SUFFERING MOTION SICKNESS?

63

Journal of Biotechnology Science Research.2014;1(3):63-74

Review paper

Kinetosis: All You Need To Know

a,b Ukaegbu Chinonso Ishmael*, aShah Samiur Rashid, bUkaegbu Benjamin Chibuike

a Faculty of industrial science and technology, Universiti Malaysia Pahang (UMP), 26300 Gambang, Kuantan, Malaysia.

b Department of Medical Laboratory Science, Imo State University Owerri, Nigeria

ARTICLE INFO:

Article history:

Received: 11 September 2014

Received in revised form:

25 November 2014

Accepted: 1 December 2014 2014

Available online: 5 December 2014

Keywords

Kinetosis

Causes

Inorganic

Effects

Management

*Corresponding author

E-mail:[email protected]

Mobile: +601126653991, +234803898479

Introduction

Motion sickness or kinetosis, also known as travel

sickness, is a condition in which a disagreement

exists between visually felt movement and the sense

of movement in the middle ear. “Sensory conflict”

theory is one of the most established theories to

explain in which circumstances motion sickness

arises1. This theory assumed that motion sickness

originates from a sensory disagreement between

real versus expected invariant patterns of vestibular,

visual and somato -sensory inputs1.

It has been accepted that the vestibular system

influences individual motion sickness susceptibility

(MSS) since patients with bilateral vestibular deficit

have greatly reduced susceptibility or do not

become motion sick at all.2,3 This sensory mismatch

leads to an activation of vestibule autonomic

pathways, which have been shown to be also

involved in producing nausea and vomiting during

motion sickness and those that generate illness after

ingestion of toxins3. Depending on the cause, it can

also be referred to as sea sickness, simulation

sickness, car sickness, or airsickness4, its common

ABSTRACT

One of the major fears that grips about 50% of travelers, either by air, road ,sea

or any other means of transportation is a very uncompromising situation know as

motion sickness. This condition is branded “uncompromising” because ones it

sets in, nothing else matters, all attention must be focused on how to resolve it. In

medicine, it is called “kinetosis” because it is associated with movements. This

condition has made so many people to think a lot whenever they are going to make

any form of travelling, and has ultimately reduced some people to limited

distances and short destinations. It is also a source of worry to commuters and

passengers because a sufferer must be made to get him/herself if the situation gets

bad and everybody has to wait until the situation is calmed. This review is aimed

at checking the possible cause of kinetosis, its effects on the sufferer and how to

manage it. It also reviewed the prevalence of the sickness among adult and

children travelers.

Journal of Biotechnology Science Research (JBSR)

Journal homepage: www.jbsr.issres.net

Ishmael UC, Rashid SS, Chibuike UB 2014 / Journal of Biotechnology Science Research.2014;1(3):63-74

64

symptoms are dizziness, tiredness, fatigue, and

nausea and vomiting. In some case, headache has

been a symptom of kinetosis. Sopite syndrome in

which a person feels fatigue or tiredness is also

associated with motion sickness. Nausea in Greek

means seasickness (naus means ship) according to

Woodhouse's English-Greek Dictionary5. If the

motion causing nausea is not resolved, the sufferer

will usually vomit. Vomiting won't relieve the

feeling of weakness and nausea, which means the

person could vomit until the cause of nausea is

found. The person will even be feeling more tired

and tends to vomit more unless the cause of nausea

is resolved.

Causes of kinetosis

One of the best hypotheses for the explanation of

the cause of motion sickness is that it functions as a

normal way the body defends itself from toxins

through the help of the neurological centers in the

brain. The centers produce neurotransmitters such

as acetylcholine and dopamine which stimulates the

chemoreceptor trigger zone (CTZ) in the brain stem.

The activation of the CTZ receptors sends signals to

other vomit control centers to induce vomiting.

