On-road evaluation of sickness-less motion planning in automated vehicles: 'Head motion first' helps!

Physiological data-driven models for motion sickness prediction.

Change detection is a cognitively challenging process that involves three stages: spotting (becoming aware of a change); localising (establishing the specific location of the change); and identifying (recognising the nature of the change). Each of these stages has the potential to be influenced by both the way the data is presented (e.g., display type) and the fidelity of that data. To explore these issues, we conducted two studies, both of which looked at the effects of display type (immersive virtual reality (VR) or desktop monitor (DM)), and the semantic availability of the scene (low or high realism). Study 1 ( N = 38 ) explored the VR–DM differences in a broad scope, which examined six change types spanning both spatial and non-spatial changes— disappear , appear , translation , rotation , replacement , and colour . However, there were no significant differences between VR and DM in spotting, localising, and identifying at either level of (semantic) realism. Study 2 ( N = 20 ) followed this up by exploring only two types of spatial change ( translation and rotation ) at a much finer degree of granularity while retaining the same experimental paradigm with necessary refinement. Study 2 showed a significant VR advantage over DM, with different patterns across realism conditions: In low-realism scenes, VR significantly outperformed DM on localisation and change-type identification overall, with the largest VR–DM contrasts observed for the smallest translations . In high-realism scenes, the only significant effect was a display-by-magnitude interaction for change-type identification at the smallest translations . Taken both studies together, VR benefits are most likely for subtle spatial changes, particularly small translations , when the semantic availability is limited. Questionnaire ratings also suggested that reliance on visual features varies with semantic availability. Semantic cues were rated significantly higher than other features in high realism scenes only. Finally, there is no significant difference between VR and DM in terms of workload, motion sickness and self-confidence, suggesting that the perceptual advantages of VR come with no additional physical or cognitive costs for change detection. • Examined change detection in VR vs desktop under different semantic availability. • Covered spotting, localisation, and identification comprehensively across two studies. • VR improved localisation and change-type identification in low-realism scenes. • VR advantage is most pronounced for small spatial-translation changes. • Visual feature priority adapts; semantics dominate when available.

Freely moving pupillometry and awake vestibular recordings capture acute vestibular-autonomic signatures of motion sickness in mice.

The aim of this study is to evaluate the effectiveness of virtual reality (VR) for learning ophthalmic anatomy and to determine whether peer-assisted facilitation produces learning outcomes comparable to expert-assisted facilitation among preclinical medical students. A secondary objective was to contextualize learning outcomes by comparing performance of preclinical students with that of senior medical students receiving expert-assisted VR instruction. This is a prospective controlled experimental study with repeated-measures assessments. Second-year (preclinical) medical students without prior formal ophthalmic anatomy instruction were recruited voluntarily (peer-assisted n = 31, expert-assisted n = 32). Exclusion criteria included previous VR-based ophthalmic anatomy training, history of severe motion sickness or vertigo, or refusal to provide consent. In addition, fifth-year medical students undertaking their ophthalmology clerkship participated in a parallel prospective pre-post cohort (n = 61 baseline; n = 55 completed the intervention). All participants first attended a conventional didactic lecture on ophthalmic anatomy. Second-year students then completed an immersive VR learning session exploring a stereoscopic 3D model of the globe and adnexa using a head-mounted display. Sessions were facilitated either by an anatomy faculty expert or by trained peer facilitators. Fifth-year students completed the same instructional sequence with expert-assisted VR only. The primary outcome was change in anatomy knowledge measured by a 20-item assessment administered at baseline (T0), after didactic instruction (T1), and after VR (T2). Among second-year students, knowledge scores improved significantly across timepoints (repeated-measures ANOVA: F(2,124) = 251.0, p<.001, η²ₚ=0.802). Post-VR scores were comparable between peer-assisted and expert-assisted groups (15.1 ± 3.1 vs. 15.2 ± 3.4; t(61 =-0.12, p=.905, d=-0.03). Simulator sickness scores were low and did not differ between groups (4.2 ± 4.0 vs. 3.7 ± 3.7; p=.649), and satisfaction ratings were high in both conditions. Among fifth-year students, knowledge scores also increased significantly across instructional stages (F(2,106) = 33.4, p<.001, η²ₚ=0.387). Despite higher baseline scores among senior students (t(121)=-3.17, p=.002), post-VR performance was comparable between cohorts (t(115) = 1.11, p=.269). Peer-assisted facilitation produced learning outcomes comparable to expert-assisted instruction while maintaining high learner satisfaction and minimal simulator sickness. These findings suggest that peer facilitation may represent a scalable approach for implementing VR-based anatomy education.

