Simulator Sickness Symptoms Research Articles

HOW DOES MENTAL DISTRACTION INDUCED BY AN ADDITIONAL TASK AFFECT THE SEVERITY OF SIMULATOR SICKNESS SYMPTOMS IN PILOTS: A SPATIAL DISORIENTATION SIMULATOR STUDY

Introduction: To improve the effectiveness of spatial disorientation (SD) training in a flight simulator, pilots are recommended to perform an additional task that induces a mental distraction. The presented study explored how the inclusion of an additional task that may enhance the effectiveness of SD training changes the severity of simulator sickness symptoms reported after exposure in the Gyro-IPT simulator. Methods: We compared the incidence of simulator sickness symptoms in pilots across four setups of flight scenarios (varying according to cognitive load distraction) collected during our previous studies. A total of 77 male military pilots (age 28.3±6.2) with flight experience (810.72 ±969.43 hours) were randomly assigned to one of four groups and then exposed to a 60-min long flight session (12 flight profiles, six involved an SD-conflict) with active control in the Gyro IPT simulator. In addition to the primary flying task, in three flight scenarios, pilots were asked to perform an additional visual (a change detection flicker task [CDFT]), auditory (an auditory N-back task [NBT]), or duration-discrimination task (DDT)). To measure simulator sickness symptoms, the Simulator Sickness Questionnaire (SSQ) was administered pre- and post-simulator exposure. Results: The severity of simulator sickness symptoms due to visual and motion cues did not significantly change when the pilot performed a non-sickening cognitive task (additional visual or auditory task). The total SSQ score and scores for nausea, oculomotor disturbance, and disorientation in the CDFT and DDT were slightly higher than in the control condition (flight without additional task). Despite the observed differences, according to the SSQ scoring criteria, the simulator sickness symptoms reported by the pilots were negligible. Conclusions: The additional tasks (CDFT, auditory NBT, or DDT) applied to improve the effectiveness of SD training in the Gyro-IPT simulator do not significantly change unwanted effects, such as simulator sickness.

Effect of screen configuration on the neck angle, muscle activity, and simulator sickness symptoms in virtual reality.

There is a lack of information about the optimal setup of multiple screen configurations in virtual reality (VR) office work. The objective of this study was to evaluate the effects of different screen configurations on neck flexion, rotation, neck muscle activity, and simulator sickness symptoms during Virtual Reality (VR) office work. Twelve participants (7 males; 21 to 27 years old) performed copy-paste and drag-drop tasks in three different screen configurations (single screen, primary-secondary screen, and double screen) in a randomized order. Optical motion capture system, electromyography (EMG) device, and simulator sickness questionnaire (SSQ) were used to measure the users' responses. Neck rotation angles, muscle activities, and VR sickness were significantly affected by the screen configurations (p < 0.021). The primary-secondary screen showed the highest right rotation angle (median: -33.47°) and left sternocleidomastoid (SCM) muscle activities (median: 12.57% MVC). Both single (median: 22.42) and primary-secondary (median: 22.40) screen showed the highest value of SSQ. The screen configurations in VR could be an important design factor affecting the users' physical demands of the neck and VR sickness symptoms. Asymmetric neck rotations caused by the primary-secondary screen conditions should be avoided.

Development and testing of a model for explaining learning and learning-related factors in immersive virtual reality

Many believe that immersive virtual reality (IVR) possesses transformative potential for a plethora of human activities that are mediated via technology, including education. In light of this, it is critically important to understand the determinants that influence learning in IVR environments and the interrelations among these determinants. For that matter, a model was developed that encapsulated ten potential factors influencing learning outcomes. Three hundred and thirty-four university students interacted with a purpose-built application that presented ancient Greek inventions through the use of head-mounted displays. Data analysis, adhering to a structural equation modeling approach, indicated that a multitude of factors exerted a positive influence on learning outcomes. These included the perceived quality of graphics, the perceived quality of feedback and content, and the perceived degree of interaction. Moreover, intrinsic motivation and the immersive experience that IVR provides also demonstrated a positive impact. Conversely, the perceived cognitive load and symptoms of simulator sickness manifested a negative impact. Interestingly, these factors did not appear to inhibit learners' motivation or their positive feelings. Age did not have any effect, while gender seemed to have an impact only on immersion. The implications of the results are also discussed.

