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Simulator Sickness Questionnaire: An Enhanced Method for Quantifying Simulator Sickness
Abstract
Simulator sickness (SS) in high-fidelity visual simulators is a byproduct of modem simulation technology. Although it involves symptoms similar to those of motion-induced sickness (MS), SS tends to be less severe, to be of lower incidence, and to originate from elements of visual display and visuo-vestibular interaction atypical of conditions that induce MS. Most studies of SS to date index severity with some variant of the Pensacola Motion Sickness Questionnaire (MSQ). The MSQ has several deficiencies as an instrument for measuring SS. Some symptoms included in the scoring of MS are irrelevant for SS, and several are misleading. Also, the configural approach of the MSQ is not readily adaptable to computer administration and scoring. This article describes the development of a Simulator Sickness Questiomaire (SSQ), derived from the MSQ using a series of factor analyses, and illustrates its use in monitoring simulator performance with data from a computerized SSQ survey of 3,691 simulator hops. The database used for development included more than 1,100 MSQs, representing data from 10 Navy simulators. The SSQ provides straightforward computer or manual scoring, increased power to identify "problem" simulators, and improved diagnostic capability.
... However, effective mitigation first necessitates reliable metrics for quantifying and differentiating Cybersickness. The most common method for assessing Cybersickness involves the use of self-report questionnaires, with the SSQ being a standard instrument (Kennedy et al. 1993). The SSQ evaluates sixteen symptoms, categorized into three domains: oculomotor disturbances, disorientation, and nausea. ...
... Upon conclusion of the simulation, the participants are instructed to fill out the SSQ as part of the experimental procedure (Kennedy et al. 1993). This post-stimulus assessment evaluates acute symptomatic responses and immediate effects of VR exposure, facilitating further comparison and modeling (Kim et al. 2005;Dennison et al. 2016). ...
... Based on the responses received, we found that no relevant issues were reported by the participants. Figure 6 provides a visual representation of the scores derived from the SSQ, which were calculated based on the formula provided by Kennedy et al. (1993) . These scores are grouped into three scales: nausea, which gauges feelings of nausea; oculomotor, encompassing factors related to vision; and disorientation, which pertains to feelings of being directionally unsettled. ...
One of the major obstacles to the widespread adoption of Virtual Reality (VR) is Cybersickness. It is a sense of physical discomfort akin to motion sickness experienced by the users either during or subsequent to VR utilization. Typically, it is detected through explicit methods such as self-reported questionnaires, which are not ideal for online and implicit monitoring of users’ well-being. This study tackles the challenge of implicitly detecting and measuring Cybersickness in VR through physiological signals. Therefore, we propose a multimodal approach that integrates physiological signals with self-reported measures. We utilize a mixed-methods design combining quantitative and qualitative analyses, using a roller coaster simulation as the experimental paradigm. The research analyzes physiological data collected from a group of 22 participants exposed to a simulated VR rollercoaster experience, through statistical analysis and machine learning algorithms. The physiological markers studied include Electroencephalograms (EEG), Electrodermal Activity, Blood Volume Pulse, and skin Temperature signals. Additionally, the study elucidates the complex interplay among physiological markers using Explainable AI (XAI). We found out significant correlations between high Simulator Sickness Questionnaire scores and physiological measures such as brain rhythms and EEG indices related to engagement, visual fatigue, and drowsiness, as well as heart rate variability. Moreover, the proposed machine learning model achieves an accuracy of 86.66 % in detecting elevated Cybersickness symptoms, which is higher than the accuracy achieved by existing techniques. Further exploration using the XAI technique confirms the elevated levels of drowsiness and reduced engagement in participants experiencing elevated Cybersickness. By providing a comprehensive, multimodal approach for quantitative assessment, this study fills a gap in the existing literature and paves the path for the development of adaptive systems that modulate their behavior based on physiological data.
... The most popular method for evaluating the simulator sickness is the simulator sickness questionnaire (SSQ) [23]. The SSQ is a self-reported symptom checklist, including sixteen symptoms that participants rate on a four-point scale, ranging from no symptoms to severe symptoms. ...
... The SSQ is a self-reported symptom checklist, including sixteen symptoms that participants rate on a four-point scale, ranging from no symptoms to severe symptoms. Factor analysis was used to categorize these symptoms into three main parts: nausea-related subscore (N), oculomotor-related subscore (O), disorientationrelated subscore (D) [23]. Weights are assigned to each category, and their sum produces a total score (TS). ...
... questionnaires: Following the experiment, participants were then asked to complete different assessments:• Simulation sickness questionnaire: This questionnaire aimed to measure participants' experiences of simulation sickness during the experiment. It is a selfreported symptom checklist that includes sixteen symptoms associated with simulator discomfort[23].• Post-survey questionnaire: This questionnaire aimed to collect their risk perceptions of scenarios and identify influential risk factors. Questions in this survey were structured as Likert scale questions, allowing participants to rate their responses on a 5-point scale. ...
(1) Background: As cycling gains popularity as a mode of transportation, the frequency of accidents involving cyclists also rises. This has become a major concern for traffic safety, sustainability, and city planning. Identifying the risk factors that contribute to bicycle road accidents remains a significant challenge. This study aims to figure out which risk factors make some road segments more dangerous for cyclists than others. (2) Methods: This study introduces the use of a bicycle simulator to test different road segments involving thirty-nine participants. The impact of demographics and some risk factors related to infrastructure were analyzed in terms of their influence on the perceived level of risk through pre- and post-surveys. (3) Results: The findings showed that the bicycle facility type affects the perceived level of risk. Shared-use roads were ranked as riskiest, while separated bike lanes were least risky. Bicycle roads with no separated safety barriers had higher risks. Heavy traffic jams increased danger among cyclists. Women gave higher risk ratings than men. The perceived levels of risk were then compared with the previously developed risk index and they correlated well. (4) Conclusions: This confirms that the risk index can reliably evaluate the degree of risk of each road segment.