Various chemicals such as serotonin, dopamin, and

/or muscarinic and cholinergic receptors in the CTZ

are stimulated which leads to induction of vomit

through the coordinated generation of action

potentials with the vomit control area that ends up

in vomiting6. The toxins are usually perceived to

be neurotoxins7. The chemoreceptor trigger zone

(CTZ) which lies in the area postrema in the brain

stem made up the vomiting center which is

responsible for inducing vomiting when poisons are

felt in the gastro intestinal system, and for resolving

conflicts between vision and balance. A conflict

between the sense of sight and sense of balancing

usually puts the whole body in trouble and this is

usually resolved through the induction of vomit by

the vomit center in the brain. When motion is felt

but not seen (for example, in a ship with no

windows), the inner ear sends signals to the brain

that it senses motion, but the eyes tell the brain that

everything is still. As a result of the mismatch, the

brain will come to the conclusion that one of them

is seriously not sound and further conclude that the

hallucination is due to poison ingestion. The brain

responds by inducing vomiting, to clear the

supposed toxin. This is the real cause of vomiting

which will tend to remove the toxin from the body.

An alternative theory, also known as the Nystagmus

Hypothesis8, has been proposed based on activation

of the vagus nerves resulting from the stretching or

traction of extra-ocular muscles 4 co-occurring with

eye movements caused by vestibular stimulation.

There are three aspects of the theory: first is the

remarkably close linkage between activity in the

vestibular system, i.e., semicircular canals and

otolith organs in the middle ear, and a change in

tonus among each of the eye's six extra-ocular

muscles. Thus, with the exception of voluntary eye


65

movements, the vestibular and oculomotor systems

are thoroughly linked.

Second is the operation of Sherrington's Law9

which describes reciprocal prevention between

agonist/antagonist muscle pairs, and by implication

the stretching of extra-ocular muscle that must

occur whenever Sherrington's Law is made to fail,

thereby causing an un-relaxed (contracted) muscle

to be stretched.

Finally is the critical presence of afferent output to

the Vagus nerves as a direct result of eye muscle

stretch or traction10. Thus, stimulation of the 10th

nerve resulting from eye muscle stretch is proposed

as the cause of motion sickness.

This theory is supported with the fact that people

without Labyrinthine are immune to motion

sickness and also why symptoms emerge when

undergoing various body/head accelerations; why

combinations of voluntary and reflexive eye

movements may challenge the proper operation of

Sherrington's Law; and why many drugs that

suppress eye movements also serve to suppress

motion sickness symptoms.

Types of motion sickness

Motion sickness can be divided into three types

depending on presentation

1. Motion sickness caused by motion that is felt

but not seen.

2. Motion sickness caused by motion that is seen

but not felt.

3. Motion sickness caused by mismatch of the

senses.

Motion is felt but not seen

In these cases, motion is sensed by the vestibular

system in the middle ear and hence the motion is

felt, but no motion or little motion is detected by the

visual system. Examples of such situation include;

Carsickness

Car sickness is very common and often shown by

ones inability to read a map or book during travel.

Trying to read a book, a map, even from an

electronic device, down to watching a movie inside

a moving car worsens the situation. Car sickness

results from the sensory conflict arising in the brain

from differing sensory inputs-sight and balance.

The eyes mostly see the interior of the car which is

stable while the vestibular system of the inner ear

senses motion as the vehicle goes around corners or

over hills and even small bumps. This is more

encountered when travelling a long distance on

poorly maintained roads. Therefore the effect is

worse when looking down but may be lessened by

looking outside of the vehicle or ahead of a driver,

making sights and gazes of far objects as movement

advances towards them.

Airsickness

Airsickness is a sensation which is induced by air

travel4. It is a specific form of motion sickness and

is considered a normal response in healthy

individuals. It is essentially the same as carsickness

but occurs in an airplane. However, some


66

significant differences are that an airplane may bank

and tilt sharply and due to the small window sizes,

unless the passenger is at a window seat he is likely

to see only the stationary interior of the plane.

Another factor is that while in flight, the view out

of windows may be blocked by clouds, preventing

a passenger at the window from seeing the moving

ground or moving lower clouds. It is actually less

severe in air plane as the tires of the aircraft are not

making much contact with the ground but tilts and

bends may cause kinetosis.