Virtual Reality Simulation for Suicide Risk Assessment Training: Prevalence of Adverse Effects.

Virtual reality (VR) simulation is changing the landscape of simulation-based medical education. Immersive VR allows users to interact with a computer-generated environment and digital avatars using a VR headset and controllers. However, current literature regarding the use of immersive VR simulation in psychiatric medical education is sparse. This study describes its use and considerations regarding tolerability. At a mental health hospital in Canada, two immersive VR suicide risk assessment (SRA) case simulations were developed. These simulations have participants interview VR patients to characterize their suicide risk, offering a novel and safe way to engage healthcare providers in SRA training. Regarding user tolerability of these VR simulations, the Simulator Sickness Questionnaire (SSQ) was administered to participants after the simulation to characterize any motion sickness symptoms experienced. Of the 22 participants in this study, the overall SSQ scores demonstrated good tolerability of the VR SRA, with the majority of participants reporting no or minimal simulator sickness symptoms. Moreover, the majority of participants reported being satisfied with this training and that the VR SRA simulation enhanced their learning experience. These study findings are novel, given the current dearth of data regarding the use of immersive VR in simulation-based psychiatric medical education. Further studies exploring the educational effectiveness of VR SRA in simulation-based psychiatric medical education are indicated.

THE INCIDENCE OF SIMULATOR SICKNESS IN PILOTS AND NON-PILOTS EXPOSED TO SPATIAL DISORIENTATION EVENTS IN THE GYRO-IPT SIMULATOR

Introduction: A previous study conducted in the Gyro-IPT simulator revealed that applied flight scenarios induced minor severity of simulator sickness symptoms in participants. In this study, however, we did not investigate how the severity of symptoms differs between pilots and non-pilots. Therefore, the presented study aimed to examine whether the symptoms of simulator sickness induced in pilots and non-pilots during spatial disorientation (SD) training are significantly different. We were particularly interested in whether the standard flight scenario used in SD training could be a contributing factor in increasing simulator sickness in novice, inexperienced pilots. Method: We used the data from the previous study, where twenty male military pilots (age 31.6 ±8.22) with flight experience (total flight hours 1300 ±1167.4) and 20 non-pilots (age 30.9 ±7.72) were assigned to one of two groups and then exposed to a 1-hour long flight session (12 flight profiles, six involved an SD-conflict) with active control in the Gyro IPT simulator. To measure simulator sickness symptoms, the Simulator Sickness Questionnaire (SSQ) was administered pre and post-simulator exposure. In the presented study, the SSQ scores were analyzed independently for the total SSQ and subscores for nausea, oculomotor, and disorientation, and then were compared between groups. Results: The score of the total severity and for each subscale of SSQ symptoms in the non-pilots‘ group were higher than those in the pilots group, however, these differences were not significant. Despite the observed differences, according to the SSQ scoring criteria the simulator sickness symptoms reported by the participants after exposure to the applied flight scenario were negligible. Conclusion: The flight scenarios used in SD training did not generate significantly different symptoms of simulator sickness between non-pilots and pilots. The low level of severity of simulator sickness symptoms in these two study groups may indicate difficulty in predicting simulator sickness based on SSQ only.

Effect of Frame Rate on User Experience, Performance, and Simulator Sickness in Virtual Reality.

The refresh rate of virtual reality (VR) head-mounted displays (HMDs) has been growing rapidly in recent years because of the demand to provide higher frame rate content as it is often linked with a better experience. Today's HMDs come with different refresh rates ranging from 20Hz to 180Hz, which determines the actual maximum frame rate perceived by users' naked eyes. VR users and content developers often face a choice because having high frame rate content and the hardware that supports it comes with higher costs and other trade-offs (such as heavier and bulkier HMDs). Both VR users and developers can choose a suitable frame rate if they are aware of the benefits of different frame rates in user experience, performance, and simulator sickness (SS). To our knowledge, limited research on frame rate in VR HMDs is available. In this paper, we aim to fill this gap and report a study with two VR application scenarios that compared four of the most common and highest frame rates currently available (60, 90, 120, and 180 frames per second (fps)) to explore their effect on users' experience, performance, and SS symptoms. Our results show that 120fps is an important threshold for VR. After 120fps, users tend to feel lower SS symptoms without a significant negative effect on their experience. Higher frame rates (e.g., 120 and 180fps) can ensure better user performance than lower rates. Interestingly, we also found that at 60fps and when users are faced with fast-moving objects, they tend to adopt a strategy to compensate for the lack of visual details by predicting or filling the gaps to try to meet the performance needs. At higher fps, users do not need to follow this compensatory strategy to meet the fast response performance requirements.