... Simulator Sickness (SS1-SS16) The Simulator Sickness Questionnaire (SSQ) (Kennedy and Lilienthal 1993) is a sixteen-question questionnaire designed to measure a user's degree of simulator sickness. Users were asked to rate each question on a scale from 0 to 3 (0: no, 1: Slight, 2: Moderate, 3: Severe). ...
... The scoring standard consists of three dimensions: nausea, oculomotor and disorientation. The final score is a weighted result of the three dimensions (see Kennedy and Lilienthal 1993). ...
Asymmetric collaboration is an important topic for the research of multiuser collaborative systems. Previous works have shown that by providing different abilities, devices or content to different users, users can take advantage of the unique features of each side and collaborate effectively with each other. However, there is limited work comparing the differences between asymmetric and symmetric Virtual Reality (VR) collaboration systems. How task complexity may affect symmetric and asymmetric VR collaboration is also unclear. In this paper, we present a comparative study that investigated how user experiences and task performance vary in symmetric and asymmetric VR collaboration. In addition, we also explored how task interdependence correlates with user experience and task performance. Participants were asked to collaboratively perform 3D object selection and manipulation tasks in pairs. A within-subjects study was conducted, where participants used PC and PC, VR and VR, and PC and VR, respectively in three conditions. Our results revealed that the asymmetric collaboration using both PC and VR showed the best results in closeness of relationship, social presence and task performance; the PC symmetric collaborative system showed the worst user experiences and task performance. Both user experience and task performance showed a positive correlation with task interdependence. We discussed the effects of the collaborativ mode and device on the user experience and task performance, and the implications for future symmetric and asymmetric VR collaboration systems.
Graphical abstract
... None resulted in an interruption of the experience, suggesting that these effects are minor in most cases. Regarding this point, we are aware that there are more thorough, systematic, and validated ways of evaluating the feeling of sickness due to the usage of VR technologies (in particular the Simulator Sickness Questionnaire-SSQ-introduced by Kennedy et al. [31]), but we only wanted to have an at-a-glance indication about the fact that some adverse effects were perceived by the users, and also to evaluate the real need of performing additional experiments on this point. Short-term sickness was mentioned by 26% of the participants (Figure 13). ...
... None resulted in an interruption of the experience, suggesting that these effects are minor in most cases. Regarding this point, we are aware that there are more thorough, systematic, and validated ways of evaluating the feeling of sickness due to the usage of VR technologies (in particular the Simulator Sickness Questionnaire-SSQ-introduced by Kennedy et al. [31]), but we only wanted to have an at-a-glance indication about the fact that some adverse effects were perceived by the users, and also to evaluate the real need of performing additional experiments on this point. ...
... Hence, to avoid and/ or counteract potential occurrences of CS, we first need reliable methods to measure and detect CS. Measuring the occurrence and severity of CS is often done with subjective self-reports (Kennedy et al., 1993;Keshavarz and Hecht, 2011). Using such questionnaire tools, however, has notable drawbacks. ...
... The most widely used technique is the self-report questionnaire (Davis et al., 2014;Chang et al., 2016). Typical examples are the Simulator Sickness Questionnaire (SSQ) (Kennedy et al., 1993) and the Fast Motion Sickness Scale (FMS) (Keshavarz and Hecht, 2011). In addition to the advantages, such as the easy implementation and simple evaluation, these subjective methods also have drawbacks. ...
Cybersickness is still a prominent risk factor potentially affecting the usability of virtual reality applications. Automated real-time detection of cybersickness promises to support a better general understanding of the phenomena and to avoid and counteract its occurrence. It could be used to facilitate application optimization, that is, to systematically link potential causes (technical development and conceptual design decisions) to cybersickness in closed-loop user-centered development cycles. In addition, it could be used to monitor, warn, and hence safeguard users against any onset of cybersickness during a virtual reality exposure, especially in healthcare applications. This article presents a novel real-time-capable cybersickness detection method by deep learning of augmented physiological data. In contrast to related preliminary work, we are exploring a unique combination of mid-immersion ground truth elicitation, an unobtrusive wireless setup, and moderate training performance requirements. We developed a proof-of-concept prototype to compare (combinations of) convolutional neural networks, long short-term memory, and support vector machines with respect to detection performance. We demonstrate that the use of a conditional generative adversarial network-based data augmentation technique increases detection performance significantly and showcase the feasibility of real-time cybersickness detection in a genuine application example. Finally, a comprehensive performance analysis demonstrates that a four-layered bidirectional long short-term memory network with the developed data augmentation delivers superior performance (91.1% F1-score) for real-time cybersickness detection. To encourage replicability and reuse in future cybersickness studies, we released the code and the dataset as publicly available.
... Assessments on technology acceptance referring to joystick controls were taken with the UTAUT scale (Venkatesh et al. 2003). Before, between and after each session, ratings were collected Kennedy et al. 1993Kennedy et al. , 2003. During all sessions, performance measures were extracted from 5 Hz logs for movement of both joystick controls (all directions) as well as localisation, orientation, and height of the MEWP platform in the industrial hall. ...
