30 to 39 vomited.

iiendford of al (1954) found a 341 incidence of vomiting among troops On a militaryi , 1,41tt0 sh -rcmarrng t~hu Atlantic. A LIlmilar 3tudy involving 15 crossings resulted in

tive prevdletnce of vomiting varying between 1.11i and 43.0% with an overall average of 22.9%among those taking a placebo, drug on 10 eastbound tripe and varied from 15.5% to 35,7% withan overall average of 19.6% on westbolund trips (Anon, 1956*, . Trumbull at al (1960)reported that on military transport sihips travelling across the Atlantic the irncidence ofvomiting in control gtaupc varied between 13.5% and 22.1% on three croitsings, Aquestionnaire survey of 699 men aboard destroyers Involved in escort duty in the 11.5 Navy

*indicated that 391 were never sick, 391 were occasionally sick, 10% were often sick and 13%were almost always sick (Bruner, 1955).

Pethybridga et al (197i) found that V7% and 73% of the crew of two British Rtoyal Navysh'ps had been asea sick during their career, and 424 and 56% had been sick in the past 12months, During sea trials over five days with rough weather (wave heights generallybetween 4 and 14 metrers), 38% and 47% of the crew on the two vessels were sick on at leastone occasion From 1746 responses to a questionnaire of men serving on a variety ofBritish Royal Navy vassals, Pethybridge (1982) estimated that about 70% of naval personnelslifferr from some of the varied symptoms of sea sickness. The inaidlence of sicknclsb variedwith vessel size (see Section 4.3 below).

Amsong 335 participants in an Ocean Youth Club hoia, 57% experienced sea sicknesswhen no active drug was taknni this reduced to 26% among those taking a drug (Hargreaves,1960) , Attias et &1 (1987) report a 3 day drug trial aboard a 300 ton vessel in seea states2and 3 during which 53% of those receiving no drug we~re sick on the first two days and 23%

wrav sick on the third day.

V.i

7-3

{. ~3. OM& STUDSNI Or TIM CROOUN OF NOTfl01 UZCIWUII3.1 Introduction

othes bytonrviw studlee which have obtained measurements of motion and ameasure

Limitations, empecially to the equipment used, render some results insufficient todraw general conclusions as to the motions causing sickness, Nevertheless, observationsmade during these studies may be of some value in identifying other factors whichcontribute to the complex rviation betwoen motion and motion sickness. Where appropriate,the reported incidence of sickness and vessel motions are compared with predictiona usingthe 'motion sickness dotie value' IMSOV) calculations defined in Section 4.2 below,

3.9disawnyof experimental studies3.. tdes wit emall vassals

Using fast patrol bcats for more than 2 hours anrrd encountering rough sea (givingvertical motion at 0.36 to 0.48 Hz with acceleration in the range -2,5 to +3.3 me") Glaserand Harvey (1951) found that afpproximately half of a group of soldiers vomited, Soldie11rawithin enclosed floa~ts in a 3w timing pool were made motion sick by artificial waves havinga frequency of 0.29 Hz and peak acceleration in the range -1.6 to +4.3 me" (Glaser andHarvey, 1962) . Approximately 57% of soldiers felt ill and 36% vomited with I hour of themot~ioni - although there was evidence of habituation to Elie motion over six exposures. somedrugs wern found to be effec-tive in reducing the incidence of illness end vomiting,

Tokola at .11 (1984) reported that a 24 hour study in life-raftsl at sea in 'hardweather conditions' (e.g. 3 m waves) did not produce much vomiting becauase the volunteersweLR "acoiustomed to heavy sea". A similar study in a wave tank produjjk ng a frequtncy of0.37 lIN with acoelesration reported to be in the range 3 to 5 ma" prodcided vomiting In all).4 inch exposed to the condition without any medication (drugs or placebo) within one houron their first exposure (Glaser and MoCance, 1959) , Repeating the exposure five times attwo day intervals reduced the incidence of vomiting.

Latndolt end Motnaco (1989) report that in four cases of crew abendonin oil rigs Intotally-erelomed motor-propelled survival craft, sea sickness occurred in 7'1% or more ofthe occupantil. The condition developed quickly enid wee severe in some casaes.

3,2.2 Study by SendfordHandford re al (1953) report a survey of 638 men aboard a troop ship crossing the

Atlantic! Ocean from West to east. A gyromcope was used to measure roil and pitch whilevertical motions were measured with accoierometerb at four locations in the 186 metrevessel. The average roll frequency was 0,07 liz while the average Pitch frequency was 0,17Ha, The vertical acceleration varied with location and with time. tt Is reported that the"overall average" vertical acceleration for a 7 hour period on the second day was 0.7 me-'.(This may be the average of the peak accelerations recorded over 5 minute periods everyhalf ert hour.) The averiage roil was reported as 1.9 degrees and the average pitch as 0.7degrees.

The Crosingilh was described as exceptionally smooth yet 35.5% of the men succumbed tosickness (i.e. they nither vomited or were obviously seasick to an observer) . The authorswere unable to find sny correlation between sea sickness and measures of the vessel motion,The rate of sickness reached a peak between 06.00 and 07,00 hra, corresp onding to reveille,(It is not posanbltt to trOMPUte r,111,1, acceleration from an leverage peak acceleration,# butif t;ia r.m.s. acceleration is assumed to be 1.4 times lower that, the 'average peak value',as for d sinusoid, a seven hour exposure to 0,7 msa" will yielcl. a motion aickness dose valueof 79 ma-,'' and a prediction of 26% of persona vomiting)

3.2.3 Study by NiouitonhuilsoinNisuwenhutisen (1958) reported the results of a questionnaire survey of motion

sickness among 423 passengers aboard a 149 metre vessel travelling across the AtlanticOcean. (The accuracy of apparatus used to measure motion is unknown.) The vertical motionIsi reported to have had a dominant frequency of 0,14 Hm with a magnitude of about *1 me"when the sea was in a "normal" condition during the first 24 houtij at sea. The motionýincreaased over a period of 8 hours to more than :L4 ms-'# when sailing in the tail of ahuirricane, and then subsided over the next 36 hours. The numbear of persons motion sickinorodhaad from about 4% to 22% as the magnitude of the motion Increased but did not reduceuntil almost 36 hours after the reduction of the motion lsee Figure 2).

Assuming a vertical motion of I me" r.m~s, (i.e. a peak acceleration of 4 ma"' with acrest factor of 4) the motion sickness doese value procedure would suggest that 20% ofunadapted persiona would vomit within one hour, This ceilculetior is highly dependent on thecrest factor but a value of 4 has been obtained in some studies (see Griffin, 1990)., Themotion sicknaes dose value procedure is intended for short duration exposures and does notincorporate a recovery (or habituation) characterist±i. ,consequently, it implies that aomepassengers will become sick even if thre magnitude of the motion reduces I this loearsapproprJite to the data reported by Nieuwenhuij.4*n. The data in Figure 2 suggest that therate of recovery from motion sickness is slew and that in the conditions encountered bythis vessel, the rate of recovery wee matched by the rate a! now oases for about 36 hoursafter the height of the storm. The author says that the average passenger needs two or

t three days to become "adapted".

NieuWanhuilsen reported that females were move susceptible thanm iales (in the ratio20)0, that there was a non-linear dealing in susceptibility with increasing age, and that

. .. .. .....-

id-i4

J 7-4

those taking Anti-motionsickness drugs were more likely Acceleratlon (me'- peak) " 8aulO..oto be sick than those who did 8 100not take such drugs. Thelatter finding was attributed -- 'Acceleratlon -- Seask (I) 0to both the higher 4 0Osusceptibility to sicknessamong those who took drugs and/- 70their tendency to wait -ntilthey felt ill before taking the S S0Otablets, The taking of anti- 60motion sickness drugs wei twiceas frequehtt in the females 2- 4003%) as in the males (37%)•,_ so

3.2.4 .iapaneee studies 1 20During a 4 month voyage in

the Pacific Ocean aboard a 97 10metre sail training chip, 35cadets (aged 18 and 19 years) 0with no recent sea experience 0 6 12 18 24 00 Be 42 48 84 60 68 12 78 84were asked to report their Time since departure (houre)motion sickness experience(Mends and Yamagami. 1962), A ri e I Variation in vertical motion and percentage of

The vessel had dominant roll# seasick passengers during 84 h voyage (adapted frompitch and vertical motions Nieuwenhuijeen, 19.8).between 0.14 and 0.17 Hz.Using data from a later study(see belcw)i Goto and KMnde (1977) resnalysed these results to quantify the decrease invomiting with days at sea. They suggest that motion sickness incidence should becalculated from the product of two vari bless a 'human response function' and an 'exposure

*• effect function'. The human response function ie determined from the acceleration raisedto a suitable power (see below) while the exposure effect function is derived from thechange in motion sickness on successive cruising days. They showed that serious motionmickness, and lesser symptoms, decreased as days at sea increased, with a straight lineinverse relationship between days at sea and the logarithm of sickness incidence: theincidence of motion sickness symptoms fell to about a tenth over the first 10 days at sea,

A study of motion sickness among first year cadets with no previous experience of thesea during one month aboard a 115 metre training ship is reported by Mends et al (1977),The cadets were monitored at half hour intervals during watches and during rest with thereported data coming from 2-day cruises during a one month period which also involved timeat anchor and in port, Vertical motion was measured in the navigation bridge and isreported as r.ms. acceleration with a frequency in the range 0,17 to 0.21 H2, Observationover a period of 8 hours after leaving port, with a 4 hour watch commencing 2 hours afterleaving port, showed that the incidence of motion sickness increased greatly during aperiod commencing half an hour before going on watch, Those with Isevere symptoms ofmotion sickness' increased from less than 5% before this period to more than 60% while onwatchs those with 'any symptoms of motion sickness' increased from about 20% to about 80%,The incidence of motion sickness fell immediately after the end of the watch, In theexample shown, the magnitude of vertical motion Increased for a period shortly before thewatch but subsequently remained almost constant at about 0.6 ms

5' r,m.c, The authors

explain the fall in motion sickness incidence following the watch by the crew lying downor going to sleep. Goto (1981) links the increase before the start of the watch to thecadets wakinq up to prepare for tasks.

The study by Hands iL dl (1917) also yielded graphs showing Low the percentage of thecadets with sickness increased with exposure time during seven different periods at sea,DifLerences between voyages are explained by either differences in the magnitude of motionor the prior experience obtained during previous voyages, It is shown that the incidenceof sickness continued to decline with up to 12 days at sea. Gruphs are also provided ofthe maximum number of persons to suffer from motion sickness during a voyage as a functionof the vertical motion present at the time when this incidence of motion sickness occurred(after about 2 to 3 hours) , It is shown that for slight, moderate and severe motionsickness the incidence of sickness increased with the logarithm of the magnitude of thevertical acceleration, a (ms"- r.m.s.)]

Percent with alight or worse symptoms - 106 loglo a + 104

Percent with moderate or worse symptoms - 108 logto a + 75

Percent with serious symptoms - L14 log,0 a + 56These relatios are illustrated iin rigure 3 Using both logarithmic end linear scales ofacceleration. The similar gradients for the regressions between sickness and the logarithmof acceleration for the three degrees of sickness suggests that the use of only severesymptoms (i.e. vomiting) in other studies may allow the estimation of the relation betweenmotion and lesser degrees of illness, Howeveri also shown in Iigure 3 are the values- •. • ~~~obtained for vomiting incidence preduced by vertical oscillation in the laboratory at 0.166 •.,...MH by 0' Hanlon and McCauley (r974 and vomiting incidence predicted using the motiohsickness dose value procedure (MIDV) for a two hour period as specified in Aritish Standard6041 (1987), The authors suggest the greater sensitivity to motion in their Study at sea

.. .... . . .. ..... . ...... .. .

14_*ý ," .. J-.44 ,i '

if 1, r l 4 _

7-5

OfthMotlcn M' 416km (S

*% or Mors. or more

'80B SD

400 4

20

8 0 Ole 1, 1.6 2 2.8

lfiguzae 2 Variation in motion nicknaes with magnitude of vertical motion. [Data from handeat al, 19771 O'Nanlon and McCauley data lasee section 4 .3) and MSDV predictions (see Section4.2) for 2 h exposures to 0.166 Hz).

was due to -the absence of toll and pitch motion in laboratory. experiments., Othera planationas are possible, including a different interpretation of the descriptors ofmotion sickness severityi the definition of serious symptoms in those aes triaai ieAim "extremely unp #*sant sorenations, Vomiting, lost of desire to do anything", whereas thedata from the laboratory experiments and the data used in the motion sickness doae valueprediction are based solely on the incidence of vomiting, (The degrees of motion sicknessused by Kanda at al, 19717 and shown in Figure 3 &ate Grade 1 (slight) - "somewhatuNpleasaent sensations, but capable of carrying ot normal, unchanged life ... "I, Grade 11(moderate) - "considerable unpleasant sensations, occasional nausea, hard to do work orcarry on other activities aboard ship"t Grades III (serious) - "extremely unpleasantsensations, vomiting, lose of desire to do anything").

Further analysis of three onea-month voyages consisting of two days at not interspersedwith 7two or three days at anchor around the coast of Japan is reported by Goto and Kanda(1977). Vertical motions measured aboard the 115 metro motorised ship wers all in therange 0.4 to 0.7me-' r~m,s. (dominant frequency 0.14 to 0.2 Ha) . Groups of 40 to 60merchant cadets with little sea experience participated in the study and were questionedabout their symptoms of motion sickness at half hour intervals throughout watches, An

* analisis of data from the two or three hours of the first day of each voyage showed that*the noidence of vomiting increased very rapidly with increases in the root -mean-s quare

vertical' mationt approximately 10k vomited with 0,45 ma' tin~s, while about 501 vomitedwith 0.55 ina' r,m.&. Use greater rate of increase in theme field studies than. inlaboratory studies with vertical motion was attributed to the presence of motion in otheraxes (e.g. roll) and the infeotious influence of tailors seeing others vomit. It wasinferred tram the data that$ between 0.4 and 0.75 ms" r~m.sa., the motion sickness incidenceincreased in proportion to the r~in~s. acceleration raised to the power of 4.6. Above 0.75ms-' r~m~s. it was assumed that there was 100% sickness incidence while below 0.4 me" r,m.s,it was assumed that sickness incidence increased in proportion to r,m.s, accelerationraised to the power or 1.6, Compared with the earlier study it was observed thatacclimatisation took place more slowly when sa experisnce consisted of a series of shortvoyages as opposed to P continuous voyage. The authors concluded that the incidence ofmotion sicknesam reached a peak witi2 or J hours and that there is both a fatigue effectand an Acclimatization effect, They suggest that motion sickness does not, therefore,follow a simple time-dependency in which exposures are equally. severe if the exposure timedmultiplied by the squares of their r~m~s, accelerations are similar, (Unlike some otherstudies, the measure of sickness used it this series of studies was the number of personssuffering at holf hour intervals and not the cumulative number of persons to have sufferedsince the cormmencement of thu voyage.)

Goto (1901) suggests a refinement to the above prediction method such that the power*jto which the r.m~s, acceleration is raised varie with the severity of sickness in addition*to the magnitude of the motion. Formulae are also provided to predict the riese and fall

in ntwfbers of Persons $uttering from sickness as the voyage proceeds over s few hours andover several days. He suggests that habituation to motion is less on days when themagnitude of motion is low.

.2,.5 UmLted states GOWs OWLS& Stuhd61Wikuer at dil 1~99al7$b 19S0) report a comparison of sea sickneoss among 10 Geast

Guardsmen aboard three very different craft steami 9 side-by-side in sea state 3 over anoctagonal course for 4 hours twice a day for three gaye. Theo qraft were a 23 metre patrolAJ

:y_ .'r 4A 4.`t "AV

v_~

7-6

boat, a 115 metro outtor. end a ?7 metre small waterplane area twin ~utl (SWATK)-. Thevertical motion onr the patrol boat fell-il the range 0.15 to 0.15 ma' r.m.a, (ovar thefrequency range 0.2 to 0.45 Hs(i the vertlcal motion on the cutter was in the range 0.08to 0.27 MS-2 r,m,s. (0.12 to 0.37 Ha)j vertical motion on the SWATH Weis in the range 0.4 to0.37 ms*' r~m~s, (0,12 to 0.4 H%). O f 64 episodes of vomiting, 63 occurred in the pat ro.1boat and one aboard the SWATH - a5 finding consistent with the higher magnitude of vrticalmotion) in the patrol boat, Vomiting and lesser symptoms of mot ion sickness were greatestwhen steaming with a component of head msea, Multiple regression analysis of data from the

arlbat showed tthat motion siokness severity was greatest when motion frequencies wereow ad mgnitdeswere highi dooreasing the magnitude of the motion or. increasing thes

frequency of the motion resulted In a decreasee in the severity of motion sickness, Theauthors suggest- that the data support the view that motion sickness 13 primarily caused by -vertical translational moinand nob roll or pitch motion,

A, further study) was condu~cteA to compare responses of 11 Coast Guardsmen to themotions aboard the 29 metre patrol boat with the 27 mptre SWATH during one day in dock andtwo days at sea (Wiker and Popper, 1991)., Again, there was more severe motion and mores evere motion sickness aboard the patrol boat, Motion sickness severity increased 'duringthe sight hours at sea each day, Although the motions wore similar on the patrol boat onboth days at,.aqa!. th mot4.gneickneso was apprecik)Zly greater on the first day,M

32,8.0 Dav~id.* Taylor Naval SU~P Reseauch and Development Cente, studyA four day sea-keeping trial on a 42.6 metro Coamt Guard Cutter yielded date on ship

motion and crew sickness while sailing around an octagon course seven times (Applebee at&I, 1980 . Each log of the course lasted 30 minutes, commenring with head seas andsubsequently turning 45 degreesto port until the octagon wascompleted, Vessel motions weremeasured in earth-referencedewxes at the centre of gravity Prcerit asaslakand in sh~ip-referenced, axes

* within the pilot house *and the _

mess, The vertical motions and * lotUf ru *fd&Uf &W un ownsrrprcentage of crew reporting ga 4t ru 6 1 u th runs.icknesas were greatest with head

seas end least with quartering* and following seas.

Significant sicknessoccurred among the small creweven in sea state 4. ThePierce ntage reporting to be 40.Mentally or physically impairedby either Iseasick only" or"seaesick and excessive ship go.motion#" varied between 0 and654, rigure 4 shows the

* variation of this measure ofsickness with heading for thesix runs around the octagon for 46 0 48 0 IN ¶14 0 IN 70 615 6OWwhich it is available, Figure, Hedn ose dgn4 also shows the equivaleant H~~gt e dqmvariation in the aotion norma-lto the deck surface in the crewMass, on some rune there isevidence of the severity of v..~a oin(e ITIg)* motion sickness symptoma'lajqing C 4behind the severity of themotion but, generally, thle mo let run 060&Wrun O Ord runmotion sickness varies in a__aimilar manner to the magnitude 4thTf ru 2106th rna 60 7th run

* of vertical motion,..

Figure 5 shows the relationbetween. motion and motionsiok~ess over the octagon coursefor the six rune, it 14sapparent that nome habituationoccurred during the trial sothat tihe extent of symptomsdecreased as the runs increased Oindependiently of changes in tilem~gnitude of 'the verticalmotionin The Bidrcentaqereportin sea sickess Lo D _________________________consistently greater than the 0 48 0 a IO M 10 66 Opercentage who would he ex-ce Heeding so ING no 17goil )to voloit based on 30 minutetosxpo~iurss to the reportedmca ions during each leg of the VrLgua4 Variation in maqhiUd4i of Vertical motion andoctagon andi the motion aitkregs sl1Tiorisiokrtoes during six runs around an octagonald~se value (see Seotion 4.2)ý VOUX86s in a 42 5 Ma Coast Guard Cutter. (From Applebee, ý

1980t 0 deq correspunda tn head bess),

ol .A1'.

J-' 0

7-7

100 1mrI 0 00-

lot run. R4. run s0o I

40 *40 40!

0 0, 11 is 0 as 1 1. 0. 6 1 I

10(o 100 10

s o sos

4.0 40 40- 40-0

0. 10o , g0o

0 0.6 1 1.8 0ý 01s I i's 00 0.6 1 1.6

Acceleration (ma-1 rnmas)

riyus aI Rolstion between magnitude of vertical motion and motion sickness during six runsaround an octagonal course in a 42.6 m Coast guard Cutter (data from Applebes, lineD),

This may be partially due to the cumulative effects of motion amparionced prior to each leg( there was appreciable transit time to the location for the trials and a 30 minute periodof wave measurement before the first run) . Additionally, the reported sea sicknessresponses do not necessarily imply vomiting as predicted by the motion sick~ness dose value,

Applebee and Baitis (1984) report sea trials aboard an 92 metre Coast Guard Cutterduring Which both motion and the effects of motion were monitored. The magnitude of themotion and the extent of sea sickness varied with heading relative to the sea end thelocation of crew in the vessel,

3.1.7 fltu4Ls by the Institute e1 *huatd. and VibrationMim eeaueb, ZI.V.,,Atudies of motion sickness among Laze-paying palseengets on ferries around the wiritish

coasts have been reported by Lawthor end Or-.ffin (1866, 1907, 19886,b)., The full aeriesof investigations, which were conducted by the Institute of Sound and Vibration Rfleearcha t the University of Southampton in Engqland, yielded data from 20,029 passengers on 114vcy ages aboard six ships, two hovercraft and a hydrofoil. Passengericharacteristics andreaponses to motion were determined by means of questionnairs administered near the endof each voyage. information obtained about passengers from the questionnaire includedtheir regularity of travel, whether they had felt ill, when they had first felt ill,4whether they had vomited, whether they had taken anti-seasickness tablets, how much alcoholthe 'h4ad consumed, where they sat on the vessel, their age and their gender The..illnessrating~waslabtained from a four point &*alai It felt allaright', 11 felt slrghtly unwell',t I*-feji: quite All? , I.I felt abeolutely dreadful' . In the subsequent analysis theseresponmpswers adok~d from 0 to 3 and the average determined over the groups surveyed, Thev::po. mtin. w~ esrdi i xsC-p y-# n- roll, p itch andi yaw) such that theinstantaneousi: motion *.khroughout every voyage at any location on any vessel could bedettrmineod. The motikoft were based on ship-referenced axes (not earth-referenced) sinceit was donp-tdarid that these motions better represent the forces experienced by passengers.

condtiod- arid fom almto erytouh, he ertcalmotion varied from less than 0.1ms1r,m~s. to almo~st 1.0( me" r,AY p. and the incidence of vomiting varied from 0% to almost

40%. rigure 6 illustrates a typical 100 a period of ship motion on one voyage. Thevari~kt4.on in motion with positi!on irn this vessel is discussed in Section 3.3 below, It was$hewn that there wA4 a high correlation between the 2- atie motion of the Vesee1 and both T,vomiting incidence and itllness. rating, Although a significant perwentage of passengers who

- U -YV .`lj*ýý'--"4-.

.+~ ...1..f

7.8

0.01

IV-I-II P YVY

lim I.) Ti..

tigut 6 Ar~elrat~c tim hisoriesfor 100secon per.od f t yawsaina n

Grfil8, Ac celeration s ti elatis tore fo a 1hi0-secorned periordinat Lnsystem) an

felt unweil did noat vomit# there was a high correlation between vomiting incidence andil n esas ratings across v~yages. It was found that the mean illness ratings increased withLi1me at assa and, of course, the niumber to have vomited also Increased as the voyagesp Logressed, Figure 'I shows how the relation heti.eer vomiting incidence and vertical motionand the relation bstw~en Illness rating and vertical motion changed s. the voyagesprogressed. It was shown that the effect of exposure time could be incorporated within ameasure of motion dolse given by the integral of the acceleration raised to a power ofaiher 2 or 4 with respect to time. A power of 4 eoquivalent to the vibration dose value,.'Ie British Standard 6841, l9871 Griffin, 1990) provided the highest correlation

coefficients (0.86 for vomiting and 0.88 for illness rating) but the advantage of thismeasure over the more easily calculated power of 2 (equivelent to r,m.a. acceleration) wasnot great I)cirrelation coefficients of 0.83 for vomiting and 0.86 for illness rating).

.1301 [ ]Ik Ihr 2kv, hnv ONv

10.5~ ~

0 0.5 1,0 0 0.5 1.0 0 0.5 0.1 0 0.3 1.0 0 063 1.

"WreIPercentage vomiting incidence and illness ratinq ab a funcOtion Of the M99hitUdie

of vertical motion for periods of 4# 1, 2# 3 and 9 hours au reported by Lawthe: andGriffin, 1996. (Data ohtained on a 400 tOMO,' P9 Mett paueenyer fejuyý each pointrepresents one voyage: spearmalk'S rank correlation coefficients also shownl

-2 1

"7.9

0.2. 1,0.O5xx Y0.o0 0.1 1, I'

iti • 0 ,10 0 , , 0, |100,10 0.4 0,.0,0 0" 0,4

0 00i0 0.6 1 0,11 0.4 0,0 O.1 0.0 0,02 ,4 0,1

Prequenoy HI)' PFrequency IWO) Frequenoy tHa.

0,0010 000"0~001 0 0- ,, ,,

Floll 0.0 Pitch .w Yaw0I000 0 0010- 0.00011

0..001

0,0000000l ~0.00000,oo0004 0,oo1 o,oooo:n

0'4 o0,1 0, 0.3 0,4 0,6 0.1 0,8 416 0,4 0,0 0,1 0, 0,8 0,4 0.

Prequency IHa) Prequency Iat1 PFequenoy (HW)

rigure I Averaged acceleration power spectral density functions for various voyaqes on

five posaenjor vassule as reported by Ltwthet and Griffin# 1980, (Vessel 1: 67 metreal

veoel 2: 99 metreso vessel 31 l09 metreol vessel 41 121 metresl vessel 51 ý30 metroe.

Accelerations apply to the centre of each vessel and are relative to ship-referenced co-

ordinate systems, Prequency resolution 0.01 Hz.]

0,30 80, 1,0x V0.00 00 8,

0,10 0.04 0l

S 0"0 1 0,0,o 0I 01 0,4 0, ! ,

0. o 0.4

0.3 0.4 0. 0 .0 O 10 all 0.4 0.6 01 tO 0,0 1 ,4 0 ,3 03 0 104 1Frequency tHI Frequency IHI) Prequenoy IHi

0,00- 0.000 0,00l .

Roll Pitoh Yew01004 0,.1001 6

0.,000 0.3001 0000468 0,00 0.000

oo oe,0.004.61,0015

11, 0,4 0,0s 60 111 0 ,0 0.4 0.1 .08 0,0 0 ,11 4 0. h 1.0

equronay, tHI) 'taequety (HN) FPrequeny INS)

ft.VAe I Averaged acoleration power spectral density functions for various voyage@ anhoverraeft and a hydrofoil as reported by 1Lawther end Griffin, 1906, tVessse) 71 hydrofoil(tC:AmllatiOnal Assets only) j vessel Si 56 metro hoverotraftt veesel It 37 motIto hoyvirrlft;Acceleuations apply to the dentre of each vqduel and ate relative to Goa*t-r+oarenaed o,,ordinate yeOtems. rreque•cy resolution, 0.01 Ho.]

: ]~

7. .. .. .... , . ,

40 U

4.4

CIOs . A 0 0. . . .0.4 I'*ll ta-mull~ ~ ~ ~ @@oo.to 4mrs -xsselrto M.rs

all 0oyge 04 five oftesip ,hc vre ro 7t 1.30 motto i.4 lengt an.5 o 125

to7-3 os. Fiur *@ sh~~ows sim ila avragd et asf ir thaeatwton hovrcrafm ad h

vtpe1 omit ing incidiences and illness ratings onsis aofnvioro the somagnidThde daf sugestia

20%ofio dersnvoiing,3hu voyhes onvforag difllnentshis ratingepor thid bypoawteei andu 1rifin

Aeln 'amla rih' etc.a~ uigDate from the hvessels awerepsornted fiy Lthe same reltioniIbetweengr Sil~srss the mantd fvriavertonane sp~etr after eaheaiao mo tion oadbtaind fromuweligh voag d in feighie i ofe behow ship wihv riedufcet 0 toe i 30porutane o hin egth n freqec ot. (in.to 700 tensI F igquren weighowng aimla aheprevioulypectred feasrtes tof hoverorn do nd itheahydrnofoilnd thet thydooldtere waonsihly obetair coreinalmo susn &Figure 10of t(ie. highorahrelhatin abetweer ofm2 (ivertca accelriaveraehedioverec 3a hours andl both the

auhr ocunta ohvomiting incidlences and illness ratings onsisoewh ao ere iodrl rel.ata ugetothae ovr athe hu prod vertical motionFgr o1 0.ow theis rel mio s. fo ill resuelt in alou

2% of peron Vomiting, in h.nc aveag illness riating for thi 4oue saou .

naeiween the magnitude of Veta oinad t~esotrte oinhdbe requicylwe;ightedprusinseightin a, soee beow) toul rduce the im1ortanoetof high reenymotidon.UsAingd) this a freqen m weihtin and Gh rifvioul def6ned mebue ofntods t

rather thn a powe of 2 (i~. rmas.) Hoevthth difrec wsh agai2 hamcaft andthauthodrs otilu thav it bota vomiingencywiden tead. ilEsch rating wepreset linearlyriaged, t

4

7-11

8'roin the questionnaire data obtained in the above studies, Lawther mnd ((riffin (1998.)report that, overall, 1.011 of passengers vomited at some time on their journey, 21.3% felt'lightly unwell', 4.3% felt 'quite ill' slid 4.11 felt 'absolutely dreadful'., Vomiting

incide nc* and illness ratings were greatest in females (a male to female ratio of 3 to 5)and there was a slight decrease in sensitivity with increasing age (mostly due to increasedsensitivity among thoem aged l eas than 15 years) , Vomiting incidencoe and illness ratings

*were greater in passengers with leasnt experience of ea& travel. Twice an many passengersvomited in the group taking onti-motion sickness drugs as in the group not taking drugsan effect attributed to a greater urne of drugs among peassengers who are more susceptibleto motion sickness, Consumption of alcohol during the voyages was associated with a lower

*incidence of vomiting and illness - possibly because those susceptible to sickness are lesslikely to drink when exposed to motion,

3.3 Milleat *9 position in vesselChinn at &1) (1953) observed that during drug trials on five crossings of the Atlantic

in transport ships, the sea sickness was least ftequent among those quartered amidships andi ncreased among those quartered to the fore and those quartered to the aft. Handford et.1 (1954) reported a si4milar finding, From the results of 15 areasings of the AtlanticOcean it was found that there was aickness in 17.pt of troops quartered midshi, 2 3.7%among those quartered form and 32.611 among those quartered aft (Anon,1956).

In their surveys of sea sickness onpassenger ferries, Lawthen and Griffin(1906, 1987, 19B8a,b) measured the vesselmotions so as to h.' able to calculate thedifferent motions experienced by differentgroups of passangeri. Figure 12illustrates how the acceleration powerspctra of motions on oils vessel varied

wIth longitudinal, lateral and verticalpos0ition within the vessel, Sincevertical motion warn shown to bs thedominant cause of sea aickness, thevariation front bow to stern is of greatestimportance.

In ships, the liae' vertical motion(and lowest incidence of motion sickness)lbWCAmybe axpcted amidships - unless thim 0s0location aworse for some other reason

sunh aso a move restricted visual field,On hoveroraft there in appreoiably moremotion at the front and more sicknes siey h-.be expected at Lhis location I(Lawth~r, andG rif fin, 1 9 e~b OIt-l

3.4 Effect of subject othavaoeuias~ticas3,431 Ofdene

Two studios at tesm have found femalesMakto be more susceptible to motion micknessthan males, and similar findings have beengepoted in laboratory wexperimentsa (seeriffin, 1991), Nieuwenhuijsen (1958)

reported that females were moresusqeptible than males (in the ratio 3s2),using data from one ship, Lawther andGriffin (1996) found a ratio of 513,Lowther and Griffin 11908b) showed thatthe effect occurred in all age groups over15 years and that It was not, due to the Yigure 12 Variation in the accelerationincreased use of anti-motion sicknes power spectra of translational motion as adrugs among females, Indeed, the effect f unction of position in a ship (from Griffin,was greater among passengers not taking 1990),drugs (a female to male ratio of 1807 to I1) than among drug takers (1.15 to 1) . Incontrast, Levy and Rapalpor~ (1988) report no difference between the melee and femalespartici Pat Ing in a drug trial aboard large sailing yachts.

3. 3. A"eChinn wt o4 (1952) observed that on a troop ship the incidence of vomiting declined

with increasing atge: when including those who received active drugs thero were 33.61 whovomited in the age range 17 to 20 years while 14.1% of those in the range 30 to 39 vomited,Chinn et dl '(15953) again observed that the incidence of sickness on transport shipsdecreased with increasing age between 17 and 39 years. Handford 3tsC(94 fun asimilar trend with 33% vomiting incidence among troops less than 20 years of age and 13,3%vomiting among those over 40 years of age. Using data from troops on 15 crossings of theAtlantic Ocean, 0 clear age effect has boen reported with 28.1% sick among thome aged 17to 19 years, 22.3% among those aged 20 to 24 ypi 16,1% among those aged 35 to 20 yeatsand 0.7% among those aged over 30 years (Anon, 1956), NistutenhuiJeen (195S) reported a ~non-linear decline in snusceptibility with increasing age. .

~ :~T.

7-12

Lawther and Gtiffin (1988b) found that both vomiting incidence and illness ratingsamong passengers below the age. of 15 years were about double those of older passengers.Above the age of 15 years there was a slight decline in illness ratings with increased agebut no change in vomiting incidence.

3.4, VosetJaJra funtion u.Minor (1896) reported that he had observed deaf mutes to be immune to sea sickness and

concluded that the problem was caused by "irritation of the semicircular canals". Hementioned some experimental results (involving rapid turning around) in support of theconclusion that a solution of cocaine.dropped into the ears was a moat valuable remedy forsea sickness. Among laboratory studies, Sjdberg (1931) reported that three deaf women Afailed to become sick when raised and lowered by a crane in a manner which caused othersto become sick.

Kennedy et al (1968) compared sickness in twenty control subjects and 10 labyrinthine-defective subjeots during a 28 hour voyage in a small vessel in very sever* ases. Whilethe labyrinthine defective subjects mainly experienced only drowsiness, 15 of the 20control subjects vomited and the other Live felt rather ill. The authors conclude that thepresence of vestibular function is necessary for sea sickness.

3.4.4 poatureWollaston (1809) offered a theory of Aea sickness based on the motion causing movement

of the blood and intestines, He referred to a friend who achieved ;eliof from sea sicknessby lying oh-the deck with his head towards the stem of the vessel. It was suggested thatwith pitch motion of the vessel when lying in this posture he was in a position equivalentto descending backwards in a swing and, unlike descending forward in a awing, there was notendency for the motion to force the blood towards the head, Irwin (1881) refers to "thewell-known fact that see-sickneas is least felt in the recumbsnt posture, with the hoad lowand the feet towards the stern" and offers an explanation based on the anatomy of thevestibular system and the intent of nature to provide for body equilibrium in a vertical,but not a horisontatl orientation. Brooks (1939) advocate. a prone postute with the headraised ver litle$ if at all, facing away from the sea.

Studies with more than 2100 soldiers on landing craft found that there was 25% to 42%prevalence of sickness when the men crouched for up to 3 hours but only 5 to 19% sicknesswhen they were allowed to stand, apart from the last ten mintute before reaching the beach(Tyle, 1946) . The increased sickness when crouched might be due to the differentorientation of the head or the reduction in external vision,

Several studies have reported that motion sickne.N increases when crew leave theirsleeping quarters (e.g. Handford et al 19531 Kanda at &l, 19771 Goto, 1981), Studies ofthe effects of head position and body orientation on sickness induced by the drugapomorphine, revealed that vomiting was far loes when subjects were supine (Iseacs, 1951).The benefit was shown to be due to the supine posture of the body and not from the changedorientation of the head,

3,4,5 Visual fieldLooking at the horiron is commoniy said to reduce the incidence of sea sickness, while

working below deck with no external v sul field will increase sickness, Studies at seahave not clearly separated the influence of the change in the visual field from the changesin the motion and the changes in body posture that occur with different locations, forexample, Tyler (1946) found that a crouching posture gave rise to increased motion sicknesson landing craft but was unsure of the extent to which the effect was due to the postureor the Inability of the soldiers to see over the gunwales,

The widely accepted benefit of a view of the horizon is largely based on the personaloxpetlenca of many sailors, Controlled studies have not been conducted to determine theprecise requirements for the visual field to be beneficial or how thin benefit could besimulated without an external view, The percentage of persona who benofit from 'viewing thehorizon' Is also unknown.

3,4,6 Ae•AvhLLesSome old accounts of sea sickness advocate the benefits of taking -tctivc oxer•cie aso

as too lesson the signs and symptoms of motion sickness (e.g, Savory, IVU10 Bronke, 1939).Among troops crossing the Atlantic Ocean the type of duty did not appear to affect theincidence of sickness (Anon, 1956).

5.4.7 Susesptibility to diffeent typeo of smotionKennedy and iraybiel (1962) ewposed 21 subjects to motion in a slow rotation room,

aerobatics in en airoraft and to heavy and calm seas in a 19 metro boat, They report acorrelation between findings in the slow rotation room and sickness in heavy seas. Kannedyat al (1968) also report a significant correlation between the speed with which controlsubjects succumbed to sickness at sea and their susceptibility to sickness in a slowrotation room,

3.4.1 Pladelse ofaohtIt is often suggested that the administration of an alleged remedy may be sufficient

to reduce the incidence oa severity of motion sickness. Tyler (1946) found that in Studieswith 563 soldiers in landing craft those liven i placebo drug auffemed from sickness to asimilar degree to those not provided with any medication, In contrast, during a studyusing waves generated in a tank, la8e. and NcCanoe (1859) found that there wassignificantly lss vomiting among men taking a placebo than among men taking no medication.

• " '~~~~~~~~~~~...... ."........ . ........ •.',. .•'-:....." ..... ' •..AN"11S. .. , . ... ,.•• •. . •A • L • .• : : • :. . • . ... .. ... *!, '• .. . . .

7-1L3

W~hen passenigers choose whothezt to take anti-motion sickness drugs there in greatersickness among those who take the drugs than among those who do not (Nieuwenhuij~sn, 1958;Llwthe and Griffin, 1986b)(, Passengers presumably take the drugs because they believethat they may reduce or eliminate sickness. The high incidence of sickness among drugtakers suggests that noither the active component of such drugs nor the placebo effect ofconsuming the drugs are sufficient to counteract the increased iusceptibility to motionsicknes among those who believe it is both necsessary and beneficial to take anti-motionsicknes, drugs.

3.4.0 NabituationVarious studies have shown that: the incidence of sickness declines after a period of

eXponure to motion and two or thrqe days is often quoted as the period required foraignificant habituation Inse Glaser and Hrey, 195kr-'Bruner, 1955# Glaser and McCance,19919 McCauley at al(, 19761 Kanda or *1, 1977; Goto and K(endal 19771 Attics at al, 1967).However, a previous exposure to the motions of ships does not guarantee immunity to seasickness, )'or example, a famous English Admirel, Horatio Nelson (1758 - 1805) wascontinuing to complain of sea sickness after a career in which he had spent more than 6300days at sea.

3.4.10 Other eftectsA trend towards greater sea sickness among heavier men was found in studies of troops

crossing the Atlantic (Anon, 1956),

Lowther and Griffin (1986) found that passengers who had rarely or never travelled tosabefore had a greater incidence of vomiting and greater illness ratings then those whotravlled more frequently,

4, ITANDMDI ]Pon A81388=0 111P NOTION WITK PRX81,T0 TO 113h UIONIE4.1 Intemnational Steandard 2131 Part 5 (104S)

This standard suggests the magnitudes of vertical motion in the frequency .ange 0,1to 0.63 No which will cause vomiting in seated or standing young fit males. The magnitude.are specified for expomures of 30 minutes, 2 hours and, tentatively, eight hours, Themagnitudes and durations &to in an inverse-square reletionship so that doubling themagnitude of the motion ie equivalent to a four-fold increase in the exposure duration.The dependence of motion sickness on motion frequency given in this standard is such thatsensitivity to scceleration is greatest between 0.1 end 0.315 Ha and then fells so that theacceleration magnitudes required to produce sickness at 0.63 No are 3.15 times greater thanthose required to produce sickness at 0.315 No and below (see rigure 14 below)., Thecontents of this etandard were formerly known as ISO 2631 Addendum 2 (1982),

4.2 *ziLs~h Etandard $641 (1987)This standard defines a frequency

weighting (W,) to be used for assessing ,oNrmaIlmed vomItIng (ft per rnr'r^me)vertical acceleration over the frequencyrange 0.1 to 0.5 HR. The weighting is + 4. glehmontasietsfo rmulated mathematically so that it can be +.incorporated within analogue or, digital WIaypoi 441 +filters - but a simplified, straight line W "1 8abesI5eNl BOSMapproximation is also defined. This has + +4maximum sensitivity (i~e. unity gain) in ther ange 0.125 to 0.2b HR where bensitivity is 1drpendent on acceleration, bletween 0.2! and +0.1 Hal sensitivity falls at 12 dfl/octave so +that response is dependent on thedisplacement associated with the motion. Theshape of the weighting was mainly influenced +by laboratory studies, its derivation henbeen detailed by Lawther and Grý,ffin (1967)end is compared with some laboratory data in 00.Figure 13. Other information is provided in Prequency (Hz)Griffin (1991). figure 12 'Normalised vomiting incidence'

for 2 h exposures & weighting W1 fromiSritish Standard 6641 also defines a 31ritish Standard 6641 11967) . (Data frommeans of predicting the incidence of sickness M~cCauley at al 19761 norumalised vomitingVdue to varying durations of s-axis vertical incidence - ( vomiting)/(rm.o',.

motion , A'motion sickness doese value', acceleration, ma IMSDV,. is definedi

motion sickness dose value, MatDV,

where0 a,ý. is the root -mean-squareo acceleration (in ma" after frequoncy weighting usingweighting W,) determined by linear integration over the period t (seconds)

The standard says that the percentage of unaeipted adults who will vomit is given byt

percentage who may vomit M /3t4DV.

Doubling the mhagnlitude of the motion, or a four-fold increase In exposure duration, willtherefore double the predicted incidence of vomiting. The standard states that the aboveIrelations are based on exposures lasting from about 20 minutes to six hours with a

7-41

prevalence of vomiting up to 70%. i'igure 14 AooeleratIon (mse- rmae,)shows the root-mean-squara acceleration 10required for 10%, 20% and 40% of persona tovomit due to 2 hour exposures to motions inthe frequency range 0.1 to 0.5 Ht. The peakdisplacements corresponding to these valuesare shown in Figure 15.

BS 6841

4.3 Obhem emRhed 40 %The data from various studies, and

common experience, suqgests that problems 1from motion sickness are greatest on 20 %smallest vessels. Pethybridge (1982)reported the results of a survey of motionsickness among crews of various Britibh 10ORoyal Navy vessels and determinedmathematical relationships between the ISO a1 Pt 3incidence of sickness and vessel aime. Forexample, with displacements of 200 tons, 101000 tons, 5000 tons, 10000 tons and 20000tons the predicted incidence of motion 0,1 ,sickness was 67%, 62%, 50%, 41% and 29% 0,01 011 1respectively, In this study, motionsicknoss incidence included any of the Freauenov (HzI

rijAre 14 Verticul acceleration expected tovaried symptomi of motion sickness and was cause 10%, 20% and 40% vomiting during 2 hnot restricted to vomiting. exposures from British Standard 6841 (1987).

Only two serieseof studies at sea have (10% vomiting incidence in 2 h according toresulted in suggested methods of assessin� ISO 2631 Pt 3 also shown, Figure fromship motion with respect to motion sickness. Grffin, 1990)The findings from the studies by Lawther andGriffin are embodied in the motion sickness uaplaeoment (/- metres)dose value procedure defined in British 10Standard 6041 (1987). The studies of Gotoet al led to a prediction method which is 40somewhat more complex buL has somesimilarities. Unlike other procedures, themethod allows for the percentage of sick 20%persons to fall during a voyage and formotion sickness to decrease on subsequentvoyages (see Section 3,2,4 above), 10

From the results of laboratory studiesof motion sickness caused by verticaloscillation, a series of formulae forpredicting motion sickness incidence (MSt)were proposed by O'Hanlon and McCauley(1974), McCauley and Xennedy (1916) andMcCauley at al (1970), The method appliesto motion in the frequency range 0.08 to0.13 Ha with maximum sensitivity to __ ,_ ..... _, _ ,_,__acceleration at about 0.16 Hm, Theassumption that Mal will vary with 0,01 0.1 1acceleration and with time in ogival form Frequency (HZ)6i0.T a cumulative normal distribution)resulted in mathematical operations somewhat FIfgure 15 Peak displacements of verticalmore complex than those required to sinusoidal oscillation required to producecalculate vomiting incidence using the 10%, 20% and 40% vomiting incidence duringmotion sickness dose value, Motion sickness 2 hour exposures according to Britishincidence (MSI), expressed as a percentage, taindard 6841 (1987). [Figure t•om Griffinis assumed to be the product of a term (1990)Hrepresenting the influence of motionmagnitude and frequency, PA, and a term expressing the effect nf motion duration, PI

Mal - 100 PA P,

The term PA is Lalculated from a term, %At quantifying the effect of magnitude and frequencyand a term leacribin4 the form of a cumulative normal distribution (in practice this maybe obtained from statistical tables), The effect of magnitude and frequency was determin-dfrom a curve describing the acceleration required to ptoduce vomiting at Variousfrequencies in 50% of persons during two hour exposures, The mathematical expression maybe written *as

rA 2. 13 logoa - 9.28,logjaf - 1.81)(JogLf) - I,8

Where a is the v.m.,s acceleration in gs f is the frequency in Ha, The term P, iscalculated similarly to give a value for ~s:

--- A

4 'A

Xr. 2log10t + 1,13 Z -2.90

where t is the exposure time in minutes.

Values of PA and P are obtained by consulting a table of the normal deviate z at the valuesof zh and sz respectively, For example, with a 60 mit. axposure to an acceleration of 2.1msa, rnm.s. (i.e. 0.21 g r.m.a,) vertical sinusaidal -. Gion at 0,25 Hi, za - 0,19 and z, -0.87 So ?, - 0,57 and P, - 0.81 giving a predicted motion sickness incidence of 46%,

Lawther and Griffin (1907) compared the extent to which predictions derived from theabove procedure foroalcoulating motion sicknesa incidence (M9) differed from the procedurefor calculating vomiting incidence from the motion sickness duse value (MSr)V,). It wasshown that the frequency weightings were similar and that tho dependence of vomiting onacceleration magnitude and duration were similar for magnitudes up to about 2.5 ma-, r,m,s,and durationa up to about 6 hours, It appeared that the differences betwean the methodswere not sufficient for the available data to identify either method as being appreciablymore accurate than the othei, The MS1 procedure has an advantage of not being capable ofpredicting a vomiting incidence greater then 100, although in practice this does notappear to be a significant problem with the motion sickness dose value procedure. Themotion sickness dose value procedure may fit the available data Ilightly better at lowincidence@ of sickness and allows the prediction of illness rating as well as vomitingincidence. Additionally, the motion sickness dose value is easier to calculate andprovides a convenient standardised method ot quantifying low frequency motion,

3. IV0NTZO O MOaTZON xzcmiuu

A wide variety of drugs, potiona and behaviours have been advocated for lessening theF.oblems of NaO sickness. Many recommenddtions appearing in the early scientificliteratuire appear to be based on personal experience or anecdote and are not supported bycontrolled studies. Today, many individuals going to sea still adopt procedures that havenot been proven effective by conventional scientific methods, Statistically significantbenefits to groups of travellers from the consumption (or avoidance) of certain foods anddrinks or the use of various commercial devices have yet to be proven.

Some behaviourial changes may help minimise the likelihood of sea sickness. Thosethat can be recommended with most confidence involve minimising exposure to low frequencyvertical motion, adopting a position where there is a distant external view, minimaisingmotion of the head and eyes, or adopting a recumbent posture, In general, learning thetrue nature of the complex vessel motion is likely to be beneficiali this may minimiseconflict between information from different sensory systems and harmonise the variousreflex responses to motion.