SIMULATOR SICKNESS AND ITS RELATIONSHIP TO OCULOMOTOR ACTIVITY – COMPARISONS OF A FIXEDBASE VS. FULL-MOTION SIMULATOR

Introduction: Studies on simulator sickness take into account an increasing number of factors regarding individual characteristics (e.g., gender, age, experience), testing time as well as simulator testing conditions, to name a few. In addition to the symptoms of simulator sickness expressed at the level of subjective indicators, it is also important to consider physiological indicators. The present study was designed to test whether the use of a fixed-base vs. fullmotion simulator influences the severity of simulator sickness symptoms and changes in the level of oculomotor variables. Methods: Twelve male subjects with age M=29.8, SD=4.26 participated in this study. Each subject performed two 30-minute simulator tasks following the same route. Each of these tasks was performed in different configuration of a truck simulator manufactured by ETCPZL Aerospace Industries: Condition 1 – fixed-base simulator, Condition 2 – full-motion simulator. Eye movements were recorded during the simulator task. Additionally, the SSQ questionnaire was filled out immediately after the simulator task and 1 h after leaving the simulator. Results: The results show a higher level of most symptoms of simulator sickness under 2nd condition (full-motion simulator). In the case of measurement immediately after completing the task on the simulator, there was an increase in oculomotor problems. On the other hand, the measurement after 1 h also revealed a significant increase in nausea, oculomotor and disorientation. Moreover, after 1 hour, a relationship between nausea symptoms and oculomotor indices was found. Discussion and Conclusions: Results indicate the influence of simulator testing conditions on the occurrence of simulator sickness symptoms. In addition, the relationship between variables measured by the oculograph and subjective symptoms of simulator sickness was demonstrated. The results obtained indicate changes in the sensitivity of physiological indicators and are discussed in the context of the possibility of using simulators in the diagnosis and training of selected functions.

A social VR-based collaborative exergame for rehabilitation: codesign, development and user study.

Immersive virtual reality (VR)-based exercise video games (exergames) are increasingly being employed as a supportive intervention in rehabilitation programs to promote engagement in physical activity, especially for elderly users. A multifaceted and iterative codesign process is essential to develop sustainable exergaming solutions. The social aspect is considered one of the key motivating factors in exergames; however, research on the social aspect of VR exergames has been limited. Previous studies have relied on competitiveness in exergames, but research has shown that competition can lead to adverse effects on users. With the aim of motivating elderly individuals to participate in physical exercise and improving social connectedness during rehabilitation, this work presents a social VR-based collaborative exergame codesigned with elderly participants and therapists. This exergame stimulates full-body exercise and supports social collaboration among users through a collaborative game task. Furthermore, this article presents a user study based on a mixed-methods approach to gather user feedback on exergame design and the effect of social collaboration versus playing alone in a VR exergame in terms of physical exertion and motivation. This study spanned five weeks (99 exergaming sessions) with 14 elderly participants divided into two groups, one playing collaboratively and the other playing individually. Between-group comparisons were performed at baseline (first week) and in the fourth week, and within-group comparisons were performed in the fifth week, when the participants played the exergame in counterbalanced order. In contrast to the first week, the participants exergaming collaboratively in the fourth week reported significantly higher intrinsic motivation on all subscales (enjoyment: p < 0.02, effort: p < 0.002, usefulness: p < 0.01) and physical exertion (p < 0.001) than those playing alone. Thereafter, exergaming in counterbalanced order during the fifth week resulted in significant differences (medium to large effect size) within groups. The participants found the social VR gameplay enjoyable and agreed that collaboration played a vital role in their motivation. They reported various health benefits, a minimal increase in symptoms of simulator sickness, and excellent usability scores (83.75±13.3). In this work, we also identify various key design principles to support healthcare professionals, researchers and industrial experts in developing ergonomic and sustainable VR-based exergames for senior citizens.