... The questionnaire on symptoms for simulator sickness (Kennedy et al. 1993;Pfendler and Thun 2001) was rated before, between and after sessions and resulted in 'no symptoms' for an initial training session S0 towards negligible symptoms for experimental session S4 (see Fig. 4; Kennedy et al. 2003). Statistical analysis revealed significant effects only for the interaction Session x StopForce, F(1.7, 34.0) = 3.43, εHF = 0.43, p = 0.051. ...
A mixed reality simulation study evaluated human factors, ergonomics and safety of an additional safeguard for the prevention of mobile elevating work platform (MEWP) accidents while at the same time enabling unhindered MEWP task performance. The simulation environment consisted of a real MEWP work platform, real controls combined with virtual MEWP chassis and telescopic beam in an industrial hall for performing on-site navigation and inspection tasks. Mental workload as reflected in task performance and ratings from 22 naïve and experienced MEWP operators was investigated for 3 hrs each while controlling the MEWP by joysticks with built-in supplemental emergency stop function and release force of either 14 or 36 N. Task performance resulted in several virtual collisions of the MEWP operator and the MEWP with obstacles in the environment and the MEWP surpassing floor markings, however, without triggering the emergency stop function. Instead, a release force of 14 N as compared to 36 N resulted in significantly more actuations happening only inadvertently and during hazard-free navigation sequences. In addition, the joysticks order of system control dynamic was configured as a velocity control for operational reasons and raised serious concerns for use in combination with the stop function in hazardous situations due to increasing risk of severe injuries. According to the results of the evaluation study, the safeguard design as investigated is not recommended for accident prevention. The study provides information for safeguard development and future evaluations.
Practical Relevance
This empirical investigation contributes to state-of-the-art of science and technology and provides scientific evidence from human factors and ergonomics to be used for design and selection of effective safety devices in occupational safety and health.
... VR-induced sickness was assessed with the Simulator Sickness Questionnaire (SSQ) [37], where the students had to rate 16 symptoms (eg, nausea and headache) on a 4-point Likert scale from 0=none to 3=severe. Ratings were then converted into 3 subscores and a total score. ...
... The acceptance of the VR simulation as part of the INTEAM training course was measured by usability, VR-induced sickness, sense of presence, subjective workload, user satisfaction, and technology acceptance. The INTEAM training course demonstrated good usability [44], despite a relatively high rating for VR-induced sickness using the SSQ [37]. Previous research suggests that high levels of simulator or VR-induced sickness can lead to reduced usability [49,50]. ...
Background
Effective interprofessional teamwork is vital for ensuring high-quality patient care, especially in emergency medicine. However, interprofessional education often fails to facilitate meaningful interaction among health care disciplines. It is therefore imperative to afford early opportunities for cultivating interprofessional teamwork skills. While in-person simulation-based training has been shown to improve performance, this is resource-intensive, especially if it involves multiple professions. Virtual reality (VR)–based training is an innovative instructional approach that demands fewer resources and offers the flexibility of location-independent learning.
Objective
This study aimed to develop and evaluate the acceptance, learning outcome, and feasibility of an interprofessional team (INTEAM) training course that included a VR simulation of a neurological emergency case.
Methods
This 1-group study used a pre- and posttest design to evaluate the 2-hour INTEAM training course for nursing and medical students. The course included an e-learning part, VR simulation, and debriefing. The main learning objectives were derived from the entrustable professional activity 6, namely to handle a common problem in emergency medicine (headache due to subarachnoid hemorrhage and epileptic seizure) that requires interprofessional collaboration, including a structured handover. We used validated and self-constructed questionnaires, pre- and posttests, and open questions to assess the acceptance, learning outcome, and feasibility of the course.
Results
The data of 42 students (21 nursing and 21 medical students) were analyzed and showed good usability in the System Usability Scale (median 72.5, IQR 65‐80). The perception of usefulness (median 6, IQR 5.8‐6.9) and ease of use (median 5.9, IQR 5.1‐6.3) was good among all students. There was a significant increase in the handover performance from pre- (median 8, IQR 6‐9) to posttraining (median 8, IQR 7‐9; z =−2.01; P =.045; r =0.33) and of the confidence in caring for patients with seizures (median 3, IQR 2‐3 and median 3.5, IQR 3‐4, respectively; z =−3.8; P <.001; r =0.60). In 67% (14/21) of the simulations, technical issues occurred, but all simulations could be carried out completely.
Conclusions
The new INTEAM training course was well received by nursing and medical students. The handover skills and confidence in caring for patients with seizures were improved after the course. Despite technical challenges with the VR simulations, none required termination, and this demonstrates that our approach is feasible. These promising results encourage the use of VR simulations for team training in the education of nursing and medical students.
... Multiple questionnaires were used to assess all the variables, namely, the Integrated Workload Scale (IWS) [23] and System Usability Scale (SUS) [24] for Usability, the After-Scenario Questionnaire (ASQ) [25] for Satisfaction, the Igroup Presence Questionnaire (portuguese version) (IPQp) [26] for Presence, and the Simulator Sickness Questionnaire (SSQ) [27] for Cybersickness. For the technology acceptance from participants, a custom questionnaire was used containing 19 questions divided into seven subsections: Technology Anxiety [28], [29], Perceived Ease of Use [28], Perceived Usefulness [28], [29], Attitude Towards VR [30], Intention to Use VR Again [28], [29], Perceived Enjoyment [31], and lastly Self-Efficacy [32]. ...