Many studies of the effectiveness of drugs in minimising motion sickness have beenconducted using lkboatory apparatus. Most laboratory studies have been conducted usingCorolis stimulation (see Oriffin, 1991), The sensory mechanisms involved in theproduction of motion sickness with this type of motion may not be the same as thoseinvolved in sea sickness. The studies reported here are restricted to investigationsconducted at sea.

Holling at al (1944). report an investigation of various drugs on minesweepers andtrawlers, Drugs containing atropine, hyoscyaminp, and hyosoine provided come protectionwith the grmatest protection coming from hyoscine (i e. hyoscine hydrobromide, also calledscopolamine hydrobromide) a 57% were protected with a 0.6 mg dose and 73% were protectedwith 1.2 mg, Hill and Guest (1945) found hyosoine was the most effective drug with about80% of soldiers in lending craft protected by a dose reported to be 10 mg, Tyler (1946)also found that hyoscine (alone or combitied with hyoscyamine, atropine, or barbiturdLur'afforded protection in landing craft.

From studies aboard troop ships crossing the Atlantic Ocean, Chinn et al (1950)concluded that hyoacine, diphenhydramine hydrochloride, dimenhydrinaie, trihexyphemidyl andohlorcyolisine were all effaotive in reducing sea sickness. Chinn et al (1952, 1953) founduseful protection with a variety of other active drugs on many further voyages, Handfordet ml (1954) reported a study conducted on a voyage acrost the Atlantic Ocean whichincluded a comparison of hyoscine, benadryl end postafene, While 50 mg of benadryl and 50mg of postafehe were effective, a dose of 1 mg of hyoscine provided no significantprotection from sea sickness, A later study (Anon, 1956) found some protection withhyosoine but the greatest benefit Was obtained with either 50 mg of meclisine, 50 mg ofcyclisine, or 25 mg of promethazins. On three trana-Atlan.io voyages, Trumbull at al(1960) again found significant benefits from t0 mg doses of both cyolisine and maliminat2.5 mg of pbehnglutamide and 7.5 mg of oinnarhaine also afforded some protection.

Glaser and Hervey (1951) report that 1 mg of hyoscine afforded p Leotion to 96%, 25mg of phenergan protected 61S, and 25 mg of benadryl protected 44% of men on small boatsfrom vomiting. Using artificial waves in a swimming pool, Glaser and Harvey (1952) foundthat 1 mg of hyosoine (and 0.6 mg hyoaoine with 15 mg promethasine) were more effectivethan 35 mg promethasine hydrochloride. A I mg dose of hyoscine given only five to tenminutes before the exposure to motion was offective, but less effective than whenadministered 75 minutes before the exposure, Glaser and HoMCance (1959) compared fout drugswith soldiers within tented rubber floats in a wave-tank. Again, I mg of hyoscine provided

S. . ...... . .-$Ks i ',• , *.i "' : .: i' ' •i .:• • ;: :• 5• . • :• , '. : ' . .. •"

the greatest protection from vomiting (81%). A 50 mg d~si of cycli 11ins hydrochloriderotected 50t whereas 25 mg of meclorine hydrochiloride and 8 mg of perphenazine waro nogetter than a placebo.

Aai"ýnq participan~ts in an oiean youth sailing club, Harcqreavea (1980) reported that'ssauickness' was experienced by 511 of a group provided with a placebo &no by 26% ol' thoseprovided with 15 mq of cinnarazi.ne. Traatrment consisted of two doses one or two hoursbefore the start of cruises and one dose *very six to eight homrs at sea, A similarprocedurs found that subject reports of drug effectiveness were similar for 15 mg ofcinnarazine and 0.3 mg of hyoscine (Hargreaves, 1982). A study or' life-raits at sea for24 hours found that both 0.3 Ing Of hyoscine and 0.3 Mg of hyoscine combined with 25 mgephodrine hydrochloride provided useful protectton from sea sickness (Tokola of dlp 1984).

Levy and R~apoport (91915) repiort benefits of hyoscin. when administered transdermallyat leaP't eight hours before sea travel, Athian at al (19811 found hat protection providedby transdermal hyoscine wee 74%, 13% and 391 over three days at sea on a 3000 ton vessel.A study of long term use of tranSd3rmal hyosoine at asea has also reported bentfiis (8hupakaf al, 19891.

The effectiveness of drugs depends on the conditions and the time of consumption.Most drugs aea said to be suitable for administration about half an hour before exposureto -notion, but cinhariuinie should be taken sbout 2 hourui before exposure. It i passiblethat while smem may have a protective atition others may be more effective therapeutically.

Many drugs have unwanted effects which very butween individuals and range from trivialdiscomfozt to serious Interference w!.th activities. The most common unwanted effecte aredry mouth, drowsiness and headache, The wanted and the unwanted effects of dvugs may havenon-linear dependencies on due., vary between indiv~dusls siud clapend on the consumption offood and drink. The time of adminiotxat ion and method of adminiatration (oral, transdermalor injection) may alai influence effectiveness. The preferred drug for a single do*e maynot be appropriate for continued administration over several day$.

S. DZUCUISZOU AND MCULUS110111

Laboratory studies have shown that a wide variety of motions can give rise to motionsickness, Sickness ccii be Induced bP translational oscillation (in the vertical, lateralor fore-end-aft directions), by rotation about a vertical axis, by continuous rotationabout an off-verticial axis, by rotational oscillation, by head movements when totatingabout a vertical axis, and by some other conditions - including motion of the visual scene(see Griffin, 1991).

It is generally concluded that the vertical motion on ships is primarily roapnnsiblefor sea sickness, This concluqion arises from evidence that vertical motion alone issufficient to cause the sickness while other motions alone arm generally Insufficient tocause sickness.

From data obtained during a range ofvoyages, Lawther and Griffin (1988a) foundhigh correlations between the magnitudes of *Alexanlder e el ci§(IN?motion in all six axes on vessels: when the * C&Iacaeiystt w 11116sea was rough the motion tended to increa~se Lothor and Oritfie I I55Iin all axes, Correlations between motion sosickness (vominting prevalence or illnessrating) And the magnitude of motion were high 11for all, axes, Lut the s-axis motion and thepitch motion gave the highest correlations.Using multiple regression analysis, afterincujuing the z-axis, the addition-of other .axes ir'tn the regression only marginallyimproved the overall regression coefticient,Lowther and Griffin (1981) showed a high **

cerepondence betweean motion sickness dataobtained at see and data obtained in the *laboratory by considering only vertical *..oscillation. figure 16 compares vomitingincidence as a function of mottin sicknessti tdose f(,r the Lswther and Oriffin sea studies,the laboratory data Obtained by Alexander at N )0 IN M5 MUaJ (1947) and, the laboratory data reported by DM5 lom15iMcCauley of, al (1076). This figure suggestsithat laboratory data and see data fail about Vfiune Ill Relation betweeti motionthe *assi regression line# with moat of the sickness doese value and vomiting incideelaboratory data giving high vomiting for laboratory sudies with verticalincidenoes and most sea data giving lower motion reported by Alexander et &1 (1947)vomaiting rates, and McCauley at al (19161 and seed studies

repnorted by Lowther and Griffin (1986).The vertical motions of vessels sare

partially caused by pitch motion, so sicknesswill reduce if the pitch motion is reduced, However, the magnitude of pitch motion isuuausJly very small (sometimes below the threshold of perowition of rotation) and there isZ"no evidence that the pitch motion experienced on shilps is sufficient to cause sickness

r'M

ft ,

7-17

horizontal axis, suIggest that roll and pitch motion can often b6 discounted as prime causesof sea ikea(s Grfi,19)

isuni magtocntibtues tof ysa moickne ashich aee es thevrialoin o the magitdecomot io.Whiesthe prviindo the l y-axiiaomponant vearisin pary froe vriolls benefiets*.0assiti th pothea stabiisy omonet croweverinshipges, the dombiinatfeuny of crgollthaccray o wapo amting, islwrtandrucn the domfinantyf*ue of pirratdch lanodicng)te h-aveno bonsown t equetl evein sifcthesbdse..i al sniiei, 1t

Whenusin sit woulrnd aotxollo thet magnitue ofel-axtis aring fromxros motionarAwofuldc cnrbu the pitch tod tihetall Alo, the human bod map y reAin uarghtwhleromtherorasnale ion o esnn thes lx(ie atralll tomponen dec) il tons qav grviaioa ~oefcomdponenproortiontal toathe sin afte urngle onsffpitcient toll Daapeentifted rol Lthorizanta

alessation thagntudes ofro rotaimotona acclhrwtrongincally metoss sickntss masonitudis nofknoswmtin whenhe earth-referenedor si-rrnced axes (a~give a) Theteincaonfthevariedbtwoeoiena mto n vessel@, an S -xeome laboratorysn epsr.l fofiental have een onuted

sugreate than when Iaxhoisota component, Howeer acclratio hies doiast afresult of rotaio

spolelying thexi motion) dirs lon.r thanwuugstta the measuredqunc o ptc valouesn fX-aiismotio). fuseqmotion. n i he bd ee smial estve i l hetranlatinal xed.it ofl vesse motionw tat yomatim acclreditod w~ith sfeoma power mof

causi cngrbt i-yt sickness. CokooinAlsod bye semasn thbowy oayremi quprrgh fwheamlethinvolveroalcombined rolling, ptchin landeyalncomponetdetion grwvint(881 Domsiotedcht. dmafohorizonsa woscillation ae nocurrently indufficintoietf the reglraigole a at undrizonalaceloeraticon arn frowm rotatiora acctelerat.o He atributmothen differenc t o ithesnomnotins inehe diff.'ree axes ccmhprfrecdae give ria tobetbydfertent moionsication somtemavriner blam forizna motione Howverm there labpeartor pelnt have been nocuissownducthatphas ol importaont abodut rnmains poj below that chyoangs to thuie freuecy thel mandoizotudloth irecltion of the moiony mayg Mecriarley resalpon7)ible fremanytclaimedevriationsiinnthproootiv nhatrhen oa homeimontlcmonsn Addiceertionalyic habituatio to mosution isrotaion-:bqifout ahsomea of i th ita may not dbe toiadequaen hab iituatintr aelnonee

motion~~i~wn rah. thanraio opcalncurrniprprtenoghemtin

Noel n-vheria motion~somgt lo. ThyotheIsd asugs thavinge a uiri effalect sof xhatisicnes y.is gretion uhang woulbefoexpect ade fr-om the nau.,of the icknes due torvertoningmeation aofe zaxis mthsioknes. u oteohrmtosaln. etyaalbedt

suggest thatmtisatisn not thessel amdtiondicate tomatimse credise wainly duea towverticolocilatsion, sickesu. poksredimotion* h icaimdence of vtmitinw andqillnesscanrbe made iinonlyvte acmagnitde aolnd, freuengy ofd yheaewing motion. erwnd the) durationof expsur "ary

Altos hou vertical motInonveaipnpear to the priegucausro swicnessf at yaceht inersaliklythb come factor hnav aowng bnflent orasevmen ' thouHeatiud thei diffrcnnt etnbe toathe"AIrreguarty understncrding of the imfvement ofVisyion, body poastue, heladinhp moemetseenhatituatin mayfassist thes rdcmtioe ofise t perceptbl amonfpferengtr moins whesom

maicknesblmfo iswidkely acoeetedrs, nthereappa oto huane bof noi studisee showing effotphasbeni exportndead in remkinsa psoluion tha seangsi~s to thefretuency# the magnitfdantimo dretion sions thrge mtho a e log istory rofseasicknwlot many hlavemed va omeon to thecronclusioentatur scientificotudy$ Ahud net beay astned hbtuatkion tmoinolul pr oblem.

Hoevr, thoeetn of the pir osmyblem adu the hinaeuthert habitant iontof a ttael ntionit harecived sugest that seitl .iusaeobelem meriting morte inesigtion. U~etfcsuywl

determnes the gextent toe whicd the eprebtem isrolul when understandicngess been tncreiased

motxon aoer,.. andthe icness, due to~, the other, .Suiso motion$ sickness Curntyaaialedtsuhes efethsuo icnsate ohi isnovteeas and iniaeta ea ickes s mqainlys bueto identical ,oscelltation. Useusnl pof xpeimnta o theicideonce of, vomtin 447 llescaemaei

Anonyoush (1ertic alumotion ofpar drugls tor primecauset ofaicnest aot s4#itknis aioaly

t httransport ships, thena ofAeducican oedial AsickeisAmiong 160,ner (8n, 755 ow6,

Sickness~~~~~~~~ is wiel accepted asanaualc.sleceo gig ov itl efr

ApplQca,''.Ih,* Bati~i:,E.IA, (1984). oZakeepirv i rivestigation oE the U.S. Gusrc~ard 2.70 ftmedium endurance. cutter Prear (rnkC '901) , Report 4T SRDC/SPD-1120-01 David TDaylor Naval

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†††††††††††††††††††††††††††††††††††

7.19

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~ ;y~ ,.4' -WAl

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Wallaston,W.H. (1009), The Ctoonian Lecture, Philosophical Transactions at the RoyalSoCiety, London, Part 1, 1-15,

.. . ... ....

9! -. ! Oj1 WA,

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DivlonVlualsatan!ntds E/ tudes Avanedos8IXANTAvioniquo

33166 &t bldad sid on Ses Coda. FIX

RNLMIJILisaluatlon st Is pridietlon do It suemaptibillti ditselon doe indivlidisa prisentastt uno eandblltdindlvldualie aux ulnteau pripontoat do multiplE mpOrtantS at, plua $6*4raloMISnmt l'dvaluatlon -do Isdiffloullta Codloael trouvoat lout oriin doma Isa rhiealatn doe personnels aux saviroanmontapattlmulahltk Wto-petboollquea du rindronw I"lo qualms naluslognlques primaent dont un intdrk panit~celr anMINe on Je4L rapd. do proesasus d'habituatlen, Is milieu adronoutique at spatial. 11 £eglt opondmk 11 dondistribution non-gausalwoa dolk ouswqtblbtit dana Is domains oomplaso at dlfluai qui requiert uno &=adopopulation, Ill epdclIol dot stimulus diulenobainti, Catl prudencle damn l'lnterpritation dua *tsutai obtonus, quells

waalrltlqusnratoatIs itdesiti d~un. grands liguour quo poit Is lsclhnique dvialuatlon emplcv'do.mothodololliqit pout toutee I lu tdom ttimtant do to aujet.

Outre Ildvaluation do Is saimaptibiblit individuolle,Treah pads. toohnlquo mitbodolooglqow. Awl 1'aimten" phloW- do Is oppaciti natasicgstiquo d'un.kabitusllsment utllisioal: len questlonnairsa I& rochorcaho do stimulation via I vil d'un. population aspoodo, coat i dirs Isowrdlationsm pqvho-phyeilogilquu lndirwtas ot lea twint pr~cditon do Il'naldenul dn m os ali oti maItuo un autreprovocateurs problimo. Plueloura dtudo o nt dgalemont Wt Maniaa dana

as dousine (1), appliqu6a on partloulier mux etimtulationaL'utilismtion dos questio~ntalrmanomnesmntquea prsaonto des renoont"o an navigation maritime, Cot asp"c no saraLimitations importanto. Lma corriatlons pqclto. coepodant pam diudid ol 1st mtsules l'dvalumtlon it Ispltysiologiques indiroctom mont rim at linirslsment pou pr~diction do Is suacoptirbilltd, Indivduslla soret snviugiaa.fiabio tsr Is plan do ka prdiciltion Individuollo.

Lak rovuol ultautive doll rdultats trio dWivora ebnus juaqo'kLas ipbeavat prwovoscatlue on labooatolro rosont k 11houra ptitont strait san sauun douts trim tongue at festldisusa.macuollo Is moillouro mithodo d'iyaluatlon do is Ausal, lapproche du problinis so vout Ale avant toutsuseptlbllitd it.v popont topendant Is probtinto do Is qIllthdtqus 01t didlactique, mu *laup do paraftre*amtt doss~ua~n omlpa Ml quo solul do I& rolatelaowot ticlduotre par rapplort I, Is mawa dosIlebit deal mitko" d'vealual do Is obv~irlE. A moki dot oeennlsaNo qul ot did mecumuld dan to domain. Lonmitivot stsb~otif habltuollonwn utilad (Ecislo Wallwise dlintoswrdatlott doe dennis. do Is Unttratuosntcfabimratton. -ou. d auto..stlmatton), din. offort mont pouw uno pant Importants Idea aim diffdrono dama lodiplo'jde pour dWsr doe permitru phllalologllqual conditiona upduMentoloa ompliepio, omsaasol redantON~e llwatlv m isltourable. putbimla I oontparaslons trio diftflodlw Dama usto tovu

A rdooAfto (9), Xilnn*y alai attaohi i rsisdro Ioe apparonts.Cal toat clondulsent ginirelmant I usto pr~diction onitsettona qul pouaveont mister. airs divorsa hudosconaota do Is suacaptilbiltit on situation rdoila. LA irk propoust unol pprow olofnddsoustr Panalyeo atatitliqus.pr~dition du stat do. fl'eplaso onaitmso copondant uns

asphl t a s f tto rit 0 polls det problbms. Mowo mel L'omplol do tahWtquma slatistiquoto roprtsent un dtdmentrdusou auourdhul. tout A felt tondamantal quant k la valiWt dot sndhodea do

prddlsilosl a dos tkatii dtdt'dalualdo Is ausecaptib~d vimAAJW2GDU~~~N W va doe "ndow (29, 9). Ils. donourat sopondelnt pour

uWO P0111idspart d domoa doeN.' dmleoa poWn doDepsald Is so"ed soeflt nadial. in lumoeptibillt aux vinedo .plqisldoglctour-uol pneoaro0alsitwa a ambit tie omuboum tronavacs, dona nt &om mo paagmatlquo oppurall don ptdlirab. Coad cohit itluttdramre UMtritnANt ahodint, aomapoftantparfol dot assiaew en premier lieu I"s dflfotdsntafE~ets quArdAulat ratolvo nsoo eoniadeuiro CMs eappliquo tou conttlpan ama, diffloultia ""t ooatd on 1at111"

posloullmat um psaa Evelaii a dopridlemimf d'dt laftl it do piddi it.m Lam diffdronau m1010d6" atdo Is smsqalbillt Wnioaola. 11 oat on loft klen smen setnlqutos mpldomloamoaot insults peep.n on fslue, doquo do ir la"p varlatioa senk renontrdo den %inl ~ago A efotuor an. Pmtha Slobals Mtu"tti do quAlque

min 1 A sE .a vbIia do ilmloWtlona peovooiard utosnpaPeathlyso

Is WBWM". WM -du- *mm #Mo 'WON*op~. oIpuAft*om O Au OWNP twtqum ot Ittus~ fooaatreatWOAffo -Pft 30f kon Jhv*tMW osm Inft d$ 1smt As

2. Li IONPEEU li P~h~hOKpopulation do pilotos ot lour sonsibiliti iv mal desaimulaetuua.

Si queliqus standese igns pouvent Wet dilgka quint &usfactours 16ndriux irtfluant surIs ouScoptlbililt aux vintlosa, 11 poumi~ft done uidater ds dlimento do sovaeptibilhtiI'dvaluoation del Is uscaptibifiti d'un individu on partismUelr prlfdrentilell via it vIS d' ou do pluau tpo doprisente pluodoura diffotitli. stimulation, On pout faire 11"hkpile que so typo do

Ascaupfibilltd Indlvduelle pourrait Otto 114 soxEs evivan I* modble prkent6 par Denson (I ), qualiquos corasudriatiques do fonotionnoment des daptfurt (toutpoints intirestants peuvon Otto notmono Clogt tout dlebord perticulliomont dos tranadustours vutlbuiairoa) ou soxto problime do Is spdsilsti do&s atimulations provouatrises, modalitla dintiltatlon multissruoriehll do a irmationablon sonnu pout so qui concern* lidaptotion, male qui pout dloadentaiton epatimlo. Quol qutIl on soit, *I*#tli' Is "versont41ularnent Joust au nlvuu do Is ouesepltiblliti indiciduello. neurosoenoriloi du syndrome do cldtost. qui sorahCeog sued Ia miss en Jou gnkatontet trko rpide do di*Rosoot on cause.prososea d'idapstlatin d- bien quo touts tentstived'Ovaluiton dolIs iusaeptibilMt I on instant dennd dolt hor Un mults, amap do Is sustliptibillig Individuel sotpondiode en tentant campts do so fastout., Enfinl, 11 no Naut mmdonfosent 116 A l'.pd~ona pulialabllo d~un indiviR.

Aoeoubger quo Is epsironto do urintoe saeprimne per Is donn au moment ob Ion eoshert It 6Wiuer am talkingl.mkso an Joe du Wfsyoit nervous utonomo at quo too A"s AI a pu Atto oboorvl onosodatiquoment que deecaroatklstiquos intrinsiques do fonatlonnomant do to porsonnels issue do Is marine, babiltuilment rweaftnta au

funtdm vent gOidment sawer une Mialun o ur I& mat do met, r6~laient uns osnalbiliti uoeladement plussumcptibilltd. Co sont ftlaniemot I.o dams vereinta du iovne viai & via de atimulation du t0p ooollrtstons dosyndrome, nemrosenorioio ot nourvdgdtaif, qul dolvont Coriolis quumn population do pilot.s do chaiseAtto cona~idk pour dvalsoor mu miova Is susoeptibilild d'un L'Iibiltuitlon, prialoblomont esquiso pout us -typo. dolndil~du at Otistusahtoitot tenter de prdir eont stimulation (aesloritatons vortisalsa), note o twaaiom pas amsomportomost dana Is situation rhollsob AiI dolt dvoluor, pov dana Ia nouvolie uituationt ahoiesi pour #aMest Itt

poutleson 26),mciso uajit gobeomet ~suseptbiIti do Is population. 11 ont done olair quoPou Rom (6),oW s tsdut loboomet a toes I'Intorpratation do "flmiat& d'Ovaluation, quille quo solt Is

t'aisplabllI114 do rhoeptiviti at do capoot& do Mdention. mithodo utillsko inrfalt prondtre en oompts, oil eagitDune mentors plus ginirale, on pout sanoidker quo Is d~uso idlostion, am Oventuolloa difrdrosces lias kdistuibustion non-puseealwo do Isnsuaspiblltd dlassI in lespkirnce dee candidate,population corrspond mants doute k Is combinatison desverhblim qui peuventMowflunr d.iifdrents niveux our Is . da nm a faamadhhtalmmnulbMl6hltlInviduoll

L'liibituation mux atimtulations provoailoes sat un pointCoo diffirents points vont done Atto maintonant ibordds oontual dui probtime dus cindtoso Laopparltion do soeusosiolvomonet do tapsr plus d~taili pout tuntor do mieva qdtiomo oat pour cortains un offot smendaire do Is W"ie

farcomprondro lee diMultis hoe; it i'vaiuation at It Is, on jeu do Is ploavidtt nervouse raquise pour maltspridioltlon habituation (9125). L'hbtmatilado *lultant do Psl'moultlon

l'ornitvltruorivet ou auxoatimilatlowncdo liboratohr evavent2.1 ldml~tttd lm aitmatnaplus am moins rapliomot mien lea indivdus, Resont

dhstalo k iso nlveiu dos "adaptours" rpidesa isti ots (26),On admat oaasmqumamnt (32, 27)quo Il 0osuos -tro sMains sosnblont no Jinamls atteindes mat nivou istishlaintauscoptibles aux "s"atto es nt sonaiblos it lenuemble des (11). La plupart do& techniqums dvaluation utilmnt dostlimulations niaustoginiquus qul pouvat lout Atto strmulations provAstricsm candudeent dons I Ilapporition

appliqudo, cslloobul entretaant, d'une manure plus ou dlung asoutumance k osa stimulations, AMns faut-il Attomains lIdntique, llappathtoA do& qmptdma bien soneclentt du falt qoumno dpouv voegibulainr ielio no

sasdiiumdos "oinsoo. Codt rprdamtte is base do& donnte quinnk clish6 "Instantand" do lit svseeptibilitS d'untoehtiqm dOvsuatonuihlent eodrouoopoveatrses lnMdk vis I vie dune stimulation donnis,

Caltls A&le st. pus Wloaismen. vhtiide notmalntent pour jn d ab du lm m ngu lIs. iussoplbhhoau anal dol'paos (21), Do Mle, Mos#I Cot. (23) dOt toppWid qm'am doll P4M~t dot It L'Imphisoton du eoisoll nere aN utenome danas Isstmaihihtti sad intmrutdlirs ou 101be on pouvi abeouss qundome do sinktos o#et.un Aldeneto mteens do lenauedos diessca~tio oafts diffunts stimulatwIon, a do AA, M7 evs Une dofniante trk o stto do Vsel"4tpar*t*Nf Ieuion 4OikMe Wniut" *%WiuetNWo (pMUnMo Paoraapatillque am MRtt it d"60Opaeenh isulWetlands) ofa " "io nuIt par din atlmulatleou qmptloa. Alsl II ost posbles do penis.r quo toov§OebusRWM (Cotlode, retats aUtou dm" M oeas"Ahelquo WInaiqus &do W qotlew n omfvgtaihorlsoftlAI, Pius indhrOt ln, LogWof Utlnder (Mi no dos asdillmatoaardpopiatA sidtobe ntsrMWW4en Is" do o haml~if Mintro Is st00401b114t uM powtvut sfoWe- Is_ ouu"htiOMlt -fiiitil U(b* .Mdeinbao &Wsud au mopn Ama quesostleana dents use sutetr bowvidtiqu, pour lou pow "UM) Inisn kti Si1.

'o4 IM

nioauiltd d'uno Itha Apanda stabiliti "Yeolbul vdigittmilva" Mo dirlvi. (9) divalloppill Aux Stmte.Unle at It "MotionpotIt odisasmonautoo. sickness Quustionnaire' rihtanntflqus da Ration (MSb).

La tablilti aroulva du q*atlm* narvalu autonomas to son L& piuport doo autsurs (%, 9, A2 27,) eoceadant k*ao.itabiltt" somebla done pouvoir conaltllur ian bon consldirar quo In. divers. ilidso ompdtlnlntael maniaoeandldat @0mme Aliment doa mull %wguant dons Is Modbla dapuls ise travaux hlatottquu do Almandar at Cafl.(194S)do Dnown. La pranda variabliti dana to tampa dia tonus at do 311mm (1949) dimontront Ia valdldti dosnasurovigoif alms oft in ndivdu doann oftm alna une questionnaires, Daesi bonn.s oarriationa ant SinW pucui~altion ph~eoel~quo simplo -aim Variationa do Is W@a obtanusta vee des iprouvo. do labartaltulr male auulsuseaptlblll abwpvioa pout ian mime indivdu (1, 9, 21, avac I* mal do Ilair atIs mel do mau, plus idoomment, an27). Cadi past bion iar ian probbimo dani llvmlumtiont do utillsant oan questionnaire apillquo, avac Is mal do$susceptlbilllti prinelpulormont avo Ilutillutilon dliprouvee simulatours (8). Sion quo plus 1o0b6 male statlatiquamantpravobataloe. slgnficastvo, Unan eorarlllon e igalamont Iti rapparti# Aved

Is suela an Wcel do plilatac (7)

Pluslaun points Impartanta miritant d'khas sauligni A,ILea blon oannia quoalm distribution do Ia susospl~bIt0 atn prapas des questionnalrot.elniteom dano Ia population linirals no suit pus una lonormala, Quells quo suit Is mithada di~valation, an Lhlstoirs do mel des transporta rapportia Pat man sujet doltobserve jiniralaniont do. distribution tenesment toujouro itt. pondkis par rapport A Imepimlanca doeaeqamittlquat, partals multimodelles, male en usuon cas situutione provocataleo. Cod oat trio bin pris on compta

faa~nu par Is N30 qul attaelua una pandiratlon on fanotion, doPlt'ntanlti dim O~mptlima rapportis at do Is Nrqooenco

On paut pensor quo Ia comblnalaon dos dlffrante 01imanto d'sspWtolin I Is situation qui I@$ a dkulonobia. Coegnititutlls do I4s uscptlbililtl Individualla sont A lorilna qusatlonnmirs comporto igloatmnt Unn.station qui $platsdo go type do distribution, Cella approali corrospond l'hlatolr do mob des transport& avant Polas, do 12 ans.d~aWom uss ace. Wn It lidia quo Poan pout an waoit an,ut~iant Ite nations do nleaptivilti at dladaptablllti Los questionnaires mont habltuallornent trise torus It utillserpricansiom par Roosn (26), qithitlaeiu plus rieommenl mints avoc une population tile Iimpananto. Lout coOt estpar enarmn, (1). maddri souls bian out Is plan financier quo star colul dma

tamps eansoeri It lacqaslelton des donnlea at k louwQuail# quona molt Ilouigina, I& distribution anotiqua do I& trsitamont,eumoptiblll dane Ia population conetltaao ans WWfemtI&supplimentalre an matlito divalluatlon. Duen s m E n favendia, Ilie cmportont do. Inconvniants Inbiuanta kcondltions, i ls noeen offst pas poseible d'utillsat Ito Ia mitltoda sasninasiqia.. Alnall, eaton I@ dWOg dotechniques rolstivomant elimplo. dlanalys stlistlatqu motivatian d a endidat at Is canlasta, on pout fullamonlcomma ronlygo do veriants at Jos eddmatouws soul aboultf It una souisestLmatimn (condidat triO moasti) eta onesamanadee quo It mayeNn at liata.In r~go surorastimlon (sujit pata moilvi) do Is suuWptbhI# n~al.skinilso, II ftug tocolarr k do. toohluques nion Quoday (7) noto quo I'assaclotion, amo do. dprotavos doparamidtrquus utllllant I# dslasamant par rang des variables laboraolok condultithabitualolamnt I doe *ioltal plusota h i'snollaa mul~lfactorlollo, tiallakso quo teisque is quaatlonnalra as utlu leolimant

an dibut doadslaction,

On cnalius inislamnt 7,9,21,27) uo . mihod a ni htm o Inconvintanl rancantris Is pouvoir disoamlnantOn orr~clts ii amot (, 9 21 2) qo I mihods, do. 4uoslonnalres eanstitus ian problims majoutar It sit an

d'ivaluatlon do Ia suscaptibllliti lndvdcueba is riparilasani afta roconnia (M7 quo lto quadostaalre donnant dosan roile $Mop. pfiiinsipull questionnaires anamnostiques, aisuttata oplthalow~ pour teo sum"6111tlbilltle mens,cOWiletlon Pq~o~loglqoo ama phsIoiogquos ipratvo. suscptlibto ama ewmpil. male sent do pama d'malffidptovocostrlo Chop.o typ do. mifthda puiaaloot do. pout abassoItseadl Wa~t pnt manit umoptbili~t ilwtmkidlsalovamago. at do. Inoonviniante qu'Ul corriant donayma anfonstmIado I'appllostlon, quo Ilon vaut an falsoa -

Dascm nomb~rousso. marble. pqfcht4*~uo amaplyIolglUasiurili amo It minoopebillt6aa Ind dos

Los laeq nuee iralo oa'tlrosaakeI'Mooe otollrdosmaldao ooao t aotidia~rliss (01 St.7,). 1 evol IIIdotransports viaas par us Winlvidma din d'"asua eam do varloblaa qul ent od cas alo . Is, Wee iaptlvl ("Mal;sp"i",. em Wepaltiti vie & via dUn stivro~anannt oant nowaareamorseee au to 'wswsl# (wisest mnwutomdiat,

ithgntnpayidanado mutllp~la Ofta~SUNAIWnASIM tidmlvan nt dit divolwkApp ON oft oh. L" Par, doniatienI, ii6vatmat"o 14 t mauom dIs W va 4 no#u. hiqurm"Mw oW~k I 1'ou actuallea slm,. ham e do ig rMN at pastramis an cotaves m P~ev i glwaftuifto 10flioubmalk o MOW mnoe Quoc~tit'nau t (MUO) eta Coal INe dirlsnola darts dos atMlio ptipclaglqo" portal

r k.

utilladi pour Juger do Is Adviolrid du malaiue pravcqu per inltdreasst, Ison qv'll no roprhoens URIn douto qu'un aspectdoe stimulation as noudoglquos. Leat lnadit on matike do du problimo do Is svumptlbI1116 individvoill.prddifitan, pourralt Otre trio pond dana Is manure ob,Gmnus la quagtonnaltos, sIda pridootot une Maneb 3,2122 varlobles nourossonsaulleslhi.dpeondono pot rapport lux adimulatians prisvaaitrlaus.La isonfestone sisithsmt fohibls inaitont oopondian k Los vobble nourooonaoriellu qul ant OtO propaledutootr trig prudent, as qut on linkalumont W am. on comma Indies. do susooptlbllht pouvent ltto Glaum" onrallike do adlowtion. nAi* pour as qui nsonomo )a doux WtguSWa asian qulsilea caommeont INauwompUM~ fast lndividu doAandoil no oontaltuint fonaitonnimena. du labyrinths am quv'loslb tauchimt ivSkiretment qulano Lodbutlon. adage do IWormiatian waeorioll at k IN, plotloA tdu

Li premilbre utigarie A ovuaM do nombtovom triviue asIUP scat aurtaut niontloand ei s pout mdmolro oa, of osrainoment autmnt do oontrovoesao Vl'aomple Is plus00"e omblont ketopadols algnflootives don Is cadre drunts dauquo oat Is oupologrenuns do uonsition, qui musoniatPOPu1114ltion OW10 A oaxdlSlA VI o ten o.nt tris lo11n ddklr meount Is durdo do aenaistlons Paul.trotatolrs *n udisoime &ibsolvos. do. stimulstIons Impublslanolil, Moet quo Mairone outeurs

commo Do Wit ot VIA Bilmond ant trovvd var corrilationDos rellations ave ]a suacoptibl~lti sun ulndtaow on: Wagn elgnitatlve intro IN pent. du oipuiopamnn a Ilkpa Otto syvende pour do& trolto do psorsnnalltd, comma suwsoptblbiti, su ma1 do mor, Dobt. travaillant out ung

1'utrvonanlntavrslnI" londoneus niarotiquos, Is population do 1000 #Wke& piloto nlan etouvo suumne pour ospour it i'aniddtd. Dos vorliblu oompoanomsntalls oanai IN qui canoomo Is mall do l'al (27). Cm idoultots. MOMit nttnotion do Adipnsnooinhaddpertdmn du champ on A#O ultdrbeuromsnt oonfltmdo per lie (2) dams uno itudoOplomemnt talt laobjt Vun certain nombro d~twidee, avoo out Is mul do met ohroniqvo.dos idwittst portals noo oanradilcttoo~t

11 Wad it. oIM dos relations eatt oe hIlvl lson# aonorlolloa3.21 variables phiyeolologquos on rdponi k dos stimulations vostlbul"le at Itsa indlowe

qui alant Jamhs 4t4 porfoltemont acaluldu En trovolilinttLa vairlobla phy~~i~olqooa ow imycha-phystatagtqvu out Ie perceptions Wlusabross ov dipert it h Paiti d~unoipporaluonwt un pov plus lntdreoamatu it ant btal I'objet oonrhftiuaoo (1), II a pv Stto mis en dvideono quod'dtudso rdeaont. Levi Inetrk pratlqus damns inpricdlation I'amplituds des illusions sensorilolss porgy. par vn poupodoeIN suloeptlbllled at molgr fout relamotomnt limiti $I Ile do wo uses vbptiblue italt oanlpt tlvemont plus Important@rdeultats los plys ricents midritent monore d'Stro villdda iar quo pour dow nori-woospithlbl. Le ibtlbe aombro do sojetivart plus ponds dolts. Biles pavenst Is *Aslar on dane ohaqus goup. no permst eapondont peas do conolurovariables nevrovdgdetatlv of neuraoeneouelles, oursa laplotres

31.2.21 variblabs nourovdgeollve Pour Roean (27), II opperoft pov "damon quo des momaursdoi Is oensbllt6 veelbulaire ov in$= do I'lusbltuobillt6 do J

Uns trio bonn. rovuedoodetudos onalehesute our lIn vaelablas Is fonotion puisan fournir dos indfoe flables do isp~eololoiqus asoodier amo 1& ouoseptlbIN ave daidsouso ouasoptlislild, suo elntoem,jso. prdeontdondes l'ouroe do Reason (27). Catd de INaphlek MKOrdoWao&llr quo Its tIsltato los plus nombreUN Doi rdvltoto .pddrmeintawet riuantsoabtonva par Diamondant did oavnada. Liddo quvuns ousesptlibllti Movsk sit at Markham (4, 10) reloncont opondoint Callefriquemmnot masodde Ao one tendon.s & Is brodye"Sl at & probldmotlque on montrant van roliotln trko slpiflcetlvef"W'peonsion at rolaulvmmont tdpaindue (9, blast quo antroIs to uesptbilt$ au Mal do J'espails it Voqnuidsrl do Islaiupm swontroverah.o Do msake, Lepoy (16) roeirouve NMoAhm otolililsque. 1i taut remsrqvor quols sIva bdtquoovWve@ pond.Sil Iltiquono, vallotosdeb at ipsamofitshlo lchas utllisnt depus do nombreuses guno eanun paddlaur

4to dm, 9e10 p iots dusu powr mnid do t'aslt addri' smn do IN 101*v ifotslhe I'Aqimdtd. doleIiiponsom otollltque, loseiportar rdeUomnw do donndu oHotfailiqus L'n do dldptouvee sur IN bshaatgors powalh& (81 20),I

prnlUtprobtimes dens' "a ltp idtudo am blen sO,.1 ý IPabee~dosa psup tinein. ** In oomplimoal do oee l fdloos lids dklaeetesno au

fonotlonsiomant Yoftaiburs, Reasn (2U, 27) a tonti doLes 6uds plus rfsontes moins par Ma~ (11) our dog ddveopper dos smeuto 14todloie quit soon lietbire hormonaeum (ACfl(, CRF, ..,) indliquiste quo Wee rkd nleoaet Is r~oesIlvitt do oseqjua vie & VIA dom o~iallaue40 I~W asilopdelrbt pour aso vaiaboles wnsedsLo 11 ainai pis meetrop oat *lom dos neorfilitoamroandoosiomdoes aeadso Me at de oaqmo tedwplua agleul offius to suseplbl" # su dotteso

Impotant. soam-aemisklosu quo len amoat useapuitte. dtneoopat oin questonnebo, I& peltonoddlas 00 plrsTovetobe on veleurs roearsbt k J'liadsleu dom vanou afte oMW (&AQ It- In Iou pqswliluda 7

,;Woonaias tles. on dithnIque I"v rdesu dune Volinatt fiatoteadk ORe se 4 Aft Aiisag IO I(llrpp

- ~ " dgehdes o Usitltu pouwelt No *AWde ýtdUita~lt~stnaleU~eoitatuo It diwtostitldon 4h dapaeloe,

I. A" - i-M"

Uuno ditrholt global., utillsable pour l11auation at la otoUthiquus addquetu, Ce typ d'dpreuve figure dan asspridisalon, Asiton delis huscptibilltOl d'un individu viiiA viz teats do eIlestlon do# pilot"s at des coomonautma soviftiqusado& dr108.. @A gOndal, do main da Is catilgorle do risque (10). Pius Muermmant, Money at Omeh (22) ant lonts (evesdons isquells ha isiAtus, peu do weak) dlutil~ser un aoillkatetur hotisontal (sled).

mialament Is mouilsiur iOprouv do stimulation otolithiqusconsit sans douteoen one rotation &t vitesu constantsT

A c0 jour, on dipit do Ilintiltil prAont par lea mithodes outout d~un ane inclni par rapport &t In veriasie tertatte.tindirtese qui viennent d'Otre 6vaquies, lot ipreuvec Do nombraumsa iquipesA se tnt mintwirauds sox effet dopiovoaatrioee, dont Is but eso da Waie apparaltre In Otte stimulation qui solliaite In foriotion otolithlque pat isrimpt~mes eawrmtirltiques de& cindtoaa oonalthunt blisi do as rboriontation constants du Ye~eu grarvitilofncore Vesaentila d~une dimardhe d'ivaluation do Is relativemont aux maculn utriculairos at macculalre. 1I #,not

usuceptibilliti Ai d'une Apreuvo tirkprioeatfloa dont Is mini on cOUYNLeas ovums do Is llttlrature (21, 27) montroat quo do irk5 dmuorlsvmn ipenombroux maou osant ditd min en oguweo pour provoquer Plusleura veors oncodiflir do on test existent comma Isleppiurltion do syndrome do cinkose, auusi bio. on wflted Axis Rotation Tomt" (TART) utibiui I Pensacol octisborawuirs quo nor hi terrain, So fait qualques tecnitques ts "0ON Vertical Rotation testl winltlement Congo Weprinpsiple largammnt utiliels pour i'ivaluaaion, do Is Oraybisl at Miller at encore utUM si ous one forine modhifisusceptibiliti, peuvent Mrs, Identiflues at seront dilcriesa lei. (OYR) par is NASA (28). Dons lea deux one Ilane doQuUeRS quo salemi lIN stimulations mpicyise plusiours rotation eat incline do 25 a W0 ail mudimui awee desprobilmoes me posont it ileapidmontatour, Atoma do rotaion qut no dipassnt peas 100 */a pout W0

TART-at-pauvant attolndre 2O40 /0 pour l'OYR. NotonsClst tout d'ahord Is problimo do llintensitil at do Is duneo enfin quo lea rotations sutour dates puraiment ltotiaontauxdos stimulationts, Ia protoeole choisi devant. art (PAM) ant fgaloment 64O utfilitie avasunek dan desdiscnimiAnt at *Aiter 'loft pianelohr at l~effe pisfond, Ce itudea d~valuatlon do Is auscoptibliltil (12, 22),Bont asload In ithres uthlsi pour arritar l'1prouve, pourjuger do Is "krti du malaise proaull at pout quantifler 3312 AkolciliratiorutangulairesIs suseptibiliil iAn It via do Is stimulation amploidk

Llufitilston des acuilikatons angulairo m 0situo one33J.1 Techniques at protosooem do stlimulation mithodo do cholx pout ptovaquar rapidomant Is syndrome

do droionit. HU e asrequiero giniralamont qu'on AimplLents (17, 18) a effectud one revue comparative diltailies laotaull tournant at qui en fait one teechnique t*tdes " Yeuvs do laboostolre lei plus usldisiac pour Ovaue Is 6wanomniquo sour Is plan do& installations. LA fmutoullmuecaptibllltil. Elles ant pouw prinuipo commun do glnire taumaint a maintenant preaque lotalontant tempissi Insdes situations o0 so ptodoisent des confilts snsoriles qui matme gdnirsturs daecollirstions angulsiree, coming INaboutines bosucoup plus rapidament au oynd=r6n do balsnghrean argament utillisies dans In travaw hlstoriques,cinlahos que lea situations tklWa do terrain. En. tilisant an perciculier su Canada.unes dichotomla simple, on pout ilgmioiont diewo weOpneovos solon Is type do stimulation do mouvemonit diliur Plosloura technqoue diffilrentos peu~uv fientO d~init engu Noj1t1 pfinaipelosnont acoillkations llndaius loaction dos pratoolea utit".dossetllratioh nuplaire at Interactions visuowveobulairs.Lea mithodes utilusnt lea situations do terrain ala lea LA *iptiton darris raplides do In rotation apr05 une phasestimrulations mont habituellement beaucoup, plus it vitsem constnts eat connate do longue daue pour GOdifflailement contr~lables no woont pas Oouies lei. aI"t pravouatatas. Cett technique eat identiliooemme Io

"auddon~oop test", Ed*e cnlatai mattto Is aujol en reotion3.3-1.1 Actldrations Maimie 11 300 4/1 pendant 30 sesondes patia &t laa*warn 1,5

isaegond AprO. 50 meoacds dNOrW, Is n$n are dir eaCmA dprauvo& vont esontiallsment stimuler leIn oper rk~o i pdtlo 20 fobe In you too"i pub 20 foi den uk aen lea

yer oUver a iventuellement 20 lol don Ilauts a metjulqulk vo quo I$ $weot wtegoo un WOtNr do malais dilWn

Lasaloratsur vertca a 616 tirk larlancent utUd en A l'mvAan.partimalber pout hi preldiction do mal do met. Cotuplte lnadat domelAc do lriq_4ewe relalivartnla bee des stimulations La Spreuosm0 utlionl 'et deu weilildretits do CorilolhOffiftes (0,1 0,4 t4o) at do nlyean d'aeolliat~i onequin, wu Wa q91immo Vatibtalalre moat sne daut teo pius

Ao tye1 do rtImoition eadgo one panda amplitude do ripande en mutike d'Ovaloelaleo do Is suseeptlitmowveannt dones un &Wpreilag IoWr at oaoobrmul dont Forwn isamen sl~nt eos 4"moe reposet our V'sastwiepeat do lboaaoir peWAM dispse do mnoceigvncats Wilk oam pwibsi do Itip Wk Oudat u teq

rolt~et vtess owstint be nomrabun proto~olm amUle eltoostWv eto osatllis par l'oWmatlo duno s&nM 6WO atiasbolak oW psrail"inqu permot 44 dlivv doe sftimlaio

~ ~E41

U" Al V .i

L4 "Biefl vaftiul disorientation tost' (BVtM1' oat tan@ Le Viagal.Vmstlbular Interaction Tool" (VVrr) constituedproiave eafta ~momn rdpanidue. Apr10 30 osondes do un example d'Cproovs utlllsnt In interactions Woso.rotation I une vitoeon Consants do 00 /# s tosujet vricite vastibialatres, nl consists A soumeottre tan iaujit A unoroutes lei 3 smnndes des mouvemoants actift do Is tits stimulation oscillatoirs a 0,0M Ho ave. tane vitesa. wits dodoamplitudo 4S' 1, n alterviont Inclinalson I drafts it 155 1/s en liii domandant simultandmant deaffectuor ine

* l~nollro" oit Voclsuh (*pdt daa fois), puts fietion vera tich. vituello dextraction do doannios done ane motices dolavalht. Aprbe chaque mouvemrint Is sujot nivisnt in nombrus. It a dii sinsi montrd quo. Isomploadlt do Is Wlhoposition nouirw tke dracti. Lo tempo maximum do rotation visuolle ltarvesnit stnlcailtvomont darn s a ~vdnl doset do 8 mirtutal at 30 lecorides ot to sujt offectue I Pinsm malaise obseri. 5dia tam oine autodvlttaton confrmift pe un scone kabliper tan observatowa, Money at Coll, (22) ont utilhi Is port do pnismes inverineta

pout tateor Is ouucetiblfltd deo osroniutes dia premier volLes diodes manioa daue to cttmbro do rotlton lent@ do Spacelab. Toutsolol In mouvementa do Ia the0t1 4 loPojuscola vav Wi "dial test' ant kod IsJ source d'un des dlplacentinti ifficitak diant libres, I'lvahaation a Un.protooolos Ios plaao utbids It I1hure aittuailt (18), to valour plus quaalitative quo quantitative,"Coriolis Sidmans ouaeptliblty Inrtd tea, (CMSI). Ca testa did dhvelo*p on vue d~aboutir A une qaaontillsation do is Diana marniko 64nirals, on poiat diplsment asatmflir IonJsusoepiblllhl su maystn d'un nero numitique unique. dprveiav utitisant Is vection elaculalro ota U~nfair* ouLipreuvo eansloto an lethutllon do mouvoanent motifs do I& ipreuvos d'lntanaction visoiaoevatbulalro.tits & 00 * altomativement dana le quadrant& avant, droll.,onlike, gauche, aovin retour on position noutro ontre doux 3JA. ortthni iijugamneatmouviments. La vitouo do notation doa fatoult toumnant oataurnetie par pallor pout attetindfo sam msximumt 180 1/1, Jem enitimo utillsh pour Juuor do is Auseoptibillt6 dos aujotoL'4prouve ast ariof toroqato Is kaset attonth un Mnvou do prhosntont an@ Standa Importance. 11 conwlent on offstmoImst pridtarinatd is worso do suuiptibullth sot atio dlktwtoole ptoblimos deoffot planeher at d~ofelt platond Wlcalculi on pronont on oompto Is nombre do mouvomoniao Pon veut riallsoa uneo loasitlcstlon sullsameninnellsdtuk pendant chaque pallor, pondird par tan faceur 116 dlascrminanto do IA population Coldide. Pr example unoi as litoss do rotation. 6prsuve pou pravocatnico manoel h dus enitbre do snalalso

s~ivro donne lieu a ian ultot planchor dam Ito mssure ob*Do nombreuso varianta do sotse Oprouv oant did adaptioss beaucaup do aujoto riaquona do no jamais aitoindro to

en uittlaant dos protooolso &A ramips do vitows ou sum..s at crltiro. Linivora., (6preuve tirg provocatalce It enitirdon jouani our Is nombra, lomplitudo at as nature des baible) donne lieu I un offit plafond. On doll distlnpaor leimouvemants do thetsaelon 10 but nodiorchC Iot dpruvos offictiades on lsomstimulua comma Is BVDT at

ls dipreuves on lscomalalao comma Is CSSL Dana le douxLes Wo&dIques utdilunt pour Is adlection des coenionauts cos I# problimo du crttko do julloont. mnitlif darra ota

* plusloeur protocol, tauent "Ipo It 1.llot cumuli dos critbro d'hvaluatlon vga asposer. LA valildith do l'hvoluationaccitlhtlons do Conchs, do ]a suscoptbllti va roposo pour une part Importanto attr

Ia Ilabilitil do con critbros.LeU plus tipandia consists & falro effectuur des Mouvoenlonidu busts doS 9 dam s I.plan saOttall aeye une pdriodlelti do 3.3.2.1 crlibro d'arritIt5 saonides at une vituasa do roitoatio do autoult dtabliedemblali k IN0 0/s. UA durk minimum do 116prouvo wat do 8 Do nombroux critires darrht ant pu OtrN utillada,minutes at. ail s tolksAois dia oujoltoI pmrmot, s#lo so L'apparitlon du vomiasomoni, sign. objoctif do Isashdviitiprolongs Jusqulk 12 minutes ou plus pendant du mlolosm, at conaldird commeoun bon critiri maliIlsninatnament. II saogit done duns 6prouvo uxtnimemont prilsonte do. Lngonvinionta Ovidonti, pRArIVAUbltrament densJ

* brutal#. lnosdeuds nhcowitani Is ecoopiatlon dos sulets UA plupartdos autoura utlillsoni plut~i taopparition dlune nauai.