Sea-sickness

Seasickness is a form of motion sickness

characterized by a feeling of nausea and, in extreme

cases, vertigo experienced after spending time on a

craft on water4. It is, again, essentially the same as

carsickness, though the motion of a watercraft tends

to be more constant. It is typically brought on by the

rocking motion of the craft11, or movement while

immersed in water12. As with airsickness, it can be

difficult to visually detect motion even if one looks

outside of the boat as water does not offer fixed

points with which to visually judge motion. Poor

visibility conditions, such as fog, may worsen

seasickness. Some sufferers of carsickness are

resistant to seasickness and vice-versa.

Centrifuges

Rotating devices such as centrifuges used in astronaut

training and amusement park rides such as the Rotor,

Mission Space and the Graviton can cause motion

sickness in many people. While the interior of the

centrifuge does not appear to move, one will

experience a sense of movement. In addition,

centrifugal force can cause the vestibular system to

give one the sense that downward is in the direction

away from the center of the centrifuge rather than the

true downward direction. Centrifugal movements set

the fluid in the middle ear into motion and if this

motion is not supported by sighting the motion,

kinetosis is imminent. When one spins and stops

suddenly, fluid in the inner ear continues to rotate

causing a sense of continued spinning while one's

visual system no longer detects motion.

Motion that is seen but not felt

In these cases, motion is detected by the visual system

and hence the motion is seen, but no motion or little

motion is sensed by the vestibular system. When

motion sickness is caused by imbalance from visually

perceived motion but poorly felt, it is called Visually

Induced Motion Sickness (VIMS)13.

Motion sickness due to films and other video

This type of sickness is particularly prevalent when

people are watching films on large screens but may

also occur in regular format theaters or even when

watching TV. They feel the movements on screen as if

they are being involved thereby seeing movement but

actually they are not feeling it. This imbalance leads to

perception that one organ is actually in a hallucinating

condition and needs to be resolved. In regular format

theaters, an example of a movie that caused motion

sickness in many people is The Blair Witch Project.

Theaters warned patrons of its possible nauseating


67

effects, cautioning pregnant women in particular.

Motion than the average movie camera.

Home movies, often filmed with a hand-held camera,

also tend to cause motion sickness in those that view

them. The camera-person rarely notices this during

filming since his/her sense of motion matches the

motion seen through the camera viewfinder. Those

who view the film afterward only see the movement,

which may be considerable, without any sense of

movement. Using the zoom function seems to

contribute to motion sickness as well as zooming is not

a normal function of the eye. The use of a tripod or a

camcorder with image stabilization technology while

filming can minimize this effect.

Simulation sickness

Simulation sickness, or simulator sickness, is a

condition where a person exhibits symptoms similar to

motion sickness caused by playing

computer/simulation/video games.

The symptoms are often described as quite similar to

that of motion sickness, and can range from headache,

drowsiness, nausea, dizziness, vomiting and sweating.

Research done at the University of Minnesota had

students play Halo for less than an hour, and found that

up to 50 percent felt sick afterwards. This usually

affects people who already have a tendency to get car

sick or sea sick14.

The phenomenon was well known in popular culture

before it was known as simulation sickness. In the 1983

comedy film Joysticks, the manager of a local video

arcade says, "The reason why I never play any of these

games, well, they make me physically ill. I mean, every

time I look in one of the screens, they make me dizzy."

Motions that are seen and felt but do not

correspond

When moving within a rotating reference frame such

as in a centrifuge or environment where gravity is

simulated with centrifugal force, the Coriolis Effect

causes a sense of motion in the vestibular system that

does not match the motion that is seen.

Sometimes when riding a vehicle for a long time on a

badly maintained road at a very slow (10–20 km/h)

speed the two senses fail to correspond. Due to the poor

road quality the vehicle will jerk too much giving a

sense of severe motion to the inner ear, but due to the

slow speed the eye doesn't sense a proportional amount

of motion leading to a sensation of toxicity and

subsequent nausea.