Over the years, various immersive virtual training environments (iVTEs) have been developed, allowing companies to start transitioning to Virtual Reality (VR) technologies to train their personnel. This transition forces companies to start using game engines as a foundation to develop such iVTEs, which also requires a multidisciplinary team. When developing such training environments, challenges on how to present tasks to users arise. The way these tasks are presented can dictate the efficacy of the VR training application. This paper presents three different task presentation methodologies (avatar animation, videos, and instruction manual) and assesses them using 36 participants, divided into those three groups. Usability, sense of presence, satisfaction, cybersickness, and technology acceptance variables were studied and results indicated that only the total number of actions performed had differences between groups where the instruction manual reported the higher number of actions (usability) when compared to the other conditions. Therefore it was concluded that the instruction manual proved to be where users kept losing focus and making more actions. It was also concluded that all conditions had a similar sense of presence, satisfaction, cybersickness, and acceptance scores.
... Other outcome measures ► Simulator Sickness Questionnaire (SSQ): 55 Children's symptoms of cybersickness are measured by the SSQ, using a 4-point Likert scale from 0 (none) to 3 (severe). Higher scores indicate more severe symptoms of cybersickness. ...
Background
The rise in the number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) highlights the need for effective interventions targeting attentional control. Although recent research has demonstrated the potential of neurofeedback training (NFT) for children with ADHD, most studies have been conducted in laboratory settings, raising questions about their real-world applicability. To address this issue, virtual reality (VR) may offer a solution to the ecological validity challenges encountered in NFT. By coupling NFT with VR, individuals can engage in self-regulating brain activity within a simulated, realistic environment. This study aims to investigate the efficacy of near-infrared spectroscopy (NIRS)-based NFT combined with VR in alleviating ADHD symptoms among children, addressing the need for interventions with practical relevance and effectiveness.
Methods
This study aims to recruit 138 children aged 7–12 diagnosed with ADHD. Following baseline assessment, participants will be randomly assigned to one of three conditions: (1) NIRS-based NFT in a VR classroom setting; (2) conventional computerised cognitive training (active control) or (3) a waitlist control group. On completion of intervention sessions in the two training groups, all groups will undergo an assessment at time 2, with a follow-up assessment scheduled 2 months post-training for all participants. Primary outcomes will include measures of executive function, such as attentional control, response inhibition and working memory, along with changes in oxygenated and deoxygenated haemoglobin levels monitored by functional NIRS. Secondary outcome measures will comprise ratings of children’s ADHD symptoms and executive function behaviours in daily life, reported by parents and teachers.
Discussion
The three-arm randomised controlled trial will address research gaps regarding the effectiveness of NIRS-based NFT for children with ADHD, particularly when integrated with immersive VR technology. By combining NFT and VR, this study aims to simulate a real-world environment, potentially amplifying intervention effects. The findings from the study will provide evidence for the efficacy of this innovative intervention in improving executive function and alleviating ADHD symptoms.
Ethics and dissemination
Ethical approval was obtained from the Human Research Ethics Committee at the University of Hong Kong (Reference: EA200247). Results will be published in peer-reviewed journals and presented at conferences.
Trial registration number
NCT05906485 .
... We administer the Simulator Sickness Questionnaire (SSQ) before the experiment and after each block and compute the pre-and post-block SSQ score according to the methodology described in [29]. We also computed a delta SSQ score for each scale (i.e., the post-block score minus the pre-block score) to gain insights into cybersickness variations after each block. ...
Understanding how people effectively perform actions together is fundamental when designing Collaborative Mixed Reality (CMR) applications. While most of the studies on CMR mostly considered either how users are immersed in the CMR (e.g., in virtual or augmented reality) or how the physical workspace is shared by users (i.e., distributed or collocated), little is known about how their combination could influence user’s interaction in CMR. In this paper, we present a user study (n = 46, 23 pairs) that investigates the effect of the mixed reality setup on the user’s immersion and spatial interaction during a joint-action task. Groups of two participants had to perform two types of joint actions while carrying a virtual rope to maintain a certain distance: (1) Gate, where participants had to pass through a virtual aperture together, and (2) Fruit, where participants had to use a rope to slice a virtual fruit moving in the CMR. Users were either in a distributed or collocated setup and either immersed in virtual or augmented reality. Our results showed that the immersion type and location setup altered users’ proxemics as well as the users’ subjective experience. In particular, we noticed better task performance when users were in augmented reality and more considerable distances between players while interacting in a distributed setup. These results contribute to the understanding of joint action in CMR and are discussed to improve the design of CMR applications.
... • Virtual Reality Sickness: As an essential factor of overall user experience, potential VR simulator sickness was assessed after each condition using the Virtual Reality Sickness Questionnaire (VRSQ) proposed by Kim et al. [27]. The questionnaire is based on the Simulator Sickness Questionnaire [24] focusing on characteristics of simulator sickness observed within VR environments. The selected items include Oculomotor (four symptoms) and Disorientation (five symptoms) measured through a 4-point Likert scale, where each point represents a level of experienced severity. ...
... After completing the tasks, participants filled out the USE questionnaire [Lund 2001] to evaluate the system's usefulness, ease of use, ease of learning, and overall satisfaction. They also completed the NASA-TLX questionnaire [Hart 2006] to assess task load and the Simulator Sickness Questionnaire (SSQ) [Kennedy et al. 1993] to measure any discomfort experienced during the study. Finally, participants took part in a 10-minute semi-structured interview to provide more in-depth feedback on usability. ...
We present VR-Doh, a hands-on 3D modeling system designed for creating and manipulating elastoplastic objects in virtual reality (VR). The system employs the Material Point Method (MPM) for simulating realistic large deformations and incorporates optimized Gaussian Splatting for seamless rendering. With direct, hand-based interactions, users can naturally sculpt, deform, and edit objects interactively. To achieve real-time performance, we developed localized simulation techniques, optimized collision handling, and separated appearance and physical representations, ensuring smooth and responsive user interaction. The system supports both freeform creation and precise adjustments, catering to diverse modeling tasks. A user study involving novice and experienced users highlights the system's intuitive design, immersive feedback, and creative potential. Compared to traditional geometry-based modeling tools, our approach offers improved accessibility and natural interaction in specific contexts.