Uos auteura sovitlques (10) attaclhent tane grand* froneho it nion iqiatvoque,Importance ams rhoations iervia lve pelquoi du;P*014mo malls aGoal ousr hastions ao~ovaeculalroed Un Pour pallor tei diflliultis dantimatlon, del khaltoa dlaut.Autre protobol$ utlflsi on u#Mediao Wiidsa del maavementa astimation oa d'obsorvatlonk do l'lnionslid do# lptpthmosAliornailfa do I& tto I dwolts at k gaucho pendant un oant did diveloppdos, Un repke sur cattldlsotlo,m otaion h 1800/ eayes sn* toutas lIs minutes, Lma ghldruatemmot numiriquo, posnat store do &wieporanhiliros Oardlo#asoslovko pNWReln artkslits0 rythmo contnoddmonen Ie ritlas dank do 116prouavs.ovardlaque, &W ons al~sneri pols Is rotation ropnmnd ansmInonslver. Uo eandIdal dolt oubir cotie ptochduro 10 lots 33.2.2 111chofles d'hvaiualloni do "~ritiisaveesbovement ame ian trko bu ariftenire detw phdrododo rotation. IA notion do transormaitaln d'unJagsmnontk iubjoi oan

variable numdrlque at A l'oelin dee diverges toielvanus3.3,1.3 Interactionsvtu~atbtle doatlmaton pqsltoph~flque, 1t at #A'raft- poe"bb

* d'e~Outawto do lago Itrattospolve lompltlud dos stti

4

conaiesnts risultint des dvinsemnta awiquols nous sommes 11 taut nator quo co mode do quantifncation falt appol I dos

Psoumii par l'onvlonnomont. Stevens a montr6 quo oet.s j.ppr~atiaonA subjectivist do to pert du patient at do

uhimation pouvalt itre nurndriqus ot a reprlbonter sous taobsorytour. Do pitas, Its symptbmui pris aon empts

fam ftaga pochohpiua.pouvstredflnr uAn Aposevtirtio dak pnarat oiu ionti dondscatar in apprtelat non aubjotreo ot k Is tAraftdormto dtow

duMtrmtI qugon ploturva mndlslo uWatpar sond utnfluente Iulans dbim qIlittvun dconl ptan hsiqo peausddJ& ltarpn. dultolla pchhyqUo btnj augi otfs quo Minept sow quanttt milostiont danabl roplatlon mpordoW psiatduo-ipntifLon Mclsndtani Vdubs ludia da o I ne unaidoacuvont plusmottontim pu do unlfanhlir dtos nouaivonwCIols~ do udvtimlati oon, trala rdo no Inatr, tl ralo 'noo do isdrm dimir do rdtasc

d'evidenou ~ ~ ~ snatmno onloue pltasqoIscadolitrd#dstiuluons dhqo auue ittdauo igut Uanja Inontrol quo n do eAa nb# intmnr n orl

nom russ ksloi ouvnt dtr unmonotourne J~ M ttre lu khyla l edagl u t es~timtono 1uoitPtprincipo ty uiqo Pe nn~os, Onuon (24) It sWt o pout w a sscmd angnil u esnildoc ecomtdrk do e aftl~ dana ott Iiprwlatlo du. ffirnldo Ldvaluatla dos divktC dminiondun paritir 4ehll Ib

des ampdrimas dao dnka po, ftem. antod spariulor I on Isubnaltor Ino piatentor u edmpeglobal hopmum upetsalatiqon d~uno donututae Iano dyn-mnibqo hi Pdalutlo Iibjotit do mais tooltnqo Ithployh. tehnqu unomarte dofot

do Itadrllt4 dun mItsMe a.ux pout f IpioriO utid dose don antit pou donivrerd I mluioni des point domootrpoerrocousta do moddllatle on, le dosllbq roprdeetstlvo doIltostddo mat"

puiquells o pwynt ~nficardoniv.:x 110 A rirp.ra6oquks pachopIs atultan doa l'aborigsdtolr LLor1u ganbl u~dmbo do totoes diltli khontai aulUModnk udtoinentatla ddtsniinta otbjoelfh 10flammiunt Wabe.tpponi coantontMd glnalmont~ d'dlto to t niotux li pua ill" pour pouK lvolm tro dutld don e t do qo inltsed dardlovIs nsut qi nt Ist dos card~inald I'par itiSowsOlnu at at.Ida do I pordn riredavrlt C outsi t b u to Alo ont fidunsstesvmhoonapovnt Isrvinir Lank mt ddcidE par gm tlostvriande qntdlt atassi Wan ure los protoslo on vnariablisI~og~. auu, priaaboms intlnorni cadu dions & n atoinrt it qustno lsoamttlm pauoluo.rnce dsAnrount dar Ibavaditi lnur. Arpos Inodot tr ptcha dintblm d asrdbovsaruoms oontos IA lappE tan su"ints pacd dvauaion eantsln & tilo ardqonulbrdatome at pou Isg prAlon utilo a14 doi touet

Los~ mu Law w oIs litIs pluso Eaou r do s oe t otron t quo do tlmclsur eon vaiat oso uion degrn. a ~nnost mu datao dltlbosd peuv bent Att Minteruli ou dahs $323 Matvlurels ph~olooa%'ds donjctvsIutou a

d'eutokitlmdon w idesluas dns laper ctl'udontt doI s *An ao vklulquon drahao~tec Is Iiid mas par qunts 6cnnde Wanssdooyptsn oobrtn Auoatuln anielv quloiiro o ars btiacoIle n 'dons subwtuerebnlant&tave impuvasion Hildsndo UlouIavata mudon~u dono nobsomagteu pounIsmosim ro Idvo I vrition obe do Is Wtquine aardlaqu, dar Dot sne ou WortspdouIyr itf du Ialauditi on.u p'boutlfe~a &i IaU denst dab Ioatr0 do plus d 10lba-tomsssa paroinutid ospoautr o. q~umod (natai~on mllvitlono rondaanledoumontl d WptmG

eipltso, dequlbbo) ontappoi Itat~osbzntbo. L puate lo~itb do imlgat ntlgido lfs rownm JALmars I doOrtlu do tr'ig "40LMM uit d ylt, d~ordnallon d tametsps betriftsuummeat laioohte

onLnien ghwaaen ~io I ~eu Ispu riaai pout 8 povi mo uils don tentqo. "IItiut e'spmaddievs par1ints suibuk der Ileiwlos orue &lfonts iypdon sioaeule aulaa ou omeIdi oukritisandt obionta pademt Part (

atla vmiumnt puvntauvni, 'ari @ ddd pr radInt sua *o ou tspoool o s-mliIt ujl, rislaleentInornl u nyev &Gisinra.........iimuutnon W Pobe.vo-s.i

U maur dov.als.crwwls oeI

avoc Is meutt. do Is conduction cutmnie PalMWOatr moum Indian do tol~rance, en particullor dons lea Etudes on isaplus ridonta do Geldlng (6) qui a utdlmi aveo suaccs I@ stimulus (BYPT).mimne mithods au nivoam du front. 11 taut Egslomentsignaler lea rmisutata obtsinus wee IsN enrqlatroment BEG Dana Is iltudas oil lao-malalse, INs Mdthodft IN Plus

p.,tdant Is Stimulation (3), qlul strmblent ntontrer Simplot consistant it utWur dirsactmont I& dunes do Itdtveloppenuont du mealaise mubles par Is aujut, IA notion do duilo pout Egalomnsft

antror am is tiara de malalsa dens Is composition d'unLe reteanussmnnt des urintowsasur Is liphiras ditsitlv tactics unique utill par aswmpla pour ranger dos denridscanstitue Agalaemnt un point d'intirst pout l'obtenttion do an yes d'une splolt~tlon satetstiq4e (12)Ymeavuum objectives. Deau types do techniques ant didprinolpalement UUtiWii dadts los Etude r&ostes. VLndoso Is plus utlW am 1tk wrtsoatanoment Is C-3,1l

(Corioli Wicness SMIlsatbiity IndW. mInt AU Point ParClut d'uno pant Ia astro-antdrographla, ost- A dire I& Miller at Orayblol. Cat India., a did htabit pour lIs Etudesmosars dos variations du chiamp utostrlqus do loatomao et utillsn In 1Auuliations do Carlotta Solon 10 protocoledes vildaol 1o01 I'lnluanua do stimulations provocatriass, 6voquil plus haut (CSII imos). Pour une Witess dornkts IsBit dipit doe dlfihtalta donreglstroemnt at do traltemont nambirs Os mouvomonto do tits nMcassalra t Vilattent duadu signal qui peuvent firs renoantriaes, so typ. do mature niveut do sivtit$ MidE ea un t~moln do In susueptblltisomble pouvolt aboutir it des tsutata Intirosawts (30). indlviduelle oau ofnitoaos Plus Is nombre do niouvementoCotta technque mantis on partlautfor I'vidttnco d'une do thte rtas Solt important, moins If smtjot ean sensible atatortle antrale qul uamble blan connIE.o avoo ]a Sensation do inworsement, Lorsque Is vitoos do rotation augMonle, tonautde, stimulus doviant Plus Important At Is nombre do

moumrugiiLs do atit Mot~ualto dicrolt .Miller ot Oraybeloin duWmi~me technque felt app.! k rimagerle ant oalauld, lots d'itudes en Isomaleal. at A des vitesss do

* Ehogrephlqtus A I'aide do uette teshniquo H Set possible do rotation diffdrentes, 11061t "atrowsnt" d'un uniquemittre en Evidome Is retard do vidange gastriqlus rsultant mouventont do tits, Cott* relation eat do typdua qndroms do cinktos (S1), Line Etude W~ants (32) a Iolarlthmilquo,montrE quoaIs retard do vidangs gasiniqus d~un rapes semi.lilquids WSW~r avant wns Epreuve pr~ovotrico Mtall oorr~li LA osuceptibillltO sun cindtotas indultes par IN accil~ratlonsilnialnsamont (R1.055) I Ilimnaleslt du malsais provoqud do Coriolis (score CIII) pout dons Sire salouldopar is sthmulation (dyaluds au moysn d'cthollaa). It elate simplomentcepandont mane uses forts variabl~iltE Interndlvidusoll atl'dtudsas ne s Peat p. ntir"~ sun Oventmalilu variations C.3.31 - E 01,NjIntrai~ndlvlduellos (test-rutest), La meaure nicosilie unebanns prattique do l'Echographie digettive at Is ripitition It E e ffet d~un mouvemont do WotIntorvalles rillepasr dos prism d'imios, as qlul Suppose unsimmobilisation roIstivmmnent prolongis du sujot.5 So s N: nombre do mouvomenta& it ne Aitoms do rotationfIabilitil htalt dimontres, as type do mature pourralt &ire donniaspartioullilnemnt intkreasnt pout IN Eprouvos en ISO.Stimulus ott Is cd~tormination do Is sWdritE du melaise oat La flablIlt do cet Indies dipend done emsntisllornont do Is

* toujoun adlsoteo flebMIit doit cia dtermInatilon du cur.tit d'ani qul oat enprhinielpo I' moderate nialsiso It" do l1eltolle d'observation

Dans Is mime Etude, Valmealls at Call. so Sent Sgal0omnt do Orayblol ci Miller.Itlnroreuds k l~valation do varielabso lormonales on fonationdo ao aOvdMt duma mllso, It seoglit plutat d~uns Etude ~J6.MM

*pilots, portent cur 6 aujets atIes rtsultata obtanus dolventbit. oonsiddris avoo prudonce, Line relation Wen~irs Las mithods; d~lvaiuation do is saumoptiblllE sun clntomea(RuO,8) did obsorvE. enirs I. tsar d'AVP plunietlque otIls sont done multiplem Ent rlgo Sknirale, so typ do situationsiviliti du malaise k Iliums des Eprouves provocatricos. Do sigple essantlolionmsta qu~sucano d'cntte siun no consttuemilme une sau. bonne sorr~latIon ein obtonus ontes It Uina e nick COWl eat Egalmot vial pour los crltimru i"siiriti dua mealase it Is teau dlEplnlphrlno main Is taut do insures Wtilieds par ean dlifidsnicso mithods.nordipndphrins nec semblot pea volt Eit modiflE d'unsmanihro alnifloativo. En a'appuyant Sur dots coneldiratdona statlsitluoa, Xaonney

(9) soullgne ttr ocluitement quo It flab~tit do Is per&Iimon3.12A 4 orns do suscptlblillti st dirootoment condlitionndo par Is flab006 doIsle tecnIque

solo-mime st cello do" a tnures queall. utuse. CoOlIt conviant g~ndirlontont do nos pas contondro In &Aotlles constuitus boidt tin point ssontiol I prestdio otaboutlssan I Pwlmatlon dut malalse ave In Indiano do sontidiatolmn lunqikii N'A ltest dirl& er Is sman"lbilhttollirancse qui rohiteati Is 'quentiti, do stress' asob(e par un d'un, ktlvidu dunn via i via dune wlWalofl opdatloatuwil.sujos pout arihe I tin aivow do malalise ditMistE Sin eppiutat as tpo do raholusmamit &WatIE&Ique mnToutafole lea wmor do malales mont parfait utlla coeain dIfffirent. techniquets d~valusetlon, I abomatit At is

~ ~ ~4

j.?I~

conclusion quo lee variables phyolologlques et ls traits do groups intermidlairs, Is pourcentaioa doe seoes ontre D at 2pursonnallid ant iane valour pridictlvo fbible alots quo des diminue at am prodo. do 30 % (figure 2b). Lo indlIvIdusrisultate plus estlefoisonis sent obtonus su mayen des clankdam donsm daux groupos& ant tous termind l'dpreuvoquestionnaires at dos Aprouves provocatrlcas. Leos ,olilouros sane uttsindrs Is clitisr d'arrit qiti dtash Is Allude 0o odveupiddltiono sent copondont obteiueo ark tiltlownt del Is "ollM fti" ott Damt iS groups A rdoctivt6 forts. onniosures an situation opdreiionnolle. rsrowsv ensoro prousqu 15 % do sore trio bool (figure 2.),

esqul n'sot poll itannsat Outs donad Is motivation doSams miter dons des conslddratione statiatlqumvaies A St"o Undioa, mos ork consistesauni quo lin qtsolqueo candidatevoc Is scud do ret.:r concret, Is principal eneolwentonti admis aux dpnftuva ave. des scomn Nevis be trouvent damequo P'on pout titre dos diudes ouri l'dvalustlon do a& so groups. Cos qusiques wndmas montirot nlew bWen In0sucsaptibiliti eit qu~ll foul adapter soolneussmenl lea limifts dos questionnalros doas lea proussuo do silloction.techniques St lee mesures mu but resliorchi, Le problimosma an elt d'utiiser am absus doe techniques quo noam En revanche, done 11vl'olstion do Is eaasptlbilltd via k Viesevens kre imporialim Doux pointo sawrentlel dolvn late, do certaine siatuations do terrain, cmmmc Is aimulaeour dosoullgndst Is ndumm~lt dure Srands *oguur vol, lea quostionnialres constituent oane nidhods trionfidthodoloslquo drune port at Is prudence dons intireosonte, oonmse en timfoipnent IN rdsultato obtenus&l'lnterprdtatlank dim "duIett d'outre pan. par Kwns* (11).

Lea mdthods d'valustlon utilis inim queeaionnalro m Let e dpreuvms provocoarloes en laborstoire, no sont posun intdrat certain bisque P'on cliorcl. It dvoluer In dpourvuus d'lnoonvduilnte deam 1ee e41detons. 11 tautauseeptblblihd don grand nomnbre d~individum. Riles dlslnguer iet dews coo, mien quo l'objectift echerchid sot dopornittant do trier relatlvemmntalslament lea tindv~idus pridir Is tilitrrnes damonen onvitonnament prooho do Isutrimees, trio susceptiblea out. peltssoeoiptlibles. situation do laboratolre, ou qou'un prddtiion plus gindralaMellsursussemnl, pour bet aseoeptibiath nlnom~daloloo Is ma rsechsrhidepouvoir prddltif devinAt beoucoup plus incertain.

Duel.s premier ase, as problimo man reoaletvemnt simple etLe probillme qul pout ase poser concriltement ma done colul Is difficultid majoure consists h aJuater 1* nlveolu do dlficuliddo Iaa calibroalon dos rdoultato en fonction, dia but it des dptsuves at t Nevoer do koenif compte des eapacitloattelndre, Vt~tsoU dons ian proceons J do alotion, Uls aldont d'adaptation des caondidate. Cleot Is ao done lot protodoolmprincipslament & d~lminenr lee mujtso trio suseeptlbles, La Francoodovliltques all Von oslfforcsl do prddire Is capockitquestion qul "s polse alonatem do savoir ala planer Is ]Indite des candidate & endure Ientralmmentn veotlbulolreentro lee lndivdus iells souscptlbles ot Ie inturnuddlolrea, mlrlaneMent pounod priconisil par lIn lovidlIques event lIeL'updrlence montre qu~ll esegt Ia d~une tiche dillcats. vole qsptlout. 31ils protocols do Adloetlon mas trop fbible, an

lantant do solliclier In caspaditld fdadptatlon, piut~t quo IsL'lllustratlon dens propo. pout fair appal aux dannhes ridmslaac, on pout parfols observer des dlefie La solutionacqumleots i Wo dn promosiv do 41ficlon do candidala qul a Atd roesnue lore do Is dmreib adleetlon effectudecoamonoutu pour ica vole Pranco~ovidtlques (14), La (MIR 92)s ;64 do tentsa d~dtabllr Is tolerance do bose d~snpopulation intial do candidate retanus opts un premier tri bible. noenbro do candidate prdaidloctlmnnds, pub do toesirour "onser &a contpoeoli do piloate militaire at clviii iot oapaoeltd d~habltuatlon do omin qul samblalant Ino plusdibnlonteur at do usloalifiques. MLotogromms dos score inAdressonto, ourI plan dot csandidature.do suscoptblllti obtonus I laid. d'une variants diaquestionnaire 3450 donna un profll reoltiveniont habitual L'dpreuve, toujoun fondiesour Ileffet Jo Is cumulation despour ae typse do population (Weur 1). A as stade, lee occedldretione do Coriloll, a dtd acongue on eoneduoncs . LAquolquos sujote prdoentont des more trkio levil, wupdisvrar session oomplite do stimulation veotibulalre, comports, Iit50, ant Wt Unlimnk, pollen do vitaos do rotation (onre 30 at 2 0/&), Pour

MUPO PW In " ho do at a dvflo APormli as utres, sprile pumpa done difionts I'ires, S0 ant sue sIlemer ti.e ion hor~olr Stot dtamt so do Monoubi UI provve provocatrios our faustoll tournant, milnutes, Leos stimulations provoeotrlose wln Produltes Patuslflisent 1Us adaildrstions; do Coriolis aelon ian protocol* k des mouvernwat actifo d'imlnelnaon dol Ils di drolto St kdes. niveom do vitems do rotation, (80 *St 130 */s) avas oan gpushe, slv Wa s due Mnont du busts on evet. Lamouivemmnta nit do Unioin dv bugse toutelesSI, secondoee pdriodll des mouvorninta ma do S wosconde at Is sotiLa clrk malntlds destdea 6st do 8minuias, rtwo done Is position o6al Uso trouv osnire dose

mauveenente ausosOaf (poel do rebu an positiolk amuls).A Plieu do calls dprouvo, INo candidate ofnt d16 alu*osden Cello Oprouve pornot uno bonne disacrimnotion do Istrais otagoles ( idectivid biale, moddrds Lloyd.) aelon toidrnanc does saljetou6 dst ouplawauntour In base dianaPrlonlnt kitd des qmtpadtaa obsorvis on aulan I'dahefll do Optaevv sovldoque clesaiquo onl minutes, eel heINl Sur 0aOt"a 01l Lwrque Pon felt Il'tblogran list dowesoe MW1 dlagramme & dose dimensions Is position dee dlfdrnt

vbiu alon aestroesda prlesson musatsdffMonte &WOWa nfontondu eoredeno Maw" bsovkIsM Ifin dopoints Dim to &Mpopo k 101bi rhacl"11 (Ilposs 2a), p10 do l'dpreuve dontrs l'ldlc do taldr anos wsed (4W 3r))50 % des MsiaOM ant abobtenu twtore" 345 comptisantreo 0 aut nn'aUUIWedo Non svpdriovr&20, Danels

Dens towats I"s Opouves do skdluton, l'vaustion do as prtmondro conventir A l'Maorieiblo dos situations rencontsrlismAk d ualse provoquil pas l'iprouve pose un an milieu op6rallonngl,

proh(11mns Laulo-seemtlreon do Is nmusko q% a outan6ddment !onhamegnt des toclutlqua d'obsestOWN, e La plupail due auteuts ssccsdont it considkorr quo Iearelativemant peutk ible ame dos sujola nowlk. Cast queettonnulro arisanoutlquu at le" Epuves proeocattioepousquoi Ur n nkomamr do faire ar~ta l'dpseuv We une componetsai It l'heur actuells, lea plus grandol potaloatitisactien volonta do W'sjee lorsqull attolnt to critbre do pout l'dveluatlon. Permi lee 6preuves provocstrilces callosnrAbaie 66ke priedden In vetlwsumont so dishier offictuils mar batalatil tournent it utfisent l'nffet dostennisntn en fafl til soavont l'dpreuve, Ca 0"e diphiuve eccikutlons do Coriolli eont los plus 06mnmnb~n~derak bion Ovidemnent do l'udhisstlon do moawee utililhesphysologquos objoctives.

Dets tendences somblent coedstor dens lea kudos anBe revanclto do= toutso lea kutdes do Is coopfradon du eours.l1lagiatd'une pan. durecoursitdes bonories do too&401 sON eaqule "a priori", Ie deolAsf d'euto..slmaslon isl compllesat it des lreltiments stallsllques complutudoennut gkiealesnenl des uisultats adsslssanit ots a m damt IlobJectif so debotair I 1`6leboretlon do vfitablolflaiedit semblo asoulement Wlmilo par lie variatione modblos do prdidction, D'autre pan. U solst. tns, tendanceinteitidividueilesait Ia copociti do dlarmlnnow anise dis qul tints d'amillore Is flabilitil dos crtlbves diveluation,oulls da matlaws pWAohs an recherclaanl tout partlculitrimiatl Is misS aut point

d'tndlco reposant msu lit muatue do variable&La probilme do lIveuetion gfinkslo do Is suacipbllh: A physilolgiquus quentltatlvus.partir d'iprauwes provocatrict adt beaucoup ptits complies.Cut lsose pour I% pridlatlon do Is eswceptlbitii sut mel do 11 fauta romarqito quo sos doux tendancee sontlospace do lee stimtulation, do laboretolre classiques rondent coznpldenenteroo at devualont pormettre d'aomiorsoriris trial compt; do is situation peuticutbO" roncontude in consldilroblomtent Is pridiatlon des cinilosus tertistoso,mlcroprvivti. Rawclke (28) a emisl montri quo ies mali eusai cello du mel do l'oepeso qul, pour lI'nstant, posecorruallns SOUSe Is suiceptlblllt6 ivlutie au, m~oyon do encore qutelqutos problbmos,diffkenea Ipreumi do laboretolro at Is murvonuo dutWundroi eau sas du vol perabolique en mlcrogravitilitalent tIse feiblee. Plus ricemmont (29), Is milne eulgua Remoerohemntsi Lauteur souhalte remercies Martinsconclut k Is n~oficil d~uttllsor dos batlirlou do tisl qui Yerguiln at Patrick Sander pout lowt aide deas IspoM~smeta dWbONir dos sroot compooites plus priparation, do so document.ropr~tiootel do Is susesptlblllitta emnal do Impose, CodiImplique Is miss on coeture do triuniquua ilatlitiquosdishorioa At Iuttllosaton do modlii pridlaifi,

pour tornn"i culto ynthiei mar li6velustion it is Rifironcos Bibllographiquespuildictiank do Is susciptbllhe, U sitkomarssnt do rivenirButr lea rwisulws itatistiqua obtonuts par Kennedy qulmontr, quo lee meoures cpkirlonneoll dannont do tris I Benson A. I., "Motion Sicknoess", In *Aviationbons siultats. 11 beut romarquor iod quo, powr cc qui Medicine1 2nd ad. J, Erniling and P. XIMgconcerns to real do lilr, I'Armie do l1Air Frangelse utilise Dulterwostlta, i9M. 3111437,an &&*Wton initial. van. technique qual snan dfte otalemont 2 Bles W., do Jong H. A. A., Oosterveld W, L,retlonallsie pout los cinitoses, ii rapproche sasm dos 'Prediction of So. Sickness Susceptiblity", inmisuses opirstionriellos L'Arm6e do PAir dioposi. U ont "Motion Sickness: Mechanisms, prediction,vred, d'un potontial do rcilM eniO~ Use Importmunt, qul lul Prevention end Trisarnent", AGARD CP 372, Maydoing uns co&tiln Uborti dens ce domalno, LA iechniquo 1934, paper 27.consist. simplement I faire effectoes uso 61li phobes dee 3 Cholen W., Kabrbdy M, Hatsell C,, Morales R., Fixmsnooutvres ucrbeuquos doeIns e quints proanikes houes to ., Scott M~., -Use of Phe"yoin ink the Prevention ofdo vol a. & no retedta quo ceou qul pransennt un nivseu do Motion Sikluss", Avial. Space Bnviron.Med., 61,performance setifelsesat. Cott@ aIleaon &Weal, aa Ileffet November IND, 1022-.5des ciniWeo ad implictiement Inclua, samble doaner dos 4 Diamond S.Q., Markham C.H., "Prodoct~o of Spacerisultels -sa mistisalnt4, en no reteananl quo dos ouists Motion Sidinee by DWsonugeto Bye Torsion ininoAwuscaptibles out cepable do oeadeprteri Ise sildoemnt It Parabolic Roletl, Avist. Space BnivironiMed., 62,

leOnvlrotuneitu dut vol. March 1991, 201.55 D~osoA. D., loopgnovBH. M., Olu trlssn mne

L92MM~UM labyrinthiques at wns lnbrlniatiquta den s IdlveOppaeannt du real du ineuomont: in

11 msits an irke WVg dvetall do techniques pormittant spouanlsug, Kosmdanltahs.ki Biol. I Avis. Mod.,060u10%06ll sWK **ON&ts Cos teclunlquos lont pours Ia 6 Golding J. F., "Psl Skin Conductance, Activitplupent elothlvsnten caenplk"uAlrenib malucnh nos peutl end Motion Slckness", Aeroespac Wedi"

Association 62nd Annual Scientific Meeting, May 22 Money X.R., 'Meaagrement of Susceptiblity t

1991, Abstract 127. Motion Sidinesa', in 'Predictability of Motion7 Guedry P. B., "Selection and Prediction Tiats Space Sickness In the Selection of Piolot, AGARD CP?

Sickneas, in Proceadinga "Space Motion Sicknest' 109, september 19A2 paper 2.Symposium, T-1300,a ovm berS. AIMIO, 14 Lanes of Moe . atheG. Omceabn C.MreflightMaindS eneymoim T.180 0, Novem ber, lgodG 07,1 papa. Potlih toe stn of!, W tt e D.C).9 b m an , In'Pre tigh ondN. B., Lilienthal M, 0., Balixttey D. Rt., 'Etiologloa Sidcinowa Mechanisms, prediction, Prevention and

Histoty In Simulator Sickness' in 'Motion cue in 14 Oman C.M,, 'A Heuristic Mathesnetleal Model ftoFlight simulation end Simulator Induced Siaigno.', the dylnamics of Sensory conflict and MotionAOARD CP 433,Septembor 1987, paper 1 Sldinese', Report MVr4O-l. M.iT., Men Vehicle

9 Kennstly R. S., Dunlap W, P., Fowlktes L B., Lab,, 1IM0"Prediction of Motion lidinmom aecili) In 25 P&atie D.E., Resohke MY,., 'Pteadaptation to the'Motion and Space Sicktness', Ed. Crampton, CRC stimulus leurengoeant of Weihlesasnewapress 1969,170-226. Preliminary tudlss and concepts for trainer

10 Kilhov, X. 1, 'Quelquea probilunes ir l'4valustionk dusigna', in "Motion cues in Fftiht Simulation aniddo Is fonction vestibulahr chm lei pilotes at lea Simulator Induced Siskaide." AOARD C?cosmonusuen, Kosmitchooltala Diol. I Avia. Mad,, 433,1aptembor 1937, paper 181974,5,47.52. 26 Remao 3,T., *AFantr Contributing to motion

It Kohl R,. L,, 'Endocrine Correlates of Susceptibility Sicknes llusoptlbfiltyý Adaptability andto Motion Sickness', Avist. Space ZnvlronMed,, 56, Receptivity", in "Predictability of Motion Sickness inI98, 1158"5 the Slecstion of Pilots', AOARD CP 109,

12 Lager A. Money K ..3, Landolt 3. P., Cheunll a.5., aeptember 1972 paper 4.Roddan B, B., 'Motion Sicknes =used by 27 Reason J.T. Broad 31., "Motion Sickine',Rotations about Berth-horlsontall and Barth- Academic PYesWO75vertical Asia, 3, AppI. Phyalol.: Respirat. EIviron. 28 Readin MY. Hosnick J4L, Ryan P., Moseley &C,,Exercise Phyalol., 50, 3, 1951, 469.77, 'Prediction of the Space Adaptation Syndrom', In

13 Laser A,, 'Suacptiblhid aus drlloasm at amplitude 'Motion Sickness: Mechaniansm prediction,porque des illusions senrsoleile', in 'Motion Prevention and Treatment', AGARD CP 372, UaySicknes: MechanIsms, prediction, Prevention and 1914, paper 26.Tretment', AOARD CP 372, May 1934, paper 32. 29 Reading M.F., 'Statistical Prediction of Space

14 Loser A., Lejeune d. , Midy P. Kerguelen U., 'Lea Motion Sickniew', in 'Motion and space Sickness',teat vestibulairee done la sdlection at leantrainancent Ed. Cronmpton. CRC pro. I, 1992W16.des cnosmonutos', Prooeedinigs 2nd Internat, Cord. 30 Stewart 33,, Wood MA,, Wood C.D,, Mims M.,on Space Phyaiology, BiSA SP4137, November 19815, 'Effect of Motion Sickcness end Antlatotlon,143-141. SIcktnes druga on Gastric function', Aerospace

1S Liage A., Sandor P,, 'Etud~e Horieontale 4., Medical Association 62nd Annual Scientificl'incidence du Mal de, simulatemr dana In Force Meeting, May 1991, Abatract 123,Adriennea Frangasee'", in 'Motion cues in Flight 31 Valmalls Rt., Arbaille Ph,, Pitot F., Poltder 3M.,Simulation and Simulator Induced Sislutess', 3hmArb C. Pourcelot L., 'Gastric EmptyingAGARD CP 433,Seoptember 19117, paper 4 Asscanent by Behopraphy after Stroes (Rotating

16 Laguqj G., Hadnld LC,, Gousra Iii, Golly R,, Gibert Chair)', Proceedings of 3rd Hurop, Symposium on%A. P., "Posslblitd do prbvoir Is prddlpositlon au mal Life Science in Space, BSA SP.271, 1987,319U.3dfs transports lota de Is adlection dus pilot.', In 32 Vaimaile R., 'Rifimee 6mitique at rinlose', Tthes'Predictability of Motion Sickness in the Selection of do Doctorst en M6dectne, Faculti do Midecine doPilots', ACIARD CPP 109, september 1972 paper 3. ToursM 1989, 118 pages.

17 Lents 3.M, Guedry FE,, 'Motion SickinessSusceptibility. A compactio of Laboratory taeas,Aviat, Space Onviron.Mod., 49, 1978, 1281-12M.,

*18 Lents I.131, 'Laboratory 'Teat. of Motion Si1cknessSusceptibily", In 'intion Sicknese Mechanisms,prediction, Prevention and Treatment', AGARDCP 372 May 1984, pawe 29.

*19 Mas*Jsam CK.H Diamond 5.0., ' A Further Teat ofthe Asqmaity Hypothesis of Space MotionSickneWs, Aerospace Moedsca Association 62ndAnnual Scientific Meetnin, May 1991, Abstract 86t.

20 Matsnov, communcestioon pursomele 100t.21 Money K. H., 'Motion Sickness, PhysIO~glce

Reviews, 50, 1, January 1970,1.39.

4...........,

., JAr"X

* figur 1 :Distribution do I& ausceptillWlIN6 6valu6, au moyen du MSQx(Motion Sickness Qucstionna) damauns population do 193 candidats coi-amonautes.

mor

flgurs : Distribution des scores MSQ to~~dtobtonus par Its candidata salon lourclassemont en trois group.. do sus-ceptibilitd (faible, moyenne,forte) &l'lssue d'uno 6prouve provocatrice.

figre 2.i O roupe I, susceptblt faible. a s

0 cmndidats

figure 2b i Group. 11, suscepIbtmoyenne. I is 10 12 413 1cr

%0 r Andldiits

figure 2c: Groupe 111, susceptiblithdforte.

5*Nom

'y. J"

.......

30-

Scare doGrayblel is.---

10 -... - .............

- - clI dles

Fiuo3: LA diasraming pserits Is score do malaise & Is fin d'urie dpreuve contrelIndico CSSI calculi an fo~nction du nombro do moveoments do titso ffectuhs, Ua

comparalson entre Is& r6sultats obtenus lors d'une dprouve do 8 minutes (MEDES) otI'dprouve do toltrance do 34 minutes (LAMAS) montro bion la discrimination obtenueenire lei diffirentes iusceptibiliths Individuelles par ce dornier test,

I"N Institute of Aviation medicineFarnborough Hampshire

Unit~ed Xingdom

neither necessary nor possible withoution. 1 .imposing unacceptable constraints on

Intrductontravel or leisure activities.

The Concept that. conflicting sensory he has been described in a previous paper(tatternO OA: mtion Constitute thii timulUg sensory conflict can occur between vsa

hotIn uscptile mbjotsgives rise to and vestibular sensors of motion, betweennotion sickness allows rational measures the canal end otolith components of theto be taken Aimed at mintimsiniiasensory vestibular systemt and as a consequence ofconE hot and thereby reducing th -ol low frequency oscillatory motion.deftee of Crmptoms, Iuch maicsurge add to

th e t5 fctmvane of prophylactic drugs VisUAl .,vPsat10Wa FAno1iet, The normaland may alone be sufliciant to prevent expectation for pedestrmian man is that inmation sickness, the presence of need rotations tits exter-

n Al visual world will sweep away in theIt is well known Weong 9ailors and astro- opposite directions that is it will appearnauts that continued or repeatef exposure to remain #pace stable. it is an Golan-to an initially nauiaceogsio motion stimu- tial f unction of the vestibular system tolug leads to a state of increased resist- generate compensatory eye movement so ammace to its effect.* This provides a to stabilise the retinal image of a space-spantaneous cure for some individual, and stable visual taret i h rsneoforms the basis of therapeutio programmes motion of the heead n certain circum-to assist others, stances this reflex is inappror nate and

there is consequent sensory conflict,

Thi

Tis paper deals with the strategies thatindivIdUals can adopt to minimise their The navigator who is nap-reading while theexposure to nausebjeftio stimuli, as well aircraft is mancouvring experiences angu-as with adaptation and its application to lar motion s*ened by the semi-oircular a&-th treatment of chronic airsickness in nals, but because his field of view isairorw. Also considueed are some Of the confined to objects within the cockpit, henon-pharmacological measures that have locks anya visual evidence of rotation, andbeen used in the treatment of motion any ebular induced ey movement has tosickness. be suppressed if visual1 degradation for

the task in hand is to be avoided. limi-Th ataion~ nt Affnsorv cantict. larly, the susceptible individual aboard

ship will experience less conflict if onTo those of a more adventurous nature a doek with a view of the hansonn or evenmotion stimulus that oreates sensory the restless sea rather than twa visualconflict is a pleasurable and awaiting world below deoo s that moves with the:xprience - initially at least. much of ship,thie popularite of fairground amusements

derives from t patterin of motion son$&- car sic ness Is a common problem in chil-tion that • annot bso eyed by pedestrian dren whioh they are said to 'grow out of'.man, and the various Vinda provide eKam- in fact, physi cl lrowth ma well be anpeas oa Menga types of sensory conflict, important factor. I emall child confinedThe fairgin ad operator's treetment for to the rear seat of a car soes little ofmotion $sikne• s is to stop the ride be. the outsie world, In artioular, the roadforpe, a least gar the majority of the ahead, that would prtvide him with thepopulation., the pleasure given way to visual accord when the vehicle Gorners ornausea, That way he maximiose ýis trof- changes speed. Reading I D a car is wellits, wile the most susceptible indi d known to redsiitate metion sickness inale quid ly learn to avoid4 thoe rides in suloottible individuals. to this situp-

Aoo .A~Il .h Mlo of Ioannroina one -hexyomo-

ON on at Ilkis tee rapidi n Afed by th n he detale i • eye nIserye W nth und am~io en4 avo- oiMpleo With the need to oIppre•. vtappebonole athe I rein able prorgp lae i. in I Ad o oe 0 e toy 0t an intele-

:oinaryagAMnuean~ oAnlAu tot V.e•o in ah ves6rtib oa yo stud ai

e e iniiuasteto�st al vd- visual task that requ red a sub act toeonce of conflicting senmoe y stimuli is search for numbers Within a gril while

WON, !"A'oe A.

•o noAI•o~heo, senoe •h~ re•ex A Inapropiat , n

1*=-* u-eyiglwfeuny(.2M)aglr o akt 0o ota hr sol

cocil ation in yaw was shown to be nausea- small increase, to 1.150m, in the intensi-genic OQuedry et al, 1982), whereas the t of what is perceived as gravity by thetas of requegndgiy sequentially re-_ __p

bot ttetsaen loationirundar an rl rtains(Lyhe aGifimoin odthocons wideno prooti symptoms 15) he ceantre of rollt rotatIon i

principal oscillato ry motion# afth

Coinl-aalit fljj~j., he sateof esfe ativers~tieal tansuscetiblean paitcn0~ ~~~~~~~~e or codbt miiolras and adoplrttios toLsttinhmelf at thefild~~~~~~~~~psto atltoocr hnmto fte 11) hofmntmum vfrtoll ercursionipith a rol wth he eaduprght is (ovesrithe atsof pitcha moasltion oftheti

acomanedb a euiaen aqa veaessel fo the shppe doks rollgrheavtlychange~~~~~~ ~sm inedu irction oth rval Imranthpintche cotonse0ueth hoin-tional~~~~~~~~~e acceletra mtion cnsne y h t- hc cusaotan berachivers byiand~~~~~~~~~~en onct sesiyboe na onr fte shop aeut dec as ossibercon-ing ehice wethe th tur isf a sincesten with vethea ne forsaicleatry voien af

in ca a nigs an~6 un fajalr~ cornei ar stah e howandsoen inorde t oh aoi v isulhepakflying aco-orinated curninlictt-,

crat (LO1).ly n he frequency oftevrtialg 1 o~scil atinofr tby ves& ciia factor if11,1igtelngthe

Fig~e 1 Thefores etin n a nauloomelngct ofethse type of motion

cosneriMM -/ :oa veil n narrf thils, isp affectedn bynte otheadn moftaeooA~aee eun. he ostral 1rewpe te bacti withraegspet t sogthbe directon-oof th car toleapodvaniong wavs minhu vertisa eartculrsiynearnr whreasthe asmartend t vestrel if sheagoing isaioling heoats.lWhehrown~som rrs eatingtion windwr ther is loftent mores

plosndinllofthboatasi metontsb achiwavedband, whaslew imay bec asncomfostble, itois

reulan accela eration formed by the tione then wavte fneqenc isr rdcledr vindoaddition owe of thegrvity veto tote there is asn ainooranrintoorwad visuale-

radial~~~~~~~~~h aceeatorroueqbuhcre t ndy dclrton ofe vethea boascaslitisnoath~~~~~~~~ a oftevhce hsrslat oetahen bysl .acriwav.ao largeri vhessl

rInuertial h forisdected dowinwad ond a ne oemto oniinaemrotards, butd veicls otard swng arafro the nauseogenict wonhedngif thitye onmomiong

stmuus incsmane byece any therreadindn6otdato sinal iun. rohl fotr alremos the bematr win cr requen t brain anedircclrtion o

ofu the canas dhise cofIct olan bmIn i-th gevnerate whatvis. Tin e isc palofrtiquenclyconer whereapitds ofthe radialo t ends -ta lo bereo sed-ongfailini g for t# wus eptbl

!rorbeiting to. thewar theare is thee veicerotoulocity, ~~ nd wech ml rdcin Vricle osillmatoy is ucmotbenoutered

in vlociy g~s adispoporionce genearrafly lohen iynugein turueneandwelnarg redationuin rhedial acces @tone tne mayin beaf o reithcwnds. In commercnialronseuetnt aelnernatcon flict bth tliong this isv noaasifrequeny sinedcedn

addiionof te gavit vetor o te teren is aircraf flayin fratrltde wcellrarana acce-erdtionprducd tur the curvedf is o abnd dhe urble ce of the weather It irholle bye aneamountwhich reaintainsth ma oertae if tealchnav.for encouner vsscleaIesultiant veoresi directed atwniarht angle air towrulenceoa altditudeors mtor cloudvetocla the aircaftloo Te sentesorye corn-r wactvity onthe apro but suchpro.flictianenderedl invrolve afromtep son of lmn cans ofteqent beravoidead ace-eroutiongroll a& nyhi conlactv chanbe mini th ge cntrastha in iniag nloh vrequei-dirledyardction of speedra on hen~ byother coional oscillatory m stohimulusb adturisotolifora girvine raiusat muvaur im s the len iscuanfetursf. p-q~~fyn

cofitoa bylting theqae ra th vehihcledceti wtei niiosblevels a prt lochim t henc a doal r:heducton veryiceversclaoyftinsecutrdoarg peruction, irandibylmicelerathen anglela oaiscns.incmeca

cosqen esrycnlct n ti o oaas nrqen ic

passenger* aicatfya attdswl

Vtpostural regulatory activity in order to

Ci ,fi•lUanah Ofs a hpad mysI ntsE maintain it. A study to oompere thenausoogonic off eet o0.K * nusoidalWhen undorgoin rotation, heed movement osaillation at i 2.5mm applied vertical-in any lone1not r than that of the rote- ly to seated subjects and horisontally to

tion vi I Induce a Grose-coupled vesAtibu- cupine sub eots (Golding a Kerguelenlar signal that Ao potentiaIKy dia tiron- l~ O .? e finding that oscillnaton in the 1tating and also nauseoogonia. iAores ere heOissonta3 plane with the subj•et supineinstructed when manoeuvring In aloud to was longe rovocative than vertical $soii-minimise head movements principally in lation is in keeping with this proposedthe interest$ of avoimina disorintaStion. relationship to body posture. However, thesuch advice to irsrev. uring manoeuvres findings could also be related to thein alear visual conditions is not apra- changed nature of the sensory conflictpriate however, becauee of the need to between the two conditions.maintain good look-out when changingheading.

in abnormal 0 environments hoed movementsare aleso rovoaetive of motion sickness :t is "ell known that the driver of a carbqth in t* sera grav o environment of or aoach is spared the motion esicnessesace, (Oman at a 0, ), in parabolic that may, as a consequence of his enarget-

I ight ((Lnekner a Groybio•, to41 19100 io driving, afflict his passengoes.or during high a manceuvrel in slet jet tIoral factors, may contribute to rt~heaircraft. The eliminsatonoat unnecessary relative immunity Of the drivoe% buthoeadmovements in thong circumstanees will prosbaby the most Import&et his wtherefore be protective against motion ability to anticipate tia osts of hissicknees. actiones in accelerating, brakingaand

cornering. Tn consequences the driver:t would seem to follow that head move- will lean into the corner while his pee-nents made in the alternating hyper- and cenger ttnde to be thrown outwards, andhypo-gravity environment.produced by low ikewise, the driser will breas himsell infreousncy vertical oscAilation would be an preparation for braking whereas himadd tIonal factor in the provocation of oassenger is initially thrown forwards.motion 4sikmne Thi p however, ham not n abrupt change in the fores environmentbeen clearly established. A otudy of generateo roprioeeptive signals that aremotion siknoess indued by verntoal eisol- suddenly a variance with those expectedlAtoy otion found no .,otentating effeat om aonsequence of the existing posturalfrom the addition of had movelente or regulatory efferent eativity. It may bewhole body pitch and roll movements thot this aonstitutes a neural mismatch(Macauley et al, 176), znitiael trials in $ianal that contributes to other diecord-paratroops of the ume of restraints to an? motion mignals in the provocation ofminimime head movement found significant motion sickness.benefit, but only in conditions of *normalturbulence*, Zn conditions described as A similar benefit from being in control is*rough' or Nviolent" no eignifc•ont dif- enjoyed by the pilot of an aircraft asferences in the incidence of airsicknese coparm d with his navigator, though thiswere found (Johnson a mayne, liss).. A mal be loea evident in early trainingsaimiler study (KAist eat a, 1935) failed whIle he is still becoming accustomed toto show any benefit from head restraint, the sensory aonsequonaoo of his controlwhereas hyoscino 0,65mg taken 1 hour aations. Likewise seasick erew members onbefore flight reduced the incidence of sailing boat• may derive come benefit fromvomiting from 31t to 7,5. taking the helm.

g hs An~lugnap pa body, oautua. A study to inveetigate the effect of thesubject having-control over the initiation

several experimental etudies have investi- of a crose-coupled stimulum (Reason agated the offset of body orientation in Nesson, 1975) used three stimulus condi-relation to the direction of low frequency t10o1. subjects were rotated at increment-osaillatory motion. Ing velocitiso on a turntable and tilted

in roll by 45 dog either passively byAstudy in aircraft undergoing aller- moans of a mechanical actuator under

coaster type manoeuvres showed that sub- operator control, or actively ueans theirtoe sAtting upright were less likely to own muscular effort or ?n an

become motion sick than subj• ts mitting aotive/pasmive condition in which thewith the head and trunk flexed forward to subject initiated the actuator-driventhe hertont•el (von Sauagarten et all chair tilt, Asesesment ofumtion sickness19g0), A similar study, which used alterý eIyptoms indicated the passively, rotatednating periods of weak acceleration at group to be the most afooteod• and the0,Sg and forceful oraking at about O.Ig active group leat so. tIn an ambulence oar, found that subjectswere less tolerant of this stimulus if A further benefit of being in control uysitting up rather than lying don. These derive from the montal distraction that Itstudise would suggest that poovaide, There is experimental evidencemotion is more nauseogenic when applie o es that motion sickness s9 teosthrough the X (dorso-ventral) ai of the are teduced by mental activity th a de-body than through the I (cranio-caudal) creases the subjece awarenese of theaxis (Vogel at a81 ll), Nowever, in the prevoeaave Motion Zn :a udy o vestibu-tratment of seasickness it is well known Lar resPNes to whole bodyreotAoe aboutthat seasick mariners are better if made an arxh-horisomtol ais (Uorrgia a Geo"to I Ls down. Zt is poesibla therefore that to 6)p a high iaeineiee 0 Notiop 0sickess.an . hillatory stimulus is best tolerated vat reported. Of the It .subisaos who"in a posture which requitre a minimum of ftaled to soapleoe the test procedure en

IA

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thiolacount, all were in the sub-gpouP instructor* may have to resist the tempta-who had been asked to report accurat•ly tion to show off to the student the fulltheir aeneations of motion, vhereas all capabLiotis of the aircraft at this stagesubjec• t who veto assitned a key press or in training. Tolerance builds up with

* a mental arithmetic oolk were able to continued flying but airsickness may recurcomplete the test, with the introduction of new manoeuvres

%uoh as steep turns# s•inning and &*robot-Ioa (Tucker at all It 5).n space flight

i i L..mJhuihkUiimafa 66 nraA*iVS the maIlLis and nausea that. ma inL•i•alybepAevokad by-head movements nthe seraSriv.ýy environment graully diminishest

In addition to behavioural measures 12 ypically over a. periodof 2 -o 4 days.,further important factor in reducinmotion aicknees susceptibility in that •• similarly in laboratory experiments, theadaptation. in this contextiX adapttop *04In.e of image-inverting spectacles

refers to the increase in tolerance tQ a initially provokes severe visual Macerien-nce ogenic stimulus that occurs a,,v U ttioa and, with continued efforts toper .4 of several dots or even wssiso carry out normal Activities,# ymptoms ofreatedexposure. h neurephysiologit maaise and naueca. After wearig e*pets-would use the term habituation for this alse continuously over ceveral dayS4phenomenon, and Would reserve the term nausea is lose readily provoked and looe-adaptation to refer to changes in the motor activities become more normalmagnitude of the response during the (NilaeLian & Held, 196$), Likewisecourse of the application of the atimulus, experimental subjects who a @pnt severalSoth types of adaptive responne can be days living in a room that rotated about alean With action sIcknes., EXposed to an vertical axis at 10 rpm showed adaptationappropriate level of stimulus over say 30 to both the neuromuscular and nauseogenicminuteeanindividual may show an initial consequences of this environment (OraybielloTs of Well-being followed by partial or at e.1969).complete recoveo.y indiative of a shortterm adaptation ithin the period of the A distinction eon be made between thosetest (Fig 3). environments that produce a consistently

reorganised rel•dienmship between theILee. various sensory output of motion such as

4. o oti mnerogrdty envYironment of space, the0...... -- No 4-1tms oilaoninued wearing of image reversing

Speo eotele eand to a lesser degree themotion environment of a ship# and thoos

1*environments to which exposure is briefand Intermittent, such an •light InvolvingAerobatics.