Mild simulator sickness can alter heart rate variability, mental workload, and learning outcomes in a 360° virtual reality application for medical education: a post hoc analysis of a randomized controlled trial

Virtual reality (VR) applications could be beneficial for education, training, and treatment. However, VR may induce symptoms of simulator sickness (SS) such as difficulty focusing, difficulty concentrating, or dizziness that could impair autonomic nervous system function, affect mental workload, and worsen interventional outcomes. In the original randomized controlled trial, which explored the effectiveness of using a 360° VR video versus a two-dimensional VR video to learn history taking and physical examination skills, only the former group participants had SS. Therefore, 28 undergraduate medical students who participated in a 360° VR learning module were included in this post hoc study using a repeated measures design. Data of the Simulator Sickness Questionnaire (SSQ), heart rate variability (HRV) analysis, Task Load Index, and Mini-Clinical Evaluation Exercise were retrospectively reviewed and statistically analyzed. Ten (36%) participants had mild SS (total score > 0 and ≤ 20), and 18 (64%) had no SS symptom. Total SSQ score was positively related to the very low frequency (VLF) band power, physical demand subscale, and frustration subscale, and inversely related to physical examination score. Using multilevel modeling, the VLF power mediated the relationship between total SSQ score and physical examination score. Furthermore, frustration subscale moderated the mediating effects of the VLF power. Our results highlight the importance of documenting SS to evaluate a 360° VR training program. Furthermore, the combination of HRV analysis with mental workload measurement and outcome assessments provided the important clinical value in evaluating the effects of SS in VR applications in medical education.

Feasibility of utilizing clinical and driving simulator assessments to indicate driving performance deficits in adults with multiple sclerosis

BACKGROUND: Drivers with Multiple Sclerosis (MS) experience visual-cognitive impairment that impact on-road driving performance. OBJECTIVE: This study examines the feasibility of utilizing visual-cognitive and driving simulator assessments to indicate driving performance deficits (operational, tactical, and strategic maneuvers) in drivers with MS. METHODS: Through an evidence-informed feasibility framework, we evaluated recruitment capability and resulting sample characteristics, data collection procedures and outcome measures, participants’ acceptability and suitability of the driving simulator, the resources and ability to implement the study, and clinical and driving simulator assessment results. RESULTS: Thirty-eight persons with MS (median age = 43 years, IQR = 19) and 21 persons without MS (median age = 41 years, IQR = 14) participated. Missing data on the driving simulator resulted from scenario complexity (13 with MS, 4 without MS) or the onset of simulator sickness (1 with MS, 1 without MS). Seven participants with MS and two participants without MS reported symptoms of simulator sickness. Participants with MS (vs without MS) made more adjustment to stimuli errors (tactical maneuvers). For participants with MS, immediate verbal/auditory recall or divided/selective attention correlated with simulated driving maneuvers. CONCLUSIONS: Study findings identified challenges (missing data, simulator sickness), but established feasibility for executing a full-scale study to predict driving simulator performance in drivers with MS.

Postural Control and Psychophysical State Following of Flight Simulator Session in Novice Pilots.

Flight simulators can cause side effects usually called simulator sickness. Scientific research proves that postural instability can be an indicator of the occurrence of simulator sickness symptoms. This study aims to assess changes of postural control and psychophysical state in novice pilots following 2-h exposure to simulator conditions. The postural sway was quantified based on variables describing the displacement of the Center of Pressure (COP) generated in a quiet stance with eyes open (EO) and closed (EC). The psychophysical state was assessed using the Simulator Sickness Questionnaire (SSQ). The research was carried out in a group of 24 novice pilots who performed procedural and emergency flight exercises in the simulator at Instrument Meteorological Conditions. Each subject was examined twice: immediately before the simulator session (pre-exposure test), and just after the session (post-exposure test). The differences in postural stability between pre- and post-exposure to simulator conditions were assessed based on the normalized Romberg quotients, calculated for individual variables. The lower median values of all Romberg quotients confirmed the decreasing difference between the measures with eyes open and with eyes closed in the post-exposure tests. After the flight simulator session in both measurements (EO and EC) the values of the length of sway path (SP), the mean amplitude (MA), the sway area (SA) have changed. The visual contribution to postural sway control was reduced. The median values for all SSQ scores (total, nausea, oculomotor, and disorientation scales) were significantly higher in post-exposure tests. The largest increase was noted in the oculomotor SSQ scores (from 7.6 ± 7.6 to 37.9 ± 26.5). Over 50% of pilots participating in this study expressed symptoms typical of simulator sickness connected with visual induction: fatigue, eyestrain, difficulty focusing and difficulty concentrating. The severity of oculomotor and disorientation symptoms were rated as moderate (total SSQ score of more than 25 and <60). This study concludes that changes noted in the postural control and psychophysical state of the studied pilots after exposure to the flight simulator confirm the occurrence of the simulator sickness symptoms. Although, we did not find significant correlation of postural stability with SSQ scores.