Motion sickness caused by strong offensive smell

Among factors that may contribute to motion sickness,

such as alcohol or hunger, the presence of strong smells

is very often reported by individuals who are sensitive

to motion sickness15.

General susceptibility

90% of individuals are reported having experienced

motion sickness at least once in their lifetime. Indeed,

motion sickness has been described as a normal

response to an abnormal situation, it’s never a disease

per se.

Table 1. Motion sickness experienced by adults and

children when reading in passenger vehicles 16


68

QUESTION ADULT

(%)

CHILDREN

(%)

Frequency

of

motion

sickness

when

reading

Never 43 69

Rarely 15 9

Sometimes 17 9

Often 9 3

Usually 8 6

Always 9 3

Severity of

motion

sickness

when

reading

None 43 69

Mild 25 22

Moderate 22 3

Severe 10 6

Individual differences in susceptibility

Age

Motion sickness does not affect children who has a less

developed sense organs, within two years of age, and

the elderly ones with a defective sense organs4,1.

Gender

In general, women are more prone to motion sickness

than are men4,1 but, female astronauts do not report

more frequent motion sickness than do male

astronauts4, meaning that there is no gender differences

in susceptibility.

Behavioral styles

Introverted individuals and field-dependent persons

appear to be more susceptible to motion sickness than

other individuals 4,1.

Effects of Kinetosis

Dizziness

One of the greatest effects of kinetosis on sufferer is

the feeling of dizziness long after the situation has been

resolved. Dizziness is an impairment in spatial

perception and stability. (Dorland's Medical

Dictionary)dizziness does not have a direct meaning

and can be referred to as vertigo, presyncope,

disequilibrium(Reeves et al 2008) or a non-specific

feeling such as giddiness or foolishness18.

Fatigue

Fatigue (also called exhaustion, tiredness, languidness,

languor, lassitude, and listlessness) is a subjective

feeling of tiredness which is distinct from weakness,

and has a gradual onset. Unlike weakness, fatigue can

be alleviated by periods of rest. Fatigue can have

physical or mental causes. Physical fatigue is the

transient inability of a muscle to maintain optimal

physical performance, and is made more severe by

intense physical exercise19,20,21. Mental fatigue is a

transient decrease in maximal cognitive performance

resulting from prolonged periods of cognitive activity.

It can manifest as somnolence, lethargy, or directed

attention fatigue. Medically, fatigue is a non-specific

symptom, which means that it has many possible

causes including kinetosis.

Vomiting

Vomiting (known medically as emesis and informally

as throwing up and numerous other terms) is the

involuntary, forceful evacuation of the contents of the

content of the gut through the mouth and the nose22.

Vomiting can be caused by a wide variety of

conditions; it may present as a specific response to

ailments like gastritis or poisoning, or as a non-specific

outcomes of disorders ranging from malaria, typhoid

fever and brain tumors. The feeling that one is about to

vomit is called nausea, which often presents first, but

does not always lead to vomiting in most cases if the


69

offending situation is solved, but if not resolved, about

80% of nauseated conditions leads to vomiting.

Antiemetics, which are drugs that inhibits vomiting are

sometimes necessary to suppress nausea and vomiting.

In severe cases, where dehydration develops,

intravenous fluid may be required.

Loss of appetite

Food is not a matter of interest within two or three

hours post kinetosis. Sufferers usually complain of not

being able to eat after about two hours of kinetotic

episodes and tend to regain appetite after a long time

of rest and possibly a short nap. Appetite and strength

lost during the episodes of nausea and correspondent

vomiting that follows kinetosis is a major contributor

to the loss of appetite and exhaustive feeling.

Prevention and mitigation of motion sickness

Many have not come across the different ways of

preventing kinetosis when embarking on long distance

travels and it is very necessary that those that have

suffered this sickness know some of the things to do

when embarking on their journeys, because once a

sufferer is always prone to it. Some of the basic things

to do include.