4' in the form•r group of onvironments it ishypothelised that new sneeory inter-rela-tionship s are established that to someextent replace or overlie those thatpreviouly existed, As a goenonau e thereturn to the normal torrestriai environ.

0mont is Associated with a temporlry degree* 5 a is . sa 8 of mel-adaptation and evon mild motion

TWme (m) sickneaso symptoms, termed mal dodebarqueinsn,Figsre a, rt term adaptive responseto a JO a expoauae to a conae Adaptation to aerobotic flight may beIntensity low frequeny vertical quliti vely different and involve anosillati~on. rho onset and cessation of extension otthe repertoire of patterns offorehead sweating r•f•e•ts the chamnges i noeory input that the brain accepts assubleov~el well-being, legitimate.

Adan~p~tA. •iank afr makian Slak pnt.

Researdhere have attempted to use other The use of adaptation as a therapeuticmeasures of adaptation such as the rate of procedure is most apropriate to thosedisappearance of illusory sensations situations in which, Polowing treatment,produced by repeated head movements in a there to sufficient continuity of exposurerotating environment (Reason 1112). It is to the stimrulus to maintain the state ofnot however clearly established that sunh adaptation and also in which the economictests of perceptual adaptation are pradio- or parlonal conenquences of continuedtive of the rate of increase in tolerance moton sickes a ke a time-oonsumingto nauseogenic motion, treatment programme worthwhile. Though

paefolilht Mit thee or rter:i it isThe phenomenon of Adaptation is well known imPol ib e at yet to prodict who willamong Mariners in whom seasicklins symp- sufer apices icnlll and uncertain as totome abate during the first few days at whether t9 eronao aguired to any earth-sea accompanied by an improvement in bound s t?.uiu would tranifer to thelaodootor ce-ordination aboard ship, a mLrogravity anvyxofme• in mimia., t% isphefemloon colloquially known as getting perhape in the treamnt ef ain 2 1oknes inonels sea legs, Adaptation Is also a military 4AiVrow that adaptat on treat-fes4ure of airreaw training. The faMil- nent hag proved t of mast vaue.

* icrisation sortie mAy give rise to alirarwpinkness in M13 of sircrow and flying Zn 1035 Dowd described the successful "X

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return to flying of an alrsick pilot who subject carry out a visual search took.TheONe Vi I week period received twice daily severity¥ of the Ltimulus ie also doter-sele one of crose-coupled stimulation. mined by the peak acceleration level, The

Name level ts used throughout each sessionTreatment programmes for airsickness in and is set to a level named on survivalstudent pilot were otarted in 1t65 both time in previous seomLone, that the sub-in the RAY by Doabi and in the UNIAl b loot wo:ud be expected to tolerate for go.Dowd. groas-coupled Stiiulation was U161 50 minute.,a4 a means to provoke eyptome of motioniliChese and subjects•" nhekaed their Under this treatment regime most subjectstoaeransa to this stimulus by increuental show adaptation as evidenced by an ebilityexposures. Unlike the Uspr egrime, that to tolerate increased stimulus intensitiesIn the IRAP invoved frOm the outset a or by longer survival timoe. Also in the*envd Of remedial flying before the course of adaptation subjects find thatndvviual was returned to trainin. following a treatment aession, their

Review of the first four years of the In recovery time from the Sme level ofprogramse showed that of 75 sircorw treat- malaise *comes shorter, by the end ofed, 41% had continued in training for the the grpund phase the expectation is thats month follow up petiod. The comparable the maArity Of Subjeots will tolerate 30-sucoems rate in the firet 50 cases treted 30 head movemoent sequences while rotatingin the RAY Programme was Mt (DObie, at d0 deg..' and will survive got 301174), and It hks continued to be at or minutesi. vertical osoillation at 0.3nsmabove this level, it in therefore tempt- *3,bmms. While some exceed this rites-ing to ascribe this difference to the rLo,:, others show a very poor ccapacity toinolusion of remedial flying, adapt (Fig 3). This failure o adept

Be ms to ae more common among airorewThe RAY airsickness deasnmitimation pro- referred from maritime reconnaissancegrame at it p reent itene of evolution aLrcraft In whichi compered with aoro!aticconsm Its of a day aesessment phase a 4 feat jets# the atTuluse level is relative-veak ground phase and a S week fying y. now. but eotinues for 0-. hours,phase. ;(n practice, owing to the va- Aiarre who continue to have motion mick-garies owehe aiArcraft serviceability nose problem. on thim type of aircraft areand airorew Il nem, onlýy the ssessment probcbly failing to adapt, not just be-phsea is of a fixed length). twean succeasive sorties, but alms within

t;e duration of each sortie,The asseesment consists of a medicalinterview, vestibular function tests (postrotational and sinumoLdally Induced nys- stimulus doestegmus and positional test), psychometric Tootests Iysenc2( Personality inventory andCatell 11 Personality Factors tests) andassessment of initiLl tolerance to the sac

aund-phase stimuli (oroms-coupled atimu- -

Ston and low frequenoy (0.35Hs) vertical tooosoillation). During t e ground phase oftreatment su eats undergo twice daily -.

asesions of e crosse-coupled or low 400frequency vertical oscillation stimuli(usually the same stimulus in any given solaweek) blt with an overall bias oawardsross,-oupled lesions.

During aross-coupled stimulation ths esubject site in an enclosed cab on a to: --turntable and makes head movement me- , 55tquences to and from each quadrant in pitchor roll in random order over a 30 a peri- 1 10 is go gs

od, During the earlier part of the coursethe rotational velocity of the chair is Run numberincreaented grom sera by 1,2, or 3 deog.after every head movement sequence. The Pflge $, lowg term adaptive remponsem Inrate of increment is determined on the two Individuals erposed to twice dailybasis of initiel sUlelrtLLt~ o the more loemaoll of *Ancree•atI•q levels of aroea-SUsceptible .ob a ets bain allg ned lower coupled stimulaton.rates of Increment and hus relativelylonger session duration. liter sessionsar•e erted at higher rotational veloi- Pollowing the ground phse*, pilots andties. Ivory 3a the subject reports his navigators fly a Is hour coUrse under the

bell being In a I to 5 scalel the session supervision of a dedicated pilot. Theis61 stoepod as soon as a rating of 4 flying I! graded in the Introduction of(Moderate eausea) it reaced Reserch is provocative manouvres according to theyi* . e e% rmat of tc ee th sesio rZ earh heo .i csoure ,is similarart ntle fn prograes to 94u1y the effect cub1 eot*a .ellbeing during the sortie,:11 adopt itAlrl Oa IIIp~ In i t e asso zn to oar, sagesl the course is similar

atl mild 211 malaise). for bot 111tsla navigators and bothro~p eri encour ed to t•ke aonthcl of

lessions of low frequency vertical eomil- IN !rcraft$ Zn t1 e later staest pilotelation are carrieli out on a an stroke learn to tolerate incrasingly vigorouspltform oscillating t 0.oSIo, NauILefg- aar.bOtia sequences while navigatorsnioity of this Imulus is int.s.lOL at undertake the navigation of low eovlINK an' .llesure that preuluIas A Lev of voltol AM Iritl (lehev t It a itIs viua erld l01 ; SAMg the t e t)t

I.. -. , ,* . . . . . . . . . . ., ,,.-;-_ • _-. .. .,._-...

in aircrew referred for treatment of____ranser __ ad_ _ _ation_ airsickness failed to show a correlation

e -f abetwemn the rates of Adaptation to the two

Implicit in the use of qround-baeed craos- stimuli (Itott, 1990).coupled stimulation Is the eassmptionthat tolerance acquires to this stimulus Although the adaptive rate may be anwill transfer to the motion environment of individual characteristic it may be poasethe aircraft, This proposition has not ble to influence the r~t~e of adaptation Liformally been tested. Much of the experi- the laboratory by the ep repriast choicemental work on adaptation (reviewed in of conditions. par example, it is likelyPar er A Parker 1990p Stott 1530) tend$ that if each treatment session repeatedlyto indicate that the heot term adaptation provokes Vomiting this will be counter-that ocuurs sver minute. or hours is productive to the process of adaptation,highlg specific to the initiating stimu- geveral experiments to study the effeet oflse, but that a somewhat more generaliosd difforent stimuls proflaes in adaptionadaptation Is evident over a period of were conducted in the Peneaca slowdays. Nome deo•es of correspondence can be Rotation Room (Iraybiel at Ali 1961,doioerned betiwot the laboratory stimuli 1069). Subject@ spent up to 16 day$ con-and the aircraft motion environment. Low tinuously In this rotatin environment.hvequency vertical oscillation is one The responses of subjects who began rote-nauseagenic component of flying in turbu- tion at 10 rpm from the outset was com-lence, similarly, croas-oupled stimuli pared with various incremental approachescan result froma pilot making head move- to the final Velocity. using a protocolments when the aircraft Is in a sustained of nine increments over a period of 16turn, This is particularly so in the high days adaptation wac achieved in .ourrates of turn that can be achieved by subjects without motion sicknees symptomsaerobatic light aircraft or by gliders other than excesoive drowsiness, Byflying in thermal•. However, the crose- uontrast four subjects aMposed to thecoupl•d stimulus is lass saevere if the abrupt easet of .0 rpm expe•r4ened nausea,turn ai not sustained or if, as in high two of whom vomited# one repeatedly, andspeed flight, the rate of turnis low. it was judged that none had fully adaptedby the and of a 12 day period,High performance Aircreat manoeuvres oftenInvolve high a# and head movements in this zn thons conditions in which motion sick-environment can also be both disorientat- ness is provoked by movement kn an atypi.ing and nauseogenic. It is unclear wheth- eel environment, for example, wearinger tolerance acquired to a laboratory image inverting spectacles, In mlcrogravi-crose-coupled atimulus transfers to the ty, or in the slow rotation roomt activehigh a environment. stIl less Likely I movements by the subject are likely to beit that crose-coupled tolerance can give more effective in promoting h adptationprotection against the low frequency than when the subject is passive and movedvertical osoillatery stimulus typical of by external means, It is postulated thatflight in low level burbulanca, Laboratory voluntary movement generated •repri!cptivestudies on the transfer of adaptation end tactile sensory signals that feed backtound no increase in cross-coupled tolsr- to the brain (reafference) and are com-ance as a consequence of an increased pared with what is teormed an effereneetolerance to low frequency vertical osoil- copy - an oxpected sansory pattern basrilation acquired by repeated exposure to on the init el efferent motor activitythis stimulus for 2h/day over 15 days (Von Hoist 1054), railure of the reaffesr(Pobvin et &1, 1977). ant signal to match the efference copy

leads to illusory senfations and Correa-tive motor activity and, if a consistentnew sensory pattern persists,,to an adar-

iLaEI f inflmnainng th at&a qf adapt&. tiva response.

Anti-m•tllon sickness drugs have been usedThe rate of adaptatLon varies widely in assocLation with ieeatitve nauseogenicbetween inditidiiais both in adaptation to stimuli in the expeaeation that they willnovel motion environments aind to laborter- facilitate the adaptive process, tn ary motlon stimuli. Although a period og study to ýest this posaibility (Wood at2 to 4 daya is often quoted for adaptation al, 136) it was found tYlah hyoasine 0.6mgto the space motion ensuironmqnt some with amphot~mine 10mg or hyoaaine 1.0 mgastronauts have experienced spac s•e•fnea alone produced a more rapid rate of in-fer longer periods, In a review of space orease of tolerance comparuJ with ploceanmotion sickness in RuesaiI missions one over the 3 dayd on w ih the drug wascosmonaut suffoced space eiaktass th•r-ugh- taken, However, when the subkýr,:ts wereout ,he 15 da.,• of the mission (Matonev at testoe 1 day after etc ppng mi'jication,4 l, 1'03). fh,& persintonce of sea sick- tolerance had deoreeas, ta,,.•:rds pro-treat-ness symptoms during A voyage I less l enPt levels and was signiticantly le~sclearly evidence of slow Adaptasion since, than the level ot tolerance acquired byon account of the variability of ine sea sub3eots on placab. ThL Oxgpt ftal inIstte, periods of calm could lead to the tolerance was ascribed to a phsranoegi-aee of previouely gained adaptation, cal rebound effeut, but an equally valid

conclusion is that scopolamine hindere theGreybiel ansd Lackner (1303) compared the process of adaptation, it may be ofadaptive rstes of 14 indivi'riuea to three relevance that hyoscine has been shown todiffoefmet nAUUeeqm6Ae, stimuli and found •nhib£t verbal searnint proess .(2oewthat qualitative omtLmates of adaptive 1970). There is some neurophysiologai

rate for each stimulu wars similar within evidence to suggest that a.adlttih toeubjeote, A study of the adaptive re- con li"ting Matiah simuli nlve

sponsa to rep*eated Oross-coupled and to could be considered as Cerebellar learninglow S equency vertical oscillation stimuli mechanisms,

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k,,4aeio ..~ack~Iafti~n.of eleeticated bands sold as *Ne a lnds'or *Acubands", that apply pressure to a

Autogenic training, has been developed as point above the wristf known to acupuna-an alIternative to repetitive st imul us turisto as the 116 or ROLeii~an point, as aadaptation to alleviate *pact sickness prophylactic treatment for motion sick-(Cowing. et &1, 1077). The essential ness. Two controlled trials have failedproblem in attemptting to. pro-adapt indi- to show, any benefit of this treatmentviduals to the action environment of space (Irc at a 1, 12001 vijtdeahaag at al,is the inability to produce a weight laes 1991). Nevertheless, the placebo ef fectenvironment Nor adequate length* of time of any form of treatment, prescribed withto enable subjects to build up tolerance conviction, may be beneficial to somato movement in sero, 0. individuals.iAutogenic feedback training is described while acupressure is not significantlyas a combination of bieofedback and auto- better then placebo, self-administeredini therapy. it is based on the proposi- alectrical acustimulation has been shown

lntat the acq uisiti~on of voluntary to be of benefit when compared with acntrol ever cartain of the autonomic control group who received no treatment,

reeponses that characterLee motion sick- and with a placebo group In wh.4.chath.noes would allow an individual to attsnu- device was not switched on but who were

&to at will the whole symptom complex and told that the frequency of the atimalAsthereb Increase his tolerance. Further- made it imperceptible, However, even thismove il the training were aimed at control experimental protocol does not eliminateof the expression of motion sickness the placebo effect of having perceptible,tolerance tdicrant motion that was the form of aelcrcshock that thenot confined to a specific type of atimu- therapeutic device is doing something.lue, Tbs technique involves both visualdisplay and auditory feedback of several Similar considerations about the placeboautonomic responses that occur during the effect agply to the conductive strips thatdevelopment of motion sickness, In the dan le ron the rear of cars to preventstudios carried out by Coving. a Toecano motlon, sickness in the occupants by dis-(reviewed in Cowings, 2 900)p tne monitored charging to earth any accumulated staticvariables worst heart rate, respiration charge on the vehicle. Even if staticrate, pltymgeh fth igrado lectricity were to p lay some part in thethe sin adjacent to the mouth, skin development of car sickness, the charge onconductance of the fingers and electromyo- a hollow metal box is always on the axte-graphic activity in intercostal muscles. nor surface while the interior is alwayscu Ocet: were taught to control some of at cear potential,

theme ,aeponsaa both in the direction ofreducinq the autonomic response to motiona1kness and also in the opposite direc-

In a series of experiments it was shownthat tolerance to acrss cou pled stimula-tion administered at weekly intervals ~ .increased at a faster rate in subjects whoreiceived autogenic feedback training thanin corntrols or in subjects given a acghi- Applebee TR, McNamara TN & Sitis An.tive task~ to perform. It was also shown Investigation into the seakeeping uharac-that there was an increase in tolerance to teristioc of the Us coast guard 140-ftot~her nautteogenic stimuli namely, head WIGS class cuttersi sea trial aboard themovements during 0.33 No t0.36 0 vertical UNCOC mobile bay. Report DTMJRDC/EPb-o§38-ocillation, and head movements during 01. Dlavid W Taylor Naval Ship Research andsimultanecue chair rotation and yaw axis Dlevelopment Centre, Ship Performanceeptokinetic stimulation. flepartment, Bethesda, Md. 15000

sagehaw, N & Stott JR3. The daseoneitisationAn assessment of the technique has hither- of chronically motion sick airarew in theto involved only one space mission. Two of 1Royal Air Force. Avist. Space Environ,the four astronauts an the mission re- Ned 86 35, 1144-6I.ceived autogenic feedback training. Allfour astronauts suffered some symptoms of Besnon AJ. a Quedry ?I, Comparison ofspace sickness but those were least in the tracking task performance ano nystagmueindividual who was considered to have daring sinusoidal oscillation in yaw andachieved greater autonomim control follow- pitch. Aerospace Ned. 42, 1071, 553-601.Ing treatment.

11ruce 0O, Ooldig 319J, NockenhullN 4Asimilar technique has been used by thb rehybnidge Ki. Acupre Isure nand motionus Air Porce in conjunction with cross- sickness, Aviat. space Envira on, d. 61,coupled stimulation as a treatment for 1ogo, 381-.8airsickness in aircrew (Cons "et al,11385). of Is sircoew accepted for treat- Caresia, P.. Airsickness rehabilitation inmint, 79% successfully returned to flying the Canadian forceni A preliminar report.and a fulther It were partially success- Annual scientific meeting Aefos ice maiful, Ih atreatment also forms art of cal Association. 1933. Rprints 63-64.the Canadian Air Force progrem for the

axis, Acta Citolaryagol. fat 1368, 212-305.Therem has been recent interest in the use

. ... ....

___ ___ ___ ___ ____ ___ ___ ___ ____ ___ __ j~r, A

Cowings 1, P iiinghem J A ToNCano WS. Lackner JR A Graybiel A. Elicitation ofLearned control of multiple autonomic motion aickness by head movements in theresponses to compensate for the debilitat- microgravity phase of parabolic flighting offsete of Motion sickness. Therapy maneuvers. Aviat. space environ. Ned.PaycIooom. Nod. 4, 1977, 318. 51, 1354, 513-520.

Cowing. P. Autogenio feedback trainingi a Lackner JR & Graybiel A. Head movementstreatment for motion and space slckness. in non-terre•trial force environmentsIn, Motion and @pace Sickness, Ed. Cramp. elicit motion siaknesss implications forton ON. CRC Press, $Doo Raton. lot; 0 he etiology of space motion sickness.Ch.l?, 363-72. Aviat. Space Environ. Ned. 5?, 1316p 443.

448.Crow TJ. Action of hyoecine on verballearning in meat evidence for a choliner- Lowther A A Griffin NJ. The motion of agic link In the transition from primary to IhLp at sea and the consequent motionsecondary memory. Zni Drain Mechanisms in sicxneus amen passngers. Srgonomios.Nemory end Learning! From the single 03, 1936, 635-1I.Neuron to HNe.. Rd. $rasier NAN, RavenPress, Now York. 1073. Natsnev at, Yekovieva 11, Taralov 1K,

Alexseev VNI Kornilove LNM Nateov AD aDobie TO. AOARD/PATO, Meuii"y-our-opine. Gorgiladie 01. space motion sickneessAirLioknese in airorerw. 14, AG&ARDo- phenomenology# countirmnaaureso and mocha-graph AG-i??, 1974. nisms. Aviat. Space Inviron. Wed. 54#

19683 312-7.Dovd P3. Resisaence to motion sickneslthrough ropmated exposure to Coriolis McCauley ME, Jackson WR, Wylie CD, OHand-etimulation. Aerospace Ned. 30# 1305, ion JP A Hackle kR. Motion sicknece432-455. inoidence: exploratory studies of habitue-

tion, pitch and roll, and the refinementGoldding J a Norquslen N. A comparison of of a mathematical model, Humen factorsthe naumeogenic potential of low frequency Research %no. Eanta Barbara Research Parkvertical versue horisontal linear ceci Is- Gola!: Ca, 1376, Technical Report, 1133-2.tJon. Aviat, Space Environ. Ned, (Znpress). Mikeelian H a Hold X. Two typesI of.adapts.

tion to an optically-rotatod visual field.

Graybial A, Kennedy RI, Knoblock mC, Am. 3. Psychl. 77, 1364, 257-6),cuedry FBI Hertz N, NoCleod N, ColehouriK, IIllser IF B Frgly A. Iffects of Cman CH, Lichtenberg BR, Money RN & McCoyexposure to a rotating environment (10rpm) RN. NZT/Canadian vestibular experimentson four aviators for a period of •3 days. on the Jpacl~ab-I mismion. 4. spaceAerospace Had. 36, 10605 733-54 motion sickness symptoms, stimuli and

predLctabilLty. Ixp. Brain Rei. 64,Oraybiel A, Deane PR A Colehour 3K. Pro- 106, 316-334.ventios of overt motion sickness by Irore-mental exposure to otherwise hiqhly Parker DE A Parker KL. Adaptation to thestressful Coriolis accelerations. Acro- simulated stimulus rearrangement ofspace Med. 40, 1•60, 142-8. wsightlessnoss. lno Notion and Space

sickness, Ed. CraMpton Gm. CRC Press, BooaGraybiel A A Lackner JR. Notion sicknessi Raton, 1330. Ch.13, 347-62.M oqusiti=on and retention of adapstatono ts compaeod in three moti on- Potvin AR, Sadoff H a Billinghem 3.Monts. Aviat. Space Environ, Ned. 54, Notion sickness and otolith aensitivityi a1103, 307-11. pilot study of habituation to linear

acceleration. Aviat, Space Envircn. Mod.Griffin NJ, Handbook of Human Vibration, 46, 1077, 1060-1075,Academic Press, London, 1390. Reason ZT. Factors Contributing to motionGuedry FBI Benson AJ & Moore Mi. znflu- sickness susceptibilityi adaptability andance of a visual display and frequency of receptivity. lno Predictability of Notionwhole body angular osclatilton on the sickness in the selection of Pilots.incidence of motion sicknems. Aviat. AGARD-CD-10O, AGARD/NATO, Mouilly-surspace Environ, Mod, 53, 19832, 264-269. Seines 19720 B4, 1-15.

.tohnson WH A Nayne 31. Stimulus required Stott JRR. Adaptation to neassogenicto produce motion sickness, Restriction motion stimuli and its application in theof heed movement As a preventive of air- treatment of airsiakness, InI Notion andsickness - field studieo on airborne Space Sickness. Ed. Crampeon OH. CRCtroops. J. Aviat, Nod. 24, 1963, 400- PrewssBos Raton, INC0 Ch. 16, 373--0.411.I

Tucker 03, Hand D., Godhey AL a Reinhardtaones DR, Levy RA, Gardner L, marsh RN & RP, Airsickness in student aviators.Patterson JC. hli-control of psychophyo- Pensacola rlm, Navel School of Aviationiologic response to motion strs go using Medicine, NRAN-039, 1605,biofoedback to treat airsickness. Aviat.Space Environ. Ned. 56, 1915, 1152-1157. Uiltdehage HIs, Saligiver P1, Sterna RN

Xooh XL, Acupre•sure fails to releiveIeist IF, Shelley MWT Byers 31 A Chinn Ht. symptoms of veation-induead motion sick-Iffoot of head immobilization on Ancidmnoe nose (abstraot). Conference of the "arr-ot airsickness, J. Appl. Physiol. 8, can Gautroentoroloogicl Society / Americanlos5, 361-370. Association for the 1•Btdyo Liver Dis-

eases, New Orleansa lo le aoay 10,1.

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Vogel H, Kohlhaon R a van Bumgarten RJ.Dagendelol o• motion o~sinesm n automo-

abile on the d reotion of linear eacelera-tion. Sur. 3. Appi. Phymiol. 48, 1082,399-406.

Von soumbarten RM hdrigh , Vogel M It

ThUmler R. Physiological responsea tohyper-end hypa-gWavity duringa roiroast-er fligt. Aviet. ipace Inviron. Ned,

•)1 148-184.

von Hoist x. Relations between the centralnervous esyste end thP peripheral organs,Brit. a. Aiml Beheviour 2, 1064, so-94.

Wood CD, HMnna J11 Manna R, Odenheiome RCI Beitnefeher LU. The efeet of anti-motion ILoaness drugs on habitL•aton to

motion. Avlat. Speac Environ. Mod. 87,1086, 930-42.

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Prof.dr, W1J, OosterveldUniversity Hospital, University of Amsterdam, The Netherlands,

Motion sielekns onthnues to be a problem encountered In AviL.ton*, s well as in other means of travelling (1,2).Recent studies (3,4) have stressed the fact that the main teantment is still based on the use of motion sicknesssuppressants, Although a variety of drugs 15 available, none of them provides a watertight solution.

Motion sickness as An entity exists as long as men makes use of artificial means of transportation, As long as mensuffers from motion sickness methods of prevention and ways of treatment have been developed and ore still underdevelopment.

Besides advlces about food and fluid intake, the use of neklaces, a metal ring around the arms and plugs into theexternal Gar canal at the lite opposite the right- or left handedness, pharmacotherapy is as old as the problem Itself,

An important issue in the search for drugs against motion sickntes is that not only a satisfactorily action andprevention exists, but also that a compound is free from any distutbing side effect, Side effects which include anyInfluence on the working capacity in any respect.This regards especially crew members who have a responsible task, When it concerns paioengers side effects aremuch lass important,

So two different groups can be distingpished in the search for compounds active against motion sickness.

For centuries the search methods for new drugp ware restricted to experiments and experiences with drugs In so-called field conditions,

Laborattofy instruments are able to provide a means of investigation in order to evaluate qualitatively andquantitatively the effect of a drug on the vestibular system.It Is mumed that an effect on the resitance against motion sickness of subjects has a relationi with the resistanceagainst sickness provoked by stimulation on a rotAtion chair or in a rotation room. It should resemble the sensitivityfor motion sickness,However, the final Assessment of a drug Is si•wyi. nade in the particular motion sickness condition Itselfe

The Assessment of anti-motion sickness drugs into the laboratory sounds much more attractive, however there isaiways the lack of reality, the lack of stress as well as to some extend the lack of sway movements and verticalmovements,

When a drug Is expected to exert a suppressing effect on motion sickness, the available laboratory test methodsshould not only provide objective measurements about the potency and the duration of action, but should also allowto eliminate adaptive meohanisms by the body, As well as psychic Influences, In addition this research model can usea placebo-group, which is usually impossible in clinical studies of this nature.

Old prevention methods concerned behavior activities such as eye flxation at the horison, and controlled respiration,Also eating onions In order to avoid an abdominal vacuum, Purthermore a whole bunch of advis with regad foodand liquid intake As well as the use of a spread of products,The use of a drug wast first mentioned in 19 in "the Lancet" where in a letter a combination of chloroform andtinctura of belladonna was recommended. This was als the first mention of a belladonna derivative,

A study published in "the Lancaet" revealed that between 1829 and IO00 practically evecrthin8 that could be carried,worn of swallowed wat prescribed at one time or anotlier, Thest prescriptions werL Ao. opium, cocaine, strychnino,creosote, quittine, nitrons exdde, amyl nitrite, hydrocyamic acid, nitroglycerine, warm salt water, strong tea or coffee aswell as a variety of Aleonolie bevermea (5).

The se-land operations in the Second World War initiated the development of modem drtV because of the militarynecessty,It b ycame apparent that in the deulp., of motion sicknes drug tril useful control - of uttermost importance

because of the many influential variables involved,

In experiments several methods were used, all providing at particular combination of movements. Many differentdevices were constructed imposinil a controlled motion upon their occupants,

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Mehdduration (h) bmvetltorcrmnll ships 1 - 4 Hill 1945 (6), Glaser 1951 (7)a Ircraft I -7 Chinn 1953 '8), Strickland 1949 (9)1ifa rafts IGlaser 1952 (10)r~lnp 1/31 Smith 1946 (11)vertical accelerator 1/3 Johnson 1964 (12)slow rotation room 1/2 Oraybiel 1960 (13), Wood 1968 (14), Wood '1970 (15)troopships Atlantic 48 Gay 1949 (15)mine swtiepers 48 Arrcr 1958 (17)

However, thetre were many doubts as to the relevance and validity of the devices In the evaluation of anti-motionsickntess drugs. The muspiclanas were partly c~rtfimed as It appeared that drug. with a promen value against seautlckneaawere relatively Ineffectivec when tested by the motion of swings, accelerations or life rafts.Furthermore we. ef~ect of a drug was usually assuessed by mneatns of its effect an symptomns as vomiti, mweating andgeneral feelingsp of vieU-being. Real objective measurements were not available,

In considering the effcacy of ti drug the aize of thme given close Is for many reasons an important factor. Usually adrug hits a rngep of doses over which a gradually increasing effect wil be observed until a maximum Is achieved.Very Important is also the time interval between intake and maximum effect. Miscloalne, a long-iatting drug, activewhen gives in a once dally dose In experimental conditions at sepi for 48 hours appeared no more effective than aplacebo when given In the same -dose, but only 2 hours before exposure to 60 minutes In it life raft, So manyexamples .An be given1 with regard the moment of Intake, the moment of maximum action and the duration of theeffect.

In this respect the following diagram (5) gives agood example of the effective blood level to timeof experimental observation. The moment the test .

procer~urc Is applied gives false Information In caset- C ,.,.~ O~

b (fig. 1).It means that for every drug to be Investigated at anumber of Intervals after the administration a tellhu to be conducted,. . :::::.

In tho pubication of Wood (18) the antl-motiotsick eat drugs at that time were divided Into tour I __

groups: anticholinerglils, antihilstamines, tranqulizsers ~F4 F.

and miscellanteous. DIt Is nowadays cleaw that such a classificationt doesjriot serve any purpose,The Pensacola Investigators, headed by Ashton . . . . . . .

Orayblel, made a review of the available drugs inthe sixttles and with the use of the slow rotationroom made~ studies about the etffetiveness. • ... L.... . . . .. .

Several laboratory techniques were used In ratherrecent times.The oupulometry was first described by Van IFig. I. Diagram relating effective blood level to time o,Egmcand (19) and later used for many years as a experimental observation.screening test for the sensitivity of the vestibular"sytetm. With this test an individual Is subjected to an acceleration on a rotation chair tIll a constanit velocity Isreached, Ihen, following a sudden stop both the length of the provoked rotational sensation us wall ats thepootrutatlonal nystagmus Io measured. T1he change In thean parameters Is assumed to give Insight into the effect of adrug on the vestibular systemi, and so on the tettaltivity for motion sickness,Cupulo014toey Is not vcry popular anymore in motion alckritcu studies, especially since Dobie (20) was not able toconfirm the assumption that motion sickness uscrwntiblllty could be determnined in an extensive study In 1000 humansubjects.

With the dili test (21) a stimulus was admininstered for the c.,ntrolled production of mol~on sicksiess. The test requiresthe subject to make prescribed settIngs on a series of E~ve dials situated at fixe positions around his chair. Thearrangement of the dials is In sitch a way, that substantial head an body movements have to be miade In order tomake the aetting. The head movements are asaumed to stimulate the nauseogenle conlollst vestibular reaction,well-being ratittia wert ma~c at the completion of each sequence of five settings. The ratings were basled on an 11point scalle: 0 w I feel fine, 10 - I feel awful, just like I ant about to vomit,Obmective signs and subjective symptoms reports together have toi be collected Independentiy,The method can be appilied before as well us following the administration of an anti-motion sickness drulg,It ttes a great deal to commend It ax technique far evialusting drug efflecacy because It allows a quantitative1anssaient of the amount of stimulation required to reach a welil-defined pee -vomnItting end point,

Several dirug studies have bean published by Wood and Graybiel (22), Wood (23).Fig, 2 gives an Impression of, the: results. Accordingi to these studies the combination scopolamine amphetamineproved to be most effective.

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Fig. 2. Hifuctiveness of antimotion sickness drugs In preventing motion siekness in 50 subjects e"psed on 500occasions in a rotating environment using the Dial Tast. P'rom Wood and Oraybiai (iD9l),

It must be emphasized that because of the chosen moments of measurements thene results did not fit very well withthe expieriences to reel motion sickness conditions,According to Parrott (24) traenadermal scopeolamine Is the most effective single drug for the prevention and treatmentof motion sickness. Chalo (25) reported that phenytoin increased the tolerance to motion sickness considerably.As an example of a drug study I present you the data of a trial conducted in our own laboratory,The effect of the two drugs. of their combination, end of it placebo on angular accelrartion-inducedd nystagmus andon linear aceeleralion-Inducod eye movements wus xcamnined In normal healthy human subjects. A compound such asCinnarlaine, which specificallyi suppresses the activitly of the vestibular organ, has proven to considerably counteracttorsion-induced nystagmus (26). It seems that under the effect of this compound, the, Inbytth becomes less sensitiveto stimuli, wiht the effect that roeaiv nyatagmus starts at a later point of the sinus-ahapedi stimulus and that it stop*soon r.The linear acceleration and deceleration test, specifically on the parallel swing, makes It possible to observe a drug,induced reduction of the dleflection of the nystegmus movement (27,29),Dotnperldone, too, has an effect on the duration of nystagmus, but apparently via another mechanism of action(27,20). In addition, the pharmacokinetic profile of Domperidone, a compound with rapid absorption and relstivelyrapid excretion. is cleauly different from that of Cinnarisine, which is slower in reaching Its peak effect, and which isexcreted more slowly. For this reason, It was decided to combine the two compounds and compare their combinedaction with that of the separate compounds.

Teat subjects and sellsadiullet Te stud) was carrded out In 25 healthy subjects. DEalt subject participated four times Atweael intervals. The teats wereN perflormned In the morning after the subject had a light meall,The torsions~wingq teLi The torsion~swing provokes an angular acceleration whic stimulates both horizontalsemicircular canals On the other hand the parallel swinl provokes a linear acceleration which stimulates the otolithu.The torson sr.mSg produce rotating accelerations In alternating; directions, In the tests, a 20.# oscillatIng period wasused . ne swing was rotated 90 in the horlornotal plane aind subeequently relleased. This produced a rotatingmovement of the swing in alternating directions. The slow rotation time of 20 a had a relaxig affect on the testsubjects, w*Ale the stimulation, which was supralimlnal onl Induced a slight senstion Of oscilltion. The stimulation011brought about a clear nystagrus wl'lch was possiblet to record eetcrsamgahelyThe head of the test subject was fiated by mean of a headrest with two pads. T1he subjects were blindfoldled whilethe eye were kept closed. Regular als tgogahclelectrodes, were placed on both sides of the huad at theOnl eye nmovemens in the horizontel plaus were reocorded. At the beiginning of a sequenee a subject was subjected

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to the torsion awing test and oxposed to five complete aecillatonI after which the test med;,Ation was administaredIn te~et form. At Ifixed points in time, after the administration of the medication, the torsion swing test was repeated,Bach time subjectt were exposed to five complete oscilations, For the calculation of the ealec of the compound onthe duration of the itystagmus, the time betweeni the firet and lut nystagmus movement in a given direction wasmeasured. For each subject, measurements were always based on the %lime direction of nystagmue,The parele~lak" tsab For the second part of the Investigation, a parallel srwing was used. This ronsisted of a load-bearing surface suspended from the celling with 4 ropes, 7The maximum deflection of the swing was 123 am, maximumaccaleratlon 348 cmxr', and maximum speed 203 cm.ý. Ithe time required for a complete oscillation Will 31'a. Withthe parallel ewlq, a airusoildally alternation liear acceleration wee produced which gvav rise to vestibul"e: yeImovements. Aus linea acceleration Is a saecific stimulus for thes otoliths, the Paalflel ewing tati may be fogarded a a,test for the otolitha. When a subject Is rw4Mn sidewerds, a sinusoidal eye movement Is elicited that Ie In phaee withthe ewing movements. Thes movements are caused by stimulation of the otolithe and of the uttleull.71a subject was positioned on tWe ewing with his heed flted in position on a headrest between two clamps. 74e eyes.which were closed, were covered With a piece of cloth, 7te swing was then pulled away laterally ovr a distance of123 am and relcased, resulitin In the oubjet's body making. lateral swilnging mvements. The cmpenststory eyemnovemlents were registered as described above, For each tast the subject was swung to and Wri 10dtmes, Aftersubjects had been submitted to the teat 3 times at 15Sthin intervals, the drug under study wee administered. altarwhich the test was repeated at Read. points In time.Before each test, the appatatus was calibrated by having the test subject with fixed head, look In alternating fashlouat two Buxd points on Cu oeftln an eye movement of 200 was made to correspond to a 20 mm deflection on *theregistration paper.The swing-lnducad regitered eye movement was a sinus movement. For purposes of calculating the effect of tilecompound administered, the maximum eye movement deflections were averagcd fbr each sub~sct, Each subjectcompleted the test fbur times, after receivingl at different drug each time, Thus, It was possible to compare change inthe regitered eye cmmvrents.Medisatiott In both petafs of the study, randontiestion wauswed for the seqenc of the four treatments In eachsubject (plcobo (pI) Cionneriline (C), Domperddone (D) and Trjurlstil (1+1))). as well Us for the order ofadministration to alsubjects pat saJy Awaj Cato *u &Ms taken that each drug be given with equal frequency inthe 4 phases. The investigation was carriead our In douole-blind fashion, I^e neither the subject nor the Invesidgetorwats aware of the composition of the tablets, which ware all the same colour, shape, and sizsa

Intemitly of thea veftiblar Itlbltiont During both rotation anid liear movement, Touristil (C*D) causedasignificantly greater reduction (p<0.05) of the duration and amplitude of nystagmus and eye deviation onl 15 mmafter the Watke. As early as 30 min after intake, Touriatil (C+D) performed significantly better (p-0.01) than theother medications. The shortening of the duration of inystagmus obtained with (C+D) was exceptional In the rotationtest: almost 61% ( 4%) vs. a maximum shortening of 28% (* 6%) for (D), 37* ( 6%) for (C), and 396 (:b M)for (piI) (Fig 3).

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Fig. 3. Vestbular depMesalo (shortenting of Fig. 4. Vestibular depression (reduction of Amplitude

duration) during stimulatiodn torsion Of 6"e movements) during stimulation ortoftPeakoffk offourmedlfitltilparalel win

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"s he average maximcum reduction of ampltude 0%~ the parallel "Sin tast was 2 (:k 5), 16 (~4), 26 (a4) and 30 (5) ror (p1). (D).,U nd(+) respectively (P4., 4). In Increasing order of potency, the following series wE.

obtaood plaebo Damerilood CinarilneandTowristil. Eaah of these "step$, wa# statistocally significant (pac0.05),The aibledm tiaslmrum inhibition (Pigp 5) was 4%, 30%., 39%, 62*, for (p1), (D), (C), and (C+D), rusplactilsely, in therotation test. 'he median amplitude reduction Was 6%, 1796, 269*, and 34% In the linear test. As previously, thedifferencels were statilst~clly significant (pcO.OO1).Thmet of masimum vudbulrIu luhblka -Maximum vestibular Inhibition was '" '

ruhdafe n average of I h (* 12 to or' l 1N~l i aso oa* ih (D ;24 It (ah 42 min) with - lw twIit(4 SW ft 4,UII

(C) and 2.12 hm with Touuistil (C+tD) In Is a 450, 4 1, lothe rotatio teat (fit. 6). This maimudmita

Mo~btion occurred at a signhlantyNI MS45earlier point in time with (D) than wt ism(C+D) and (C) (pmcO.0001)i while thedifferenes betwean (C+D) and (D) wasumsueffect in the Parallel swin test occurred .,at the end of 2.53 h (ak S8m in) for45.(C+D), 2.14 It (* 35 mlit) for the--placebo, and 1.24 It ( 42 min) for (C) iN N i

and (D).The Beptic (1%g. 8 and 9) of the countseof the vestibulair inhibition during the 4-h

*investigation give a sleaw picture of the Fig. 5. Shortening of nystagmus (torsion swing) and reduction ofeffiect of each medication. The placebo amplitude (parallel swing) at time of* maximum activity,effect hardly deviste from the 100%line, Cluisisnlan, with Its well known inhibitory effecst on the vestibular apparatus, Is slower In reamchingS Its peak thanDonaperidlone, Touristi (C+D), like Cinnarizine, induces a very strong reduction of the duration of ntystagmus at theand of capproaimatelys 2 ht, however Its peak effset is considerably stronger. Thea. curves, which were derived from the

two partial Investigations (rotations and linear), showved an Identical pattern. As already stated, the rotation testevidenced a stronger quanthtative effectThse 10* bhI c vietlialt knhblcu A shortening of the nystagmus by at least 10% in practise Is asummed tocorrespond to ant aotrty in the prsvsntqc~ of motion sickness (29). C~ts level was reached with Touristfi (C+D) in 16teat eubjasts within IS main and lIt the total study group (n-25) within 30 min. With (D) the figures were 0 mid 21qubjects, respectvlvlyl and with (C) 0 and 10 subjects (flit, 7). The WO =I .. 1,11111114

eaun time (6aD) to the occurrence of 10% inhibition was 20 min M____wi'h Touristill (C+D), while the same values for (D) and (C) were, -

respectively, 35 nin and I h (fIgl 10). These differences were also b~l

statistically significant (p40.,01).

Although measurements were only taken up to 4 h after Intake of e,

the teat medication, the duration of action of Touristil (C+D) as a ~7medication against motion sickness in the present Investigation was __ UIs. 411is alllonger than that of (C) and (D) (Fill. 11). Again, the differencesu '" *NI,were sig*Mcant (p-O.001). Contrary to the torsion swing, the U 14 aeevaluation criterlum adopted for the same santi-motlon sickneass,activity in the parallel swing teat described in this paper was a less. . ,

than.1096 reduction of the amplitude of nystagmus. A comparison ,~,,

of the data% obtained using the two swings shows that the value inthe parallel swing teat must be around a 5% amplitude reduction. Fig. 6. Time to maudmum inhibition wvithThe times recorded for reaching thin minmum of 5% amplitude rotation and linear swings. Wflcoxonreduction show a rapid effect, similar to that obseived In the 2-talled.torsion swing As before, the diffrnusns with (C) antd (D) werehighly significant (pa;0.O0l) and in flavour of Touristil (C+D). to factn this point was reached at the end of anaverage of 25 mins with Tourlatl,Superior~itofTouisial to annarislsi:Ftg. 12 and 13 show that the gretest differsice In afflcacnybetweenChnnarisise (C), the more potent of the two compounds, and Tourissi (C+ D) was seed In subjects who respondedpoorly to () on its own. Toa Pearsn correlato factors were 0,34 for the torsion swing and 0.81 for the parallelswing, and both were higly significant (pac.000OO1).filde @&ft No side effects werte observed or reported during the study,

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Pig. 11. Vestibtular inhibition durin Stimulation on Pig 12 Correlation between the additional effect of taturitilthe torsion swing The mediano and the and the offset of cinnarrlae separately (rotationextrectes of the duration of the nystagmus are tests)indicated for all four components separatelly.

The aim of the study was to asamine the inthibitory affect of Touristil, a combination of Cirmarizine 40 mg andD pedoe30 mg, on the labyrinth. Each of these two compounds amerts, a vestibular inhibition separately, albeit

through different mechanisms (1-5), The activity of Cinnarialne (C) Is rather slow at the onset, and reaches amaximum after 2.3 hours, while the peak effect of Domperidons (D) comes about more rapidly (slightly more den 1b). It emergad from the present Investigation that the two separate compounds (C) and (D), once In combination inTouristil (C+D), had a synergistic aoffot on the vestibular system In the torm of an Inhibition, The msimumreduction of about 60% obtained in this study Is altogether exceptional In this typ of investigation end clearlyunderlines the potency of the new combination. In addition, the rapid onset of action of Touristil Is a furtheradvantage of this new medicine against motion sickness (fig. 10). This prompt action, moreover, has long duration,which would be especially useful in case of a long-lastln endogenous or exogeonous excitation of the labyrinth.Finally, It should be emphasized that ftO UP., Okiboth Touristil components are safecompounds. In addiction, this studyshows that Touriatil In moat affective inthose subjects who are not affected by ?(C), the most potent of the two, when$Iven exclusively (fig. 12 and 13). Thiscan be explAined by the different Ipharmacological properties of the two jComponents: Cinneuluine is a Ce~l-ntryblocker and Is known to be, amongstother things a direct vestibular Inhibitor, 1 0It Is not known with certainty in whatway Domperidone, a peripheral -dopamine antagonist, affects the silabyrinth. As there Is en obviousrelationship between the Inhibitory actionof a drug on the labyrinth and its value Fig. 13. Correlation between the additional effect of touristil and theas a medication agsinst motion sickness effect of ciannriuine separately (parallel swing teat).It may be conchsded that Tourietil is avery potent prepa~ration against motion sickness, In addition, Touristil approaches the profile of the Ideal drug againstmotion sickness marm closeely than any other medication. In this connection the rapid, potent, and long-lasting effectsof Touristil are of particular relevance.

Representation of the data of this study are meant to show you that laboratoty modeis are useful to some extend.However, the finai proof must always be given In the conditions where a drug is expected to work.