Subjective Evaluation of Visual Quality and Simulator Sickness of Short 360$^\circ$ Videos: ITU-T Rec. P.919

Recently an impressive development in immersive technologies, such as Augmented Reality (AR), Virtual Reality (VR) and 360<inline-formula><tex-math notation="LaTeX">${^\circ }$</tex-math></inline-formula> video, has been witnessed. However, methods for quality assessment have not been keeping up. This paper studies quality assessment of 360<inline-formula><tex-math notation="LaTeX">${^\circ }$</tex-math></inline-formula> video from the cross-lab tests (involving ten laboratories and more than 300 participants) carried out by the Immersive Media Group (IMG) of the Video Quality Experts Group (VQEG). These tests were addressed to assess and validate subjective evaluation methodologies for 360<inline-formula><tex-math notation="LaTeX">${^\circ }$</tex-math></inline-formula> video. Audiovisual quality, simulator sickness symptoms, and exploration behavior were evaluated with short (from 10 seconds to 30 seconds) 360<inline-formula><tex-math notation="LaTeX">${^\circ }$</tex-math></inline-formula> sequences. The following factors&#x2019; influences were also analyzed: assessment methodology, sequence duration, Head-Mounted Display (HMD) device, uniform and non-uniform coding degradations, and simulator sickness assessment methods. The obtained results have demonstrated the validity of Absolute Category Rating (ACR) and Degradation Category Rating (DCR) for subjective tests with 360<inline-formula><tex-math notation="LaTeX">${^\circ }$</tex-math></inline-formula> videos, the possibility of using 10-second videos (with or without audio) when addressing quality evaluation of coding artifacts, as well as any commercial HMD (satisfying minimum requirements). Also, more efficient methods than the long Simulator Sickness Questionnaire (SSQ) have been proposed to evaluate related symptoms with 360<inline-formula><tex-math notation="LaTeX">${^\circ }$</tex-math></inline-formula> videos. These results have been instrumental for the development of the ITU-T Recommendation P.919. Finally, the annotated dataset from the tests is made publicly available for the research community.

Passenger Experience of Simulated Urban Air Mobility Ride Quality: Responses to Large-Scale Motion

Twenty-three participants took 10-min solo Urban Air Mobility quadrotor flights as passengers on two separate days in a six-dof large-motion simulator. One flight was in a rotor speed (i.e., RPM) controlled model; the other was under rotor blade pitch (i.e., collective) control. Both were flown in the same modeled turbulence. When ranked across test conditions, the severity of participants' self-reported simulator sickness symptoms paralleled acceleration-derived predictions of motion sickness likelihood in the following worst-to-best order: 1) RPM control; 2) collective control; and 3) preflight while still on the vertiport pad. Various objective measures revealed potential impacts of flight roughness on the learning of a visuo-manual reaction-time task and on heart and breathing rate indicators of preflight/inflight passenger stress.

Practical skills training in enclosure fires: An experimental study with cadets and firefighters using CAVE and HMD-based virtual training simulators