... Para avaliar a usabilidade, foi utilizado o instrumento SUS (System Usability Scale) [Brooke,2013]. Já para avaliar os sintomas de cybersickness, foi utilizado o Simulator Sickness Questionnaire (SSQ) [Kennedy et al., 1993]. ...
Atualmente, o uso de serious games tem se mostrado promissor no desenvolvimento cognitivo de pessoas com deficiência intelectual. Quando combinados com dispositivos de realidade virtual imersiva, oferecem ambientes imersivos que tornam o aprendizado mais envolvente. Esta pesquisa apresenta o desenvolvimento de um serious game com realidade virtual imersiva para potencializar habilidades cognitivas de pessoas com deficiência intelectual. Trata-se de uma pesquisa exploratória e aplicada. Foi realizada uma avaliação piloto com atendidos da APAE para mensurar aspectos de usabilidade e efeitos Cybersickness.
... To assess cybersickness, we used a questionnaire adapted from the SSQ (Kennedy et al., 1993;Stone III, 2017). Although this test is widely used (Anwar et al., 2023Hasan et al., 2024), we deemed it too lengthy and complex for eighth-grade students. ...
Introduction
The field of poetry learning is currently facing significant challenges, primarily due to a lack of motivation and interest among students. This has resulted in educators encountering difficulties in identifying suitable educational alternatives. To address the latter issue, immersive learning has emerged as a potential solution, as it has been demonstrated to enhance motivation and learning outcomes in a multitude of fields.
Methods
In light of the aforementioned considerations, this field study seeks to examine the potential of virtual reality (VR) tools in enhancing the memorization of poetry by increasing the engagement of the participants. The study concentrated on the acquisition of a French poem by a group of middle school students. A virtual environment has been developed for this purpose, tailored to the poem in question. The experimental design included a pretest, segmented learning sessions, a posttest, and a retention test. To evaluate student engagement, both motivation and sense of presence were measured using Likert-scale questionnaires, while memorization performance was assessed through a scoring system based on recall accuracy.
Results
The findings reveal that the VR group demonstrated significantly higher motivation than the control group, with a mean difference of 12.626 on a 7-point Likert scale (six items), indicating that VR is a notably more effective tool for enhancing motivation in poetry learning than traditional methods. Additionally, the VR group reported a significantly stronger sense of presence, with a mean difference of 6.111 on the same questionnaire scale, further suggesting that VR enhances students’ sense of immersion in the learning experience. These results indicate that students using VR exhibited higher levels of overall engagement than those in the control group.
Discussion
However, this increased engagement did not lead to improved memorization outcomes, as there was no significant difference in recall accuracy between the two groups. A potential explanation for this discrepancy is the “novelty effect” of VR, which may have distracted students from focusing fully on the memorization task. The implications of integrating VR in educational settings are thus discussed.
... The secondary outcome measures were simulator sickness and level of enjoyment. Simulator sickness was assessed with the Simulator Sickness Questionnaire (SSQ) (26). Before and after each walking trial, participants had to indicate on a 4-point Likert scale how much 16 symptoms were affecting them at that moment. ...
Objectives
To investigate how people post-stroke and healthy people experience the addition of semi-immersive virtual reality (VR) and optic flow speed manipulation while walking on a treadmill, and if optic flow speed manipulation could be used in rehabilitation to elicit changes in post-stroke gait biomechanics.
Methods
Sixteen people post-stroke and 16 healthy controls walked on a self-paced treadmill. After 2 habituation trials (without and with VR), participants walked 3 more trials under the following conditions of optic flow: matched, slow, and fast. Primary outcome measures were spatiotemporal gait parameters and lower limb kinematics. Secondary outcomes (simulator sickness and enjoyment) were assessed with the Simulator Sickness Questionnaire (SSQ) and visual analogue scales (VAS).
Results
VR did not influence the gait biomechanics, and optic flow manipulation had a limited effect. Both groups significantly increased their walking speed with the slow optic flow and decreased their speed with the fast optic flow. For the other gait parameters, only small changes were found. Only people post-stroke had a significant increase on the SSQ and the enjoyment-VAS.
Conclusion
Adding semi-immersive VR did not influence the gait pattern, was well tolerated, and enjoyable. Both groups altered their gait parameters when the optic flow speed was adjusted during the protocol. Incorporating such manipulations into treadmill training is feasible, but further research about the type of manipulation and level of immersion is needed.
LAY ABSTRACT
This study investigated the effect of virtual reality and manipulation of the speed of the virtual environment while walking on a treadmill, both in people post-stroke and healthy people. Sixteen people post-stroke and 16 healthy controls walked on a self-paced treadmill. After 2 habituation trials (without and with virtual reality), participants walked 3 more trials under the following conditions of optic flow: (i) walking with a matching virtual environment, (ii) walking with a slower virtual environment, and (iii) walking with a faster virtual environment. The addition of virtual reality did not influence the gait pattern of people post-stroke or healthy people. When the speed of the virtual environment was manipulated, people post-stroke altered their gait pattern by changing their walking speed. People increased their walking speed with a slower virtual environment, and decreased their speed with a faster virtual environment. Incorporating such manipulations for treadmill training could be feasible, but further research is needed.