~~4 1,-

01. Flomick J1. Space motion sickness. Acta Astronautica 61 1259-1272,1979.02, Kohl RL Sensory conflict theory of space motion sickness: an anatomical location for the neuro-conflict.

Aviat. Space Environ. Med. 54: 464-465, 1983.03. Wood, CD, Manna M5 Manna BR, Redlabsi HM, Wood MJ, Mims ME. Evaluation of antimotion sickneog

drug side effects on performance, Aviat. Space Environ. Med, 56: 310.316, 1985.04. Schroeder DS, Collins WE, Slam OW, Effects of some motion sickness suppressants on static and dynamic

tracking performance. Aviat. Space Environ, Med, 56t 1144.35% 1985.05, Remon 71', Brand J1. Motion Sickness, Asedamid Press London, New York, San Francisco, 1975.06. Hill 10, Guest AL Prevention at seasickness In assult craft. Brit. Med. J. 2; 6411, 1945. At07. Oloser EM, Hervey OR, The prevention of seasickness by various drugs. Lancet 11; 749-752, 1951.08. Chinn HI, PlotntLkoff NP. Evaluation of various techniques for screening and motion sickness drugs. 3. appl.

Phyoiol. 51 392394, 1953.09. Strickland SA. Hahn DL The effectiveness of Dramamine in the prevention of airsickness. Scieince, 1091

359-360, 1949.10. (laner EM, Hervey OR, Further experiments on the prevention of seasickness. Lancet I, 490.492, 1952,11. Snmith PMC Hemmingway, A. The effect of atropine-like drugs on swing sickness. Proc. Soc. exp. Blot. N.Y

63; 206-208, 1946.12. Johnson C, Wendt OR. Studies of motion slcknesit XIX, 'Me efficiency of laboratory tots of the preventive.

action of drugs. J. Psychol. 57; 71.79, 1964.13. Grayblel A. Clark %, Zarriello, JJ, Observations on human subjects living In a "Slow Rotation Room" for

periods of 2 days. A.M.A. Archives of Neurology 3; 55.73, 1960.14. Wood CD, Grayblel A. Evaluation of sixteen antimotion sickness drug under controlled laboratory

conditions, NAMI.997, Pensacola, Pla.-Nave Areropace Medical Institute, 1I68.15, Wood CD. Anti-motion sickness thterapy, Ini FPfh Symposium on the Role of the Vestibular Organs In

Space Etxploration". NASA SP.3 14. Pensacola, Pla, Naval Aerospaca Medical Institute, 1970.16. Gay LN, Carliner P. The prevention and treatment of motion sicknoas. 1. Seasickness. John Hopkins Univ.

and Hospital Allergy Clinic Report, 1949.17. Amer 0, Diamant H, Goldberg L, Wrangle 0. Antihistamines In seasickness, Arch. Intern. Pharmacodyn.

Therap. 177; 404-415, 1958,18, Wood CD, Kennedy RS, Oraybiel A. Review of intimaotion sickness drugs from 1954.64, Aerospace Med.

36; 1.4, 1965,19. Van Egmrond AA. Goaen, J), Jongkoee LOW. The mechanics of the semicircular canal. J.1 Physiol. 110; 1-77,

1949.20. Dable TO. "Airsickness In Aircrew". AGARDograph No. 177. Technical Editing and Reproduction Ltd.,,

London, 1974,21. Kennedy, IRS, Oraybiel A. The dial testi a standardized prneeduie for the experimental production of Canal

Sickness symptomatalogy in a rotating environment. Naval School of Aviation Medicine, NSAM-928Pensacola, FPa., 1965.

22. Wood CID, Orcybiel A. Evaluation of sixteen antimotion sickness drugs under controlled laboratoryconditions, NAMI.982. Pensascola, Plie.. Navel Aerospace Medical Institute, 1968.

23. Wood CD, Stewart JJ, Wood MJ, Manna SE, Mimis ME. Therapeutic. effects of intimation sicknessmedications on the secondary symptoms of motion sickness. Aviat. Space Envilron. Med. 61: 2, 157-161,1990,

24. Parrott AC. Transadranal scopolamine: a review of Its effects upon motion sickness, psychiologicalperformance and physiological functioning. Aviat. Space Environm. Med. 60 1, 1-9, 1989.

25. Chelen W, KAbrlsky M, Hasseil Cq Morales R, Fix E. Scott M. Use of phenytoin In the prevention of motionsickness, Aviat, Space Environ. Med. 61: 11, 1022.1025, 1990.

26. Goeterveld Wi. Effects of a combination of chlorcycliulne hydrochloride and cinnarlane on the linearacceleration test. Acts Physiol. Pharmsaol, Neerl. 13; 348II,195

27. Oostervtld Wi. The combined effect of domperidione and cinnarlalne on veatibular nyatagmue. JanstenResearch Products Information Service. Clinical Research Report, January 1979,

28. casterveld WJ. Vestibular pharmacology of domparidone In rabbits and man. ORL 43;1 175.189, 1981.29. Ocaterveld WL, The action of two an t-motion sickness drugs as evaluated by their effects on Vestibular eye

movement. Neth, 3. Mod. 10, 844448, 196.

'k-7,- 7

NWAGMN OF-U1 NDCRNCMTINICN

Jf. R. R. tott

RAY Inistitute Of Aviation MedicineFarnbaroulh, Uampo.hire

United Kingdom

Vomiting is a presentin "I pto in a widevariety of disease@ Iv 1gying diff e ent

To the general physician the problem of systems. Common causes.inld gaeo-motion sickness typically Presents as a teritim, migraine, excess alcohol consump-:!quest for advice on how to avoid motion ion, peti ulceration, drug treatmenticknese When travelling, or during ms- id* 46f I teats ad nyugci rn

sure activities such as glidina or mcil- acute infectins It in li ely thating. more urgently, a docktor &,%oard ship tendency towards Vomiting as a consequence i

in rough weather may be confronted w ith of an underlying disease could be exacer-the need to treat individuals prostrated bated by a neuseovenic moti~on envi'ronment,by repeted Vomiting as a resut of sasickn~es,p~ The military doctor may havie to The suggestion, oftoenby those who havedeal with the operational problem of not themselves exper inened motion siak-airsickness in trainee aircorwt seasick- noess, that anxiety is the principal factornoess in sailors, or motion sickness among in the nausea and Vomiting of motiontroops transferred by air, in encloset sickness is not well founded (Mirabile

aryprsonnel carriers, lending craft or 1950). Haoetheloess anxiety can of itselftanV*s Finally, because motion sickness give rise to symptoms of anoerexia, stomachmay have financial implioations by con- awareness and Vomiting, Phobic states cantributing to the failure rate in a costly therefore occasionally be confused withtraininl programmes medical advice may be motion sickness. Anxiety may however, i

suh norder to minimise the economic worsen an already existing susceptibilityproblem of wastage in training, to motion sickness, It has been observed i

In a~psiakness susceptible aircoew thatsymp toms call be exacerbated lby increasedwork loadi pressures within the sertile andalso by an excessive Anxiety to succeed intraining (Isgshav a stott lees).

motion-induced nausea and Vomiting isseldom a diagnostic problem. Those whotend to be susceptible often know from a~o~lcti mmai cMotion Sisuffass.experience the circumstances %hat Ledges!ymptomsý Most of the available traphy- rI many circumstances in which motionlace ia medication is available without a sicness is 4kproblem it is important todoctorls prescription and often suf I oers instruct individuals in methods to avoidWill have found a suitable remedy. mdi- or mintimise the stimulus. IOuh measuresviduels may present to their doctor be- may makq the di ffsrence between success orcause drugs have failed to prevent symp- f~lilure in the effectiveness of prophylec-tome, because of unacceptab le side sf - tic drugs or may eliminate the -need forfeats, or beCAUsC the use of drugs would drug treatment. When exposure to thin

ifbe contra-indicated, for example, when stimulus is likely to be frequent, anpiloting an aircraftt assessment of the likelihood of useful

adaptation may give the mutterer someThe doctor should be aware of other ding- grounds for optimisin.nostic possibilities, particularly whenfrom the history it would seem that the In a review of drugs used in motion sicd-

we eItin persisotL"s aterlu m a~cm l p or (arged & Pert lo66), the authrtj ol 5 't dia io point, but 'andnua a kWish the results of

the stimillus, Won jrp~lci p ~o ld t experimnatal tr aX which can probably behas mad no Dgaysne 0 the hec dance o1 trae &* o satioms In th interval

if symptoms, or when there is not a slikilar betwee meiaion, and exposure to motion,degree of susceptibility to provocative in the duration and tke ofmton and in if

motion in other environments, msuh factors as the md of administration

if ifP.~i~~<'

A _ :: _ L iii.iff

Drug Route Adult onset DurationDOle (hr)

MyolOine oral 300-S00sg 10 min 4patoh 3oo1g+!O#/hr 6-9 hr 7?injection 2009q 15 min 4

Cinnari•Lne oral 1.5-30mg 4 hr 0

Promethaline-:theooolo oral 3img 2 he 24-hydrochloride oral 25mq 2 hr I A

injection 0meM 18 Imn is

Dimenhydrinato oral 50-10Omg 3 hr a

oyclimine oral 50mg 2 hr 12

and dosage level of the drug. The design sickness prophylaxis. Table I liets theof mo•t field trials has *ignally failed currently used drugs, their dose, and timeto take account of valable Information course of aotion,about much variables", if this is truefor experimontors, how mush more so is it Despite Its longevity, hyoscine probablyfor mere practitonere or their sell-medi- rem&Lne the most potent sIngle anti-motiongating patients, iokness drug, It is rapidly absorbed

following oral administration and reachesmany of the drugs that are used to treat a peak conoentration In the blood after ifnausea and vomiting from other causes are to I h. Its relatively short half life ofineffective in motion sickness, Thus about 2. h Implies that its duration ofmetotopramide, widely used for vomiting action is no longer than ebiut 4 h. it tIdue to gastrbihtembi nal disorders, mi. therefore most suitable Cir short expo-rains, maemmothtic agents and cytotoxic murse to relatively intense provocative

drugs is almost certainly ineffective in motion stimuli, lide effects from hyol-mat or,-induced :ausoa and vomiting (Kohl sins are frequent, in particular light1007), although an earlier study (Von headednese, drowsiness and dry mouth. ThelIaumgartn to0o had indiuated some bone- drug is not recommended for children infit. Likewise prochlorperlsines also used whom the therapeutic margin is probablyit the treatment of nausea and vomiting, narrower and whn are therefore more athas been shown to have nagligible beneofh risk of serious toxic coentrl effects ofIn motion seakness (Wood & Graybiel 1955). roetlessness, hallucinations and psycho-A reoertly lntroduced drug, odonsetron, i1 mis, For similar reasons hyossine is nota SOT5 reoeptor antagonist which is highly well tolerated in the elderly. Addition-effective in the treatment of nausea and ally it should not be used in patientsvomiting induced by radiation and nhemo- with glaucoma and only used with cautiontherapy, but hia no effect on laboratory- in patients with urinary retention frominduced motion sickness (Stott at al bladder nook obstruction, Hyoecine has1080). also been shown to impair vigilance and

short-term memory (Aresell et .L. 1909),The succoclful use oa prophylactic drufl poslibly a desirable feature in motionrelies upon a knowledge of thoir time ao sick travellers but not in the treiningp'ek therapeutic activity, their sidi environment,eafect•, and duration of action, it isalso useful to know momethinq of the Oral hyomcine is a leos satisfa•tory drugvarlability of response between individu- for longer expomures on account of theall to a s andard dose, need to repe•t the dose every four hours,

This shortcoming has been addressed by theThe protection afforded by drugs in motion development of a dermal patch (Faopodwrmsickness Is far from complete, A survey of TTI Transderm-loop) which delivers aover 20,000 Pasoan gar aboard firries loading dome of 200 qg hyosino And 20 yo(Lowther A Griffin Miem) found that lt por hour for up to 72 hOurs when appliedhad taken medication. Of these, 11,4% to the' post-aur•ieulr lAn, An offoolivovomited during the vsoage compared with drug conoentration is not reached unti•l -only 3,.6 of those who took no medication, I hours after aplication of the patoc,af the established drugs, hyoacine (ocopo- though this deoly can be overcome byLemina UIP) has been in use for the long- simultaneous adminisuration of a eingle*et time and ie the most reosarched drug, oral does (Golding et a1, 1101); PDugSeveral of the anti-histimins group of excretion continues for vp to 4e hoursdrugs also 9how anti-motion sisknoem aoter removal of the patch probably indiffects. These include dimenhydrinato and eating that the ekin beneath the patch

its active moiety diphenhydramine cycli ontinuoi to provide a re orvir at 4oivosine, ainnariminen and promeoaltins, onu e Scitt I AV Mll, he pracitvplRecent reports indicate a • p•enytoin in use oi this pteltaton of h 18ne• must

doatge that gves antte opletic drug therefore be-in uxpoluesl .o a motionlevels %n4 also teriondina in high dosage stimulus lastih tore thn 24. hours# ae

IIhave benefic ial properties in motion for *"amIl eh'nlogr sea voyages.

'X ...S .......... ~ - - - ...~. ~ - - .- .. II-- - - !V

11.3

The efficacy of the hyosoine patch has occur after about 5 hours rather than at 2been studied on a number of trials at sne hours when peak plasma level is reached.of varying duration. On 12 hour voyages in Like•wis, iome Indices Of performancecoastal patrol vessels (may at &l. 84), impairment have shown changes only at 5-7the index of protection, defined as the hours after drug administraticin (Parrottdifference in incidence of seasickness 1986). Two studies of the prophylacticbetween drug and placebo groups to a benefit of cinnari Ino using similarpercentage of the incidence with placebo, protocols, found that a dose of 30Mwas 234, and exceeded that for prophylao- cinnarisine showed no benerit at 2 hourstic dimenhydrLnate, In a sea trial lastine (Pingree 1039), but after I hours was asI days (Attias et al. 1907), an index of effective as hyaocine 0,6mg taken 2 hoursf rotectLon for the first two days of 741 previously (Pngrse a Pethybridge 1989).all to an insignificant level on the on the basis of these observations' cn-third day. Although similar see states narisine in a dome of 10mg should be takenwere encountered on the three days, the at least 4 hours before exposure to pro-incidence of seasickness in the placebo vocative motion and 1I or $Omg taken everygroup was much reduced by the third day 6 I houre as required thereafter,presumably as a consequenee of natureadaptation. In a sea trial lasting seven Promethamine is available in two formsdays (Van Marion at al, 1136) the hyoeoine either as promethavine hydrochloride orpatch was tested against placebo during promethas ne theoclate. The 24 hourthe first 3 days-of the voyage. A signifi- duration of action of the latter may be ofcant bene t was evident during the first advantage in some cArcumstances, and would2 days of the trip but not on the third aIlow for a single daily doesa tolrerablyday. Zn addition, following removal of the at night so that the peak seoatfwe effectp 'ch, those in the active drug group occurs during sleep. Promethasine belongsexperieneed a significantly higher wnci- to the phenothiasine group of drugs# and,dence of nausea and vomiting than in the in addition to HN receptor antagonism,placebo group, it wea concluded that the this group possee em considerable anti-trinmdermal hyooine while Initially aholinergic activity$ so that markedprotectLve against seasickness, had de- sedation and dry mouth are frequent Aidelayea spontaneous ad& tation. In the effects,longest duration study (How at al, 1oss)the patch was worn for the entire 13 days Dimenhydrinate was the first of the anti-spent at sea. Therapeutic benefit was histamine group of drugs to be shown toconfined to the first few days of the have an effeat in motion aickness, in avoyaget and was greatest among inexperi- does of 10mg it is marginally lees effec-enced sailors and in more severe sea tive than 0,3mg hyescine (Wood I Grabielstates. side effects were few, There were IM6), but has a longer duration of ac-three reports of difficulty in accommoda- tion. its sedative side effects may limittioG in the drug group# and 13 reports of its usefulness,skin irritation at the site of the patch,similar numbers occurring in both drug and Cyoliuine is said to be lees sodating thanplacebo groups, promethasine or dimenhydrinate, though in

a dose of 10mg it was found to be somewhatThe rate of drug absorption is sup ooed to loes effective than the same does ofbe limitod by a membrane within t9e patch diphenhydramine (Wood I graybial 1960).rather than by the underlying Isin. COylisine is no longer available in the IUHowever, studies of excretion rates have without prescriptpion on account of itsfound between four and six-fold variations potential for abuse, In excess dose thein urinary exoretion, and other studies drug can give rise to halluoinations,have founcd variability in response betweensubjects (Pyykko et al, 1995). As withoral hyoscine tits side effects of drowei- The central sympathaoimetic drug dexampha-nIes, dry mou;ti may occur, In addition, tamine has been shown to have an anti-with the patch there may be impairment of motion sickneas effect when used alone andvisual aocmnudeation, This affects partic- to act synergistically when combined withularly hypermetropes lHerxheimer 1951), hyoscinea promethasine, or dimenhydrinetoand t hi rnik inorsasaa with the length of (Wood 1990),. Zt also antagonieso thetime for which the patch as applied soporific and performance deorementing(Parrott liII). Awon mo-e than with oral of sets of hyoscine, The combination ofhyoscine, the dermal patch is unsuitable hyoasine 0.4mg and dexamphitamine Imgfor IlI in children. Hallucinations and (loop/dex) is the primary medication usedextraee agitotion were noted in 5 out of by uq astronauts to combat space sickness24 *hIldren administered either a whole or and Is probably the most effective drughalf scopolamine patch (gibbons ot a1 combination available, However, because1934), and In a case report of a 6 yoer of its habituating properties and-itsold 20 kg child who developed a toxic potential for abuse, dexamphnatmine is apsyrhosise a plasma level at 24 hours controlled drug, Zn consequence, itsaner paten application was some 7 times general use in motion eoiknejs prophylaxisrelAter than the equivwlent adult Level Cannet be Justified, A simLar alerting(lennhausar I lchwara 11G), eaffect without the associated risks can bi

obtais.ed with sphadrine 15-30mg, WhenCinn~riAine an antihistamine which also used in oombination with either hyoOaineahna calcium antagonist properties has in or promethalino, laboratory studies haverecent years been wirely used in the Ind ea~ed emn aurented prophylaotia effect

prophylaxis of seasickness (Natgreo e Ve either h e mno or pr ethasine aloneM330). Adequate drug leVels can ba main- (Wood A Grayliel 19531, thoeah no cleart. aed wi• h an I hourly demge ach elme and benefit of hyoseia wY s dr e ifo over 2-he drug is said toe raltvely free of h eine alone wa eoo n d 14A6 at seo

the side Iffoct of drowsiness. However, (coma eot &1 1334). as with hyoqihne-after a sAngle dose, drowsiness tends to ephedrLne may precipitate acts urinary

-g , . .

• :. . . ... ..... + . , .. ..* '. .. . . . . .

11-4

retention if there is bladder outflow who vomlted in the placebo group fiveobstruction, an offset in which synergism vomited two or more times, whereas the Ucan be expected with an anti-Cho ins rgi fLive subjects who vomited after takingdrug. ginger did so only once. When vomiting

powdered ginger, perhaps once in quiteRecently introduced antihistamine drugs *nought These findings arm consistent withclaim benefit over earlier drugs in having the view that ginger may act locally toless sedating properties. This is ameliorate the gestro-intestLnal cones-ascribed to an inability of the drd1 to quenoes oa motion sickness without alter-cross the blood-brain barrier. An a Ing the underlying susoeptibility.general principle druge~that lack anyActivity within 'he central nervous systemcar likely to be infolective.Lin motioniokneas. Zn support of this principlethe Hitaogonat slastemisole is without oi.uav Eaakru'benot+ in motionsicknessl (Kohl at al.1087). Howeveri terlonadine, also said to Reviews of the various dietary measureshave no central nervous system penetra- proposed in the treatment of motion sick-tion, has boen shown to posses@ anti- ness make omusing •eeding (Reason a Srandmotion properties following a mingle dome 1973), but their diversity is some indica-of 200mg (Xohl et al. 1991). (This dome tion of their lack of value, No effect onexceeds the manufacturers recommended the incidence of motion sickness has beenmaximum of 120mg). Whether at this does found in relation to time of day or thesome drug does cross the blood-brain time of meals (manning a Stewart 19041)barrier, or whether the principle must be It is generally agreed that vomiting Ierevised, is not yet clear. However, drow- less unpleasant when the stomach containssines@ is an occaeional side #ffoct of something to vomit and that lack of foodtorfonadins. :an itself be dimgiriting. squally, it

would seem sonsible. to avoid dietaryA recent study on the prophylact•lc use of e4cesses,

,hnytoin (Chillen et &1. 199•0 found aid rease in tolerance to cross- Notion sick aLrcrow.havw observed that

Coupled stimulation when taken in a dosage their susoeptibility to airsickness is(1-1.4 grams ever 24 hours) that produces increased by even moderate amounts ofanti-4pileptic blood levels, This repre- alcohol in the previous 24 hours, and thisilnte an increase in efficacy by a factor effect of alcohol has also been observedof four over any other single drug in on tolerance to cross-coupled stimulationcurrent use. Though no aide effeots were during desensiti•stion treatment (1agshawreported in the seven subjects involved in I t•tot 196). For those taking anti-this study, possible side effects include motion sickness drugs, the instructions onnausea and vomiting, mental confusion, the packet war agionst the consumption ofdLssiness, headaohe and muscle tremor. It acOhol on account of inoreasd sedation.may be sLgnifiant that in excess dosetn is dr6ug produoe signs and symptomsreferable to the vestibular system andcerebellum, in particular, ataxia, dysar- AdaiAMnthria and nystagpus. Cerebellar atrophyMay follow larger overdosage. it may For many individuals whose exposure totherefore be that in the therapeutic dose provocative motion is infrequent, advicerango the cerebellum is preferentially on how to minimLis the stimulus of motionsensitive to the neurophermacologicol sickness coupled with the use of an appro-effects of phenytoin. At the present time, pria•e prophylactio drug offers the absthowever, its use in motion sickness pro- chance of avoiding the condition, rorphyla•is remains experimental. others, such as week-end sailors and thope

who fly for pleasure in light aircraft orgoot ginger has long been used in oriental gliders, repeated use of drugs may betraditional medicine as a remedy for undesirable or, in the case of solo fly-nausea and vomiting, One laboratory study ing, prohibited, Though repeated exposure(Wowrey & Clayman 1002) has found powdered should lead to adaptationo the frequencyginger root to be of prophylactic benefit of exposure to the provocative motion isin motion sickness, Two fmrther liabratory often insufficient to promote an adequatestudies (Stott et al, 1064, Wood M90 degree of adaptation,that dead an end point of moderate nauseafailed to show any innrease in tolerance Often the dispiriting effect of repeatedlyto cross-coupled stimuli. However, further becoming motion sick during what wouldevidence of a beneficiel effect comes from otherwise be a challenging and pleaeurablea controlled trial at sea (Gro"tved et al. leisure activity, ledse an individual to1 9686) in which I0 naval Cadets were given take up golf bird watching, or some othereither ig powdered ginger root or placebo, pedestrian Interest. Befors concurringand were asked to score the symptoms of w th this course of action, the adviceonausea, v srtico, vomiting, and cod swat- for example, to a motion si•k gliding

ing, every hoer for the next four hours. student Might be to undertake a moreThe number of individuals who reported no continuous period of training in which themotion sicknoss symptoms was equally intensity or duration of provocation coulddivided between tAe two groups. Among the be grade. It could be anticipated that61t of subjects with sepoms of seasick- having once gained some doegee of adapts.nest there was no significant differneae tion, its re-acquisition after an intervalbetween ginger and plaoebo for Ohe symp away from the stimulus might be a moretone of nausea or vertigo, Howevoo the afoelerated profess.I Shany of i"Witiaigeand the Saverity of'* c'Iol weating were @ n ificantly reduced Formal deseneLtisation treatment, onin the ginger group, of the seven subjects account of its cost and the amount of time V

". .. . ., -,.'S. ... .•' : *• , , , ..•.• o,;•i . .•. • .,I;.:J , , , ,' . . , •-...

11-5

inVolved, would not be justified for this improvement in woll-being, but with con.group of individuals, It is however possi- tinued stimulus malaisA worsens and vomit-ble that a self-administered ground-based inc recurs. some Individuals may becomedesensitieation course might affer some toially proutrated and appear very Ill.degree of pro-adaptation to someone par- When this occurs aboard ship, sufferersticularly enthuliastic to eucceed, It is should be moved to the part of the shipsimple to generate a orose-coupled stimo- where the provocative motion is at a1l0 using a rotating atfice chair kept in minimum, and should lit down, Adequatecantinuous motion with the feet, the fluid Intake is not possible until vomit-occupant making roll or pitch head move- Ing has stopped, and to this end anti-monts, Howevera rotational velocity Is motion sickness drugs may be required bypoorly controlled by this method and it is inj•ction. lever* motion sickness isnot difficult for a susceptible individual frequent aboard life rafts in rough seasto make himself rapidly unwell. Another and could be a significant factor affect-readily avaLlablo devic, is a conventional iog survival. Although drugs given Orallyowing. This device offers two types of are of no value, buccal absorption ofsensory conglict, both of which are fea- hyoscne, administered as the proprietarytures of aviation, There is an alternat- dieporsible form (Iwells), has been shownins acceleration stimulus that has both to be as offeotive as generic hyoncinovertical and horiSOntl Compohentbi Whose tablets administered orally (Golding et alfrequency of oscillation can, by appropri- 1951). An effective blood level can beate choice of rope length, be brought into obtained within S0 minutes.the nauseogenic range (Sm for 0.25 No,2.25m for 0.53 3 ) I . n addition# because The transcutaneous routs of administraLionin a freely swinging pendulu the result- is of no immediate value in individualsant force vector is Always aligned with already sugffring symptoms of motion sick-th ropehh• subje•ctexr:iences the ness an account of the I-$ hour timealternat ng angular rotion stimulus interval before therapeutic levels of thewithout a correspondLng change-in the drug are.reaihed., Toachieve a more rapiddirection of the resultant vector# the onset of activity drugs must be given bysame conflict that is engendered by co- injection. in an uncontrolled case otudyordinated turns in aircraft, To render the of airsickness in 47 individuals whoSwing stimulus comparable to that in the undertook0repeated flights involvingair, the subject would require to sIt parabolic manoeuvress the intramusciarsideways so that angular oscillation of administration of diphenhydramine 30mg,the Pwing would act In roll rarther than romethavine 25mg and suing end hyoscinoin pitch, O,5mg were compared for their bonefiolal

effects on reversing severe symptoms ofA further dvicae (AsrotrimR), found in nausea (Oraybial A Eackne: 1957). Bothsome sports eentres, consists of three hyoscina 0.,mg and promethasine 60mgconcentric metal rings, the outer one lnowed beneficial offects in 72 and 70% offixed to the ground, he Ainner two rings subjects respectivel y whereas little orfree to rotate about axes at right angles no benefit was obtained from the lowerto each other, with the innermost ring, dose of promethasine or from diphenhydra-about 2m in diameter, configured to carry mine. The therapeutic efficacy of hyom-a otanding subject. By appropriate move- aine when given intramuscularly is about 6mont of %is body, the subject who is times that of the same dose given orallytethered by the feet and restrained by a (Cirakhur 1971). This difference is ametal hoop at waist level, can ro to consequence of the first-pass metabolismabout two axes simultaneously. The nau- of orally administered hyosvine in thegeogenicity of this device is not severe, liver. Thus 0.5mg hyoscine given intra-but robably derives from its capacity to muscularly would be equivalent to aboutproduce crc s-coupling of a somewhat five times the standard oral dose, such auncontrolled nature, and unfamiliar dose runs the risk of toxic side effects,changni in the dynamic force invironment. For this reason the intramuscular injec-

tion of promethaineO s0mg is to be pre-It has to be admitted that none of theme ferred as the treatment for establishedexpedients designed to promote adaptation nausea and vomiting due to motion sick-has received experimental validation, in ness,fact, in a controlled study, repeatedexposure to swings used in the convention-I1 fashion failed to protect against

airsickness (Gibinon at &1. 1943).

The military doctorplrhaps more than hiscivilian counterpart, has to balance theh loss of operational effectiveness produced

a v nby motion jAckness with the possibled trimental effect on performance from theOnce individuals have reached the stage of sIdo effects of drugs, and, if neither

vomiting, drugs are loes effective and alternative is acceptable, to consider thehave to be gavan parenterally and in need to suspend or re-role affected indi-higher dasage. Iven in the period of viduals,me acis that precedes vomiting there it amarked delay in gastric emptying time Hetin sickness may hay. cignificant(Wood 6t aL 1987) and the absorption of economia consiegUnnee! when it contributesorally administered drugs will therefore to the failurea tt in a n eansVe train-.be impaired. In prgam.One so~itioca might be to

develop semis ataction test to eliminateHaving Vomited, there is often a temporary those individuals likely t4 noeunter

.................

00.

problems with notion sickness movers Dobie To. Airsickness in aircrew. A0ARDo-enough to result in Withdrawal from train- graph AG-i??, AGAKD/MATO, Nouilly-murt

in.A migniflicent correlation (ra.41) has Isinej 1974.been shown between failure in flyingtraining and ob actively rated tolerance Dowd Pi. The VIAFIA14 selection, test, andto a sequence of 1 Ohqad movements while rehabilitation prograbm of motion sik196) f::~ or practical purposoo hweer sikns in th seet on io

ouhatai lack$s ufficient selectivity.* AOARD-CP-100 AGARD/NATO, Neuil y-sur-An alternative might be to. eliminate $ieine, 37, 1-9.airarew who are airsick durnn tenroductory mortise of training, Tai approach Gibbons PA, Hicoluon SC, Betts ER, Roman-fails to t..ke account of the natural berry KR a .?obee DR. Scopolamine doom notadaptive proesse, an the other hand, it prevent poet-operative enesis after tedi-may require 90 - 30 sorties before eponta- at rica surgery. Aneuotheeiol. 611 1934, Aneous adaptation can be judged to have 435.failed, by which time, gvLYnhthe coat offlying hours# a considerable investment Gibson WC, Manning OW A Cohen 1. The Valuehae been nade in the individual, The of simple swings in a colimatiming toprecise policy adopted depends on the a reiclgnesa, Associate Committee on Avia-av'ailability of suitable applicante for tion Medical Research, National Researchthe training programme and on financial Council of Caneda, Report C263S, Oct.resources. because of the high -)ot of 1045.trainin , a good came can be made foretabliah ing some form of treatment pro- oil*# DA A Lochridge GX. Behavioral air-isramme for airaicknoess various nchoeme alicknese management program for studentnave been described (Dowd 1373, Dobie lilots, Aviat, space Inviron. Med. 61,1974, Orab el. a Xneption 1071t Levy at *I. me$0, 191-4.1001f Romm or 1901, Oerelia 1303, duSLGa*ohig 1915, logehaw A Stott 1065). A~ll Gelding JV, Goodon 9, Correll J. lcopola-involve adaptation to ground-based motion nin, blood levels following buccal versusstimuli that are nauaveovenic. lome use ingested tables. Aviat, #Pace Environ,.

* bieofedback and relaxation techniques. Mod. 62, 1ol1, 521-6,Theyn vary in the extent to which remedial,fliygi incorporated into the programme. oravbiel A &a Kneption .7. Prevention of

Deitailed comparison of results is comph - mot ion sickness in flight nianeuvinrms aidedoated by diffecring criteria of succoess, by transfer of adaptation effects acquiredbut it is pea sibl e to reduce by 10 to 000 in the laboretoryi ten consecutive refer..the number of trainee aircrew who would ralsi.Aviat. space Environ. Had. 40,t 1301,otherwise be eliminated from training on 1 14..oaccount of persistent airsickness,

Craybiel A a Lackner JR. Treatment ofsevere motion sicknaes w~ith anti-notionsilaneae drug in ections. Aviat. spaceEnviron. Med. 38, 1987# 773-0.

I~i*ZI~flM rontvad A, Breok T, IKamhokard J7 & HenteroI, Ginger root against seasickness, AAmbler RN & Ouedt'y VS. Validity of a britif co~ntrolled trial on the open sea. Acts

* vestibular disorientation test in screen- Otolaryngol.(Itcckh.ý, 105, 1935, 45-49,i n peilot trainees, Aerospace Mod, 37,

19,, 14-6 Nagtrrea~v68 J. A double-blind placebocontolld study of oinnarimine in theAttias J, Gordon C, Ribak 0, Binah 0 A 3rophylexim of seasickness. Practitioner

Rolnick A. SUficac of tranodernal scopo- 34,100 647-50,lanina against seasicknoesi a 3-day studyat sea. Av.Lat. space Environ. Med. 58 Nerxheimer A. A comparison of some atro-1987, 50-52. pine-like drugs in man. Br, J. Pharmacol.

Bagshaw M a Stott 3RR. The doeseneitisation 1319,14-2of chronically mou.ion sick aircrew in the Mow J2, Lee P-9, $sest L-C, Tan P-9. TheRoyal Air Torce. Aviat. apace Environ. Republic of Singapore Havy 'a lcopiderm TTIHed. 55, 1985, 1144-51. studyl results after 2,200 man days atArand .73 a Perry WLM, Drugs used in motion sea:4.Aia. pceEvrn ed5,10,*sickness . Pherpiacol. Rev. 16, 1066, 005-

924.Kommlen RW, Houk MM, sellenkes AlM A GuodryBreah C Prsto OC War CLins C 1a . Airsickness prevention training.BroellC, reson C, ardC, ineI OR 6 Asro p acei Medical Association AnnualTraub M. The scopo amine model of memn scientific Meeting Preprints, 1052, 07-68.

tia: chronic transdrmal administration,0. Pychpharaco. 3,106, 76flKohl RL. Failure of metoclopramide to

control amesis or nausea due to stressfulCeratia P3, Airsickness rehabilitation in angular or linear acceleration, AViat.the Canadian foroesi a preliminary report, apace Environ. tied, 50, 10611 135-31.Aerosp ace Medical Association Annualscientific Meeting Preprints. 1963, 63-04. Kohl mi,, fomick 3L, C1ntron N A Calkins .

D.Lack of eofet of satemisole on* cholqn V, Kabrieky M4, Hatooll, C, Morales veetibular ocular reflex, motion sicknesstA fix I aScott 14, Vas of phenytoin in and cognitive performance in men. Aviat.th prevention of motion sickness. Aviat. spc nio.Md5,1671714space Enviren. Rod.1, st13900, 1022-5. pc nfrn 6d B 97 114

11,4

Kohl RL, Calkins 09 & Robinson RE. Control stoatt jRK, Hubble MP 4 Spencer MB, Aof nausea and autonomic dysfunction with double-blind comparative trial of powderedterfenadine, a peripherally acting anti- ginger root, hymocine hydrobromide, andhistamine. Aviat. Space Environ, mod. 62, cinnarisine in the prophylaxis of motionI9l1, 392-6. sickness induced by cross coupled stimula-

tion. AGARD-CP-372, AGARD/NATO, Houl~ly-Lowther A 6 Griffin MJ. A survey of the our-leine, 1984, 39 1-6.occurrence of motion sickness amongst

sengeor at sea, Aviat, Space Environ. Stott 7RR, Barnes GO, Wright RJ & Ruddockdod, 5 , 1998, 399-406, CJB. The effect on motion sickness end ;

oculomotor function of OR30032P, a S-HTMLevy IA, Jones DR & Carlson EN. siofeed- receptor antagonist with anti-ematiiback rehabilitation of airsick aircoew, proparties, Dr. J. Clin. Pharmac. 27,Aviat. Ipace Environ, Mod. 52, 1961, 110- 1909o 147-57.21. Tokola 0 Laitinan LA, Aho J, Gothoni 0 a

manning OW A Stewart WO. Effect of body Vapaatalo H. Drug treatment of motionposition on incidence of motion sickness. sickneest scopolamine alone and combinedJ. Appl. Physiol, 1, 1949, 619-20. with ephedrine in real and simulated

situations. Aviat, space Environ. Had.Mirebile CS, Motion sickness susceptibili- 55,1994,636-41.ty and behavior. Ini Notion and SpaceIakneass, Ed. Crompton OH, CRC Pro•m, Boo van HMarion WY, Songaerts MC, Christiaanse

Raton, 1090, Ch.19, 391-410. JC, Mofpamp HO I Van Ouworkerk W. Influ-once of trantdermel scopolamine on motion

Hirakhur RK, Comparative study of the sicknems during 7 days' exposure to heavyaffecto of oral and IN atropine and hyos- seas. Clin. Phermacol. The. 38, 10B5,cmns in volunteers. Arit. J. Anaelethaial. 301-6.50, 1971, 6•1-0.

Von Baumgarteni •,. ThhUnler R 9 Vogel H.Howrey tS & Claymon DE. Notion sickness, Experimentael,, ,:Lhrsuohungen Uber dielinger and psychophysics, Lancet 1992 (1), Wirksamkeit vk.,, t•L oprsmid bei Kine-55-7. t0tome, TherapiefWL,.e 30, 1980, 5974-81.

Roy 5, Shapira 9, Bilbiger A, Ribak J. Wood CD I Graybiel A. Evaluation of tix-Transdermal therapeutic system scopolamine teen anti-motion sickness drugs vnder(TiS), dimenhydrinats, and placebo - c controlled laboratory conditions. Aero-cam tive Study at @sa, Avit. Space spacO Hod. 39, 1960, 1341-4.mnvcron. Ned. 55, 1994, 1051-4,

Wood M3, Wood CD, Manno JE, Manno Bi aParrott AC. Trranndrmal mcopolaminmt Redetoki HM, Nuclear medicine evaluationeffects of single and repeated patches of motion sickness and medications onupon aspects of vision. Hum. Psyahopharma- gastric emptying time. Aviat. Space Envi-col, 1, ).98d, 109-11. ran. Mod, 59, 1987, 1112-4.

Parrott AC, PromethaNine, Ioopolamine and Wood CD. Pharmacological countermeasurescinnarisinet comparative time course of against motion sickness. Int Motion &psychologiocl performance effects. Ineti- Space sicknescu, sd. Crampton GH, CRCtutl of 5av l Medicine Report 13/86, 1986. Prose, Boca Raton, 1990, Ch.,6, 343-51,

Pingre BjW, A double-blind placebo con-trolled comparison of hyescine with cin-narimins in increasing tolerance to anauisogenic motion challeng., Pharmaceut,Had, 4, 1989, 1-298.

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Reason JT i brand J3, Motion Sickness.Academic Press, London, 1975,

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. . . ' . . .., ... ,; .:. .. .

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U~nitcd Ki0ng'doum

1. Adaptallon/114abitumion Io......................................................... 2

A.irit:M d l1o Siddog ... ... ..... nd. ph............C ........................ ....... 3

3. Animaldu, M delsion i....................................... ....................... 93

4., Behaviou : ctral ............................................................. , . . . 3

6., Piystormarcig al gulblt Eft........ .................................... .............. .I

8., Sotivi i diffeences.... ...... ...... ............... ............................... 2

10. Sehaimulat Gecneral....... ............... ....... .............................. 2

16, Seal S uidnlng atdAnla............... .............. ................. ........... 27

17 Treatmenti Otheor that% drugs .......................................... ............. 29

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sickn 'I- X~ progress report ji.ngtishl 77058.)Parke", D. E., Reseblee, I:. F., Von GoICTI, H. E. Annual Sclca~t c Meeling of lite Aerospace MedicalLeonard, C, S. ,14stional Aeronautics and Space .tsoiSaiallo a. ahingto~n, D,.C., USA, May 7-11, l9mp.Administration. Lyndon 0, Johnson Space Center, ,Ivlat Space En viron Mod §g ."5 1989, 505Houston, Teax)(NASA, Univirnililes Space Rievearcla Associat ion,Baylor U~niversity, and International ,lcafeiny AttgnenCorposotlotIoplatury motion hickness land sk-kness

A~~ntranastics, InenllclMni ~c 'noltn niosiks floIng 24-hours of provocativeAitronautics rotarntiooa ManinSpaeyinosmm71h Hvastnon, 7?, Feb. I 13 104 1. Aviation, qyr, ~ aotationek ,Lor ,L 0 eatand Environmeuntal Medicine 1A (Sept) 1987, ppilr . ,L .HealA42-A49. (Jefflrson Med. Coil,., Philadelphia, Pa, 19107.)

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sickness In squsirrel mionkeys following continuous 4viiJ Space Environ Moed n (9 Pt 21 Sep 1987,hurizsntai rotation Iflnalishli .pA42-9aniliagher J, Wilpizeaki C, Lowry L V, Sheppýard L(Thomas Wrofrsoi. 1Ualy, Med. Coill., Pliiladciluit1a, Pa lLreeaatto oriniln fsnoyvifit1 9107.) isrtadpaint onionorsnoycnetAnnual Sciont~i Meeting qf lthe Aerospace Mledicalj Oixakriteala adaptattilas k umIrivIlam sensnrttnogAm~oclation, La Vegm~, Nevada, USA. May 10-14, kuorlliktta. IltussiinlI

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3. Anomasl ModelsIt~et o smactlar blaionon t."nenc an laenc of Motion sickness In Susmcao-marL'eus a new experimental

Efimmsstifsnnmacued ablation in frqec ndIl yo uanimal lEnglimlslintonIdue mehIntesquirrel monkey Matauki N, Utmo 5, Koji T. Saito H (Deop. Chain.ng

Briuyco, Kcnneth R,, Iasrsabii, Maiccla (Tulane Univ., hriolPe l~naot cUi.TkoCovinmgtonl, La.) Tokyo 113, Ispan.)Aviation, Tpnos, sand Snvtrlrrntminal Meudicine (ISSN 18A A S55al Metingt of the Society for Near~tc'ience,

009-652') vo, 5, Nv, SM6 p,106-100,Toronto, Ontario, Canada, N'ovember 13-A, J90,.F tX95-652),vat 57,Nov.946,~ ~Soc Meuvnaci Abyrr ,JA (1) 1955, 334

VestIbulAr-vIbail conflict In glteh and yaw planes In the Role of histamine In ittotlon sickness of Suncus-niurlnussquirrel monkey I(UnglmIsigaramshl, Mkakto, Ktmlocz, Walter B.. Kobiayashgi, oiT eoS at D hmKlituto. lesgo, HidemniltAn (Baylor Coil, ofMgd'clnoietkN, KaJIac, Fiv, Uhraeutcal S oBl,, Uiv. T~okyoeHouston, Tex.)PhrcoFa.haaatllSdUi.Tk,A4viation, Space, and EnviPOMM101nrai Medicine O1SSN Tokyo 113, Jpn.)00995-6542), vol. 57, Nov. 1984, 10f-4074, AnulSciemIyic Meeting of rtse Aeorospace Medical

Aneala, wilminon, D, ., USA, U41 7-11, 1989.Aviat Space Enisvron Md JlS() 1959, 4 2

A1

11-4

Conditioned motion sickness and rotation-Indueed Pharmnacological control of space sickness value andvomriting In squirrel monkeys [Engluisl limnits of the rheusu model Mcc~ndiatrg~hWilpizemki C R, Lowry L Di (Dep. Otolarynol,, Milhaud C L, Lagrde Di P Florences 0, Tian CThomas Jefrerson Univ., Philadelphia, Pa. 19107T) (Cn.Eue,75731 Pai dadles 15, Fr.)Annual Sciene(Ilc Mortni of the Aerospace Medical 61w: Annual ScirmsItwie Hosting elf the Altrowpact

AssoiatonWashngtn, .C.,USAMey7-1) 19~tModical Asociation, Now Orleanvs, Louisiana USA.A viat Space Environ Mod JQ (5) 1989, 505 H 1 9-1 92.O Avial Space Environ Med ILI (5)

Brain bioglenic amines and metabolites In raob exposedto croes-coupled motiont during the dark phase of a Motion sickness itt gulesa-pia Learned food aversionIllobt~dark ce [DoInllahi (LVA) Induej bs tiranoldal flinea verticalOwasy Tel 19, Lloktoda D L, Newprt 0, dlxplaeewnent [EnglIthWal'kor C A (Umiv, Arkansas at r [ns Blurt, Pins Bluff, LI 0 Wllplz~skl Ill, Lowry L Di (Dap. Otularynsol.,Arkansas, 1.15A.) Jerierson Mod, Coll,, Philadelphia, Pa, 19107.)Xixth Inforwsallonal Cowtference of the lnternalionai 61St Annual SclienatJc Mooe.ting of the AerospaceSociet fr Chronobiol~ogy, Bethesda, Maryland, USA, Medical Association, New Orleans, Louisiana, USA,June 34-24. 1919. Chronabiaologit 16 (2) 199,. 167 May 13-17, 19M0. Aviat Space Inviron Mod 61, (5)

1900, 506

Antigtank and beta endorphin (RE) responses tomntion-Alckness In monosodium tolwtomate-treated A multiculijeett rotational stimulator for taate-aversionratei (angliahI induction I nallih IScallot A C, Wilson 5, Rountree R L, Henry W ir, Harrtano W 'it, Elklns It L (Pmychol. Res. 1 16.8u,Andrews A, Walker C' A (Nati. Cent. Toxlool, Rem.. Veterans Adm, Meot, Cent., Augusta, Ga. 30910.)Jefferson, Arixona 72079.9502,) Bulletin elf the Psycltaowswic Society 2~ (3) 1987.Poll Annual Maeting of the Society for Neurtunclanc, 213.215Phoenlx, ,4ritona, UYSA, October 29-November 3,19189. Soc Nouro,,cl Abstr j~ (1) 1989, 516 u299ndcdissinteat111T ieohr

The gastrointestinal cortelotes of motion sickness In the thangl-IhITI -TIBo 61T mpiae

Caio l1ngllshI Luvolt Jhb (Dsp, PhartacoL,, Wright State Utwly., 060Lang I M, Stwonsrud M, Sat-na S K (flap. Aurg. Pawc, Dayton, Ohio 45435, USA.)Ph lw~ai.. Med. Coll, Will., Zablncki Vame, Europeawn journal of Pharmacology I3U (2-3) 1990,

Miauk, Will, 53295.) 193-200191h A4nnual Meeting of the Society far Noutwoscince,Phoenix, ,4rzeona, U SA. October 29-Novemnber 3,1909. Soc NeuroseciAbist 11 (1) 1989, 900 Pffectm of seraotiwnn antAgonists on motion sickness and

Itasuippreasson by I hydroxy-DPIAT In calts I1ngllmliILucotit T (Wright State Unlv., Deap. Phurtnscol., 060

I'rfrecia of various types of antlhiatasmilnes and Inhibitors Fawe, Dayton, Ohlo, 45435.)of histamine release on motion-Induced ewswala of Pharwnacology Biichemistry and Behavior 22 (2) 1990,suncus-nmutmus [English] 2113-2111KaJI T. Mataukl N, Salto H (Dlap. Chemn, Pharmawual.,

PaoPharacetica So,, Uiv.Toky, Tkyo 13, Cutecholamnlneruitl responses to rotational stress In rat113a dAntoial Meeting of the Japanese Phtarmnacological brain status Implications for ansphetamtwlne therapySociety, Thk*yc, Japan, March 25-28, J990., Jpws J of mwotion sickness (Englishi0Pharmiacol 12 (Suppl. 1) 1990, p I94p Takeds N., Morita M., Yamatudani A,, Wadi H..