Have something in your tummy

Although it is said that either eaten or not does not have

effect on the occurrence of kinetosis, it is strongly

suggested that sufferers eat at least 30 minutes before

setting up for their journey, sense or feeling of hunger

aggravates the possibility of having an episode of

kinetosis. Oily foods do give a great quenching effect

to the onset of kinetosis.

Have a beverage handy

While travelling, make sure to have a bottle of

beverage with you which you have to be taking as often

as possible. Water is a common beverage that does this

magic so often. Drink as often as you could because

when you keep having water in your tummy, the

feeling of a toxin which the brain detects during

sensory conflicts between the eyes and the sense of

balance will be minimized, thereby delaying the brains

response to initiate vomit as a cautioning effect. Get a

good night's sleep before you travel, eat a light lunch,

avoid alcohol, coffee and nicotine.

Have some candy

Taking some candies made of either ginger or garlic

has proved good to reduce or delay the possibility of

having kinetosis during travelling23, although the

mechanism of this action has not been fully

understood. Adding distractions such as listening to

music or using aromatherapy scents such as mint or

lavender also helps. Flavored lozenges may also help,

in particular ginger-flavored. Lozenges may also

function as distractions or, in the case of ginger, may

hasten gastric emptying.

Have no memory of past episodes

Having thoughts of the past episode of kinetosis

usually raises the chances of an attack and it is

recommended that sufferers try as much as possible not

remembering how the past experience was, because

this is going to trigger the brains’ vomit center to feel

the body is undergoing same conditions as before and,

an episode is always the next thing to follow. To avoid


70

a repeat episode, always try to forget the last

experience you had during travelling and have a

positive mindset towards your journey.

Avoid movies and reading onboard vehicles

Watching movies and reading articles on a moving

vehicle contributes to kinetosis. Viewing video is less

often the cause of motion sickness than is reading.

Similarly, viewing video is less often the cause of

severe motion sickness than is reading. However, if

one considers only those respondents who do

experience motion sickness, then the severity levels for

both activities are similar. Motion sickness while

viewing video is less likely to occur for children than

for adults. When it does occur, it is less severe in

children than adults1.

Posture

Varying posture can affect the incidence and severity

of motion sickness symptoms. Recent research24

suggests that postural instability is one of the factors

that contribute to the overall sensory conflict that

underlies motion sickness. Making much head

movements is a contributing factor. Additionally, there

is evidence that lateral and fore-aft motion and forces

contribute significantly to motion sickness in

passenger vehicles4,25,26. However, one study

concluded that fore-aft pitch motion contributes twice

as much to motion sickness as does lateral roll

motion25. These findings are consistent with the notion

that lying down flat and facing up (i.e., supine),

generally helps to lessen the effects of motion

sickness1,4,28. Not only does this position modify the

main axes of the body relative to the motions and

forces of the vehicle, but it may also lead to better

overall postural stability, especially for the head.

Conversely, the standard vertical seating position

found in passenger vehicles is associated with a

significantly higher incidence of motion sickness4,25.

However, postural adjustments are not always possible

or practical in passenger vehicles, especially in the case

of the driver or when an individual is attempting to

view video on a screen that is mounted in a fixed

location. If adopting the supine position is not possible,

restricting head motion is a good alternative postural

adjustment25. Optimizing position to reduce motion or

motion perception—for example, driving a vehicle

instead of riding in it, sitting in the front seat of a car

or bus, or sitting over the wing of an aircraft is

important. Cabin location on a cruise ship does not

appear to influence the likelihood of motion sickness25.

Closing the eyes

Given the underlying conflict between the sense of

sight and sense of balance that can cause motion

sickness, another potential method for reducing or

stopping symptoms is to reduce or stop the conflicting

stimuli input by closing the eyes. Visual input is most

easily “turned off” by simply closing one’s eyes. If

individuals are not able to set their gaze and posture to

allow for a clear view of the forward scene and/or

peripheral view of the horizon, then closing of the eyes

has been shown to be of some benefit for reducing

symptoms of motion sickness1,4,30 Indeed, research has

shown that restricting the outside and/or forward view


71

within a passenger vehicle can actually exacerbate the

symptoms of motion sickness30.