... The taxi drivers were recruited from Mowasalat, the main governmental company responsible for managing and operating taxi services in Qatar. To adhere to the minimum requirements outlined in the standard simulation sickness questionnaire (Kennedy et al., 1993), drivers were instructed in advance not to consume food or beverages (except water) within two hours prior to the experiment. Despite the provided instructions, 10 participants experienced symptoms of simulation sickness and were consequently excluded from the final analysis. ...
... Participants' levels of simulator sickness were measured once at baseline, once after each of the two practice scenarios, and once after each of the six experimental driving scenarios using the Simulator Sickness Questionnaire (SSQ; Kennedy et al., 1993). The SSQ evaluates 16 symptoms of simulator sickness (e.g., general discomfort, nausea, eyestrain, vertigo, fatigue) on a 4-point scale ranging from 0 (not at all) to 3 (severe). ...
... MS symptoms often resembled typical MS, but eff ects of simulator sickness were generally milder and less severe among exposed populations. SSQ templates developed by Kennedy, et al. classifi ed tissue disorders across several dimensions, including nausea, oculomotor, and disorientation [23]. Table 3 showed how to calculate MS symptoms results for Nausea (N), Oculomotor (O), Disorientation (D), and the resulting Total Score. ...
Motion sickness (MS) is often experienced by individuals on moving vessels which the symptoms include fatigue, anxiety, dizziness, as well as vomiting. These conditions arise when the brain receives conflicting signal from eyes, vestibular receptors, and non-vestibular receptors. While medication is often used to treat MS, non-drug alternatives can also be considered for this purpose. Therefore, this research aimed to address this problem by producing non-drug therapy tool, namely Virtual Reality (VR). Specifically, head-mounted display (HMD) VR The display was used to present visual of sea horizon with islands. To evaluate the impact on reducing MS symptoms, the research compared clear visibility with reduced visibility as form of visual intervention. Approximately two types of videos were prepared using different color tones, namely cold and warm. The research also considered passengers’ position as a variable that correlated with MS. To assess the relationship between visual intervention and MS reduction, various parametric statistical tests were used, including Multiple Linear Regression and Paired t-test. In cases where the data did not meet the assumptions of parametric testing, nonparametric Wilcoxon test was applied. The result showed that the use of warm tone videos led to a significant reduction in MS symptoms, as evidenced by the outcome of t-test. Similarly, passengers’ position significantly affected MS, but visual intervention did not affect the condition.
... Participants started by filling in a Simulator Sickness Questionnaire (SSQ) [14] to provide us with a baseline score of their well-being before putting on the head-mounted display. In virtual reality, participants were then asked to assume the role of a machine operator who monitors four subsequent manufacturing processes, each lasting for five minutes. ...
We present a data acquisition and visualization pipeline that allows experts to monitor additive manufacturing processes, in particular laser metal deposition with wire (LMD-w) processes, in immersive virtual reality. Our virtual environment consists of a digital shadow of the LMD-w production site enriched with additional measurement data shown on both static as well as handheld virtual displays. Users can explore the production site by enhanced teleportation capabilities that enable them to change their scale as well as their elevation above the ground plane. In an exploratory user study with 22 participants, we demonstrate that our system is generally suitable for the supervision of LMD-w processes while generating low task load and cybersickness. Therefore, it serves as a first promising step towards the successful application of virtual reality technology in the comparatively young field of additive manufacturing.
... They completed pre-task questionnaires on a computer monitor (24" at 1920×1080 resolution, with standard keyboard and mouse). These included the STAI, PANAS, the simulator sickness questionnaire (SSQ) [86]. They then provided their first of five saliva samples. ...
Stress carries diverse implications for perceptual, cognitive, and affective functions. One population particularly susceptible to acute stress-induced cognitive changes are individuals with high-stress jobs (e.g., military personnel). These individuals are often tasked with maintaining peak cognitive performance, including memory, spatial navigation, and decision-making under threatening and uncertain conditions. Previous research has separately examined decision-making under conditions of stress or uncertainty (i.e., ambiguous discrimination between friends and foes). However, questions remain about how operationally relevant stress impacts memory encoding and recall, or spatial learning, as well as how uncertainty may impact decision-making during stress. To address this gap, we examined the influence of a military-relevant emotional stressor on a series of cognitive tasks including recognition memory task (RMT), spatial orienting task (SOT), and shoot/don’t shoot decision making (DMT). To examine the effects of uncertainty and stress we varied the stimulus clarity in the DMT. We utilized threat of shock (TOS) as a high-stakes outcome for decision errors. TOS increased sympathetic arousal but did not affect subjective emotional or HPA responses. TOS influenced decision times and confidence ratings in the DMT, but not response sensitivity or response bias. DMT performance varied by stimulus clarity (uncertainty) but did not differ between stress conditions. TOS did not influence recognition memory or spatial orienting. In sum, high levels of stress and uncertainty characterize military operations, yet stress experienced in military contexts can be difficult to induce in laboratory settings. We discuss several avenues for future research, including methodological considerations to better assess the magnitude and specificity of emotional stress-induction techniques in Soldiers.
... Other questionnaires, such as the MS susceptibility questionnaires (MSSQ), the MS assessment questionnaire (MSAQ), the simulator sickness questionnaire (SSQ), and the Graybiel scoring methods, also included detailed subjective evaluation criteria 16 . To ensure that the results of the MS questionnaire survey accurately reflected the volunteers' MS susceptibility, we selected three mainstream MS questionnaires and administered them to 65 volunteers individually [29][30][31] . Detailed information about these three questionnaires was provided in the supplementary materials. ...