Training in enclosure fires is essential because it is one of the most dangerous tasks for firefighters. The training simulators should consider the specificity of the tasks performed to achieve the best training outcomes. Additionally, the end-users may not accept even the best technical solutions. Due to the availability of many different interfaces and methods (e.g., for image presentation), end-users' opinions are essential in choosing the best possible technologies. In this research, the aim is to create and compare two realistic virtual training systems for fighting enclosure fires, CAVE (Cave Automated Virtual Environment) with projectors and VR (Virtual Reality) with HMD (Head Mounted Display). Both focused on nozzle person training to fill the gap between theoretical training and real-life training with fires (e.g., drills with class A fuels). Efforts were made to minimize the disadvantages of training simulators while maintaining high simulation realism and low simulator cost. The study was conducted with the participation of 67 cadets and seven active firefighters. The method of reducing the limitations of VR training simulators while maintaining relatively low costs is discussed. The simulator enables multisensory experience with passive haptic and multi-user interaction considering the sense of touch. The VR simulator was rated better than the CAVE simulator, but both were accepted and rated as very useful. The paper also discusses the issues of simulation sickness symptoms, simulation realism (spatial presence), usability, acceptance of technology, and stress associated with using a training simulator.

Usability Testing of a VR Flight Training Program

Virtual reality (VR) flight training programs are being developed as a low-cost, highly realistic training option and tested to ensure user expectations for skills mastery are met. A usability pilot study was conducted in two experimental courses comparing the training effectiveness of 2D and VR simulation for flight training at a university in the Southwestern United States. The results indicated that system usability was significantly higher in the VR group. There was no significant difference between groups for perceived workload nor user experience. Although both groups reported low symptoms of simulator sickness, users in the VR group reported significantly higher levels of eye strain. Both groups found the simulations to be enjoyable and several users stated that the simulations were beneficial for learning flight maneuvers. The results of the pilot study demonstrated that overall, VR simulation is similar to 2D simulation for flight training in terms of usability and user satisfaction.

On the Effect of Standing and Seated Viewing of 360° Videos on Subjective Quality Assessment: A Pilot Study

Due to the advances in head-mounted displays (HMDs), hardware and software technologies, and mobile connectivity, virtual reality (VR) applications such as viewing 360° videos on HMDs have seen an increased interest in a wide range of consumer and vertical markets. Quality assessment of digital media systems and services related to immersive visual stimuli has been one of the challenging problems of multimedia signal processing. Specifically, subjective quality assessment of 360° videos presented on HMDs is needed to obtain a ground truth on the visual quality as perceived by humans. Standardized test methodologies to assess the subjective quality of 360° videos on HMDs are currently not as developed as for conventional videos and are subject to further study. In addition, subjective tests related to quality assessment of 360° videos are commonly conducted with participants seated on a chair but neglect other options of consumption such as standing viewing. In this paper, we compare the effect that standing and seated viewing of 360° videos on an HMD has on subjective quality assessment. A pilot study was conducted to obtain psychophysical and psychophysiological data that covers explicit and implicit responses of the participants to the shown 360° video stimuli with different quality levels. The statistical analysis of the data gathered in the pilot study is reported in terms of average rating times, mean opinion scores, standard deviation of opinion scores, head movements, pupil diameter, galvanic skin response (GSR), and simulator sickness scores. The results indicate that the average rating times consumed for 360° video quality assessment are similar for standing and seated viewing. Further, the participants showed higher resolving power among different 360° video quality levels and were more confident about the given opinion scores for seated viewing. On the other hand, a larger scene exploration of 360° videos was observed for standing viewing which appears to distract from the quality assessment task. A slightly higher pupil dilation was recorded for standing viewing which suggests a slightly more immersed experience compared to seated viewing. GSR data indicate a lower degree of emotional arousal in seated viewing which seems to allow the participants to better conduct the quality assessment task. Similarly, simulator sickness symptoms are kept significantly lower when seated. The pilot study also contributes to a holistic view of subjective quality assessment and provides indicative ground truth that can guide the design of large-scale subjective tests.

Virtual Reality Tailored to the Needs of Post-ICU Patients: A Safety and Immersiveness Study in Healthy Volunteers