Mataunala T. (Japant)

A r~it model for research of enteala and msotion slcknessvaSac nioMd.1 1)19, p 1-12

faea ,Morita M,* HamegawA 3, Yasniotodani A, A two-factor model of rotation-induced motion sicktnessKatbo T, ~,Wild& H, Matsundita T (flap. Oltolaryrtgol., ayndrome In squilrrel mionkeys, llng~llhlONakiw Univ. Mod]. Suh., Osakit5,J u. W~i lzomki CR, Lowry LD0trd Atsual Meeting of hth Japane.1ne Phuracinaologivell AinJ Otuularyngtol Il (lIJAn-Pab 1987, 1)17-12Society, Tokyo, Japan, March 25-28,' 11110. Jpn JPharwsacol al (Suppl, 1) 199D0, p26 0p Atwtonwtslc effects on It-I variations ol the heart rate

In the squirrel awoskeyt ant Indicator of aulomwostk,Absenre of postastinwulatory motion sickness land linbalun~e In conflict sickness. [Engliwhl]

sickness In monkeys following 24-hours of Ishii M, litarauhi M ' Petal S, Hini T Kulaca Wprovocative rotation (English] Am)J Otoiawytigo! I (3)May-'Jun 1981, ppl44.SWilpzeaski C Rt, Lowr; L fi, Li 03, HeArt~y J L(Jefferson Med. Coll ,. Pitlawisphla. Pa. 14107.)d1,wt Annual Sctentltct Meeting of the Atrd actc Dt.1pi~ualro blocks motion sickness and xylaaine-twwducedMedical Asswociation, New Orleansv, Louisia-na, UeSA, emuia lIn the cat, lEnaliahij

M JM Avat Sacefitiire Mod (5)Luawt JB, Crampton aH (Departmenat of Pharmacology111W, 7atSpceE4ionMe and Toxicology, Wright State Univeraity, Dayton, Oh~io

45435,)Avilat Spaice Xtnviron Med (10)Oot 1957, pt'919-91

Vase reann motion sickness tn cat.. [Englishi Conditioned toost *version induced by "oIon Isa

.. NRA KeBI LC Daunton NO, Crampton OH, Lucal ted by seet ve valotomy In the rat. [EnjllohJ

CA 9gartment a?' Psychology, San Jose State UNIV. oKA. Mc enna S (DearintoPshogy n192.) yoett nvrltC7ona912

AvIa Space Inviron Moed 11 (9 Pt 2)Sep 1987, Behav Neutrat Met L (3)Nov 1988, pp275-84ppA143-7 oetaeUlrst 992

trffect of dimlephosphon on the blood circulation andRole of otoilil eadorlan.l in the penatoa of oxygen tension In the brain of normal waking

vatlbuinr-vituai conflict sickness (pitch) to the rabbits and it motion adeknuaol Vilisnile dimefoxfonsasquirrel monke first rgprt). ftn tilhIs no krovoclbrashcehsise I naprnazlienie kieloroda vltasrahi M, HUm T, Kuleca W Kbatysahi K aolovnom moza. bodrstvuiushchdih krnlikov v norma(Department of Otorhlnolmey goiogy and iprl ukachivanlL, (Russian, Englishitcommunicative Salience, Daylor col#ies or Medlcino, Dekslav A] Skoarmnyi NAHouston, Tax*& 77030.) Forinakot ?1oksikal 11 (SiSep-Oct 1988, ppSS-8

Ava eEnvirom Mod a (9 Pt 2)Ssp 1987,ppA2rialRole of the area postrema in three putative measures or

motion aicknets& In the rat. (En tlhAdaptation and habituation of motion-induced vomitingil Sutton RL, Ponl RA,s Daunton %4 (Department of

n squnirrel monkeys. [English Psychology, san IQ,. State University, California'Wseslds CR, Lowry LD, Mletr RA. Smith 8D It, 95192.)

Qoinin (DpatnsotofOtlarngloyThomas Behav Nostral Blot 12 (2)Scp 1988, pp133-52Jefferson University Medical College, Phldelphia,Pennsylvania 19107,) rerana fli cottun fctvrywhA vlag Sact Arnvirom Mod 11 (9 Pt 2)Sep 19B7, eeroiafldcnstuts fctvrywhPA2.8 susceptibility to motion sickneass, (English)

Local Jil, Cramptan OIH, Matson Wit, Osmache PH(Department of Pharmacology, Wright State

subjective concomitants of motion sickneesat quantifying University, Doaytn, OH 45435.)rotation-Induced Wownsa in squirrel monkeys. Ltfe Set (11r 19119, ppl23 9-.1S

WlIeek R Lowry LD, Orson S). Smith 8D Jr,MlikH' C(Department of Otolaryngology, Thorns. Blockade of S-hydroxytryptoitlnOe receptors preoventaJefferson University MedioolCollege, Philadelphla, PA c Isplatin. Induced but not motion- or19107.) ,tyisaine..induced emesIs In the cat. IEnglishl01o1avynaot Read Nockc Sart 22 ($)Nov 1987, Lucot JI (Wright State University, Department orpp433-dO Pharniaoingy, Dayton, OH 45435.)

PhaormacoI Blochom ernEuv 22 (thJan 1989, pp207-1 0

Suncraa murinus as a new experimental model formotion sickness. (Engllish) (AnlInal model of motion sickness In rails] (ispanese,Utno 5, Matsukil N, Salto H (Department of Chemical EnglishiPharmacology Faulty of Pharmaceutical scienece,, MoritaMUniversityof Tokyo, Japan.) Nippon Jibirinkoka GO/c/al Kathy 22 (9)Sep 1989,Life St Al (5) 1988, pp.113.20 pp1424-35

l'lca as an Index of motion sickness In rats, [Englishl Ull-l)PAT supprosses vomiting In the cat elicited byMorita M. Takeds N, Kubo T, Maisuniaga T moincaltnor xyane ngsh

( Department of Otolaryn Ology, Osaka Univsrsity Luvot ib Crompton O Dprmn fPamclgSchool of Medlicin, Jaipa.)ý and Toxicology, Wright State University, Dayton,

Opt I Otorisinotaryngot Rekat Spec 12 (3) 1988, OH.)pptll.92 Pharmac'ol Bloehoms BEu/v 1U (3)Jul 1989, pp627-31

Effects of anti-motion sickness drugs on motion sikkness Comparlson of various motion stimulI on motionIn rats. IEn llsh sickness and acquisition of adaptation in Suncus-Morita M, ak N, Kubo T, Yamatodaril A, Wads mean/nun. iEnnlIshiH., Mataunags T (Department of Otolmrniology, Koji T, Saitomi, Uano S, Matsuki N (Dolpartnlant orOsaka University School of Modicine, Japen.) Chomical Pharmacology PIcUlty Of PharMAccailcaOpt J Olophinoiarysgoi Re-tat Spuc 2fl (5) 1988, sciences, University of Tokyo, Japan.)pp330-3 Jikkocn Dobaltra 21 1)Jan 1990, pp73-9

(lb.e role of cholinergic mechanisms In altering the Conditioned taste aversion and motion sickness In cat.~unctional aftuvity ithe rabbit brain during motion and squirrel monkeys, lEnglisimi

mickneas~ol roli cloherscheskikdh makhanimmov v Fox RA. Corcoran M, Irirtse ICR (Doparimr t orizctnuunulna'n ivklnostimosgskrlikovprI Psychology, San Jose Sutst University, CA 95 1Wo.

ukashvni Russisail Can J Physois Pharincacut (2)Pob 1990, pp269.791Makamk V, Skorommyl NA

Ficiol Zhs SSSR 74 ($)Aug 1988, ppl 109-19

Role of choilnerficl mechanisms In alterations of rabbit Iaopea'formance Application of a system enfilneserln* brain functilonal activity during aeso-slkness model for Emotion sickness end other environmental

Makalauk VF, Skoninanyl NA (1, M, Sachanov Ssltzley D R, Kennedy R 3, Jones M 9 (Essex Corp.* ~Institute orivolutionary physioloy and Uloeheaniatry, 1040 Woodcock Rd., Suite 227, Orlando, Plia. 3230,Academy~ of Sciences of the USSRl Leningrad.)

Noxw ci Re avPysloI 3. iia¶ic 1990, pi'36-45 Annuasl Sclent/c Meet~ing of theu Aerosopace MedicalAssociation, ats/angtoi, D. C, USA, Ma 7-11, 1989',

Motin aekamIn inpip C'Dpor~j~wlndsaA ,vila Space Environ Mod §2 (5) 1989, 479by body rotation.liaaced conditioned taste&versions. (En lish Effect of shlp roll stabilization an human performainceOsssnkopp DO, O1sseiemp MD (Departmient of (English]Psychology. University of Western Ontario, London, Morrison T R. Doble T 0, Willaes a C, Webb 3 C,Conad&,) Endlor I L (Naval BiodynAmiss Lab,, New Orleans,PAhvsdol Rehav J2 (3)Mar 1990, pp.467-70 La. 70189-0407.)

61st Annaual Sclontufli Meeirng qtf thes AerospaecMedical Association, New Orleans, Louisiana, UISA,

Auatonomic Indexies during the vatibular-vAsual conflict M 1M-17, )90, Aviat Spgace Environ Mrd fil (5)exposure: it squirrel monkey study. (EnglIsh) 19 0, 477grasohi M. Chas 3, MacDonald 3, Himi T, 'l'akods,

* (Department of Otorhllnolaryngology andComnedaSciences, Baylor College of Medioine, Conditioned taste aversion In humans using

Hajustun. TuAimt 77030.) maotlon-lsaduced sickness as the US naulsenpia IcAur~i Naius Ir wymx 12 (2) 1990, ppG9-76 experience lEnglishi

Arwas 5, Rolnick A, Laibow Rt W (Dep, Psychlanl, TelAviv Univ., 69978 Ramat Aviv, lsrael.)

Effects of antl-cholinerfice and chollnergic drugs on Rehavloaritexlearda wad 7therapy 22 (3) 1939, 295-302habituation to motion In rats, [EnglislilMorita M, Taiceda N, H-asegawa 3, YanistodaniA, Wads HI, Sakal S, Kubo T, Mstsunaga. T Persistent nme[ do debarquement syndrontei a(Departmenat or Otolaryngology, Osakca University anotlon-lnduced subjective disorder of balance.School of Medicine, Japan,) LgihArifa Olotaryngol (Stoca/a) .L0 (3-4)Sep-Oct 1990lnJ,01ntR

Conditioned Inhibition of ratstion-lnducedl saste aversion Motion sickness and anxiety. Ifinglimhl(Englsh) Fox 5, Arnan I (Department or Psychology, Biar-IlanLambert i.V,, Harber R,M,, Corpenito P,, Clanfrani University, Ramht-Gan, Israel,)

*M,, Mendez W,, Potosnak L.C. (USA) Arýia! Space Environ Mod 1p. (SlAng 1988. pp728-33,4nin, Learn, Behay, 12 (4) 1Q39, pp.457.467

[Well-being, task performnance and hyperventilation InCondItioned taste avesion Induced by moction is tllting~ roomi Influence of visual reference framne

prevented by selective vagotonay In the raL. r[Snlisll and art flelal hoarizon) Walbevindon, Taakpirostatieo nPus RA, McKenna S (Di ~r= 514 o PmYchology, San Hypurvcntilatlo I dod Kantalkanaer: lnvlocd van VistocelJaos Sltat Univorsilt Caifri 9192.) Rafecrantie-Kador cn Kunatmnatigoa Horixon [Dutgh)

Reha N~palSlatb ()No 199, p)27-84Blos, W. , Wientjes V' J. 5, (Institute for PerceptionSe/aa' eurl 8al _ (3NoV195, p,27-S4 RVO-TNO, Sneste~lrbe (Nethierlands),) IZF.19381-30

PI.W017536S/XAD 09118, 33pThe sureopllblility of rhesus muonkeys to moction sic~kness,

[English)Corcoran ML, Fox RA, Datanton NO (NASA Amocs I'erforifuauce and well-being under tilting condItions: ltecResearch Center, Morffet Field, CA 94086,) effects of visual reference and artificial horizon.aAviat Spave Environ Mod L, (9 Pt ])Scp 1990, lEnglishlVPp07--9 Roinkk A, Biom W (Moitiona Sicknems sand Hunacn

Porfrormance Laboratory, lsraoii Naval HyperbanricInstituto, Helirs,)

4. Bhaviura EffctsA viat Space Envirom Mod §Q (SlAug 1989, lip779-85

Situaational awareness and vestihular stimntlstlon! 'liaInfluence of whole-body rotation upon task sp..IlZI nfj s./1j11aiide gf~ectj ald

pefrac in Dutchi English Summsry iiiiz ineztkaWinjoC J. E., Bias, W. (Institute for PerceptiionRVC- NO, Sooateatrbo( Nethorlsnds),) i'esamethasone tulnulc the intIattIoon sickness effectsTZIP189 74D-89-01 5 ET7V-9O.9 386 of amaphetsanine and scopalanalne lEnglishI

Kohl, Randall Lee (Natilonal Aeronsautusm and SparcAdmilnlstralion, Lyndon 3, Johnson Space Center,Houston, To%,)Arma .4otronanslica (ISSN rx?294-5763%, vol. iS, Sept.19866 p. 565-371,

A,, .

PharacoIcIl correction of central nervous system Dose effect curve for scop-den In motion micknomsfunctiondurlam exposure to corlolls accelerations linglishlVn llshI CaodM J, Stewart 33J, Wood C D, Manno J 3,aet Ishcoenka, N, N., Dimittriadl, N. A., Manno B R, Mims M R (LSU Mod. Coant., Box 33032,

Molchanaovkly, V. V. (Joint Publications Research Shrovafiort, La. 71130.)Service, Arington, Va.) Annual Scientiflc Meeting of the Aerospace MedicalIn hIL USSR Repart Space Bialoa and Aeods ac Ass~ociation, Witshlngian, D.C., USA, May 7-11, 19819.Medicine, Volume 20, No, 5,SeptontbEr- October f985 A Yiot Space Environ Mod J (5) 1980, 492p 811 SCN87-0,1230 16- )

Effects of scopolamine on auditory mnonitoring andTranodermtal scopolamloes Effects upon psycliolomlcui arent-reiated potentlmals (English)

prlerformance and visual functioning at see. [Snillahil Stanny Rt R, Shull R N (Naval Aerospace Mod, Rom.Parroltt A. C. (North Eait London Polytechnic, Lab., Pensacola, Fla. 32508-3700.)

Englnd)Annual Scient'5c Moetin~v the Aoupc MedicalHU Pchopharmaco&ogy Clinical A ixporimenltal Association, Washington, DCUSA, May 7-Il, 1989.

(2) 1936, ppl 19-125 A4 vial Space Environ Med jQ (5) 1989, 495

Effect uf Ildecalne and tocainide on or*t1~ nausea Evaluation of the efficay and side effiects of buccalnyatagmus and voluntary eye movements LEng~lshi scopolamine In the treatment of motion sichnessPyio I, Padloars 5, Lyttkana M, Magnumfon M, EaihIt=le L (Inst. Occupational Hecalth, Helsinki, do Ollolgn~ni ), Johnson PC Jr, Cintron M M, CailkinsFinland.) D 5 (Space Bloamed, Rem. Inst., NASA Johnson SpaceGraham, M, A said A. L, A'enink ted.). 7tho Cent,, Houston, Tax. 77051.)

Vr~tibla ,~at,5,Neroplysiolagic and Clinical Annual Scientifc Moeeing ef flits Aerospace MedivalResearch,. Thirteenth Meeting of the Baronry Society, Assoociation, XWahington, D.C., USA, Ma 7-11, 19119,Ann Arbor, Michigan, USA, May 2,144, 1985. Aviat Space Environ Med JQ (5) 1919, 506xviil+68111. Raven Proxv.- New York, New York, USA.

Ills, SBN0.9167206A 187,235242(The effect of neatbuioprolectors on the cyclicnucicotide system In enperimental motion slickness]

Problems of drug prophylmxis of motion sickness Vliiania vastibuioprotektorov na sistemu tailclichcskiciihT Rulni nukieatidov prl modelirovanli boleani dvirzheniia,

has:hicov' V 5, Sabaev V V, Il'Ina S L, Gaillo R Rt iRssian, Englishl(Inst. Mad,-DiaI, Probi,, Minist. Health USSR, La'shehiniuk 11, Konovalova B0, Kvitchataia Al,Moscow, USSR.) Shamral VO, Bobkov luOilranniaklogya i Tokaikologlya (Moscow) IQ (3) 1987, Paint Finial Eksp 7'ar Jan-Fab 1989, pp26-85-20

Effects of various types of antihistamines and InhibitorsEffects oft ecopollat"lnt on physiological performance of histamine release on motion'lnduced tintakt or

[English)l Suncua-nurimus gnsllshjCrisman R P, Mayor L 0, Murdoch D M, Dellohn C Kaji T, Maisuki N, SaitoH4 (Dop. Chacin, Piarnincol,,A (Nsvol Aerospace Mod. Rise, Lab,, Ponsacala, Fla. Pao, Phannaccutiosl Sol., Univ. Tokyo, Tokyo 113,

Annuaal Sientilic: Moving of the Aerospace Medical 6.3rd Annual Meeting Of the Japanese PharnasIOW1gicalAssociation, New Orleans,, Losiriana, (ISA, May 8-12, Society, Tok~yo, Japan, March 23-28, 19M, Jpn I1988. A Yat Space Environ Mod 1fl (5) 1936, 487 Pharrnam~i U (Suppl. 1) 1990, p I 4p

Hluman catectsolattnlne responses to stream after Thie effects of tranndersial scopoilamneri on thedexainethasone scopolamine pluis uamphetamine and vcatlhulti-octslar rentw [EnglisisIK ilacebo illnalishI Dowook 1, Shupuk A, Gordon C IR, Spit,,ur 0 (Motion

ohi Rt L (Univ. Spacu Res. Amsoc., Space Blamed. Siokness Human Performance Lab., Israeli NavalRoo. lost., Johnson Space Cent., Nod., Aeronauticssand Hyporhsria lnst., PMO. Box 9040, Haillm3 1090, irsraeI)Spa5ce Adni,, Houston, Tox, 77058, USA,)111th Annual Meeting ri'flite Society fur Neurcusvience,Trtronlo, Ontario, Canada, Novemnber 13-18, 155151,Site Neurojei Abst, JA (2) 1988, 1051

6. Factors affecting susceptilblltInconsistent effect of cinnarialne an the vextilhuioocutalr A motion sickness piedlction model sand systvss

rnesl VOlt [Engishl description (English IrDowock 1, Shupak, A, Spitzer 0, Oordon C It (Motion Hiartle, Dona R,. (Air Voerv lost, or Tech.,Sickness& and Human Performance Lab,, Israeli Noval Wrigit-Patteross APB, Ohio.)Hyperbaric Inxt, Hairls Israel,) A- 776,A ICIN16-Annual Scieintfflc Meeting of the Aero~space MedicalADl771,Ai/C/c36-Association, Washinsgton, D.C., USA, May 7-11, 1989,A vial Space Environ Mod JQ (S) 1999. 481 Changes In circadian rhythmn or multiple hormones end

their relationship with Individual suaceptiblity Insimulated weightlessness flnglishlLiu, Kajie, Sun, Hanglytian, Lu, Jun, ZhAng,Ouarnsing, Poan, Xisowu1.tF International A4stronautical Congress, 4&h,)Mo/gago Spain, Oct. ?-J), 1989.0 pp.

J i

* ,,, ,

Vestibular examination of motion sick student pilots [in Selivary proteins as correlates of motion sicknessIDutch; Einglish Summary) suaceptlbltity. An .Ieatrophordetl analysis [lnglishiBlot, W, (Institute for Prvoption RVO-TNO, Macdonald S, IgarashiNM. HenleyC0M, KohliR (Univ.Socatortbcra (Neutherlmnds).) Space Res. Assocoation, Houston. Tox. 77058.)FZF-JYU.22,' T-89-OSJJ., 57*9.0-95O91 61as Annual Scleni(flc Meeting qf she Aerospace

Medical Association, Nowv Orloantn, Louisuiana, USA,4M 13-17, 1990. Avcme Space Inviron Mod IL (5)

The relationship of vinual-pereeptual skills, vision mnd 19?0, 507

skRicki L. (U Western Ontario, London, Clinical 092sd of the mec~hanimm of motion sickness (3).CanadA) .lti Investtgaiton of *.'sumeetiblit, fromDlssefation Abstraces International 11 (9-B) 1988, answers to questisonnaire [Japanese, Engilishiisp2817-2S1S Illuits N, (Japanm)

Equilih. Res, 41 (4) 1988, pp403-409

Neuropsychiatric observations of proprioceptlvosensitivity In motion sickness susceptibility. The Aerobic filtness and Nusceptibility to motion sickness,forgotten third (actor (BnglilhI ]gihFait 3 0 L, Salomon A A, alstmtroghl R L. (Inst. Leants OR, Ridley WC, McHuigh J, Crlmsstt JID,Aerosasce Mod,. Buenos Aires Argentine Cler IAnnual Scfrnsljtic Mooting qf sthe A4erospace Modioal .4la Spas ice Environ Mod 11 (2)Psb 1987, ppI05-8.4ajsocdlaon, Lm Vegasr, Nevada, UISA, May 10.1.,

JW7 via Spae 5viro Mo U () 187, 92 rediction of the Incidence of motion sickness front themagnitude, teren cne, and duration of vertleal

lThe relationship between preflight underwater training ose llation, Wyn WihIond space motion sicknissis l1nllsahi Lskwther A, 0rlfflo M) (Institute of Sound andYoumans E MI, Charleis J B, Santy~ P A (Med. Sel, Vibration Research, Thu University, Southampton,Div., Johnson Space Cunt., 1-touiton, Tnoxn 77058.) Unitedl Kingdom.)Annual SelsU/fic Mdeeting q/ the Aeorospace Moicaln J Acorad Sao Ain 3Z (3)SVP 1987, pp9S7.66,4sa'eiatlion, Las Vegase, Nevasda, USA, Mayt 10.14,11007. A viat Space 6nviron Mod 21 (5) 1987, 497

Reiaiesllity or provocative tests of nitotlon sicknssessusceptiblllty, Lunalifihl

kMotion sickness and ele ro extroaraphic activity as st Cailkins DS. Reich a MP, Kennedy RS, Dunlop WPfunction of speedof rotatin Yortoptokinlnsecdrum (Space Biomedical RaesAroh Institote, NASA/Johnson9 Einglixhi Space Center, Houston, TX 77058.)

u S, Sterm R M., Vasoy M W, Koch K L (The Pt, A4vWar 5ace Env~ron Mod 3(0Pt 2)Sttp 1987,Sutat Univ.)M/ill Annual Minding o( Ithe Sodigr ppAO.Pyh 74 ailgin 19ner~s Pa1,o~ysig 45 Th une of tise loagistic mstwi.l In upace motion sickness

Lin KK. Romelhke MPF (Krug lnturnattln~id, Hosn~ton,Ocular rounterrolllsg In parabsolic Ilight prsedlcilve tIst TX 77058.)

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Role of the area pssstreir In three puntatIve suessuria orAsyminsetric olo11th function and Increased sumceptibilty tuiloloss Aickness In the rat. igngiishI

to motion sickness during exposure to v, nation In Sutton RL, Fox RA, Daunton NO (Duluirtiicnt orgravltoineartial acceleraution level, [Engii 'd psychology, Saiu Jonse Stato University, Cuilfortia

Lareknr JR, Groybisi A. Johnson Wit, Moneiy KE 95192.)Aviat Space Envirsin Med a (7)Iul 1987, pr,632-7 beha Nu ra NO/e lin f (2)Sep 1988, pit 133-5 2

Michanisins of antmiotion sickness drugs, I181amilaht Illeriueaility of the bluotsdbrain barrier InI modelingWood CD, Manna JE, Wood Mr, Menson R. usottI o n sick ness] ProRi1 aaouns atIResdatiski NM (Louisiana State University MedigAl guimatonaumtssaliahoskogo bar'cra pri tnodolilrovsnulCentec, Department of Pharmacology and bolezoli dvizhenilia, [RuisianiTherapeutics, Shreveport 71130.) Drozd luV, Puka VM, Riurnita flldAviot Space Sinviroh Moil 11 (9 Pst 2)Sop 1987, Xomns Bile A vioken,' Moil~ (2lMar-Ape 1989, pMBitpA262-5

lThe effect on motion sickness and oculaontotr function Oplokineti and veatlbulo-ocular refla respomnse to anof OR3 380327, a SIlT3-receptar antagonist with unreditable stimulus (Unglighiantl..metlc properties, Bonglh Poo lka Robert 3., Block, F, Owen, SohoenhoffSLott JR, Barnes OR, Welght RIt1,11uddook CJ (R.AF. Momlk , B. ýOood Samaritan Hospital and Medicalinstiits or Aviation Medicine, Farnborough, Centel, Portland, Ore.Hampshire,) LNAS., Univerulthie Space Research Agsnoctalion,Pr J Clim Pharmuavl a2 (2)Fob 1989, pp 147-57 Saylo Unh'e,,fr,, and Internataional Academy oF

Aotwautnsss , Internait nI Mn in SpaeSmoi71h, Holiton, 7X, 1e. 10-iS7 1A)m6Aavi~latanpSjpiacef,

Illockade of S-hydroxytryptamnlmt recepton prevents and Onvironmenlal Medicine U (Sept) 1987cloplatin-Indtsced but not motion- or ppAllO-AI85,xyiaslnelInduced smash In thme eat. [EngsialuLucot JS (Wright State University, Department ofl'Iarniacoiaay, Dayton, OH 45431.) IThe significance of hithese hm. isamatch of sensoryPhairtnavol Bloch emt Be/san (t)Jon 1939, pp207-10 signals In mechan sme of motion-aikknees

development) Zriachonlo Fazovoga RamsogiesovanllaIehmomy k1 31goalov v Mskhsnirmakh Rittvitla

Neurochemnleal mechantintsa ofmiotksn sickness. Inoglishi ,Iaclvaia (Russia ilTAltett N. Morita M, HaIsegawa 3, Kuho T, Voroblev, 0, A.Mstsuopga T (Deartmettcl or Otolsurynsmlogy, Onaha .4kademtia Nouk SSSR, It ve~ntia, Serla 81rolgichsekaieiUniversity Medical School, lapsm.) O7SSN 0002-3320j, Sept, -01, J9117, p. 758-761.Ain J 0oldmyngo1 Ig ($)Sop-Oct 1989, pp33l.9

Control of abdominal and njilratory Intercostal musclerrhe effect of pyrld'saine an the cerebral henandynantles activity during vomitingt - Role of ventral

in vestibular disorders) Viflatni- pridoltakina mt respiratory group expiatary neurons IEnliuhhiWrahrehal'nuiu geontcinamiku pri Yastihuiiurn~vkh Millar, Alan D., Tan L. K, Suzuki, Ighirureas~trnlsvalth, (Russian, Englishi tRoo.keroller Univ,, Now YoNk.

SkI~onipNA ~ Iauna/~~rerahysiooaop4 J5BN 022-.1071), vol. 57,

Role of chalinerik nirechanismks In alterations of rabbit innervotion of perlesaphageal le.ion of cat's diaphragmbrain functional activity during oea-sickness, - ipieNjiatkia rot studies af control of vomiting

VPifiukY, Skoromnyl NA (I N. K Sachenov Tran, L, K,, Miller, A, D, (Rockefeller Univ., Newinstituta onfEvolutlonery PIhysisogy and Bi'.ý.Iemistry' York,)Acadonly of Scien. ýe of the USSR, Loningrad.) Neurateiencr etters (ISSN 0304-J940), ss.!. 68, 19R6,Nesroyci 81-010 PkV.1101 :2 (I)Jsn.FcbI 1990. li~p6-45 p, 339.344.

Weiset of mniticholinerolc andi chollnergic drtugs on Human factors In the navel environmenti a review ofhabituation to motion In rate. [rngiluhi motion sicknes anl hiundynouilc problems lEngilaluliMorita m, 'raekd# N. ilusogawa S, Yaointudanil Coliweil, 3. L. (eletnce Research EmitlohimhrnntA, Wada H. Allisl 8 . Kuhn T, Matmunaogs T Atlantic, Dartm~outh iNove Scotia).) DRIIA-'rM-89/220(Department of Otolaryngoiogy. Omiltic Unive~rsity AD.A214 73.tMIXA45 Sop 89, 7011School rmr MoiVlcine, JaIpanI'A-Id otalaryntgrl (SitockA, [JU (3..4lSop-Oct 1990,lipl96-202 Knie of orientation reference selection InI Inotion

sickness, Alp lenivilt IS lilnglshiptrR, ,P , M~aick P. D. (Good ýi~tomritan

Hiormonai ithangee after parabolic night, imnplcatiouti linopital anid Mindi-s dCente~r, Portlund, OR.) NASon the develipment (of motion sickness, [Engillil 1,26:1~i9133 NASA-CR-1S1393Drummer 0, Stmoneoyer H, Riepi RL, Kanig A, N87460V49/7/XAR Oct 67, l6pStruilo F, Lang RE, Mass. H-, Rocket L., Ourzor Rt(Modi,.inisoho Polkil Innow~adt, Universitat Muinchen,

r~a.)Significance of sensory slignnl piamas tinbtmich InAvirai Space Ennlvs ion d §1J (9 Pt1115011 i990, miechantsius or notion sickness develotntentIPpS2l -n (Ahatract Oniy) jbngiVh TrnansistilnVorsthyov, 0,. A (Joint Putblications Research Sarviao,

Arlin Lnot, VA,)NN~i-20'$7.'701XV 10 Jun 88, 1ip

iMiik between asynmmetry of optakinvilkt nysto 1111111 Role of orientation referemace selection In msotiononstovestibular and vemtlhuiovegetsitlyv vSt~bliit sicknftsi. Semiannutial Stautss report [EnulishiiEnsgiiuh Poturkat R. J, , Blac~k P. 0. AOo SahmaritanGrinsrova, V. K. (Joint Pouilcnat~n flesarcitSarvicn, Viiital twnd Medical Po~ntar, Potu~l.OR,) NASArlington, Vak,) 11 a1841109; NASA-CR-184609In (it USSR Report., Space Boiala , and AorrJ.pace N89..J51.1/9/X49 coe 88. 8211Medleitne, Vol. 20, No. , . -Jun. 1 Imt('PRS`-USD.H6-M5)5. p$9R-61 (SEE N87-0S1 esory conflict Ins motion sickanes: an observer theory

apoproach lEnglishiOiian, C,.NM. (Maissachuacts; Inst. of Tech.,Ctimbridge.)N90.22L157161XAB Jul 89, 15p

Conditioned itoastvseruion irk humans WelnNeuropsyehloltric observations of proprioceptive motion-Induced sickenes as the US nuiusecillenic

sensitivity In motion sickuens susceptibility, The experience (Eniglihlforglottu third factor [EngigihI Arwas 8, Rolnilk A, Lubow Rt W (Dop. Paychol., TelPatt ,2 0 L, Salomon A A , Dalsirooohi R L (Inot. Aviv Univ., 69971 Rsmni Aviv, lsrael)Aostspce Med., Irsnos Aires, Argentina,) Behaviour Rrasarch and Therapy 22 (3) 1939, 295-302Annual kintftesgi Meeting ill the Aerosipac,,e MedicalA,itociation, L~w Vieaio, Nevada, USA, May 10-14,1987. A Wet Spaw Unvl~on Mod al (5) 1987, 492 [Phase correlations of cupular and otolith reactions and

their Interaction In the developmient of motionsickeness) RuasianiThe use of composite Information for the prediction of Vorob'sv 0 A, Paral'man A I

motion sickness [English] hIveahlya .4kaidonxid Naesk SSSR Soriyo Dlologic'hoskayaLini K K, Rosohko M F (Space Blomned, Rec Inst., (1) i939, 19-23Johnson Space Cent. Houston. Tex, 71058.)Annual .Iclent~f~l MrotllR of the A4erospace MedicalAnnidallan, Lon Vegoa, Nevada*, USA, May 1044d, The weitibulo-ocular reflexansd Its possilble eniss in1987. A viat Space Inl Won Mod 11 (5) 1987, 504 spact motion sickenus. [Enfiishl

Watt DO (Dept. of Physyico gy, Mcell University,Montreal, Q~1ac 0iCanada,

lioperfonslance aplication of a system englinsmring pAviatSac AFO .Pt4S 97model for motion sickness mand other environmenta p 7Wlstrsons [EngishiBalicley D Moft. Kndy I. S, Jones M B (Sissei C1040 Woodcock Rd,, Suite 227, Orlaiicio, Fia. 32302,) Role of oWllth endorliann In the grovels of

vestibular-viitual conflict sickness 0(itrh) In theAnnual Scient4L :AMeeting of Ili# Agrospave Medical squirrel monket (frst report), (EingishiA4xociarlon, Wa~hinoros, D. r., USA, Mayv Z 1I, 1R9.9 Iarashi M, HimiT. Kulovy. W , Kobayashi K.4 via$ Space Environ Mod §Q(S) 1989, 4779 (~ apartmont of Cotoh Ino Isrngology and

communicative Baiances, Baylor college of Medicine,Houston, Taess 77030.)

Motion sickness and motor strateylngih A vlat Space Environ Med .11 (9 Pt 2)Sicp 1987,Watt DO0 D, Novo 1, Yon, TI' Sm ntith A (Arospuaec ppA2074tMod. Res , Unit, Madll Univ., Montreal, can, H30

111h Annual M.eoting ofthe Sociely for Nourr,.wlonce, Mec~hanismsn of selective attention and space motionPhaoo ix, .4rio, - SA - jl~e 1%Nmv.se . ilcknebs. aEngli1h]lJ.04. Sec NeuroidAsi.l.lur 11 (1) 1989, 516 Kohl RL (Divisilon 01tSImae Motielina, NASA-Johnson

31e Canter, Ht-taiton, TX 77058,)10olill tippessts mtionokknesThe elatonihpstvlia Space EnivIron Mod Jil (I I)Nov 1997, ~lpt 130-2

sickn 41 iinsiiniri oiairorall* oto 'I be. role of inotion sickness In predicting anilciputoryUUtdodohasge IN 1 Stern Rt M. Kad, i K L (Doji n~ation. IfingillhiPsychrul., -Pennsylvania State Univ., University Park, Leventhal H, Bastcrlng DV, Ncrwiny DR. Lovc MRPa, ) (Deliurtoent oft Psychology. University or, Winconmiti,,41.ommucltr of Parers Suntuitl, Io, the Apmnericam, Mad ixon 53706,)Axw.clatianfor the SlurrtfLivor Db~eiocforth~de 915 1t Behav Mod IL, (2)Apr 1941, plip 17-30Annual Meeting qf t/se American Oiatrrlentopo ' I'ahl(aA~vxaeclation, San Antoni, Texas., USA, may 12I -tnJIM.I Gartrrsesterolojy 2A (5 Part 2) 1990. 1pAO0l Whase correlation of cupulir and otnllthict reactions and

their Interrelation with the development of inoliomssickness] Psenvysaotnsini kupulinrmiykit I

Mollion sicknessi inxainva-plit. L~earned food aversion otolitovykh reaktnii i ikh v7AInw,~slaz: a ra't-vitionm(l1lFA) Indtice by minusuldal Ilinsar vertical UkacyoilmiAeii Ilt~khtIsnd~splarcement linialsiml Vumohav OA, Pervl'tnan AlLi QI Wilimituiski C R. Lo%4ry L D (Dep., Otoiuryngiil., Its, .iA'ad Nammk SSSR Jialll I)haui-Vebi 1989, ppl9.23Jofforson Mod. Coll., Phiiudcloplla, Pat. 19107.)W1t Annual ScIontylr MeetinR of lime Afroxpa'o

Medicadl AN~vr'ciation, New Orleans., Louislapta, Tl15,4. [l'ernivabiilty mif time imhad-brsin harrier In 111uidttlniluMay 1.9.17, 1990, AvIal Space Eniviron Mott faj (5) m tio II n saItkne xssI P r o nits mN 3 a .,1990, 506 otamswcnitorfaiiheskaiio hurlera lir mod~tiovurOVii11

rioiceml dvlrieniia. [ftAlainiDroed luV, Pulso VM, Kimimiihn lot

Nioikmn sickness severity under lInteractiosns of vection Kaosm Rlot A vlakaontn Modl 2 (2)Msr-Apir 1989, pg$and head nmovenmento t11inlisilhYang T, Pei J I, lowari P (Homntn PerformniaeqLab., I nst. Space sod Terrestrial Sci., 103 Miotioni sicknessi a mymmthrals and evaluation of thePtirlIui,artitn Bsldg., ~., Univ., North York, Ont., Iensory conflict tlss'ory . [siteh111Ceti, MMJ iP3.) Oimmun CM (Mali Vois7olaLstiratory, Nlassauhunumt6.,s .tAnnual Svolnliflv Meeiting otf the .4eroqpure hngtluto orf Technology, Cambtridtio 02139,)Medical A.,morlativin, Newt arleans, Leoulsawm', )$A., C~an J Ihysrlol Phatrmnacvl il (2)Fcb 1 990, )pp294-303May l.-? SWI. Aviat Space Environ Mod (~ 5)

1900, 506 VI,

[Correlation of vertical optaskinetic nvsti~stmau. and Serotuaeritlc e mehasnkims In eanesls [EnglishIasusceptiblity to motion sickness In man] Isaledovanic Lucot, J. B,. Crompton, 0. Hi. (Wright State Univ.,vzanimomviazi vertikanlnopo optokinctichoski'go Daytorn, 01-.)nistagms I podvarahcnnostl ihelovekia bolenan IN.' BaTIC and appiewd m~pects of wYnadbular/ssnctiom.dvlzhunlla, (Runelanl Hong Kong, Hong Kong UnivervilyPess 1 988, p.Vorob'ev OA, Zarilplkaia VV, KryIoy INV I0-)Ii.Katm Eioi AytkosmMod 2A(l)Jan-Fab 1990. 1pSOQ-2

Changes In eireadian rhythm of multiple hormiones andThe effrets or fisation and restricted visual field on their relationship with indivIdual Susceptiblity In

vection-Induced motion sickans. (English simaulated welighleasnes6 IOnglimlhJStemr RM, Nou8, Anderson RD, Loet wite 16W, Koc~h Liiu, K.ojla, Sun, flongyusn, Lu, Jun. Zlianh:,KL (Department oflPsychology, Penn Stato Unlveralty, Guamninng, Pan, XlanwuUniversity Park 16002.) I..tF intnernational Astnronautical Crongral, 400j,A vlicJ Spact Anrviropt Med &. (a)A~ug 1990, pp7l2-5 Malaga, Spain, Ocl, 7-1.1, J989. 9p.

(Motion mickneass the resonance hypothuuisi Bolems' Biochemical correlates of neurovensory Chang" Indvlzhenda; razon~ransiul $Ipotoza. [Riureiani weighhlessneus (EngliahiLychakov DV Leach, Carolyn S., Reacahke, Millard P. (NattionialtIspi Fitiol Namk 2d (3)Jiai.Scp 1090% ppl 25-8 Aerontautics and Space Administration, Lyndoan B.

Jithin~o Space Ccnter, Houston, TX.)L4F, International Aintromausicai Congrescs, 401h,

11, Pya.iolgicalEfftets Maliaga, Spain, Oct, 7-13, 1111W. Sp.

Effect of Vesthular Stimulation up Static P'hyksicl leersaclr etcj f mto ikeWork Capacity lEnglimh Translatlionj erbaocl fets f mtin ic"4Podiduhvaiov, A. A. (Joint Pubilicationis Resarcah Tnoehro-,.ankullamuye EIf1etty Ukowhivanlia [RussianiServloe, Arlington, VA,) M- saloalenito, En,B. Sokolov, A. I., Mkinlsmukt, V.Nit7-29101YJ/1XAN ei19117, 4p F., Skoromnyi, N. A.

Fidlogiogcheskii Zhrarlij SSSR (1394 WX)I-329X), vol.

Chinnkn of skin potential level mand of skin resistancee7,ov19,p 'i.S.liveI Corresponding to lasting motion discomfort ithe relationship between subjective and niajerfiae

1Imu, Nanki, Koo. Jimt, Takatusiial, Nntiuyuki measures of simlanitssv-lnduced ataxtia E~nitlmish.4viation, Space. atnd Enviraninrenta keoi i (ISSN Kantoir, L., Maliee, L. E., Hamilton, K. M. (Derence(k39.4,55V), vol. 58, Feb.1987, p. 1.16-142. anti Civil Init. or E~nvironmental Medictine, Downgvlew

(Onitario).)AD-A2J3O95. DCIEM-it9-RR-28t

Electros1ermol activily duaring motion disromfort'Englilsil,gu, Naoki, Tiakahashti, Nottuyuki, Koot, Jir A rl anlss mton RikEss sgletsdines I hsloshi )~DIeN,,11PIdoli mimona yiOWONSpaes TechnologynI A analysiita s lamton sikE (ltonesstd es alogrisphic

Sciece, 51hloky, Jaan, an, 9-2S 1"6Sm~ith, EKummal 0. (Air Fore lnst. ofTec.Pr'ce'edings. Vat/univ 2 (AR7-321'76 13-12). Pohyo, W-*ht.Pattcrion AFB, Ott.)A4 VNE Pujblljhing, Inc, 1941, p X049-2054, AD-,Q2 5663; AWIG/SO/ENO18%) I

Generala autonoonic comnponent~s of motiont sickonxs Motiona Sicknes: a study of its effects on hunisis

CoigPatricia S., Suiter. Steve, Toacarto, Williolai tadcut .J Aic Force lnst. ofl Tech,,

B., Kamiya, Joe, Nalich, Karcn (National Aoronaiutico Wri~hlltPatturson APB, 0OH. Scthotl or Eingineeirings.)and Space AdmInistration, Aincs Research Center, APITiOBIENG187D320Morifrct Field, calir.) AD-A 2188 8112)/JIXAB Dec 57, 10

411

1'.iyrhorhlvi.%;,ioy (ISSN 0(4081.., 772), vo . 23, Sept.291,p. 54.5.Analysis of physilokgical data related tu wolnaotksa ricknc

fair use ini a real-time msoti. a sickasesm IndicatorVtitlhular system and neural correlates of mnotion l1ng liahj

sickness lEnglishI Dry lie, M. U). (Air Forec Inst. of Tech ,Miller, Alan D. (Rockereller Univ., New York.) WrightitPatterson AFB, OH. School of Engineering.)N.4S,-CR.I/i1)85,- A'lS A.2:1113AFITIOEIENfjil7D 16

AD-A Ilt9 5894tXAB Dec 87, 8fir

Fosllow up of the gastric euiptyinj ((;b') b) ultratioindmafter a stress (rutatling chmir) - Interest of tha ~ Ftect of veatibular stimulation on shatc phaysicasl workmethod In apace duerin spacv moption .,ickancs capacity [English Tcsnilailooltgngllshl Pialahlvalov, A. A. (joint publicatioin- ilchatrclsArbellie, Ph,., Valnialle, P.., Patet, P., Pottior. , M.,, Sea-rce, Arlington. VA.,)Pleakof, L, N817-29IL69fl/XAB 09117, 4p1(Intearnational Union of Playsiahlo14-a.' Scither sCronirn~eson on 15rasvitathini at Physylology. A4nnualhieetvinit- Rth, Nitra, Czechtiov~a'lak, Sa'p. 23y-00, 2,19417) Phys -1apis,ri SupgMsalemntI SSN Ct03J-9* 76), avol..31, Feb. '988, S-8. S, -37.

Changle In functional activity or cortical brain structuresasorms ftr oatn-due ainand their blood supply In alert rabbits In response Electriaato arm afe oainidcd mtoto rocking [English Tranhlatlon] aicknesa [OnglIshlMakeimuk, V, F. , Skoromnyy, N. A. (Joint Stewart J i, Wood M J, Wood C D, Woods T W,Publications Reosearch Service, Arlington, VA.) Mims M E (L.5,U. Med. Cant., Shreveport, La.N91.429161RIXAB 5Aug 87, lp 71130.)

Arnnual Scienfjl )Woofing (if the Aerospace Medical4Association, Nlwc Orleanse, Lousanabln UiSA, May 8-12,q

Gastricepyn assessment by echogrj;,y after at 1988. A vial Space En viran Med ()1988, 486Itresa (rotatoing chair) lEngl~ohIValnialle, R. , Arbsilis, P. ,Pawo, P. . Pottler, J, lv., harlb, C. (Tours Univ. (Prance), Lab, do Effect of sound 'no some vestibular autonomic reactions

aBiophysiqus Madicate,) In motion sickness tRussiantN88-I9OS5197XAB eDen 87, 3p flodo 0, Kilian K, Skotie, G3

Ko~smlchetthaya Biotltg Io Aviakaspnichevn kayoMeditalina U (3) 1988, 9-92Investigation of simulator sickintes and an

etectronystagmntographic study) Brnquets sur Is meldes slmulatouirs do vol couplei at un. etude Individual differences In autonoistic responding tonlystagmographlqusk (French amotion staiokns stimulation ifinslishiDcheynO. ,Degrarr, P. , Vandenbosch, P. (Centre Cowings P S. Nslich K H, Toticsno W Bdo M edeina Aerosptliale, Brussels (Belgium).) (NASA-Ames Res. Cant.)N88.-121RSMIXAD clan 88, 5p 2Rth Annuat Mewting of thse Scietry foir

Psychop/nyslological Research. Psycliophysyiology 2jl'hotooleetronc smonitor of motion sickness: an ()81,4

Instrument measures the drop In skin Infraredreflectance accompanying nausea (Eng~lshi Effects or electrical and acustlmulation on(National Aeronautics snd Space Administration, electoastrorapc tactivity anid the symptomsa of

Washington, DC,) tinices ngahMA-rN47-01 May 87, Ip Hu S, Mtem iR M, Vtacy M W. Koch K L (The Pa.

State Univ.)28th Atnnual Meeting eqf the Soviely for

Ocultinuolor and subjectilve respoinstio to head PsrychopiyllgclRsac.Pyhpy~lg .miovements made during and after body rotation Ia (4) 1988l 455-456terrestrial and non-terrestr'ia grovltolnertlal forceenvironments. (EnglishiDiZio, Paul A. (Brandeis U, Waltham, MA, US) Mution sicknesa and electrogsstroitraphic activity an aDitsertation Abstracts Interailnotluc U (5-B) 1987, funoctIon ofspeed of rotailkn oran optolkinelic drtump1534 E~ng~lshl

H~uS, Stemn R M. Vasey M W. Koch K L (The Pa.State Univ.)