3D teaching, including various types of mixed and virtual reality, are increasingly being used in anatomy, including on veterinary programs. In this study we compared the use of 3D mixed reality holographic technology and a 2D PowerPoint teaching resource to investigate the proof of concept of the usability and efficacy of the 3D technology. The anatomical area of the equine sinuses was the subject matter. The study design involved a series of questionnaires and tests delivered before and after the students used the learning resource. First-year veterinary students were randomly allocated to either the 3D or 2D group. Spatial ability and cognitive load were measured before, and cognitive load, task load, a 10-question spot test, and motion sickness (3D group only) were measured after. All students provided feedback via a short survey. The 2D group performed better in the spot test than the 3D group (t16.33 = -3.19, p < .05). No differences were noted for task load (p > .05) nor in the overall cognitive load (3D: V = 31.5, p = .2767, 2D: V = 23.5, p = .706); however, more participants in the 3D group exhibited a reduced cognitive load. Limited motion sickness symptoms were reported by participants in the 3D group. Qualitative findings from the survey demonstrated that the 2D group indicated difficulty in converting from 2D to 3D, and that the 3D group enjoyed the possibility of moving around the hologram. These findings demonstrate that the 3D mixed reality holographic technology had reasonable usability as a teaching resource, but future work is required into the efficacy of such technology for learning.

Virtual Reality (VR) has shown significant potential in enhancing student engagement and learning outcomes in STEM education, yet its application in music education remains underexplored—particularly concerning how varying levels of immersion affect learning performance and student perceptions. This study compared the effects of immersive VR (using head-mounted displays) and non-immersive VR (using tablets) on eighth-grade students’ engagement, learning performance, and perceptions during a musical instrument recognition task. A quasi-experimental design was employed with 43 students divided into two groups, both of which completed pre- and post-tests, questionnaires, and interviews. Statistical analyses, including paired and independent-sample t-tests and effect size calculations, revealed that while both groups significantly improved, the non-immersive VR group outperformed the immersive group with a medium-to-large effect size (Cohen’s d = 0.63). Questionnaire responses suggested that tablet-based VR facilitated better focus, understanding, and ease of use, whereas immersive VR promoted critical thinking and confidence despite usability challenges like motion sickness. These findings highlight that the level of VR immersion has distinct impacts on learning and user experience. Non-immersive VR may be more suitable for tasks requiring cognitive clarity and accessibility, while immersive VR could better support deeper cognitive engagement. Educators and instructional designers should align the level of VR immersion with educational objectives to optimize learning effectiveness and user experience.

Efficacy of aromatherapy for motion sickness: A self-controlled pre-post trial.

The assessment of motion sickness typically relies on self-reports. It is unclear whether rating general sickness (e.g., Fast Motion Sickness scale; FMS) or specific symptoms (e.g., Motion Illness Symptoms Classification; MISC) impacts the assessment. Different from prior studies, we investigated how FMS and MISC ratings developed during the same motion exposure. Both scales showed comparable time courses with a similar direction of rating transitions. To investigate the development of nausea versus non-nausea symptoms, participants also rated the MISC2D - a two-dimensional MISC-derivative separating these symptoms – alternatingly with the FMS in another exposure. We found no clear reduction in general sickness or non-nausea symptoms at nausea onset. Nausea-related symptoms, starting with stomach awareness, preceded non-nausea symptoms in over half our sample. Although we did not intend the MISC2D as a new scale, it proved suitable for repeated administration while capturing distinct motion sickness aspects.