Motion sickness (MS) is a common physiological response that often occurs when individuals are exposed to environments with repeated acceleration stimuli. MS results from a mismatch between the vestibular system and visual and proprioceptive inputs. As a crucial organ for sensing acceleration stimuli, the vestibular system is closely related to the onset of MS. However, the complex pathogenesis of MS has led to its diagnosis primarily relying on subjective questionnaires, with a lack of objective indicators for evaluation. To identify objective indicators for evaluating MS, we conducted rotating chair stop experiments based on the principle of vestibulo-ocular reflex with 65 volunteers, obtaining their nystagmus slow-phase velocity and related time constants. Additionally, we conducted detailed MS questionnaires with these volunteers to assess their MS susceptibility. Through correlation analysis, we explored whether the nystagmus slow-phase velocity and related time constants significantly correlated with the MS questionnaire scores. The results showed significant positive correlations between the maximal nystagmus slow-phase velocity, cupula time constant, velocity storage time constant, and the nystagmus duration with the MS questionnaire scores in the 65 volunteers. These results indicated that these nystagmus parameters could serve as objective indicators for assessing MS susceptibility. Using K-Means clustering analysis, we classified MS susceptibility into categories I, II, III, and IV, and conducted K-Means clustering analysis on the corresponding nystagmus slow-phase velocity, cupula time constant, velocity storage time constant, and nystagmus duration. The magnitude and range of these indicators at different levels was quantified, offering objective and quantitative indicators for the clinical diagnosis of MS.
Supplementary Information
The online version contains supplementary material available at 10.1038/s41598-024-80233-4.
... This study measured three variables as dependent variables in the Pendulum Chair. Post SSQ [41] was used to measure the cybersickness. The SSQ questionnaire contains 16 Likert scaled questions ranging from zero (no symptoms) to three (severe symptoms). ...
... Most users preferred the head-mounted mode over the handheld or desktop modes, finding it convenient and appreciating the immersive experience. Although some AR users reported sweating and eye strain, none exhibited or reported symptoms of simulator sickness (Kennedy et al., 1993). ...
This paper examines the impact and effectiveness of educational Universally Designed (UD) Augmented Reality (AR) applications compared to traditional paper-based counterparts. The study evaluates accessibility, usability, user experience, and short-term learning outcomes in marine biology, human anatomy, and cultural history. Thirty-six participants with diverse skills and abilities, including visual impairments and dyslexia, participated in two experiments. The findings reveal that UD-designed AR applications significantly improve accessibility and usability for users with special needs and enhance learning performance for sighted users, particularly in spatial tasks. Users with dyslexia demonstrated effective information recall, while blind users could interact with and learn from the AR content without needing third-party assistive technologies, which is not possible with paper-based solutions. This study underscores the importance of incorporating UD principles in AR development to enhance accessibility and usability, ensuring that immersive technologies facilitate digital inclusion.
... Although the Simulator Sickness Questionnaire [80] is widely recognized, we employed the Cybersickness in Virtual Reality Questionnaire (CSQ-VR) due to its superior psychometric properties for measuring cybersickness, as demonstrated by Kourtesis et al. [24]. Unlike the SSQ, developed for simulator sickness, the CSQ-VR specifically targets cybersick-ness and is better suited to assess virtual reality-induced symptoms and effects (VRISE). ...
Cybersickness remains a significant challenge for virtual reality (VR) applications, particularly in highly immersive environments. This study examined the effects of immersion, task performance, and individual differences on cybersickness symptoms across multiple stages of VR exposure. Forty-seven participants aged 18–45 completed a within-subjects design that involved the Cybersickness in Virtual Reality Questionnaire (CSQ-VR) and the Deary–Liewald Reaction Time (DLRT) task. Cybersickness symptoms were assessed across four stages: before and after VR immersion, and before and after a 12 min rollercoaster ride designed to induce cybersickness. The results showed significant increases in symptoms following the rollercoaster ride, with partial recovery during the post-ride tasks. Eye–hand coordination tasks, performed after the ride and VR immersion, mitigated nausea, as well as vestibular, and oculomotor symptoms, suggesting that task engagement plays a key role in alleviating cybersickness. The key predictors of symptom severity included a susceptibility to motion sickness and gaming experience, particularly proficiency in first-person shooter (FPS) games, which was associated with a reduced cybersickness intensity. While task engagement reduced symptoms in the later stages, particularly nausea and vestibular discomfort, overall cybersickness levels remained elevated post-immersion. These findings underscore the importance of task timing, individual differences, and immersive experience design in developing strategies to mitigate cybersickness and enhance user experiences in VR environments.
... The balls showcased five unique textures resembling everyday balls, Fig. 3 A A section of balls during the inspection phase; B all five textures compared to a white texture, which was used to hide the ball's appearance Fig. 2 A The ball with the randomly selected target texture; B a section of the wall of balls that could contain zero to three target balls changes in locomotion strategies. Last but not least, we captured the intensity of CS through the SSQ (Kennedy et al. 1993), which consists of questions about how subjects currently perceive CS-related symptoms, and participants were asked to rate their response on a Likert scale as none (0), slight (1), moderate (2), or severe (3). The results can be categorized into four different groups: nausea, oculomotor, disorientation, and total severity. ...