The effect of biofeedback control on the severiy of 28th Annual Meteting of tlit Society Jutrvelitlbulo-autonomic symptoms of exiperimental Psychr hysnialogicai Research. Psychophysiology ,motion sicknessi. l~nus~snai (4) 1948,'456Soirniov, S, A., Ail~kov, 13. S. Kozlavskaya, 1, B,Koamicheskaya Eiloigiva il A vtakosmtncieskeyaMedlitsna 2l (4) 1988, pp35-39 Ditsturbances of lasitric wsyoviectrlcal and

nenrocudorrlue activity durlingl the ntress of msotionsickness (Engliahi

P.ndogienouacatecholanslnenltteeduriig vection-Induceed Koch K L, Stem RL, Demers L, I-larrition T, Seaton J,motion sickness and tachygastria [Englikhl Summy-Long SBnaa , Sperry N (lDcp. Mod.,Koch K L, Stem tM, HartlaoinT,Satan J, Dwyer A, Pa, State Univ., Hershey, Pa. 17033.)Vane M (Dep. Mcld., Penn State Univ., University International Conlfersenc (in Stress and DigeliveHnipp.' Hershey, Pa.) Mntllhty, Mont Cabriel, Quebec, Casnada, arc~hAIRMh .nnuai Meeiting of' the American 29-31t, /tlt9. Dig Dis Sell 2A 3) 1989, 484

6jsroenfrr~ogta/ 4ssecioiona Digesti-e DiseaserWeek, Chicago, Illinois, USA, May 9.13, 1987,(lastroenierokiery 2ý (3 Part 2) 1987, 1474 lThe effect of gasitric comtantt on mothin sikneiss

IlInglishIMims M E, Stewart 3 3, Worod M 1, Woods 1, W,

lmanascutareous oxygen ats a meiasure of pallor lEnglishi Wood C D (L.S.U. Med. Cent., Box 13931.,Harm D L, Bratty B ), Reschks M F (NASA Johnson Shreveport, La. 71130.)Space Ccool., Houston, Tex. 77058.) Annual Scemiilett Meeting (if lthe Aeruospace MedicalAnnual 5dm: jJfiv Meetin otf ihe Aerospace Medical A4stioclajion, Washington, D. C., LISA, May I- 1i, 1W989A~ssoceiati on, Lius Vegessi, Nevada, USA, Nova 104J4, A vial Space A8nviron Med 69 (5) 01989 4931987. A clot Spavit Ernviran Med 11(5) 1987, 508

Changes In the utotl protein concentration (if salvaAulogenic-fredhackt training as a preventive method for duriulng earrmental motion sickness l~nulalidi

apc wod aptatlsssynsiruomeon pate-4lailOn3 11nglah Macdonald 5, Itiarashi M, Henley C M, flemchke M PCowin Vat S, Tokimatt W B. Kamtlys J. Miller N B, (Div, Space Blamed., Univ. Spikes Roe. Asmanlatlon,

Sharp I C (NASA-AmoCk Ron, rent., Muflht Field, Hnounon, Tea. 77058.)CARif 94033.ý) Annual Scen~leni M~eeting It the Aerosipacet MedicalAmtnuasl Sciersil Meeting qrifthm Aerospace Medical Associlaian, Washinsgton, D.C., USA, May 7411, 19019.A~s.voctatton ,NWr Orleans, Loalmlona, USA, May 8-12, Aviat Spac. impiron Med JQ (3) 1989, 493198A. A vlot Spave Entvirrn Med (5) 1981, 481

B. 17

Preliminary Investigation of cardiovascular responses to Evaluation of veatlbuloýiwular reflexe VOR parametersarbolc flight In sick and .on~nlck Individuals according to motion sickness susaceptibility 1lnilinhi

l~nilishS Spiter 0, Dowock 1, Gordon C R. Slitpak A, (3adotawlnt hDL, Rootlike M P (STac Diomed, Ran. Init., W(Motion Sicknesso Human Performance Lab., Isrcli

NASA Johnson Space Cent,, Ilunton, Tex. 770511.) Naval Hyperbaric Inst. Haifa, Israel.)Annual Scir 0C Uflc fing ,iJ the Aerosepace medical Wet Annual Scientific Meeting of alilt Aerosp~aceAssociation, Wsh ingion, D.C,, USA, M7 7-11, /989. Medical Amooiataian, Now' Orleans, Loubliana, USA,A vial Space E,.wlron Med (Q (5) 1980, 493 M 13)-17, 19W0. ,4via: Space Environ Mod Lj (5)

Effects of liquid initiatin ono the ollactropaliogram DagotecalfatnofcagsIth hmnrecorded during motion sickness [Engliihi ilnsl lsiiaio fcagsI h uaStewart J ,1. Wood C 0, Wood M J, Woods T W, eleutroilastrograns during motion sickness Il~sglishIMimi M 2 CL.S,.U Med, Cent., Shreveport, LA. Dianford C L, Oman C A (Man Vehicle Lab., Mit,71130, Cambridge, Mans. 02139.~ gok

Anu l Sinen Mooringa of the. Aerosnpace Medical Skis Annual Scitni~ffc stalin qthe A4erospaceAssocialion, Washinillan, D.C., USA, May 7-11, 1989. Medical ,Association, Now Orleaass, Louisiana, USA,A vial Space Environ Mod jD (5) 1999, 505 M .~1 3-1~ef7 1, If vi.Aat Space Enviran Mod IL (5)

Relationahip of vasopremsin AVP to adreoocortlcotropinACTII and naluise before sod after adaptationn to Flectroencephaingra phic theta hand changes duringmotion sickness (finilliahi motion sockness lEntilslihKohl R L (Uiiiv. Space Ren. Alsane,, Space Blaomed. Morales Rt, Chaloan W E (Applied Blondi. Co., LouRen. Inst., NASA-io .hnson Space Cent., I-lasaon, Tex, Angeles, Calif. 92050,)77058.) 61st Annual Scient~ifi Meeting of thet AorospactAnnual ScientifIc Meeting of the Aerospace Medical Medical A~smoclaflon, New Orleansn, Louisiana, USA,Associnalton, Weishingian, D.C., USA, Ma -1), 19.89 Ma /3.17. 19M0 A vial Space' Inviron Mod §1 15)Aviat Space Environ Med §g (5) 1989, 705 1 NO, 507

Hlumana veanlpreasin AVIP and adrenocorticotropln Salivary proteins am correlates of mootionsa ecknoxxACTII responsea to itresnful sensory Input, susceptIbIldIty. An electrophoretle analsisk 12%~ishiIndividual different"e and adaptive responses MNAdona Idigaranhl M, Henley C M. ohl R (UnivI1s1l14hI Space Rea. Association, Houston, Tax, 77058.)Kohl R L, Calkins D S (Univ. Space Ron. Alsv.ilatlon. a6l1na Annual Scientific Meeting of filet AtrraoposSpace Blamed. Ras, Inst., Juhnson Space Cont,, Natl, Medical Association, New Orleans, Luldiona, USA,"Aeronautlen And Space Adminlstratilan, Housitun, Tex, Ma13-1~7, 1990. A vIat Space finviron Mod IL. (5)

191n A.nrnual Meeting tfiltc Socierty for Nouveasciencc,Phoenix, Aritona, US1A, October 29-November 3,1989A Sac Neurasci Abstr 11 (1) 1989, 272 ftlhedrlne effect on the blood supply and oxygo'n

regimen of the brain during motions sickneeni](Russlani

Analmgesi and beta endorphin (11E) responsea to Sicoronmnyl N A (Div. Pluannacol. Course Clio.,.notlon-ilcknmse In mortonodlam gllutasnatetreated Phermieos., Penliatr. Fac,, Crime, Mead, Inst.,rat$ (Engllishi Simuferopol. USSR.)Seallet A C, Wilson S, Rountrec R L, Henry W Jr, Farmakoiogiya I Toknikologiya (Mfoasow) IQ (2) 1987,Anudrews A, Walker C A (Nati. Cent, Tanleol, Rec. 93-97Jefferson, Arizona 72079-9502.)19th Ammman)Meeting, the Society for NsocnnePhoenix., Arizona, U S A. October 29-tNoveanthe 3. lCewebrovascular effects of motion sicknesil [Ru~slnini1989, Sac NeuroseliAbair 11 (1) 1999, 5 16 Moakalenko Yun E, Beketov A 1. Makaimuic V F

Skoromny I N A (Lab, Comnp, Physlll. Blood Ciro.,LM. Scghcnov Inst. ilvol, Piyaio I. Biocheii, Acad.

Thne gtaxtrointestinal torrelates of motion sicknnea In the Sel, USSR, Leningrad, USSR.)cat i~oglinhl Fitiologlc/itrxkii Zhurnsai SSSR lomntvi I M Seciienava LiLang I M., Steenorisd M, Saran S K (Dep. Surg, (11) 1989, 1560-1567Phyakil., Mod., Coil, Winl., Zabiocki Varoc,MI waulune, Win. 53295.)19th Annual Meeting of i/i Secleiy for Nekrmvnctnre, I'lls, effert of biofeedhack control on the severity ofPhoenix, Aricoane 'USA1, Ocftober 29-November .1, veatlbsn~loautnomic symptoms of experimsentasl1989. Sac NesgrrodAbnajt (l) 1989, 900 moction sicknessa (Russian, EinglinhJ

SmlnnovSBA,, Altlov 0.5,, Koalovakaya L B. (USSR)

Eating suppresses motion sickness The rellutlonshipao Mu~m, 8k.1. A viakostnn Med. 22 (4) 1966. pp)35-39Among v~aia activity electrogastrogralm and mnotion

sk nes gislnuUotdchugc 3 H J. Stem R MI, Koch K L (Dp. Catolamnll esos t rtational trea In' ratPsychoi., Ponnaylvania State Univ. Univesiuty Parkbanse:IsletosAranh~~sn therapyPa,)~ MOf ' motion iksa,s lnli-hlAbiuaoair of Paper~s Submitted to thec American Takcda N., Mosita IM. Yama-todani A . Wide H.,Associctionkor thle Study tyfLiver Distaze~sftsr i/e 9/st Matnumagis 1. (Japan)Annual Meeti~ng of the Amorican Owstronuvtroiogical As'iat. Spacce nvioron, Med. flJ(11) 1990, pplIlS-1O21Associatioan, San Ant-.io, T'exas, USA, Many 12-18,1W.5) Gsuirotnaerolksgy, 2A(5 Port 2) 1990, pA670

jý

Spectral man alys of inch Iastria recorded during Nugelr anediclne evaluation of mootion sicknee oldmot Iio n I [iI'Is (ngflffh medications on gasticn emptylglolp e. jfinglshi

Stem RM, Koch KL, Stewart Wit, Lindblad IM Wood Mi, Wood CD, Manno E3, Manno It, Rede~ig~epartment of Psychology, Pennsylvania State HM Dearatment of Radiology, L.S.U. Medical

niversity, University Park 161102.) CneSreveport 71130.)Ghaslroirnleroaloy 13 (I)Jan 1917, pV92-7 A vial Space Environ Med JA (11)Nov 1987, ppt 112-4

Characteristics of vestibular reactions to canal end (Ebu fvslsuoatnme dsrders duringOtOlith stim1ulation4 At Ad early stage Of eaPosure1` to hypikowinul on regional hemodynamics) Villaniemlcrogravlty, llnglish vastibulovegetativnylih raastralslyv uslovilsklhSimola MO, Dabayey 6M, Beloomrova 18, Nyrova Ipokinez mi nailelonarstsiu gamodinamiku. [Russian,AN, Yalcushiss SR, Koelovsksjra IS Cnlash)

Physoloist32 ( Supl)ob 197,ppS2-4Lapaev EV, Bedneoa VS, Vorob'ev CA, AftsmonovPhy~ioloist fl I up 987 ppS2-4IN, aritakiV

(Effect of ephedrine on the blood suppil and oxygen fyA akSS olNvDe18.pOS1regimen of the brain during motion siknesms]VIilanie efedrina nat krovosnabehnimo I kisioradnyl Hormonal status And fluid electrolyte metabolism Inrenhim golovtoogo mozga pri ukichivaitil. litusilan, motion sickness. (English]Btiglishi Orlgoriev Al, Niehiporuk IA, Yasnotsov VY, SiiashkovSkoromnyI NA vs (institute of Biomesdicoal Problems, Ministry ofFrman kol Thk-Oof X (2)M.r'Apr 1987, pp93.7 Health, Moscow, USSR,)

Aviat Space Hnviron Mod 2 (4)Apr 1988, pp30t-5

lElectradermsl activity as an Index of motion sickneas. airchntasoiedwt lnealoio

oA'swicik.3vans LA, Church RE, Hancock C, Jochim siek ness condition In man. I~n~glishjD, Morids PH, Ward F Cordon CRt, Ban-Arysh H, eyArgal Rt, Atiaes J,Avias Space Enviroin Moid 11 (SiMAy 1987, pp417.23 Rolnick A, Lauter Dl (Motion Sickness and Human

Perrurniance Laboratory, israel Naval HyperbaricInstitute, Hairs,)

Skit' poetAM el corresponding to transdent motion J Auron NMer Syvt 21 (2)Msr 1988, pp91.6d=Ucomlo't, [En shtau N, Takahashi N,6 KoAvia; Space lEnviron Mad a (G)iun 1987, p~p576-BO tEffect of adaptive biofeediback on the Severity of

veatlbulo-astonamle syniptoama of experlimentalmotion sieknesas V~lianie adkptivnogo bioujiravlanila

Autonomaic effects on R-Rl variations of the heart rote na vyrazhennost vastibulovegotativnykth aim tomovIii the sqlislrrel monkeyt an Indicator of auteonoissc oksperimentalinoil balezni dvicheniia, [Russian,Imbalance In conflict sickness, (En i11h) RngliahiIshiil M, Illarashi M, Patul 5, Himi Tý, Kuleuz W Smirnov SA, Aiaikuv 0S, Kotlovakala 18Am J Oiorasyngoi I (3)May-Jun 1917, pV144-8 Koan BiloA ,vtakosmu Mod 22 (4)iul.Aug 1989, pp.15-9

Nystatimusaepisode related to sar sickness. ffnglishl Salivary chsanges asioclated with seasickness, IEnflilhAideas J, ordon CR, Boinick A, Sade I (Sea Sekocast aordon C DeSn-Aryeh H, Szmrgel R, Alt asReerc eteIsalNavy I.D.P, M ledial Corps.) Rolnick A, Laurer D (Mation Sickness and HumanArhOahmlrmll2M (2) 1987, pp84-7 Periormance Laboratory, Israol Naval Hyperbsrio

Institute, Haifa.)

Vitiopreasln and motion sickness In cats, lEnatlishi uotNr a f IPb19,p114Fox RA. Kull L.C. Daunton NO, CrAmptun OH, LucotJ (Departotont of Psyehoioaty, Son Moac State Univ., Elecroralrosstronrsmsdurina isulot sickness In fasted andCA '5192.) fed Nuhj..ts. lnatlishfAvicil Space' Environ Meef a (9 Pt 2)SLIp 1987, Sltewart J), Wo& Mi. Wood CD (Departmentn ofppA143-7 Pharmacology and Tharapeutits, Louisiana State

University Medical Center S1hrevepurt 71 130-3932,)(inxrolsteiina mntllt In pac moton icknss.Aviat Space Environ Mod 19 (3)Mar 1989, pp214-7

Thornton WE, Linder Wi, Moore TP. Pool SL Cearebroaplinall fluid constituents of cat vary with(Astronaut Offlue, NASA/Johnson Space Cantor, susceptibility to mootion sickness. [EntilishiHouston, Texas 77058.) LucotJB, Crompton OH, Matson Wit, Camache PHA via( Snce Environ Med Al (9 Pt 2)Ssp 1987, (Department of Pharmacology, Wright StateppA16.! I Uni..'Orsit , Dayton, OH 4$435.)

LVte Seli ~(lR)1 1989, ppI239.43

luormonni repons. of meocoprsmilde~treatedu ubectseasperienclag nausea or emealls during parabolic Motion sickness and #mtirk myoelectric activity .n a

fiigh~lnglshj unlteton of spee of rotatio, of a circular iseetlonKohIR(ivmn or Spaes Biomedicine, Univeorsities drum, llnglishlSpace Research Associationn Houston, Taeas 77058.1 HuA 5, Item RM, Vasay MW, Koch KL (DepartmentAnal Space Environ Modi (9 Pt 2)Scp 1987, of Psyehology, Pennsylvania State University,ppA2d6-9 University Pat 16802.)

A vial Space Environ Mid (5t)May 1989, pp4 11-4

Soium concentration In saliva along the time course of 12. ProyoatIfve Strimuiexperimenstal Coriolis sickness. (Englishj

ý eshiM, ac~nal S Chas SY. Plilahker CiA, Vutibulsr-yhual conflict In pitch and yaw planes in thekohl L (DepartmntW Otorhinolaryngoloy and squirrel monkey (1inglis I

Communicative Sciences, BaylorCollego of Mdi~cine, 'Parashi, Makoto, Kulecz, Walter B., Kobsyashi,Houston, Texss 77030.) Kazsutoyo, Isago, Hidemitsu (Baylor Coll, of Medicilne,Acta Orciaryngeot 0atockh) 10 (5-6)May-Jun 1959, Houston, Tea.)PP483I Aviations, Sp~ace, and Environmental Medicine fJSSN

00)95-6362,D, vol. $?, Nov,1986, p. 107141074.[The effect of motin slekaeus on the diurnal rhytmo

the sinus nodb of the huart conduction [ytm The significance of the ~base mismatch of sensoryVoaeltve hacilania ti stohyi rinisignals In Mechan ism of motlon-sliknuss

avonatizms sinusovotio Wel provouiiashehoi sistemy development] Znacherls Pasovogo RassoglasovanIlsaerd~a, ~sasani ensoykhSignaloy v Mekhonizmakh Razyit~ia

Nta"hnk 'u AM Nealorlco ACI =kciaia [Russian)Va.. ble Za -Y Ipto, rp!1O-6I Vorob'sy, 0. A.

Akademlhs NeauSSSR, /averaella Serflia Bilogioghe,&ala

Neuroendoerlne and gastric myoelecirlcal responses to7S f3.33) ~:-c.197 .7371Illusory self-motion In humans. [BnglishIKoch KL, Stem P.M, Vaney MW,. Salonn I F. Domers Periodic acceleration stimulation In space (UnglimhiLM , Harrison TS (Department of Medicine, Burton, Russell R.Pennsylvania State University, Hershey 17033.) SA,4 Inma'rsociety Conference on, jiviponmenialAin J Phrysaol 2fl (2 Pt I)Pcb 1990, ppE304-10 Syston.,, 191h, San Dierge, C~A.Juty 24.26, 1989. 6 p.

[The rerchrovascular effects of motion sickness) The effocta of fisatlon and restricted visual field onToerobro-vaskulismye sffektty ukachivanila, (Russian, vieeloos-lnduced motion sickness (Engsllhilingilshi Stern Robedt M., Hu, Senciq, Anderson, Richard B.,Muskalonko lugl, Ockotoy Al, Makaimuk VP, Leibowitz, Herschel W., Koch, Kenneth L.Fiorolyis NAR~(l)o 99,plG. (Pennsylvania State Univ., University Park.)

Fitot h SIR a ( I)ov 989 pp156.7Aviation. Space, and Envliottmsental Modivine (ISSN000-6562.), YoL. 61, Aug.1990, p. 712-W,5

The stability of Individual patterns of autonomicresponses to motion sickness st1mulation. Ilinglishl Motion sickness, Visual displays, and armnored vehicleCowing. PS, Nailek KH, Tosoaco WB (NASA-Amex doea a OJnhiishlResearch Center, Moffett Field, CA 94035.) ar~ig of a Conference on Wraparound VisualAvlai Space Inviran Mod (a (S)May 1990. pp399-405 Displays, Waltham, MA 14-15 Jan, 1085 (Naval

Postgraduate School, Monterey, CA,)Autanomic lotdeues during the oeatlbulssr-wlsual conflict .4D-A222678,, ORL-CR-629

exposuret at squirrel monkey study. lnolishIgearashi M. Chas S, MacDonald 5, Fii t T1.akeoa situatisnal awareness and vestibular stliuulAtIon: TheIN (Department of Olorhinolarynitology and lstflusstce of whole-body rotation upon taskComimunicative Sciences, Baylor College of MeIZine sýerfbornance [In Dutch; E~nglsh SumniarylHourton, Texas 77030) Wlertjo C. J. E., Dies,. .W isiuefrPreto

A isiv way ary 12(2) 990 pp6-76RVOTNO, Soosterbarg (Netherlands).)ZF-IIXI, M8190S1, 5Th'-K-97.tdd

Vasopressle and niepoinls responses to Illusoryself-motion and mauses in man, (Engiiahl [Space adaptations syndromae Induced by a long durationKoch KL, Sumniy-Lorng J, Bingaman 5, Sperry N, + 3Gx centrifuge run] Opgewckt door cen langdurli.oStem RM (Department of Medicine, Pcnnsylvania holaativ. van +30x in de contritfigo) l~ngligh IState University, Hershey 17033.) Bios, . , Has, I. B.E , Furror, 1. , Cirsaf, ., D..1 Clin EAlnorrinol bluish i. iS)Nav 1990, ppI269-75l Holman, R, J (institute for Perception RVO-TNO,

Snocterhcrg (Netherlands),) IZFP*1989-251TDCK-89- 103.4Hormonal thanges after parabolic I'llsht Ilistcat'ons AD-A218 248/IJ9AB Jul 59, 45p

on the developmnent af motion aickness.,Drummer C, Stronieper H, RelRL Koi A,Strollo I, A RE, Maasse H, Rooker M, Circe Vestibular responses and Motion sickness durlng ý th(Mes IinisheKlInik lrscnsladt, Univorsitat Munchen. roll, and yaw sInusoldal wholfe-body oe I datonPRO.) ngihA viat Space 1mitsron Mod ~J,(9 Pt IlSep 1990, Ouodry, F, E. , Norman,. 1, Tumnipseed, 0l. , Rupert,PP321-8 A. (Naval Aerospace Medical Research Lab.,

Ponasoola, FL.) NAM RL-1352,4D-A22i ASWI/lXAB Mar 90, 16p

Role of orientation relerence selection lIn motiunsickness, Supflement 28 [Roegilish)Peteriss, R. ., , black, F. 0. (Gr~od SamaritanHospital and Medical Center, Purtlind, OR.) NAS1.26:181393i NASA-CR-111393AN74030497I/XAI Oct 57, l~p

.............- ,- - - - - - ~T

[Peripheral disainese. Transport sickness therapeuticSignificance of sensory #[lnst phase mismamtch In actuality] Vartl,,es. EMalidmTaspot Atmlt

mechsamlsms of motion sickness development Murput s (Frnch En ransh] t Atatc(Abstract Only) Einglish Translation] PehiC ,ls~auvage J, P., Perrini A. (Franco)Vorobyev, 0. A. (Joint Publications Research Ann. MAd. Nancy Eit 21 (3) 1989, ppl191-193Service, Arlington, VA,)N88-267817/ITAB 10 Jun 85, Ip

Asymmetric otolith function and increased susceptibilityto motion sickness during exposure to variations In

Role of orientation reference selection In motion aravltolnertlal acceleration level, (En lshiskicness. Semiannual Status report (nglishI Lcner .01K Oraybll A, Johnson WH M9oney KEPotarka, R, J. , Black, P. 0. (anod Samaritan Avlal Space Env Pon Mod Al (7)Jul l997, pp652-7Hospital and Medical Center, Portland, OR,) HAS1.26:1114W0; NASA-CR-184609N80-JSSJJ/IVIXAD Dec i5, 82p Predictlon of the Incidence of motion sickness from the

nijoltude, fro 1uesscy, snd duration of vertical

Weaion and simulator sickness. (Snash Lats A iftbn MI (institute of Sound andHetitngsr, Lawrence J.1, Bebum Kevin S., Vibration Researeh, The University, Southampton,Kennedy, Robert S., Dunlap, William a. t aI (Essex United Kingdom,)SCo Orlando, V'i., US I Acowsa Soc Am 11 (3)Scp 1957, pp957-66Mitl'as PycoLog i ~ 990, pplol-t18

Comparative assessment of vestibular, optokineti, andSinusoidal vertical linear acceleration and motion optovestibular stimulation In the development of

sickness In squirrel monkeys [English] experimental motion sickness, [English)Wilpiseski C R,. Low*- 1. 1, Thomnp son P B (flop. Mxtmncv E1, Kuz'min MP, Zaicharova LN (Institute ofOtolAryngol., Jefferson Meld. Coil.. Philadelphia, Pa. Biomedical Problsms, Moscow, USSR,)

1917,)Aviat Space Eniviron Mod 11 (10)Oot 1957, pp954-7Apitiualsdul Meeling of the Aeospacew MedicalAiroviallon, oew Orleans, Louislana, USA4, My 8-12,1988. A Wai Space En viron Mud §2(5) 1955, 65 I lead movements In low and high grovltolnertial force

estvlronsssents elicit Motion sickness: Implications for,spc oinsickness, I~nellshI

Wide angile artificial horizon i frequently perceived asE~c La mtinr GR royblel A (Ashton Orayblel Spatialnont-horlsontal a possible probleis in Its use for Orientation Lboratory Brandeis University, Waltham,

rvlinof seasickness lEnglishi Masesachusetts 02234.)oncA.Bles W. Oordon t R (Motion Slickness Aviat Space Environ Mod 11 (9 Pt 2)Scp 1957.

Lab., Israeli Naval Hyperbariv Inst. Haill, Israel.) ppA2t2.7Annual Sclont c Muetl ,ng of the Aerospace MedicalAisaacialan, Wehington, D.C., USA, May 74-1, 1969.Avial Space Environ Mud JQ (5) 1959, 454 The Influence of grawltolnrtilal force lovel on

oculomotor and perceptual responses to sudden stopstimulation. lEshllehI

Development of standardised teat procedures using DiZio P, Lackmner JRK, Evanoff JN (Ashton Orsytiollreversing prisms fr the study of motion sicness Spatial Orientation Laboratory, Brandeis University,kEnig~lihi Waltham, Massaolhusalta 022S4.)volafa J J, Brumley E A, Vanderploeg; J M. Wood S A riot Space Smviromt Mud ;1 (9 Pt 2)Sap 1987,

J1, Reoike M P (Krug Int. Technol. Life Sol. Div., ppA224-30NASA-Johnson Space Cent,, Houston. Tax, 77035,)61it Annual Sclonltfc Mueeting of the Aorer.race?Medical Aasociation, Now Orlunnw, Louit~rana, USA, Motion sickness and msotion characteristics of vessels atMa M17.1? 1990, Avial Space Environ Moid IjU (5) sA., (EnglishI190,7 0 Lawther A, driftin MJ

Ergonoinfisal.U (10)Oet 1985, pp 1373-94Motion sickness ieverity under Interactions of vection

and heed movements (Enelistil Altered tensory-suotor control of the head as anYang T, Pai J, Howard LP (Human Performance etiolo ial factor In space-motion sickness. [EngilitilLab., inst. Spmee and Terrestrial Sol., 103 Lack.iter JR, DIZIo P (Ashton aroyblel SpaeialFarquharson Bldg,, York Univ., North York, Ont., Orientation Laboratory, Brandeis University, Waltham,Can. MM IP3.) Massachusetts 02254,)61a: Annual Scientific Meeting of the Adrlsaco Percept Mot Skills 11 (3 At I)iun 1959, pp714..6Medical 4ueciation, New Orleanm, Losuialna, USA,Ma 13-I?, 19W., Aria: Space Environ Mod (LL (3)1o90, 506 Adaptation to vectlon-Issduced symptoms of motion

sickness, WEg~lshlStem RM, Hu SQ, Vasey MW. Koch KL (Department

*Shipoadevaluation of motion sickness Incidence and of Psychology, Pcnnsyl'aanla Slate University,* huma n veng ala~ problens a I~eliahij University Park, PA 16502.)

* Dittnsr A.C., Guignard J,C. (USA) A rlot Space Environ Mod ~Q(6)Jun 1959, pp566-72.1, Low Pineq, U MsSr . 2 (2) 1955, ppSO-65

B-2Reduction of vlsuaily-lnduced motion slckmess elicited Effect of ship roil stabilization on human performance

by changes In Illuminatimn wavelength. [English]lnlihDobie G., May 10, Dunlop WP. Natdion ME Morrison T R, Dobie T 0. Willems G C Webb S C,(Naval Biodynamles L.aboratory, University of Now Endler J L (Naval Diodynamiecs Lob,, Riew Orleans,

Avies Spase illvironl Med ig (&)Aug 1919, pp749.54 dial Annual Scifn#Vk~ Mestingr of the AerospaceMedical Association, Now Orlearul, Loutalana, USA,M lean1,,LA970.194407,)pLae 70189.04Meal

Cleaisn of various motion stimuli on motion 19%,4-77 9) 4a pc EvrnMd~ 5sa ams and acquisition of adaptation In Suncus.

fti T, Salo l, Us1ed I, Matsuki N (Departmient of A survey of the occurrence of motion siclknetss alonsChemical Pliarmacouloy Paculty of Pharmaceutical passengera it ona [English]Sclcncus, University of aok, Japain.) Lowther A, Griffin M J (Inst. Sound Vibtatian Ron.,JikAen Dobuisi 21 (1)Jan 11900, pp75-9 Human Pacewrs Res, Unit, Univ., Sotithamvpton 309

SNH, Bt ~ngld.)Avisation Soce and Environmntenal Medicine 12 (51

[Characeoslsttca of meodia sicknes durnn prolonged 1993, 399406ofolh stmulaionIn antl-ortols pulla

Omaobnnoati tecenlila bolemnil dvishenlia, PH dlitai'nol

VO, Markin AS

'lenn Ourlnlatingo Ja'Peb199, pp.14Physictal and adaptive meschanisms In seasickness

voction-lnduced motioni sicitnus, [Elalhl Ous Ii, n. Markt, naop. hRed. Ottynla 32 (1-:) 1918,Stem RM, Hu 3, Anderson RD, Lelbowity HW, Koch PP39.44KL (Department of Pa ohlogy, Penn State University,University Park 1612 .)

HellmannS Siet ,SheeLarynaol RlslnoI Otol (Sruflg) M (2WPcb 1987,

1i, Sa. Icirnes pp99-103

Human factors In the filval envIronmentl a review ofmotion sickness and biodynamle problems lilnsihshl Sick at seat outbreaks praint reinstatement of cruiseColwell, J, L. (Delenvo Research Establishment ship Insaections. lifliglis IAtlantis, Dartmouth (Nova Sootia),j DREA-TM-19/220 Norook MAD.A214 133/BIXA B Sep 89, 70p Can Mod ,4uu'nc I Lf (12)Juin 15 1987, rr1298&ZOO

(Semasices sut dose~effect registrations with IIM.S [Seasicknesa at 11101t) SJomykc p.ANOa Rost, INorwaillan,MakulZoizctooneoc:domise-ffict metingcr English)

aen board van HR. MS. Makkum tutch) Michaiel son PM, Pugellil PBles, W. , Doer, L, C. ,Kiluning, .A,, Vormeij, r), 7ldakr Nor Laiegforen )a (24)Aug 30 1987,

Wientija, C. J. E, (institute for Pucroe tion p22-kVO-TNO, Soestaerber (Netherlands).) IZP-195 *5

P889l8842/XtI 19s170pNytAlminus episodes related to mea sicknesa. llngliuhilAttiasIJ, Cordonn CR, Bulnick A, Slide J (Sca SlIckemno

Wide angleartifcia horizon is frequently percel-ved as Research renter, Israel Navy lODP. Mcdivsl Corp-u.)na-hrl1na a posilble prohlem In Its u~se (or Arch Otorhimolarynglol 2M (2) 1917, ppS4.7

preventlon of seasirkunes lEnglishiolnc A. Bloes W, Gordan C It (Motion Sicknems

Lab., lIraeli Naval Hyperbaric Init.. Hallk, Israel.) Motion sickness aind motion characteristics of veaisel atAnnual Scient 0i Meeting ofthe Aero~space Medical sea. IlnglishgAssjociation, Wahbinton, DIC. USA, May 74. 1, 1989 Lawthor A, urifln MJAvial Space Environ Mord IQ (5) 1919, 494 hYrionomnles U, (10)0ct 1938, pp1373.94

A survey of the Incldence of mai ds debarquemeat, Mill Salivary changes associated with seasickness, l8ifaighl9 Englishi Cordon CR, Ben-Aryeh H, Smargal It. Attila 3hpuitzef , Gordon C Rt Daweck 1, Shupak A (Motion Rolnick A, Laufert D (Motion Sickness and Human'

Sikess Human Periormancc Lab., Israeli Naval Portharmanu Laboratory, Israel Naval HyperhsriuHyperbaricl Inst., Haifs, fsrmai, Institute, Half&.)Annual Sclexti~ Meeting Amth Aeroipace Medical ,t 4 Wto Nerv Syar 2A (l)Fob 1939, ppJ7-42Association, Whm~aaunon, D.I., USA, Maly 7.11, Imp,1A val Space In viron Media (5) 1919, 485 Sesae, rglh

Ala Med al (2)Aug 1969, pp13-4

* 5-22

* Motion cammotlon..a seasickness update, (EnillishJPingroo BJJRA Nat' Mid Sery U (2)Summor 1980, pp75.34 Visual display factors contributing to simulator sickness

minet, 2 LawraneoJ, Nolan, Margaret D., Kennedy,(Se sckusa a evew f tirloypathophysiology, Robmrf8,, Bobaum, g5v10 a., Ichnitalus, Kevin P.evaluatimn and trlutmeritl [H etrow) XN. Human Facto,,i Society, Annual Meetting, .9k:,Shupak A, Gordon CR, Mourned Y New Yorki NY Ot 92,18.PoudnJs. VolumeHamejkals 1A (3)Fgb 1 1990, p9153.7 I (A88-3540 14-54).S Santa Moniba, CT, Human

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14. Simulator Sickness Simulator sicknots research program at NASA-AmesResearch Center IfEngislah

Simulator aficknas - A review of Itsn cots Macaulay, Michael 3., Cook, Anthony MI. (Nationalcountermetwures, and prediction engilashI Aeronautics and Space Administration. AMON Rs1164rehFrank, Lawrence H., Camiall, John Ca Entor, Moffatt Foeld, Calif.)SAE, Aerotvpaco Yrchnoloy Confrencel and IN.- Humman Factors Society, A4nrnual Meiting, 31.,,

Elpwsion Lon leah, C, ts. 1316, .986 13Now York, NY, Oct, 19423 1987, P'ocefedings, Volumeo&posllon L~oI Rech, A, ut, 1-16,1986 ~ I (A 88-35401 14-54)~. Wanta Mon ic(;, CA, HumanFacbor.# Society, 197,1 p. 502-504.

Asynchronous visual delays and the development ofsimulator sickness (EnglishI fet rvsa ipa n oinsse easaUlisno, Kevin C., Kennedy, Rubent S., Lambert,. fet fvsa ipa n oinsse easosfinaboth Y. lopat performance and uneasiness In a drivingINM Human Factors Society, Annual Moiling, 30th, Ciurlato (11,8l10[1atoOHl, Sept, 29-&ct. .9, 1986, Proceedings. Prank, Lawrence II, Chiasl, John G., Wiorwillo,

Ioum (A~87-33001 13.54). Santa Monica, CA, Walter W.Human Factors Socliety, 1086, p. 422-426, Human Factors (ISSNIVX18-7208). vol. JO2, April 108,,

p. 201-217, Navy-supporlud research,

United States Air Force experience withsmiltr osseny crsmaursf simulator scnssickneis, research and training (Englislh) oiltnyicommaue fsmltrscnsKellogg, Robert 3,, 011hhlngham, Kant K. Imsplications for a blacyhernetlc safety reportingIN., Huaman Factors Society, Annual Meiling, 5901h, device 1Enl0h)

DayonOSep. 2-Oat, 3, 1985, Proceedisj.rs Kennedy, Robert S Dultzoly, Dennis R., Lillonhul,ouMe) (0~7-3)00OI 1.954). Santa Monica, CA4 ihal0, Allgned, Glenn 0., Cower, Daniel W.

Human Factors Socliply, 1986, p. 427-429. IN.- SA FE Associatiom, Annual h4rnpuotiumn, 23th, Lai,Vegas,, NV, Nov. 16l,1987, Proceeding (AMSD-10.52

01-44). Newhall, CA, SAFE Anocial (on, 1987, p.Simulator sickness -A problem for Army aviation

rnIyJohnt S.Aviation11,111 Spave, and Ess'iranmmntai Medivine (ISSN Simulator sickness on the Increase Ilinglimlh]

0095656), ol.58,Apri IM, p MS51.Kenned"y, Rt. S., Ailgood, 0., 0. Llllanthai, M,. U.(.525455), vl. 5, Ap~l ~~ ~IN., A1L4A Fligeht S1mulation reicJnologies Con/erenctand liviibil, Brtsim, MA,Au%. 14-16, 1989, Teclinial

V'ehleular miniulalor-Induted siklness, Volunme3t Survey Paper.,iA 89-48 76 2)-09). wan/injln, DC, Anericeanof etiological factors and research facility Inmlituto ef Aercenaulkas and Astronautlka, 1989, p.requirements ltlngislah 62.87.Camsll, John U., Wlerville, Waiter W. (VirgitiluPolytechn6; Inst. sa Slte ni., Bluokuburg01l Simulator sickness In the Royal Air Parc.el A survey

ADA) ~ ~ ~ ~ ~ ~ ~ C1 73226,' J.RT.85j W.Ch0i1 ~ glh (Royal Air Fam~e Ittat, of Aviation

lihe effects of asxynchronous visual delays oat ulinulutsar Mellc otbruh(nlniflight performance and the development of In A GARD, Mation Cues in Fig)ht Simnuilatin aindsasnuiatar sickness syinptanmstologvEnihnllahj Simulator Induced Sickness 11 p rSz' N89-t12171Ulisno, K. C,, Lambert. 6, Y, Keneidy R,. S., 03-52)Shelipard, D. J. (Dusos Corp,, Orlando, 1lu.)AD-A 1110196; NA VyW,45YSCIIN4-6.-111,026-1

The rellatistnahips between subjective and objectivemeassures of sirnulator-ladneed staxis LEngliehI

Sianultator sickness - Some Measurement issues I ftsbahl Kanltor. L., Msa e, L 0,, 1lamllton, K. NI. (DefeanceUlliino, Kevin C,, Kennedy, Robert S. and Civil Inst. of Environmental Madlolno, flownsviowINM, Simulators IV.- Prvcesdin qf th SCI Corsftrence. (Ontario).)Orlando, PL, Apr. 5.9, JIMl (A 81.22867 01-641). ,zan AD-A213093,' DCJEA49-RR42iIDiogo, CA, Society for Carmputer Sitnidatian, j1lt?, p,

102-04.Guideines for slievlatllon of simnulator sicknes

l'rain the etoloigy of sismulator sickness Il~n shiil 'neody. It..~ Botbsum, K. S. , Lilienthal, M.11let4tinger, LUwsenroc J,, Kennedy, Robert 3., a, , Duniap, W, P. ,Mulligan, B. E. (NavalBortusum, Kstl, 6I. Training Systems Cnoalr, Oriando, FL.)IN. Simulators IV,- h'octod-in,74fttse .SCS C'otftesvtse, NAVTRASYSCEN.TR.17-007Orlando, PL, Apr. 6-0.laR? (A4 A-228d? 07-116), San AD-A 182 S54MIX4II Mir 67, 72pDiego, CA, &Scietyejbr Compster Skoulation, 1IN?, p.

Simulator sickness Its the All-64 Apache combat missionsimulator (En ahOower, 0D &,, Lilienthal, M. 0. ,Kennedy, Simulator sickness tol US Army and Navy fixed- andR. S. , Powikos, J, B. 2&latzley. 0. R' (Army rotary-wiasa Rigit siausuitors (English]Acromedivil Researgh L.bPort Rucker, AL,) Gower D.W, , Lilienthal. M. 0. ,Kennedy, R. S.USAARL-46-1 , Pawiicu, J. 5. ýArmy AeromoelIosl Resartch Lab.,AD-A IV) 41919/X.40 Nov 67, 11 p Podt Ruckor, AL.

Simulator Induced sickness in the CP-140 (Aurora)flight delok simulator (nglish) Manifestation of aiisusl/vestbular disruption InHamilton, K. , Kantor, L.Hesiegravo. , ,. Magee. simulatnast severity and empirical measurement of16. . Hendy, K. (Defence and Civil Inst. of symptomaotoliogy(EngfiihJEnvironmental Medicine, Downsview (Ontario),) Coalsl, J. 0. P rank, L, H. (Virginia PolytechnicDCISM-99-RR-31 Inst. and State Univ. B1&sckabur8.)AD-AZ 13 096/VX40 May 39. 25p ?49-)ZMJ8/1XAB duon 8S, Ilp

Simulator sickness In the UII-60 (Black Ilawk) flight Modelling operator control perflormance and well-boiassimulator t(Englishb as a function or simulator visual and motion system(lower, D, Wowlkos, 3. (Army Aeromedicai transport delays If'lolahjResearch Lob., Pont Rucker, AL.) USAARL-89-25 Prank, L. H. , Josali, J. 0. (Pacific Missile Test,4D.4 214 4.U/.J/XA 0 Sep 69, 75p Center, Point Mu u, CA.)

N89.12182M/X45 eJun SB. 7p

Simulator skicness In the Alt-IS (Cobra) flight (netain o iuao ikes ad asimulator (EnI9 allahgto f iuaor scnss ad a0dowr, D, W owikes, 3. (Aiml Aeromedical eloelronystaglmogrophle study)) Enquate sur Ie melRcsuarch Lab., Port Rucker, AL. US ARL-19-20 des simuloetura do vol oauple. a une etude

AD-A14 6214ANSop49,79pnystagmo, aphique (Fronch)doMdiie gnsaiaff, P.,Vandenbosch P. (CentrodoM naAooomtilBrusacids(eli))

Sinulator sickness In the CII-47 (Chinook) fl~iht N89-12101/4"X odun 48, Spsimulator l~oglishi0ower, J, Futsekes 5, Baitzley, 0. R. (ArmyAarnmedit&a homearch Lab,. Fort Rucker, AL. Cues for training vertigo, providing suggestions for theUSAARL-89-21 management of simulsatr sickness [IlngilihiAD-A2)8 2141S5X4B Map 19, 72p Nonfe M. B. (University HosptlW, Leuven

(Belgilum)

Motioutaues In flight simulation and simulator Induced W.2U 1 oun1,4

sicknees (English and Prench)(Advisory Group for Acrospace Researchi ard ()cuiornotor and subjective responieto t head movements

Developmeont, Neulilly-sur-Saine (France).) made diraing and after boy rotation In terrestrialAOARD-CP.433; ISBN-92-835-0466-6 and non-terrestrial gravitoinertlal forceN8f9-1217)/9t1(AB oJun AS, 194p environments, (EnglimhDIZIo. Paul A. (Brandeis U, Waltham, MA, US)

Dismortativn Abrstracts International Afl (5-11) 1987,Etiologial significance of equpipment features and pilot P1534

h story ýn simulator sickness (IlegimlslaXennody, R, S. , Heeiaum K, S. , Allgnod, 1.0Oý, *Lane, N. B. , Lii~enthal, M, .0,(91ssc Vection and simulator sickneou, (OnglishiCorp., Orlando, PL) Hettinger, Lawrence 3., DeBlum. Kevin 8,.,N042-121?274,48 oJun AM, 22p Konnudy, Robert 8,, Dunlap, William P. ot al (Easex

Corp, Orlando, FL, US)Atillogeal actrs I siulaor scknss Ingl~h)mllhiaay Prydwalogy a (3) 1990, pp 1lll-181

Benson. A. .1. 1(Royal Air Force, Farnhorougia(England), Inst, ofAvlstion Medicine,) Dl~rayed effects of simulator sickness Incidence andNNS-12174/.t/XIt Wun 85, Bp implicatons [Englishi

ilaitzley D R, Gower D W. Kennedy R S. LilienthaiM 0 (Essex Corp., 1040 Woodvock Ave., Orlando,

Ilierienatal study of the Incidence, of sinmulator Induced Flik. 32103.)Isickonss samong French Air rorte plots] Eiude A4nnual &We~I&/ bloolloag of thse Aarwpcre Metikathorizontal, do i'lncidoncs dlu =I deu siniulateurs done Anuodnf km. New Orleans, Loulcbum, (IV, kany 8-12,lea Forces Aeriennes francalaca r~renchl 1988. Avcat Spacto 901yonts Mod8I (1) 1063, 465Log-ir, A. , Sendor, P,. ,Dalalisye, R. P. (Centre,d'Haoals en Vol, irdislgn-aur-orte (Franoo), Lab. &eMedecine Asrosaptiase.) Conn"o of simulalca sicknes incidence by rimulatorN89-J21751/O/A oJun It, 7p usage adlaptation and other meansa (Bndglishi

enlit J1 1, Kennedy 9 5, Lilienthal M0, DunlapW P (Bases Corp.., 104 Woudou. t~ Road, Orlando,A

Simulator Induced slickneita among Hrcrules aiscrew Fla. 32101.)I lngliahl A4nnual Scloulflc Nessins of rAe Artpave Atemical

aso, L. B. Kantor, L, , Swacuuy, D, M, C. Aisockition. htintsohlk, DC., VSA, MAy~ 74), 1989.A(Do once and Civil Indt of Environmental Medicine, A4viuf Spasce Iasn vrhMod' fl (5) 1959. 4'0Downsvlear (Ontairio).)NPY-J2IYedaX4B odun 36, Al

A

.'Ol f,-~

01-24

Effect of ship soil stabilization on human perfornmance The time cournt Of poetf~llgt sImulatoir sicknss[Engulshi ogemptoss. ulihMorrison TE R nbie T 0, Willems 0 C Webb S C, UaZIe DR Itenndy RS, Bertlaurn KS, Lilienthallindler J L (lRaval Dlodynamnies Lab,, 1Wv Orleans, MG, (ower bW (Essexc Corporation, Orlando, FloridaLa. 70189-0407.) 32103.)61st Annaual Scientifi Muedasg of the Afero' ace ,4vile Space Environ Ned JQ (I I)Nov 1919, ppl1043-8Medical Association, New Orleans,, Louuisina, LV&4,Ma 13-17, IM*, Aviat Space Inviron Red IL (5)1970, 417 Control of simulator sActines to an All-64 aviator

[kotr; comment] [English]Simulator Acioknes a problnm for retotraft simnulation A Ya Soc J irnMdfl6)u190 pW

McraininMg 0 and tet Enlsh echnol. Inc., Carmel,MCalif. M 26350 nera.) Simulator sickness In an army simulator,.Eglsdint Annual Scionist~fc Meeting if the Aer pce Braithwaite MG, Braithwaite ED (lot Anhioured 1 leldMedical Association, New Orleans, Loouisana, 15., Ambulance RAMC.)

Me13-17, IM,. Aviat Space Enviroi Mled 9J, (5) J Soc Occup Mod Qf (3)Autumn 1990, pptO5-10100,491

[Motion sicknms and flight simulation, An ansimnestle I M Space Sicknesslovestslgatmco [PrenchlLeger A, Sandor P (C,B.VdL.,AM.AS., Space motion sickness status report [Engilish)Bretlgny-sur-Orge.) NASA, Johnson S pace Center, Houston, Tx (National71ravaur Sclent jquits Des Clserchaturs Dut Service Do Acronautics and Space Adminl~tration, Lyndon B.Sante Des Armnse (10) 1989, 23S-236 Johnson Space Center, Houston, Tax,)

IN. Aeroaspae envirionmental systttes, P1ror.-edings of~the Slztentih In1tordaciety Cotodferece on IN vironmental

Motion sickness symptoms and postural changes System.,, San Diego, CA, ,Iut 14-16, J986 (.487-38701foliowing flights In suotioss-haed flight trainers 16-44). Warrondalc, PA Society of Asitonotlsve(English EnioIIC,18,p1911K onneidy R.S., Algood 0.0., Van Hoy H.W,, i~nes n. 96 .i911Lilienthal MO0, (USA)1. Low Prreq. Nolve V1.i j (4) 1937, pp147.154 lnterlsbyritlnthineasymimetry vestibular dysfunction and

spoece motion sickness j~Ilnglhanrgiladtiz, 0.1. I, Saniarin, 0, 1., Bryanuv, 1. 1. (Joint

Simulator Induced syndronme in Coaist Guard aviators. Publications Research Service, Arlington, Va.)Englis(Wrh) SInt UnvriyIcolo ts USSR Ropoetv 5,act Diokg and Aeroxpaco

,4vlt Space Environ Med 31 L3)Mar 1985, pp267-72(JR.tDdLO)p138TEN172J 1-)

of isul dsply nd otin sntssidelys n [The space adaptation syndt'onsoi Le Synd.romeEfforts ofvsa styadmtinsse eastndAdaptation a l'Sopac [Proenahi

operator performance and uneasiness In a driving Oildir, Vcronlqua (Nancy Univ. (France).)shnmulator.I28ilnl1%9shl-kl2Prank LH, Cavail JO, Wiorwille WWVN-AA72Hum Fuctors U (2)Apr 1935, pp2Ol1 -1

Adaptive changes in perception of body orientation andSimlatr sekiessinUS.Nan simlatrsisental lnu le rotation In micr ravity (E1noflimSimulator sickerrtso ~~s In U..N vyfighta ohsnlatron Clement, 0l1lcs, Borthoz, Malin, f.estlenne, lranc a

6 ubishd eratin apeas I Avat-SuceKinron(NASA, Unleersirlea Space Reaseaeci Associatio,,le 99 yi M41 (Posgliehl Sarylor Universmity, aind International Arademy r0f

keusiicdy RS, Llllenthal MQ. B1crlhsur KS, llulliicy! .. rtrnaautics, Iiiivrmtstonal Man in Space Svenp'.viain.DR, Mckauley ME (Essex Corporation, Orlando, r7 7A. Houvrion, 7X, reb. 10-13, IM6). ,4vialt)Ir, Space,32803.) and Environmnental Medicine H5 (Supt) 1987 ppA'iat Space Environ Mod §Q (lijan 1989, lip10-6 A159-AI63.