Prospective evidence on the role of pre-chemotherapy psychosocial factors in symptom burden across the first chemotherapy cycle remains limited among patients with cancer. This prospective multicenter observational cohort study aimed to comprehensively evaluate clinical and pre-chemotherapy psychosocial predictors of chemotherapy-induced nausea and vomiting (CINV) across the entire first chemotherapy cycle. Chemotherapy-naive adult cancer patients scheduled to receive their first cycle of highly or moderately emetogenic chemotherapy (HEC or MEC) were enrolled. Pre-chemotherapy psychosocial variables were assessed using the Distress Thermometer (DT), selected Mini-Mental Adjustment to Cancer (Mini-MAC) subscales, and an investigator-developed behavioral/cognitive risk factor questionnaire. CINV was assessed through a 21-day patient diary after chemotherapy. Correlation and multicollinearity diagnostics were performed to assess relationships among psychosocial variables. Univariable and multivariable logistic regression analyses were applied to identify factors associated with CINV across the acute, delayed, and beyond-risk phases. Moderation analyses examined whether clinical variables modified psychosocial effects. A sensitivity analysis restricted to patients receiving guideline-adherent prophylaxis assessed psychosocial associations with CINV using reduced models adjusted for established CINV risk factors. Among 1168 patients screened, 1031 chemotherapy-naive individuals were eligible and included in the final analysis. Acute-phase CINV occurred in 72.8% of patients, while delayed-phase CINV was reported by 73.0%. Notably, 25.6% of patients experienced CINV beyond the risk phase, predominantly nausea (25.5%) rather than vomiting (3.8%). Patients who developed CINV had higher levels of pre-treatment psychological distress and maladaptive coping, including helplessness/hopelessness and anxious preoccupation (all P < 0.001). In univariable analyses, clinical factors, including HEC, advanced disease stage, and non-adherence to guideline-recommended prophylaxis, as well as patient-related and psychosocial factors, were associated with CINV. After adjustment, motion sickness history, short sleep duration, and clinically significant distress remained independently associated with CINV across multiple phases. In the beyond-risk phase, multiple psychosocial and behavioral factors, including vomiting expectancy, perceived nausea susceptibility, motion sickness history, short sleep duration, clinically significant distress, helplessness/hopelessness, and anxious preoccupation, remained independently associated with CINV, whereas most clinical determinants lost statistical significance, except chemotherapy emetogenicity. Moderation analyses indicated that these psychosocial associations were not significantly modified by chemotherapy emetogenicity or antiemetic guideline adherence. In sensitivity analyses restricted to patients receiving guideline-adherent prophylaxis, Mini-MAC/H, Mini-MAC/AP, and short sleep duration remained associated with overall CINV. Pre-chemotherapy psychosocial and behavioral susceptibility factors were independently associated with CINV throughout the first chemotherapy cycle, with particularly persistent associations beyond the conventional risk window. These findings support integrating routine pre-chemotherapy psychosocial screening into standard antiemetic and survivorship-oriented supportive care. Incorporating psychosocial risk assessment before chemotherapy may help identify patients vulnerable to persistent CINV and inform individualized supportive care across the survivorship continuum.

Although previous standard antiemetic trials evaluated chemotherapy-induced nausea and vomiting (CINV) up to 120h, recent evidence suggests that symptoms can persist well beyond this timeframe. However, the preventive efficacy of a triplet regimen including fosnetupitant (FosNTP) during the long-delayed phase (120-336h) remains unclear in patients undergoing moderately emetogenic chemotherapy. This study aimed to prospectively evaluate the efficacy of FosNTP in preventing CINV during this extended long-delayed window. This single-center, single-arm, prospective observational study recruited patients scheduled to receive oxaliplatin-based chemotherapy. The primary endpoint was the long-delayed (120-336h) complete control (CC) rate. Key secondary endpoints included the long-delayed complete response (CR) rate and the overall (0-336h) CC, CR, and total control (TC) rates. Relative risks for emetogenic events were assessed using a logistic regression model. The analysis included 100 patients. Most eligible patients received CapeOX (oxaliplatin + capecitabine) (92.0%). The long-delayed CC rate was 76.3%. The long-delayed CR and TC rates were 84.7% and 75.4%, respectively. Risk factors for CINV in participants who did not achieve CC during the long-delayed phase included age (odds ratio 0.954 [95% confidence interval 0.909-0.998]), female sex (8.808 [2.446-41.992]), and history of motion sickness (5.050 [1.118-27.548]). The triplet regimen involving FosNTP showed promising results and potential utility for managing long-delayed CINV in patients receiving oxaliplatin-based chemotherapy. However, given the single-arm study design, further comparative trials are warranted to confirm these findings. Participants with high emetic risk factors-such as younger age, female sex, or a history of motion sickness-continued to experience suboptimal control. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: jRCT1030230130.