Adaptation

Adaptation over time to the sickness-inducing stimuli

has been reported to be one of the most effective

methods for the long-term prevention of motion

sickness1,4,28. When you get use to a particular situation

over time, it will automatically stop having any effect

on you perception of its presence. The process of

adaptation involves extended exposure to an

environment containing conflicting visual-vestibular

stimuli, usually on multiple occasions and over an

extended length of time. The main disadvantages to

this prevention method are (1) persistent kinetosis until

adaptation is achieved, and (2) the need for frequent

access and exposure to the environment in question.

Though relief is not as immediate when compared to

effective drugs or other countermeasures, adaptation

generally provides more complete, innate and lasting

relief which is naturally established from motion

sickness symptoms and has no side effects28.

Treatment of kinetosis/motion sickness

Natural medicine

Out of nature's medicine cabinet comes ginger, in

capsule form or as natural ginger root, which soothes

intestinal disorders without stressing the stomach.

Massages using rosemary or basil oil or a few drops of

lemon balm taken the day before departure also help.

During the journey itself you can chew gum or suck on

a lemon or an ice cube made of ginger29. Another form

of natural ways of treating kinetosis is taking a nap,

lying comfortably and having good source of natural

air, and if nausea persists, find your way out of the

vehicle for a while.

Medications

Antihistamines

Antihistamines have been used to treat motions

sickness. Notably, the non-sedating antihistamines do

not seem to be effective for motion sickness treatment.

Induction of sleep is one of the most classified ways

effective medications works. Sleeping or taking a short

nap is a way of solving the imbalance that exists

between the motion seen and motion felt. Drugs that

does not induce effective sleep within a short period of

administration is usually not seen as an immediate

treatment to kinetosis. Sedatives are better for the

management of kinetosis because they works in

various ways-it will induce sleep, and also takes care

of the mucosal membranes for effective vomit control.

Examples of antihistamine medications to treat motion

sickness include: chlorpheniramine (Aller-Chlor),

cyclizine (Marezine), cyclizine HCI (Bonine for

Kids),dimenhydrinate (Dramamine, Dramamine

Chewable, Driminate), diphenhydramine (Benadryl),

meclizine (Antivert, Bonine, D-Vert, Dramamine II).

Side effects may include significant sedation,

drowsiness, dry mouth, blurred vision, and confusion

and urinary retention in the elderly.

Anticholinergic

Scopolamine (Transderm-Scop) is the most well-

known medication in this category. It has been shown

in clinical trials to be effective at preventing motion


72

sickness. Scopolamine is most commonly

administered as a patch applied to the skin. Side effects

are the same as those of the antihistamines (sedation,

blurred vision, dry mouth, and confusion and urinary

retention in the elderly). Persons at risk for angle-

closure glaucoma should not take scopolamine.

Antidopaminergics

Two drugs in this category that have been successfully

used in the management of motion sickness include

promethazine (Phenergan, Pentazine) and

metoclopramide (Reglan). They effectively control

vomiting through the blocking of the dopamine

receptors in the CTZ and therefore blocking the

signaling of other vomit control centers for the

induction of vomiting. Both of these medications can

also cause significant sedation and in a few people,

movement disorders (for example, torticollis or

twisting of the neck, tongue protrusion).

Other Medications

Ephedrine and some amphetamines have been used

both to treat motion sickness and to counteract the

sedating effects of other medical treatments. Studies

have also shown a beneficial effect of caffeine when

administered in combination with other medications

for motion sickness30. Benzodiazepines have also

been useful for some people with motion sickness.

Examples include: alprazolam (Xanax), and diazepam

(Valium).

Antiemetic (anti-nausea) medications have been used

to control nausea and vomiting after motion sickness

has developed. Examples include: prochlorperazine

(Compazine), and ondansetron (Zofran)31.

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UB. KINETOSIS: ALL YOU NEED TO KNOW. Journal of

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SUFFERING MOTION SICKNESS?

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