Lnimitations of postural euilibriunsintest for examnining A nounhpharmacoioalsal approach to spcer smotionsimulator sitknees. 1ito scns[EgahHandltan KM, Kanto~r L, Maisec LE (Defenve a sQukess, AntngiohCivil Instituitoof Environmtnual Medicine, Dewnsview, Miel, AntornaionlAtoaiclCgrvsANont., Caniadai) fglAF, RfInter atina Asetroaia 1ongr1ss 198t 6t,4eiat Space Environ Med fQ (StmMar 1989, pp246-51 lihoEgad ~,1.7 9 .6p

Slisulaor ndued yndoen: eidece nnlgt sand poelflitlit notauh on the causation ofSiuaftereindutsd oyadn m evienc for iong-tersm Inversion ilusions and space sickness (Ulnglishi

Ungts TJ (Wright Stow University School of Medicino, IN-Mlotleidotr Sy vu nIIifeReut fhtDaytoij, 0hio!.' INeNrmadnr. Symw o eiu oksn D1,lwernifflc Reidtlsoft.4 mat Space Eitsiron Mod fQ (3Mar 19119, lW2. 52-3 OernlanSicscl~mab issi Au. 7-9.J96,; 4 aodiig

(A 210 1OX29). Co4 cc, Irederal repiiblik eGocMT-n WtssenscimafluikhePojetiern I97

32S. o

B-25

Follow up of the gastric emptyingl (GEi) by ultrasoundsafter a stress (rltatlof chair) - Interest of this D~evelopment of methods for the study of space motionmethod in space during space motion sickness sicknmes (English Translationl(Broglishi Matvoyev, A. D). (Joint Publications Research Service,Arheille, Pht., Valmalle, ft., Piota, P., Pottier, 1. M.,ArigoV )Plaskof, L, MS14845NA a 1988, lIphInternational Union of P/,yisolozIcal Science~sC'ommitssion on Gravitational Physioalogy, AnnualMeeting, Rth, Nitra, Czechosloyakia, Sepst. 28-Oct. 2, [Preliminary studios of the pharmacological control of1987ý PhyviotlaLit, Sr lement (ISSN (k'31-93 76), vol, spc ikes tdospeiisrss controls

SI, .1, 190, p. 5.87,~hanoaeoloi~qu! do roldo Ie~a.[rnhLlih-ud C. Lagarde D. rno 0 Cnrd~ludes' .1 l Rcsrches. do M dcal.. Aerospatisbe,

Spacelab 3 flighit eiperlment No. 3AFT23: Paris (France),)Autogonlc~eedbaek training assa preventive method PBOO-21944S/XAB 19 Doc SB, 27pfor space adaptation synidrome [ElnglishlCownings, Pistriqla, S., T osoano, William 1. Kamlya,Joe, Millecr, Neal U., Sharp Joseph C. (National Spacelab exiperiments on space motion sickness [Engli1shiAeronautics and Space Admi IsItration, Ames Research Oman C M (Man Vehicle Lnb., Dep. AeronuticsCenter. MorfsttPisld, CA,) Astronautics, Mass, Inst. Tochnol., Cambridge, Mass,M.4S4-TU-89412,1 A-87034, N,4S .IS. 159412 02139,)

Acta Astronautica j1j (1) 1987. 55.66

A new perspective In the etlologly treatment, prevemstignand prediction of s pace ntotio sickness I~ngfigla Thei relationshilp between prrfllht underwater trainingMorales, Rogello, Jr. (Air Force Inot. of Tech., and Apace motion sickness [EnglislilWright-Pattorson APB Oil.) ,omn 3M hre Santy P A (Mod. s4

AD-D2$v6O, JohnsonG10- SpeC it.Houston, Toax& 77058.)Annual &ientjflc Meeting oif the Aepaspaco MedicalA4ssociation, Las Vegas, Nevada, USA, May 10.1,

Changes In cimlinada rhythm of multiple hormones and 1987. A vial Spacer Snrlron Mod U (5) 1987, 497thier relationship with Individual susceptibility lInsimulated weightlessness [English)Liu, Kqjia, Sun, Hongyuani, Lu, Jun, Zhsng, Space motion sickness prefliht treads ptatlon lunalishIatuanolng, Pan, Xiaownu Parker D E, Arrott A P. Peso hto M ;, Von Glotk HUAP, /lntrssattlanai ,stroaulivkal Comgresxv, 40th, E, Rook J C, Lishlanibeig B KI (Dep. Psychutl,,Malaga, Spain, 0c:. 7-1j. 1989. 9 p. Miami Univ., Miami, Oh o 45056,)

Graham, Md. b), and,,', L. Krntink (4d.). 77jr VoislbularSystem., Nouraphysiologic and Clinical Research.-

Biokchemtical correlates of neurosensoiry thmange in ml rtoonsh Meeting oif the fiaray Society, Ann Arbor,weightlessness (English] Michigan, USA, May 21-24, 1945, xv111+66.9p. RayonLeach, Catol~n S,, Raschko, Millard P, (National Press.- Now York, New York, USA. Illus., ISBNAerontautics And Space Administration, Ly'ndon B. 6-880167-20648 1917, 67-70Johnson Space Center, Houston, TX,)ZAF, International Astronautical Con gresas, 401/i,Malaga, Spain, Oct. ?-/J, 19119, 5 p. Mlxerlenc with developing methods for studying space

motion sicknes1 ItuNNIAniMatveov A D

p'eriodic acceleration sthmulatIon in space [English] Kosamichiska~ya fliokgia I A vlakoxmichjskayaBurton, Russell Rt. Medlisinma IL. (3) 1987, -3.5SAE, Intersroclery Coniferoes an Environme'ntal

SysinuISO Sa DigoCAmo 4-2, 09. p. Neurohiumoral mechanism of space motion silknesslEnglishI

W oIsse n development, evaluation, and use of the NASA rOrigorics A 1, Egorov A D, Nichlporuk I A (Inst.Preflight AdaptatdonTralner (PIAT) [Englislon Biomedical Problems, Moscow, USS ft)LuntNormtan E,, Kennedy, Robedt S. (Essex Cori)., Seleceld POpOP.1 from a 0hnproNism on Space LifeOrlindo, FL,) Sciencesa Hekl ar the J17th International AstronasiviaiNASA-CR-I85608,- NAS 1.24,11156dM., EOTR-88-9 Pruderation Congress, Innsibrs(*, A ost ia, October 4.1 ,

1906. Acta Astronaut 11 (2) 19111, 167-172

New perspective tn the etiokigy, iteatuient, preventionand prediction of saces uostiton sickness [EnboaT Atssessment of the efficacy of medical countermeasuresMorales Rt (Air Porce. Inst, of uh.In space flight [En lsh)Wriaht.$ateraon APB, 0ON. School of Bnginocering.) Nicogossian A, Sulamasi F, Radtkre M, Doaug MAPI lOSOIENGlBID-2 (NA SA Headquarters, Life Sc. Dlv., Washington,AD-A20S 660/41XAS Dec 84, 16i9p D.C., USA.)

Seliected Papeprs fton a 3ympcasisun on Space LifeSciences IHold at the .17t1iInternational Astrrniaatival

ISpaee Adaptation syndrome Induced by a lon% duration Fodr-sion Comgross, Immshrica, Austria, October 4-./J.+ 3(i centrifuge run] Opgowokt door oen on ladurlge 1986. A va Astronaut 11 (2) 1985, 193- 191belasting van 4;313x in do ceintriftu e lflnglishlelse, W, Boa, J. a. . Forero, lg . Orsf, I. D.Hosman, R,. J. (Insltuitu for Perception RVO-TNO,Sociterberg (Netherlands).) IZP,1989-25;

AD-A 218 248/3/X48 Jul 89, O5p

8-26 astaa7 ae~N OaaUi.Md ~.,Smmr o otionisaickiness experience on 24 shuttle [Motion sickness and sa ce motion sickness) IJaP5nosaeJ

fligahts (Entob MaotlaTTuh (sk nvýMd c.Davis J R, in e loegsj m, Stewart D oty P A, Practica 0olofgica Kysoto 11 (6) 19811, 1095-1120Logan J Fih o.,NS-ono pace Cant,,Houston, Tea., 77038,)AnnualSeoni f lanMeetinsg, f list ,4ewro7ct Medical Space motion aiclaniss llngliaa).4nocititon. ew Opr n,r Lomblana, USA, May 8-2. Ishii M. (Japan)19M.1 Avid$ Spitef Easviron Mod 12 (5) 1991,46 Asian Med. J. L, (11) 1989, ppI6OI-603

Autlogesi~enl sdback training as a preventive method for Characteristics of vestibular reactions to canal andI toadiplation.synderovasn Space-Laob 3ln Ihuh otofllth stimuelation at an early limit of exposure to2owij a 5, Toscano W B, Kamiyo J, Miller t , mlcrograyity, (Onglishi

Shr C (NASA-Ames Ras, Cent,, Moff'ett Filid, lotMG a4y6,Beloosarova 18, NyrovaAnulSclnife~1 Nesting of the Aeroj, ve Medical Phyeologiut IQ (I Suppi)Pett 1987, ppa 92.4Arrcladee, owOrlearls, Loisduia.sa Mu, May -2

198891A .4iat Space 8mv irous Mod J2 (5) 19111, 491[Motion sickness lit the aerospace onvlronssaentl Lo

malattie do niovimonto In ambionte Ailrrcazia~laoOcular counters'ol~lng In parabolic flight predictive test (Italian, English)

or space motion sickness (English) Cotndo 0DiamondS3 0. Markham C It Map., Nourol,, UCLA Minserva ModI t1 19)Oet 15 1987, plil469-76

Sch. Med., L-os Angeles, Calif. 90024.)Ift. Annusal Meeting tf e Society for Nesoremcelfct,P/wesni., ,4rkomaa, VISAI. October 29-Novembor J.1 Clinica luchracterivaaton and etiloigy of space intins,

JW. ac eumtl Awle (1 198, 31 asickness. aSn lightibi. Sc ~v~ocl lon .1(1)89,516Thornton Q ,MWare TP, Pool SL, Viindarplool

(Astronaut Offico, NASA/Johnson Sjius.' Cusjter,Space motion sickneiss, Ani histlorl perxplectlve llssuxtos, Toexa 770C6,

nona'ida (Vanderbilt Univ, Mod. Cantor, Nashville, AitSaeEvrmMrn( )o 97 i~ .1

dist Annuassl Slotni (Ac Mteltssg qj' the Aorm rop Poeixibnlle role of bsrain steml respiratory neurtins InMedtont Aisocititon, Now Orieasot, Loukiiona. S, mediating vomisting during apace motion sickness,Mar 13-11, 1990. Avain Space El's rons Med fL (5) jEnghishi

1990,461Miller AD, Tom LK (Rookaufller Univer~sity, NowYork, Now York 10021.).4siai Spat-# Epssirep Moll Is (9 Pt 2)ScP 1997.

Update on the Incidence of space motion oicknesi ointe lpA 126-8STS-26 ilrnglish)Davis )5, Book B (Mod, Operations branvh, NASAJohnson Spies Cant_ Houatons, Tex. 77058,) Gastrointestinal snutlilly In space motilon skikness.61st ,4nhual Selailess~~ Meeting of th'e Aerosp" [Esslals)lMedical ,4.nioriallons, Now Orleanw, LosmSvianoU,, Thornton WE, Lindler Ii), Moore TP, Poosl SLM~ 1.1-17. 19MJ. .lviat Space Environt Mod 1J, (5) (Astronaut Ortlie, NASA/Jolinaos Sluave Cantor,Ill 0, 493 Houston, Tess. 77059.)

.4s'iot Spaco ne hson Ned aJ (9 Pt1 3)Sop 1987,

Spare mnotion sicknpess Intenuilty correlates with averaige pI6-lhe-aid angular acceleration (EnglishiOmtan C M, IltUbantsuv I lMan 'Vhiola Lab,, MIT', TIhe veatihullo'oular refles and Iit psnnllsle rssles IIICambridge, Mamss, 02139.) nae snsslltsa ilrknesn. ten 1lishi61SI Annas~vl Sctentific Metsing of mise .errsjsue Wat DO (Dolis. of PisynbIfiloy, Mc.'ilt Ussivcrvity,Medical Anna's tallon, Ne4w orlearo, Lr'sdniana, USA, Monst real, Quishec, Canoale.)Mo 13-17, lilifl. Asviat Space Snviron Med iLL (5t Asial Space 901lr,'" Merl A (9 Pt 2)Sop 1987,tI M, 483 ppA170-4

Phasrnaroloaical rontaol of space sickness value and Head stwvemsetal In loW aild high frvtonrlumlbelimits of the rhesus model Mcatessasulai' lengiltish enavironmnents elicit motolkn sicknevss: hlsilllictksna forMilhaudJ C L, Lagerdo D P, Plorenuu 0, Trait C C space motion sickness, tan lights(Cent. Eludes, 75731 Paris Cedes IS, Pr. LWitner Jill, Grsybiael A (lAstton Orayblel Spatialt1.el Ansstuani Sciont(Rh. Meeting of the Aeeaopivares Orionttikon Laboratory, Brainsdls University, Watlthaso,Medical Aisocartioln. Niew oeleanla, Lousieana, SA, Massachusetts 02254.)Mam M317, /140) ,vianr Space Lsaviron Mod AL (5) Avs'kl Space Einviron Merl 15 (9 Pt 2)Sup 1987,1000, 504 ppA212-7

$Wpae modeon slickness prenilght adaptation Irialna Transfer of 1101eeeptual-msotor training and the apaceprellasminary studles with pr ot"yp IrInes' 11sgah adaptat iyon drome. aEngloll

Pakr D, Rook J5 C, VonOek II, osg, Kennedy RI, eorbaum S ilim C raiatRgsglkke M P. Arrntt A P (Miami Univ., Oxfoird, Oido Welsh RD (Eissex Curporation, Orlando, PL 32801,)4509w.) .4sIW twoc LImpiroes Me~d (9 Pt 2)Sop 1987,.4rta A~sitonassiili (1) 1937, 67-72 ppA20-33

I-A1 b.

B-27

The use of lb. logbisti model In space motion sikknexii~redkction, jlishah Space motion sickness. lEngllshI

I.nKK, RcnhkaMOF (Krug International, Houston, Pingree BJTX 77058,) JRA Nov Mod Serv J§ (lISpring 1990, pp25.32

APat aoce EIsvfrom W~ 11 (9 Pt 2)Sep 1987,

Instability of ocular torsion In zero gravit : possibleImplications for space motion sickness. (h2ilnllshl

Mechanisms of selecttive attention and space motion Diamond S0, Markham CH, Moticy KS (UCLAsickness, [301118h) School or Medicine, Department oit NeurologyKohl RL (DivisiIon of Space Medicine, NASA-Johnson 90024-1769.)Space Center, Houston, TX 77051.) .4viali Space 5Srivirom Mid §1 (1 0)Oot 1990, pp899-903A Plot Space Artvirom Med A (11) Nov 1987, ppl1130-2

Comtaarisona arerobic fitness and space motion siklnes 16. Test Methandnoiggy nd Amn lysiJennings ItT, Davis I . Santy PA (NASAdJotanion Subajective concomitants or motion sickness: quantifying~

SaeCenter, Plight Medioine Clinic, Houston, Texas rotation-induced Illness In squirrel monakeys.77058.)Englishi

A vial Spave Environ Mod aj (5iMmy 1988, pp448-51 Wilixosii 1 CRt, Lawry L.D, Green S), Smith SID Jr,Me nirk H(Deportment of Otolaryngology, ThomasJefferson UniverAity ModicalI College, PhilodelphiiaPA

Space motion sicknesa during 24 flights of the spc 19107.).htte 0Egih Oie IaiYHR0 Head Neck Surg 22 15)Nov 1987,

Davis JR. Vanderploo JIM, Santy PA, Jonnings RT, i430Stewart DP (Modical Operations Branch,NASA-1ohnson Space Center, Houston, Tans! 7058,1)A slat Space Xinvironi Med 22 (12)Doc 1918. ppl 185-9 Motion sicknessi A study or Its etiology and a matistlslcal

analysis l1ingislahMiller, Robert D. (Air Force Inn,. of Tcich.,Ground-based training for the stimulus rearrangement Wright-Patterson AFB, Ohio.)

encountered during spacefllght. (Enclishi A-1786-Af1 S9NMD2Resebbke MP, Parker DO, Harim DL, M ichaud L A- 771'AI/CfN~~-(Space Biomedical Research Institute, Johnson SisareConter, Hiouston, Texas.) A cosllection anld statistical analysis at biophysical dtintAria Otolaytigol Sujas (Slrneim) IQ 988, ppl?.93 to predict motionsickness Incidence (Enalihil

Me herson, Michael Rt. (Air Force Titat of Tvcit,,WrIght-Pa6titeson APB, Ohio.)Altered sensory-ruotor control of the head an an AD-AJ788,74,- AF47/oCSIENG180s-21

etioliogikal factor In spc-mo iomsckness, (EnkgllshILackicncr JR, DiZio P (Aahtomi Orayblel SpatisalOrientation Labioratory, Branideis Llniversmiy, Walthamm, Slinummator nickneasm Sonne nivaasremimeot Inssues 11nulil"IlMassachusetts 02234,) Uliano, Kevin C,, Kennedy, Robert 8,Percept Aotcu Skills §1 (3 P1 I hun 1989, pp784-6 IN: Sbrai~slopm I V., Proctedltio of she SCS Conference,

Orlando,, IL, .4pr, d-9~, 1987 (ANN-22867 07-66). SantDiego, CA, SovimIy for Computer 31lruaotion, 198l~7, p,

(Space motion sickness] Kostniichcskein holezan 102-104dvicheniia. (Rtussian, UnmlikhlGorlillasltoatd, BriarmoyKorsmm BirIA viakosn Med 21 (3)%4xy-Jun 1989, pp4-14 A stuyo motion sickness: Mathematical msodeicng and

dift anrl ala ( AirFoce Imi oh1aSpace sicknessa on earth [letter] (Unglislil Wright, Madtrko F (Air, 0 oceIn..)ec,

Ockuls WJ, Parrot R, Momwiscraluid E Wright.Pttcrsom APO, GOIKN.) D-Noalue 2N (6216)Aug 311989, 111*681 -2 DA070,4FlOON/Ht-

Pharacoogyto pac. Prt 2 Coirolin mokin Analysis of physioiogical data related to maotion sicknessl'hamacoogy n s~ce, art2, CntrolingmothtiFor use In a real-thlsim o stion sickness Indicator

skickess. (lingila lsnslifshlLatherg CM, Charles IS, Hango MW brylie, M, E. (Air Force Init. or Tech..non~dt PiD*I-rmacI1 Sdi IQ 16)Iun 1989, pI'243-50 Wright-Patterson APB, OH. School or Etvimmecring.)

APlT/OB1!NOI/87D-16(Requiremnsesation5 "Ide'al" drug Air prevention otapace AD-A 189 iit/S.5" Den 07, ISjp

mostion alk-kness 0 trehnvatiitkh kt "idea'lnomnu'.lokarnvnormorn orodstvii firrifltakmiki kosmieheskol M~otion sickninsat uaundbittve, algorlthmic snaaiNieboleol~n sviyhemidii. IRummian, Englishj Indication In real time (KnaishihKaikishehanko NN Fix, E. L, (Air Forces Ist. if To&h, Wright-PAtIlamonKoam DhiaA vlakea.m Med 21 (6)Nov.Dec 1989,I is33n APB. OH. Sc6,h aol of Engineering.)

APITIOB/EN0187D3-11£Simuliatlisofa space adaptation syndrome oin earth,.D C 7/ XEDe5.l~

i~litkos Jr Purser it, Measorsebmid E (EuropeanS Agency, HSTEC, Norrdwtjk, The Netherlands.)Le reala Re' 21 (3) 1990, pp66i-3

Stuid of motion sickanes: mathematical modeling and 17. Treatment other than drugsScata o ,a 1 EgaIt Porce Init, of Tech., Efet fpomdfr~hit adaptation training on eye

Wr i-jtaxn APý, OH, School or Engineering,) moeal t-o a perception, and motionAD-.4202 7 a/118.4 sickn 16pPaess - progress re~rt [n,#11ohi

AD-A22 7704IX48Doc 8, 106 Par erDB, Reachka, F', V, on Olarke, H. R.,Ltsitrd, C. S. (National Acronsutig loi ad SpaceAdminiatration. Lyndon B. Johnson Space Center,

Fxploratory analysis of motion sickness data: a time Houston, Try)leItti approach lEnglihlsh Gw,4& Ujniversities Spoorv Rouuarcja ,4*sovaton,Thompson, D, C. (Air Forva Init. or Tech,, W1,;o U/niversity, and International Acrademy rnf3Wrl lht-Palterson APB, OH. School or Engineering,) Astronautics, International Man In Space Symsposium,AFITIOSO/BMS/89D.15 71h, Houston, TX, Feb. 104., 1986) A vintlam, S at%,AD-A 2J5 5341P/XAD Dee 89, I51p and. Environmentalo Medicine Uj (Sept) ON8 p1,

Dceveopmsent or standardised test pmocedures usingl 42A

revvralT priasas Ibr the study of motion .ikkans Vestlibular-ylauai conflict training (EInlsh]Engliah il, Makoto, H-imi, Tetsuo, Owlea, Walter a.,

Calls J J. Brumley B A, Vandorpinot; M. Wood S oasiKazutoyo (Baylor Coil. of Medicine,J, Resetiko Id P (Krum lot, Technol. Life Sal. Div.. 1110ou , ToO.NASA-Johnson Space Cent., Houston, Tex, 77058,) IN., ftloogivat .wloen# In space .'9/Id Preoweodngs ofti1st Annual SclentsfUL Meetinfg qf I/ia Aerospace :w16 ,irol~s ~rp'wn aryJpn

ed/cal Associallen. New orleankv, Loullana, USA, Nov. J0.12, 1986 (011/.2910.1i-i) Tokyo, UfMay M1.97, 1911C). AviaS Spacea Enitvltu ModI faJ (5) Research, 1156?, p. 17M-12t4..1990, 506

Spatelab, 3 flight experiment No. 3A1"l'2MComnparative assessment of vestibu~lar, optokinetle, and Autogeoenicfoedlack training ats a peevenstiveloosthoduptuvestihular stimulation In the development of for space ada ptation ayndroiste nglishjexperimental motion sickneas, lirililshi Cowings, Patrlola S.. Toaonuw, WIlliam Li. Kamiyi,Matinov El, Kuz'min MPStakhrova LN (nistitute of lot, Millar, Neal E., Sharp, Joseph C. (Ntionill

Dioedea Prblms Msco, J5~I Aeronautics and Spaes Admlhii~tration, Amets R19s1a`01Avid: Spavt Itiviron Modc a, (l0Ou~t 1987,1)1)954-7 Center, MoffuttPiald, CA)

N4SA4.TM-6W12,1 A.811.- NAS41 15.-89412Pkla as ark Index or motion sickness iii rats, [Engl~ohi

Morita M, Takoda N, Kubs T', Matiounagia T' l~aise In developitiont evaluation, and III* of time NASA(Department or otolaryngoilogy, O~nak Univerkity 11'relliaht Adaptau~ml~ralner (PIATJEilScolonl of Medicine, Japan.) Lane, NornimsB V Konody, Robert (snex Coirp.,Or! I O1orhino/osyngol At/Of Spro U (3) 1988, Orlando, PL.)ipII 8II92 NAS,4-CR-189608, NAS 1.2,64800;* 9O7111-88.6

Subajective conconiltants of motion aickneast qiiantlfyinlt [The effect of hlorordback control mmm the severity ofrotationinoduced Illness lnsitimurrvl mmossken. 101111~atooml aip Ori~ of epOVimIHIenlal

Ma~llisclvmk CRt. Lowry LI), Orccem SJ. Smith BI)tov Sr, Alens., RAlzik, S., Ku~lovtkaya, 1. R,.MenIck H -I CLeprtmLent of Otolarymigo0uKg, Thomaski Kminmlc/eskaya Y/u./oilya I A vluaktanic/iekaycmJefferson University Medical College.hlmuiiha PA A/edlslna 22 (4) 1988, pp 35)V919107.)Otalar`Yngl litad Nec~k Sur* 22 (5)Nov 1987,lip4,) .40 A cssisparkiiaum I) two ammetloisid of trmisimi remalanla e it)

vlauaily-lndured moition uitknoss. . IIiorialiStatbtlcl aalyss o cenore mmhitlmn tk~~l~ttty ohio, Thoomas a,, May, kinvs 0.. Fiaunher, WandaSlidWivl salvi~xiof enated otin tleknsq atecy ., 11ldor, S, Thoiniii i al a (U Lmeita, Englandlldiita mxisis the twsm-paramslaeir Weiltmli diistributilon. VII Inhernatiomnal Man in Space Sip~lst/yakgc

Engiahi taop lation ofdna in Yhpace (1966, Houvton, Texas)Park Wi. Craompton ON (Dciumrtmnen o.r matlicinatisa A vlatlosw, Space, IPit vrimns Mdcn 9 Scotand StatlaticA, Wright Shtot U olversity, Dayton, 01-1 2) 1987, pp34-41

/ot 1 Himped Cornput ;I (3-4)May-iun 1988,mIlI95-301 Autulgenie-Fredhook training as a preventive method for

apace daplaInmyassiroeron Space-11ab1 Is ilnllshjMomomisicnes i guneap1a (arl pacelba) Idexd owli a . Tohcana W 8, Kainmya 1, Millar N II,Moton ickessIn oina pa Capn preelus Inn"IglSharp C (NASA-Am,.m Res. Cant,, MnfttI Fluid,

lby body rotulaton-indouced condlitionedi taste Call f. 94031.)av 0sins 411liis Annual Scist~tfc Moviting (f thea Adoratpat ModkSaOssenkopp Kb', Oaseinkopp MD (Departnowot of Aijac~atlou,'w Orleans, L~ousinana, USIA, May 8-12,

Psychology, University of Weiteom Ontario, London, 19M Apnga Spacv Riti/ron Mofd 12 (5) 1988, 411Canamda.)Pkvxil,. Hte/av (3)Mar 1990. pp4ti7-70

Nirthod to prevent and treat the tigaus and snyaptonis ofinotion siclnenm US patent.4777l 70. October I I

1911 linhl An evaluation of cognitive-behavioral therapy forHein c~h~A A (165 Ashland Rd., Middlesex, N.J. training rsuistmnce to visiumily-Induced motion08846, USA,) sickness. lEnghlshISofcial Cacette of the United States Patent and Dobia TO, May J13, Fishre WD), Bologna NB (NavalTrademark Office Patiemi =. (2) 1988, 847 Biodynamics Laboratory, Michaud Station, New

Orleans, LA.)Aviat Space Environ Med.0 (4)Apr 1919, pp307-14

Wide angle artificels horiso'n Is frequenily perceived amnon-borlsiontal a psible problem Inits use forprevention of saikess gEamih Acu reasure and moution Bicknell. (EngliahilRolnick A, flies W. Gordon CIR (Motion Sicknesm Bruce DO, Golding IF, Huckenhull N, Pethybr~ilie RILab., Israeli Naval Hypcrbaric Inst.. Haif&, Israel,) (nttt fNvlMdvnOsot a.Annual Scoten~l Moolin, of the Aesrospace Moedica.' Enpiand.)Association, Wahington, IOC.,USA, Ma 7-11.,1989. A viat Space Environ Mod 1J, (4)Apr 1990, pp361 -3A vnat Space En viron Mod fQ (5) 1989, 744

Electrical acustimulatlon relieves tam~yglastria and J&. Treatment with druoq

ofIclntdcd oin scns A neuropharmacolouical approach to %pace motionHu ,Stern. Rt M, Koch XC L (Dep. Psycho)., Perin. aickneus (EnflmhllState Univ., University Park, Pa. Ouall, AnionloAbstracts ef Papers Submitted to teistiormican ZAP, International Astronautical Congress, 38th,A.ksoclatlon for the Study of Liver Diseases/or the 91set Brighton, England, Oct, 10-17, 1987. 6 p.Annual Mieeting of the Amnerican OastroenteralogicalAtssociation, San Antonio, Texast, USA, May 12-18,Y1W. Goatroenterolagy 21 (5 Part 2) 1990, pA6S7 (Prellminary studios of the pharmacological control of

s ac e 'Wsic ne ass 8 tud e. iirclli m inairoc s oa co ntro l c

The effect of training schedule on learned suppresmion i "h1-2 C, o La.gard, 1), , Flrencr "'. (etrof motion Bicknell symptoms using d!EtudcsC dq Iecherie dA Meeio c patirile,aultoenle-firedhack training lUntlshl Paris (Praince).)Toscana, W B, Caw In P S, *aMir I, Scott 0, PEBS-2,9.448/X48 19 Dec 88, 27pRussel T, McKay C (S place Life Sol, Div.,NASA.Ames Rem, Cent., Mo ffett Field, Calif. 94035.)

Tranadermal scopolamine:i effects upon psychological61st Annual Scienat~if Meeting osf the Aerospace nerformance and visual functioning at sea. tEnglaohiMedical A4ssociation, Now Orleans, Louisviana, USA, IParrntt, A, C. (North Eait London Polytechnic,Mew 13-17 199. go Avial Space Environ Mod §J. (5) England)1900, 484 Huttan Psychophannacology Clinical At Experimntail

1 (2) 198g. pp 119. 125[The effect ot biofeedback control on the severity of

veitibuoio-autionomie symptoms of experimental Four active Ingredients declareed effective flo, motionmotion aickness] (Russian, EnlI shi sickness [Eng~lshlSmirnov SA., Aiaikov 02.1. Kolovirkiys, I.E. Anon(USSR) Amnerican Pharnacy 22 (10) 1937, 22Kosnw. Siot A iakesmn, hied, 21 (4) 1988, pji35-39

[Problems of drug prophylaxils of motion sickness]Transfer of perceptual-molor training and the space (Rusmiann

adaptation syndrome, (EnhlishL Shaiahkov V S, Sabsen V V, Il'Ina S L, Gallc Rt RKennedy RS, Bcrbaumn KS, Willians MC, BrannoniJ, (Inst. Mcd,.Oiol. Probi., Mininet Heltclh USSR,Welch RB (Essex Corpration, Orlando, FL 32801.) Mouuuw, USSR,)Ariat Space kEnviror Med 11 (9 1t 2)Scji 1997, Fartaahloglya I Tolcsik-ologlya (Mosco%) IQ (3) 1987.ppA29-f3 5-20

Effectsr of proposed prelight adaptation training on eye Axsessmuent of the efticacy of medical countermneasuresmovements, selfmotion perception, and nsotlon In spaice flight (Englishisickness: a progress report, [Englishi Nloogommian A, Sulzinai F', Radtke M, Bungo MnParker DR, ReighkeM F, von Olerk HE, LeamardCS (NASA Head~insrtcrk, Life Sol. MYv.. Washington,(Space Biomedicsl Research Institute, Jonhosn Space D.C,, USA.)Center, Houston, TX '77058.) Selected Papers topn at Symptisium not Space LffiAnial Space Environ Moed 11 (9 Pt 2)Scp 1987, Sciences Holdi at the 37th Internatio~nal AstronariitiallpiA42 T Federation Congress, Innsbruck, Austria, Octaoer 4-11,

1986. Adta Astronaut: 12 (2) 1988, 195-199[fi of adaptive biofeedback on the meverity ofmostion sickness]ni iisymtosi of experimentalna vyrarhennost' vicatlbulovegotaivirykl in~iplonloyokspcrimentai'nioi tolevim dvizhenia, [Russian,En lishiSmifrnov SA, Aitikcoy US, Kozlovskaia III

Kosmn Diol A viakosm Med 22 (4)Jul-Aug 1988, pp35.9

I hiis4 eflivt curve foir xop-drx Ini tuiiiion i xkkness Lack or anilh~aaainine priilrlics air sioiiei (lalseiLnglhial clnnarlarlne In man iEnglishlWood M J, Stewart J J I Wood C D, Manna J E, Torrent J Bartaanai( M 3,' Do La Pucnte V, Jane FManno 8 R, Minme M E (LSUI Modi, Cent, Boxt (Clinical 1karmacori. Rem. Unit, Hoip. de Sant Paiu,33932, Shroe j t, La. 71130 ) Avila. S. Anton! M. Claret 167, B~arcelona 08025,Annual Sciet, tic; Meeting ofthle ~4erospace Medical Spailn.),4.aocitalian, wh~ingtoan, D.C., USA, May 7-1l, 1989. Methods and Findings In &porrlnienal andi Ci~tdclIA viatt Space Eniviron Med Q0 (5) 1909, 492 Phiarmacolgy LO(10) 19111, 663.666

Evaluation of the efflsacy end side effects of buccal (Medical prevention of motion sickneas operationalscopolamine In the treatment of motion sickness aspecta] (Preaachl[Enulish) Leger A, Sandnr P, Kergueclen M (LA.MAS,,de 1 loannil JJ, Johnoana P C Jr, Cintron M M, Caikinsa Bmitgny-sur-Orge)D, S (Space Bloamed. Res. Inst., NASA Johinson Space 7)avaux Sclontlflqsun Des Chicheiurs Du Service DoCent,, H~ouston, Tex, 77058.) Sante Des A4rmors (9) 1958, 275-276Annual ScionIlyle Meeting of tlhe Aeroaspavce MedicalAssoaciation, Wasahington, D.C., USA, Maly 7-11, 1989.A clot Space Environ Mod §2 (5) 1989, 506 (Pirevention of sea sickness with trionadermal

acopolamlne. dimenhydriatate and a placebo]lTralttanento proventivo dols n1aupatla con acaupoolamina

lEvaluation or the efficay of buccal scopolamine tablets pr via tranacutanca (TTh), dincnildrinatot c placebo1.0 mni n the treatment of acute motion a~ckneas alalan, Engliahii~nglimlil V lglianai f., Cirillca V., Sabhat) F., Clittord M. (Italy)

do Gicianni J3J, Calkins D S, Reachke M F (Space Gazz, Mod, hral, -Arch, SO., Med. IM~ (9) 1997,Blomed, Rooa. Inst., NASA Johnson Space Cent,, pp391-394Houston, Tex. 75053,)61sat Annual Scientific Meeting of flit AeraipaceMedical A4ssociation, New Orleans, Lonuiina USA, 1'Ireatiuient of nmotion sickness with scopolaniaaie by theMa 13-0 , 19Wo. .4Wat Spateo finiran Med ~j(5) tranaderaitat route] [Italian. Eng,'laish1990,484 Sabaia P. Vig~liono Rt., Cirllo V. (Italy)

Annt, Wed, Nay, 12 (1) 1987, pplI 1- 116

A placebo controlled study of clonarlaine in twodifferent doeas for the prevention of rea scklness And-ineitle drujia and the treatmaent oif nauseai and[English) vomiting jEng~lhimiDoweck 1, Gordon C R. Spitzer 0, Situapak A HakanbasrtiG, Ziegler A. (Germany, Federal Republic(Motion Sickness Human Pedrimonnnu Lab,, hiraoli UO)Naval HyperbAric maot,, Halfit, laraoli,' Deta g Tiday 2A (8) OF"', ip567-58 16Jst Annual ScItnt(Ila Meeting (if the0 AerospaceMedical Association, New Orlaeanv, Lanacaiuaa, USA

M 1-17 1W. via 4a~eEnvr~t Md L(5 Th voaiatieactic properties of l-saalplrde in aMy1 i-i7,4i90 k. ,4ltSae nio l dt ~round-lhaacd maodel of apace mtotlon akkuisn,-4%

Millr JD, Driurce KR (Deportment of AnlmilPhlarmnacological control of apace alckatasa vialue and Phyaloliofy, Univeraity of Csalifnrnlia, Davlm 95616.)

iuaatI, or the rheaus model Moacaua-mulesla IEnglishl Lif Sd 1 5)Oct 12 1987 Pp1815-22Milhaaud C L, Latgardo D P, Plorenco 0, Traon C C(Cent, Etudes, 75731 Paris Codox I5, Fr.)Viat Annual Scienifitc Meeting of the Ater xave Tranoulerinaltherepeuutic systemN: &coprolonaalaellinglimlilMedical Axasoclutiean, New Orieanva, Leoublsapi, USA, Nialiat J.G. (Canada)Alay 13-17, JW~. A vial Space Environ Med §1 (5) C'on, .4Havip. Pliaci, :U (4) 1988, IiV2Oi-204199U, 504

A double-blinad placelrnpcontramlled romanprLaon orfhNor riaponae of plaenytonli In t1am therapy of moionlat byonclime with cinnoiasrule In lIncreasaing tolerance to

sickness jEngblihl a nauneogenle cro~ss-ouipled motion challengeCiinien W 9, Kabrialay M. Rogtacu S. Motrales R (Dep. rEnglislalVi2ce Eng. , Air Force hint. ToehnLua, Dfiyioa, Ohio, Plagrec, 11.3.W. (Uoi tcmt Kingduain414331) Miami. Med.,. 4 (1) 1989, lpp17.28OMu Annual Sulenltifi Meetint iof Ohie AM VrsscMedical Ass~ocidarin, New Orleansr, Lauhlaia, ia,Ma J3447 19K0 A vial Space lVnvlron Med §J, (5) A double-bllind placeho-controlled coaaparlson aal1990, 507 hytaicine with early adasilaintered clnnarizilne lit

Iacreasing tolerance to as naase~oglenle crosa-coupledimotaion challenge fEngliabil

A controlled clinical trial of the additiota of tranxidesnial Pingroc 8.1W., Petitybridgec RiJ. (Usuale Kingdom)

"acopolonalne to a standard aatetacloisramlde and Phamm Mfd. A (1) 1989, pp29-42doxaaauethasone antlentutlet relammen jllngllab (I .Meyer 8 R, O'Mara V, Reldoiilirg M M~vClinical Phornascol., Northa Slioto UnIv. (bitip, 300 ilacrlpheral dlzzlovaa. Transaport sickness therapeuttic.Community Dr., Matilassat, N.Y. 11030) aeultjVortigoo. Mal doa Trainslairtz AastualillcaJoirnal of Clinical Oincology 10 (2) 1987, 1994-1997 Tlea qitmuom [Frencth, Engliahi

P.nis, C., sauvageoJP,, Paurin A. (France)Ann. Mold. Nancy Sit 21 (3i 1989, pp19l-193

H-3

[Ne~w natural suhvwualce helpl against travel sickness,Thle ofmilted travelless.1 eucs Naturhoilmittal hilt't Treatment of severe motion sickness with antimotlongegien ltetsckranklieit, Die gcpiagten Rolisndes sickneis drugl injections. (Englishl(German] Grayl'lel A, LackncriRKubitachek J. (German Federal Republic of) A4 vial Space Enviroli Mod §1 (8lAug 1987, pp773-6Sdhweite. Apoth. Zrg. 14i (16) 2989, p404

PharmacologicalIinterventions for motion sickness:Scapoderm: tasnadermal hyoscine for motion sickness cardiovascular effects, [E~nglish)

"[nglish' Sunahars PA, Farewell *I, Mintz L, Johnson Wit(United Kingdom)ý (Departmenit or PliarmavoIogy, University of Toronto,

Drug Ther, mll. 2 (23) 9199, pp9 1-92 Ontario, Canada.)4 nor Space EinvIron Med 2A (9 Pt 2)Sep 1987,

[Tranidersual scopolamline and snydriasisis ScopolAmine pA7transderrniue at mydriuse [French, EngilishiRodor F, Cottin C. Jouglird J, (France) Alleviation Of motion sickness by nifedipine [letter]Therapis H (6) 1989, pp447-448 Enlish)

Marley J1111 J01 MD

The'rapeutic maunagemsent oft nausea and vomitingLacta(5)Nv2197 25

WnJ, banee M.C., Arrihas S. (Sprain) Ginger root against seasickness. A controlled trial onatm. Pharmacol, 21 (1 1990, PPl-i 0 the open sea. [English]

Orontved A, Vrask T, Kambaicard J, Hentzer E(Department of Oto-Rhino-Laryngoiogy, Svendborg

[1ranisdermal scopolamine delivery system against the Hospital. Denmark,)sea-sickness' and effects on ocular smooth .4cl solapaayngol f(Sluckh) J9 (1-2)Jan.Feb 1989,

mtrvculature: Report of a case) Sisiema transderndeo pp45.9cowflo ii 'mal di snare'a base di saupolamine cut cffeltisulks muscolaturs, lisda colars: vaia olinico [Italian,English I The Reulic or Ssingapore Navy's Scopoderm TTSorhuisrdinpor P,, Puilini S., ParrozyAni A. (Italy) stu1dyi reaults after 2,200 man~days at sea. [EnglishlaAmnn Olloinsot, Cli,,, Ocid, W1 (9) 1989, pp945-947 H.. J. Lee PS, Scot LC, Tan PIK (Diving Medicali

Centra, Republic of Singapore Navy, Ministry orDJ onuer .

Use of phenytoin In the prevention of motion sickness A4viol Spaeo Environ Mod 11 (7)Jui 1988, pp6 W650[ang 1huClieienWt, Kabrinky W. Hataolse C,, Moralcs R,, FixE., Scott M. (USA) Effects of anti-motioo sickness drugs on motion sickness

Avag Save Envirom, Med. Al, (11) 1990, In rats, [English)pp1O22-1025 Morita M, Takeds N, Kubo T, Yomaiodani A, Wdad

H, MatsuissgaT (Department of Otoisrynsology,Osaka University School of Medicine, Japan.)

Efneacyofteransdertmai.sco 1qanIneagalinstsfasickness: Orr J Oeorhlnolaryngoi Rein, Spec 10 (5) 1988,a41 3 ay stud at sea [ngIshin pp330.3

Atliss~~ EOro ,RiakJ i 0, Rolnick AA4 vial Space Emnviron Mdj(lJn 1987, pp60-2 Pamclgclteteto et~.[nlih

Pykko 1, Magnusson M, Schalen L., Fnbom IfFailure of melorioprassalde to control e~ntils or nausea (Department of Otolaryngology, Univeruity Hosplitl,

due to stressfultsangular or linear acceleration. Helsinki, Finland,)(anglishi Aries Otoilvrngol Sssppi (Slridds) M1l988, pp77-8 IKohl RL

Avia Spce Evirn Md a 2)Fb 107, pI2-31 [lPvauatlon of the effectiveness of drugt for previt ntlunof motion sickuness, Notn a U ffekti'-enu I

[P'revention of kinetcNslo In children. Tlraimvdernial farmakulatichoskith sredsiv prorilAklki holcznitherapy with scopolaudnsln Kinetoaepropylane hel dvizhrniin, (RuasmianKindern. Trarnsdermalo Therspie mit Scopolainin. (341le RR, Gusskao'a CA, Suhaxv VV, Calic NN(Grmian, Englishi Ke,.rn Ritc Aviakommr Mod Za (4(Jul-Aug 1998, '1p90-4Muller M, Beach W, Sicilner D

Farohp-Mod LI 4)Fb 10198, Vp2, 6-7Transderinal scupoaianinei a review of Its effects uponmotion sickness, psychologlical performance, and

Thie combined effect of clnnareiune and dosusperndone on physiological futict losing. [Englishvestibular Luscepitlhllity, [English)l Prrott AC (Department ol Psychology, North EastDOsierveld Wi London Polytichnic, England.)A vial Space Environ Med %j (3)Mar 1987, pl12il- 23 A4 vial Space Environ Mod fg (1)J1an 1989, pp 1-9

[P'roblems In the drult prevention of the seasickness [Effeet of the drug liomex on the development ofsyndrome (motion sickness)) Problemy lckArstvcnnoi experiomenstal motion sickness) V11ile isi repawatiarofllskttki sindrosna ulusehivanjia (bolowni dvizheitoiul) "lumeks" na ranvitle eli .rimental'tiol boictzniRussian) dvir~heniia, Russian)1

Shashkov VS, Subsev VV, Klitis SL, Calla RR Brado 0, Plksn K, Bontse (3

Farmakol TuAWuikcdZl (11)hly-iun 1987. lipS-20 Kvuprn firdl A Waknvo Mid ( 3)May-Jun 1989, 118

W.

P'iaurnIiacokljIJ in suiAft. P'art 2. Contlrolling umotion

Lathers CM, tharl.. JB, Beengo MWTrend.T Pharmacol so aQ (6)Jun 1989, pp243-50

The antl-iotion sickness mechanism of ginger. Acomparative atv d~ with place ho andHellmann 3, Clarke AN, Scherer H, Hohn M(Deportment of Otorhinoleryngology, OrowthadernMedical Center, Ludwill-Mox mualAnn UnivermilatMunchen, (cinnany.)Arta Otalaryngol Srtockh) 12 (3-4)Sep-Oci 1999,pliGI61-74

Prevetitlou or' nation miukleas with otlegiilnuothydrochioricumn. [EnglishlBodo 0, Elkan K, Diance ai7ther flung 22 (2) 1989, pplO3-6

l'hree-years' execrence or tranoderengai xeopoai'onu er effeivenqaa mud side-siects, EntilehiS huaiek 'A. 'Oordon CR, Spitzer 0, Mendulowit,, N,Mcr~med Y(Motion Sickness and Human ParorrmancoLab~oratory, Israeli Naval Hlyperbaric Inntilute, Haira.)Phariptalierapoutia 2 (6) 1989, pp365

-70

[Requiremnent of an "tIdeal" drug for prevention of spacemotion aichneox] 0 trebovaniiskh k "id"alnomu"lekaracvcnnnmu ori;dstvo profflak~lki kosmichemkolholcznl dvizhonio, 11tueainn, EngliahiKerkishchenko NNXeomn filkjIAvlakoxn rned j (6)Noiv-Deo 1989. pp33-6

Thserapeutic effects of anthoeotioo 110.11110A medicsationson the secondary symptoni. of motion sickness,

oWoýb Stewart JJ, Wood M), Manna JP, MaicmoBR, Mimns MS (Louisiana Sitate University McdleatCenter, Department or' Pharmacology', Shtreveiport71130.ý932.)Avlatj Space' Envirna Heil §1 (2)Peie 1990. plyl57-61

New antremetic. drugs. il3nglilehjSanger cii (Beceltam PharnsleL'utvloal, MediciiiilRCCL'erch Division, Hiarlow, EAsox, UK.)Can J Pkyxlel Phareracol (& (2)Pcb 1990, 1)13

14-24

[TIhe phersnacoktgicail regulatiomn of physiologicalfunctions In apace mnedicine] Farcinakologlchuxcskii

=euitii fizininiticheskikih runktgii v onceki111iltnmioualn, Englisth)

Seashkcss VSParmaekril Tijkriklke U (l)Jan-Feh 1990, p'rS. 1 0

REPORT DOCUMENTATION PAGE1. Reciplent's Reference 2, Originator's Reference 3. Further Reference 4, Security Classlficution

of DocumentAGARD-LS-175 ISBN 92-835-0634-0 UNCLASSIFIED

5. OrIllinator Advisory Group for Aerospace Research and DevelopmentNorth Atlantic Treaty Organization7 rue Ancelle, 92200 Neullly sur Seine, France

6. TitleMOTION SICKNESS: SIGNIFICANCE IN AEROSPACE OPERATIONSAND PROPIHYLAXIS

7. Presented on 7th--th October 1991 in Toronto, Canada, 24th-25th October 1991 inAthens, Greece and 28th--29th October 1991 in De Bilt, The Netherlands.

H. Autiior(s)/Editor(s) 9. Date

Various September 1991

10. Author's/Editor's Addrees Ii. Pages

Various 202

12. Distribution Statement This document is distributed in accordance with AGARDpolicies and regulations, which are outlined on thehack covers of all AGARD publications,

13, Keywords/Deseriptors

Motion sickness ProphylaxisAerospace medicine TherapyNeurology EtiologyPhysiological psychology Flight Crews

14.ATbstract

[.. n aerospace activities, motion sickness, specifically airsickness, continues to be a problem duringflying training and in regular operations for aircrew and passengers (eg. paratroops). Simulatorsickness can degrade the effectiveness of simulator training and space sickness reduces theefficiency of astronauts. Scasickness is also of aeromedical concern in so far as it affects aircrewoperating from ships and the survivability of ditched aviators,The Lecture Series has been designed, primarily, to aid practising Flight Surgeons in theperformance of their primary care duties, It should also be of interest to others who wish to obtainan overview of recent advances in the understanding of the aetiology and treatment of motionsickness:The topics to he covered in the 12 lectures are:

I, CHitiWal features of motion sickness2. Operational significance of motion sickness3. Aetiology and neurophysiologieal mechanisms4. Physical chartcteristivs of provocative motion5. Special features of air, space, sea and simulator sickness6. Selection and assessment of susceptibility7. Prophylaxis and management,

The Lecture Series will conclude with a Round Table DiscussionThis Lecture Series, sponsored by the Aerospace Medical Panel of AGARD, has beenimplemented by the Consultant and Exchange Programme,

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