BackgroundCarsickness is a potential barrier to the acceptance of automated driving as it turns drivers into passengers, thus making them more susceptible to motion sickness. However, most of our current knowledge of how vehicle motion causes motion sickness comes from seasickness studies, using vertical motion only. Some more recent studies have investigated the relationship between horizontal accelerations and motion sickness, but with inconsistent methodology and sometimes conflicting results.ObjectiveTo quantify the effects of acceleration frequency and magnitude for periodic accelerations along the longitudinal, lateral, and vertical axes in a large sample of participants, using consistent methodology throughout.MethodsIn three separate experiments, in total 107 participants were exposed to sinusoidal accelerations along either the longitudinal, lateral or vertical axis with different combinations of motion frequency and peak acceleration. Motion frequency was varied between 0.03 and 3.2Hz, with peak acceleration ranging from 0.5 to 4.0m/s2. Motion sickness was measured during motion exposure using the Motion Illness Symptoms Classification (MISC) scale, while the Simulator Sickness Questionnaire (SSQ) and a visual analogue Discomfort scale were administered after each motion exposure.ResultsMotion sickness severity due to motion exposure was similar for the three motion axes. All three outcome measures showed a clear motion frequency dependency, with motion sickness in general most severe for frequencies around 0.2Hz. However, significant motion sickness symptoms were observed for the entire frequency range tested. The frequency dependency was less clear for lateral motion than for longitudinal and vertical motion. Higher accelerations led to more severe motion sickness, with the rate of increase decreasing when accelerations became higher.ConclusionsOur results show that motion sickness due to periodic linear accelerations occurs along all three cardinal axes and that it depends on motion frequency. This frequency dependency was less clear for lateral motion than for longitudinal and vertical motion. Our results have important implications for both predictive models of motion sickness as well as for applications in automated vehicles.

As lightweight, affordable XR Head-Mounted Displays (HMDs) move toward everyday use, many popular smartphone apps will migrate to XR. Head movements offer a hands-free option for XR app navigation. However, existing head-based techniques usually require large motions and speed thresholds, which increase neck fatigue, can induce motion sickness, and appear obtrusive in public. This is especially problematic when using XR apps designed for prolonged engagement, where cybersickness is a key concern. In this paper, we present PointerHalo, a hands-free XR technique tailored for app navigation. It uses subtle head movements to invoke and select a compact halo of stationary icons around a head-controlled pointer, supporting both generic navigation (scroll, section switch, back-to-previous-page) and app-specific commands. Results showed that PointerHalo significantly reduced head movements by up to 81.1%, relative to two state-of-the-art head-based techniques.

Motorist's disorientation syndrome (MDS) is seen in 1 to 5% of patients in a tertiary neurotology clinic and remains an underdiagnosed pathology. It was first described in 1985 by Page & Gresty, using the term "visual vertigo". Patients described sensations of veering or turning over while driving an automobile when visual input was restricted. This was exacerbated at high speeds, on winding roads, going down hills, or when overtaken by a vehicle. All patients in this initial study had peripheral or central neurotological abnormalities and showed exaggerated responses during optokinetic stimulation. Some sufferers considered giving up driving. The first aims of this narrative review were to delineate the symptoms of MDS as detailed in the literature, to outline precipitating situations and to discuss associated pathologies such as anxiety. The second aim was to differentiate MDS from similar syndromes, such as persistent postural-perceptual dizziness (PPPD) and motion sickness (MS). In addition, we looked at the role of vestibular assessments and discussed the involvement of the otolith organs and semicircular canals. In this review, eight publications were analyzed. MDS is related to a visual-vestibular or a visio-visual conflict and occurs in drivers (both males and females). It is associated with anxiety in 17-39% of cases. Mild vestibular-test abnormalities or exaggerated response to opto-kinetic stimulations are seen in 60-100% of cases. Between 50 and 62% of patients have a migraine history. Convergence and strabismic problems are also often seen. Symptoms usually settle after 6 ± 4 years but can persist for longer in females. MDS is multifactorial, and similar to certain forms of PPPD but different than MS. Its pathophysiology is still in question, and we support the role of the velocity storage integrator as a recent hypothesis. Treatment includes vestibular rehabilitation, virtual reality, cognitive behavioral therapies and orthoptic sessions, and the results are promising. The authors also strongly feel that future research on clarifying MDS pathology should study a wider scope of vestibular assessments to evaluate semicircular canal/otolithic function, as well as the vestibulo-ocular reflex, analyze optokinetic nystagmus time constant, and perform a systematic orthoptic examination.