ICU treatments frequently result in long-term psychologic impairments, negatively affecting quality of life. An effective treatment strategy is still lacking. The aim of this study was to describe and evaluate the safety and immersiveness of a newly designed ICU-specific virtual reality module. A randomized controlled healthy volunteer trial. ICU of the Franciscus Gasthuis & Vlietland Hospital (Rotterdam, the Netherlands), a large teaching hospital. Forty-five virtual reality-naive healthy volunteers. Volunteers were randomized to three arms: the head-mounted display virtual reality group (n = 15), the 2D group (n = 15), and the crossover group (n = 15). Safety was assessed by changes in vital signs and the occurrence of simulator sickness (Simulator Sickness Questionnaire). Immersiveness was assessed using the Igroup Presence Questionnaire. Volunteers in the head-mounted display virtual reality group experienced more mild symptoms of simulator sickness, expressed as symptoms of dizziness (p = 0.04) and stomach awareness (p = 0.04), than the 2D group. Nevertheless, none of the individual Simulator Sickness Questionnaire items were scored as being severe, no changes in vital signs were observed, and no sessions were prematurely stopped. Volunteers in the crossover group experienced a higher total presence (p < 0.001) when using head-mounted display virtual reality, expressed as a higher sense of presence (p < 0.001), more involvement (p < 0.01), and more experienced realism (p < 0.001). ICU-specific virtual reality appears safe and more immersive than 2D, implicating that ICU-specific virtual reality is feasible for clinical use. One should however be aware of simulator sickness-related symptoms. Future research is needed to confirm these findings in survivors of critical illness.

Stress and Simulated Environments: Insights From Physiological Marker

Driving in a simulator might induce stress because of the confrontation with new environments, dealing with new technologies, and experience with symptoms of simulator sickness, which, in turn, may influence individuals’ driving performance. The present study aims to provide a better understanding of the association between simulated environments and humans’ stress level under consideration of age, simulator adaptation, experience with simulator sickness, and driving performance. Data from 164 participants (M = 61.62 years, SD = 12.66 years, ranging from 25 to 89 years, 42 women) were analyzed in the present study. During three measurement times, participants completed an advance first simulator drive (T0), followed by an online survey, assessing experience with simulator sickness (T1), and a second simulator drive (T2) including pre- and post-cortisol measurements. The hypothesized model shows no correlations of driving performance with experience with simulator sickness or stress level before and after a further simulator drive. Beyond the effect of age, previous experience with simulator sickness does further account for stress-level changes following a simulated drive but current driving performance did not. The present study provides relevant findings for future studies in the field of simulated environments.

Older Drivers’ Motion and Simulator Sickness before and after Automated Vehicle Exposure

Older drivers desire independence in mobility, and automated vehicles hold plausible opportunities to realize this goal. Motion sickness (automated shuttle exposure) or simulator sickness (automated driving simulator exposure) may affect acceptance of these technologies. This study investigated the onset of motion and simulator sickness in older drivers (mean age = 74.29, SD = 5.96; female = 54%) after exposure to an automated shuttle and automated driving simulator and assessed age and sex as determinants of motion and/or simulator sickness. Using a repeated measures design, 104 older drivers were randomly allocated to the shuttle and simulator. Baseline, as well as post exposures, were measured using the Motion Sickness Assessment Questionnaire (domains: sweatiness, queasiness, dizziness, nauseousness). Older drivers who were exposed to the simulator show a statistically significant increase in simulator sickness symptoms across the four domains compared to the same group being tested in the shuttle. No age and sex differences were detected within the groups and no participants dropped out of the study due to motion or simulator sickness. The automated shuttle and simulator hold plausible opportunities for continued exposure of older drivers to these technologies, as long as motion or driving simulator sickness protocols are used properly.

Driving simulation sickness and the sense of presence: Correlation and contributing factors

Driving simulators are useful and effective tools for conducting studies in the field of traffic safety. Simulation sickness (SS) and the sense of presence (SP) are two well-known factors that could affect the results of the driving simulator experiments. This study investigated the relationship between SP and SS in a medium-fidelity driving simulator. Additionally, the impact of the road environment (urban arterials or rural expressways) on these subscales was investigated. Data was collected by means of self-reported questionnaires, which were conducted after the participants have driven the simulation scenarios in a fixed-base medium-fidelity driving simulator. A total of 125 drivers participated in this study. Results showed that females reported significantly higher SS scores than males. An increasing trend in the SS was observed with the increase of age. Importantly, designing buildings that replicate a real-world environment could increase SP and decrease SS. Moreover, designing high quality and resolution scenarios could also increase SP, thus decreasing the severity of SS symptoms. The results of this study can help researchers using medium-fidelity driving simulators to know the influencing factors for each subscale of SP on SS. Adjustments in the driving simulator and scenario settings as well as additional training exercises for higher speed scenarios can be beneficial in reducing the severity of SS.