Tradipitant (NEREUS™) is a small molecule neurokinin-1 (NK-1) receptor antagonist being developed by Vanda Pharmaceuticals. NK-1 receptor activation and substance P release in the central nervous system leads to nausea and vomiting symptoms associated with motion sickness. Tradipitant received its first approval in the USA in December 2025 for the prevention of vomiting induced by motion in adults, and is also being developed for the treatment of gastroparesis and prevention of vomiting induced by GLP-1 receptor agonists. In phase III trials, tradipitant reduced the incidence of vomiting associated with motion sickness. This article summarizes the milestones in the development of tradipitant leading to this first approval for the prevention of vomiting induced by motion in adults.

To describe the clinical features of middle-aged women with isolated spontaneous episodic vestibular syndrome, focusing on vestibular, audiological, migraine-related, and climacteric symptoms. This cross-sectional study included women aged 40 to 65 years with recurrent spontaneous vestibular symptoms and no hearing loss, evaluated at a tertiary neurotology outpatient clinic. Participants underwent a semi-structured clinical interview and completed the Dizziness Handicap Inventory (DHI), Menopause Rating Scale (MRS), and Migraine Disability Assessment (MIDAS). Clinical features were described, and associations between DHI scores, clinical features, MRS, and MIDAS were examined. Ninety-three patients were included. Most experienced episodes at least weekly (80.6%), typically lasting seconds to minutes (74.2%) and frequently triggered by head motion (88.2%). Episodes were commonly associated with headaches (54.8%) and emotional distress (63.4%). Frequent accompanying symptoms included tinnitus (78.5%), hyperacusis (62.4%), motion sickness (59.1%), photophobia (59.1%), neck pain (60.2%), and vasomotor symptoms (59.1%). DHI scores were significantly higher in patients with tinnitus (P=0.042). Although 19.2% did not meet diagnostic criteria for vestibular migraine (VM), 95.7% reported at least one migraine-related symptom. DHI scores correlated significantly with MRS (P=0.0007) but not with MIDAS (P=0.819). Middle-aged women with isolated episodic vestibular syndrome show a consistent pattern of brief, recurrent symptoms often accompanied by auditory, emotional, migraine-related, and vasomotor features. Tinnitus is associated with greater disability, and menopausal symptoms significantly correlate with dizziness-related handicap.

Motion sickness in autonomous driving: Environmental, individual, and time effects

A novel correlation-driven cross-term compression polynomial network for classifying motion sickness levels

An exploratory study on the development of pre-service English teachers’ VR-contextualized testing prototype

This study aimed to investigate independent risk factors for postoperative vomiting induced by general anesthesia in total knee arthroplasty (TKA) patients, providing evidence for targeted prevention and intervention in high-risk individuals. This retrospective study analyzed data from patients undergoing TKA at our hospital between January 2020 and December 2023. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for postoperative vomiting following general anesthesia. A total of 452 TKA patients were included in this study. Among them, 96 patients experienced postoperative vomiting induced by general anesthesia, with an incidence rate of 21.24%. Through univariate and multivariate logistic regression analysis, 5 independent risk factors significantly associated with postoperative vomiting were identified. These factors included: history of vomiting (OR, 4.206; 95% CI, 1.148–8.954), history of motion sickness (OR, 4.152; 95% CI, 2.050–8.408), excessive preoperative fasting duration (defined as ≥12 hours, based on clinical practice and published enhanced recovery after surgery guidelines for arthroplasty; OR, 2.791; 95% CI, 1.194–6.521), intraoperative opioid use (OR, 2.884; 95% CI, 1.128–7.374), and absence of antiemetic medication during surgery (OR, 6.250; 95% CI, 2.238–17.455). Postoperative vomiting in TKA patients is significantly associated with multiple factors. The independent risk factors identified in this study provide scientific evidence for identifying high-risk patients preoperatively, optimizing anesthesia management, and reducing postoperative vomiting incidence.