Cybersickness (CS) is a pressing issue in virtual reality (VR) systems. While various mitigation methods (MMs) have been developed to counteract CS, their effects on human behavior remain largely unexplored, raising concerns about their potential applications. Using Jens Rasmussen’s skill–rule–knowledge (SRK) model as a framework, our study investigated the effects of two widely adopted MMs—dynamic field of view and dynamic blurring—in VR. We compared these methods to a baseline condition where no MM was applied. We designed three VR tasks that align with the behavioral levels of the SRK model. In a within-subject study (N = 22), participants completed each task using these MMs. We measured task performance, CS symptoms, and locomotion control. Additionally, qualitative feedback was collected. Our results revealed that neither MM significantly alleviated CS across different VR scenarios. Furthermore, while some participants found MMs helpful, a larger portion reported visual hindrances, and a significant performance drop was measured in the skill-based task. More critically, participants indicated behavioral adaptations in response to the MMs, including changes in locomotion strategies and viewing behavior. Potential causes and implications were discussed. In conclusion, MMs offer promise, but their application necessitates a nuanced understanding of their impacts. We recommend a context-sensitive approach when designing and integrating MMs, prioritizing both maximizing CS mitigation and minimizing interference with the natural behaviors of users.
... Nevertheless, it affects user experience and could therefore negatively influence NF performance. The most commonly used questionnaire to control for symptoms of cybersickness is the Simulator Sickness Questionnaire (SSQ) (Kennedy et al., 1993), and there already exists a VR-specific version (VRSQ) (Kim et al., 2018). Still, cybersickness is not always reported in VR-based NF studies (e.g., Berger & Davelaar, 2018;Gruzelier et al., 2010;Yang et al., 2019;Yu et al., 2023). ...
The rapid progress of commercial virtual reality (VR) technology, open access to VR development software as well as open-source instructions for creating brain-VR interfaces have increased the number of VR-based neurofeedback (NF) training studies. Controlling a VR environment with brain signals has potential advantages for NF applications. More entertaining, multimodal and adaptive virtual feedback modalities might positively affect subjective user experience and could consequently enhance NF training performance and outcome. Nevertheless, there are certain pitfalls and contraindications that make VR-based NF not suitable for everyone. In the present review, we summarize applications of VR-based NF and discuss positive effects of VR-based NF training as well as contraindications such as cybersickness in VR or age- and sex-related differences. The existing literature implies that VR-based feedback is a promising tool for the improvement of NF training performance. Users generally rate VR-based feedback more positively than traditional 2D feedback, albeit to draw meaningful conclusions and to rule out adverse effects of VR, more research on this topic is necessary. The pace in the development of brain-VR synchronization furthermore necessitates ethical considerations on these technologies.
... The biggest problem associated with using VR tools in the training process is the potential for simulation sickness (also known as VR sickness or cybersickness [29]). Simulation sickness encompasses a set of symptoms occurring in a virtual reality user, i.e., general discomfort, fatigue, headache, eye strain, difficulty concentrating, increased saliva, sweating, nausea, blurred vision, and dizziness [30]. Simulation sickness is the body's reaction to discrepancies between visual information and proprioceptive and vestibular signals. ...
(1) Background: This article presents research results from a project to develop a simulator and training program for tram drivers based on virtual reality tools. This article aims to present the research results on the risk assessment of adverse events to develop training scenarios for tram drivers. (2) Methods: The research methodology involved four steps, including the identification of adverse events based on interviews with experts, estimation of risk parameters, risk assessment using fuzzy logic, and risk evaluation to identify events recommended for the training program. (3) Results: Thirteen adverse events related to tram driving were identified and ranked according to the proposed classification. A risk assessment was then performed for the selected group of events using fuzzy logic models. The results made it possible to recommend situations that should be mapped in the virtual world as part of a tram driver training program. (4) Conclusions: The results made it possible to distinguish a group of events that should constitute the training area dedicated to tram drivers. Including the developed emergency scenarios in the training program allows employees to examine their reactions to stressful or dangerous situations and better prepare themselves for future duties.
... In the MR study, we assessed immersion (Slater et al., 1998), motion sickness susceptibility (Golding, 2006) and simulator sickness (Kennedy et al., 1993). In semi-structured interviews, we inquired about participants perception of the concepts, attitudes toward AMs, situations requiring support, and the effect of AMs. ...
Cyclists frequently face numerous hazards on the road. Often those hazards are posed by motorised vehicles. Advanced support systems that alert cyclists to potential dangers could enhance their safety. However, research in this area, particularly regarding hazard notifications for cyclists, remains sparse. This work assesses bi-modal early hazard notification concepts (combining visual cues with either auditory or tactile feedback) provided at head level (smart glasses with speakers, tactile headband). They are detailing the nature of the hazard, its direction relative to the cyclist, and the timing of exposure. This work investigates cyclists' preference and perception of the proposed concepts for two hazardous situations originating from interactions with vehicles: ‘dooring’, the hazard of a potential collision with an opening door of a parked vehicle (evaluated through a test track study, N = 32) and ‘being overtaken’ which poses the hazard of being cut off or hit by the overtaking vehicle (assessed in a bicycle simulator study, N = 21). The study involved comparisons of supported and unsupported rides, focusing on their impact on usability, intuitiveness, workload, and perceived safety. Our findings reveal varied preferences for the supporting feedback modality, with 56% favouring visual-auditory and 31% visual-tactile. The participants rated user experience, intuitiveness and perceived safety for the use of both concepts quite high. Further, the workload for assisted rides was rated as equally low as for unassisted rides.
... Before taking part in the experiment, participants provided personal information and completed the Simulator Sickness Questionnaire (SSQ; Kennedy et al., 1993) to assess factors related to the onset of simulator sickness. To mitigate the onset of drowsiness, fatigue and simulator sickness, the average temperature in the room was set between 20 • C and 22 • C, and the illuminance was set at 4 lx. ...
Precision Teaching (PT) is a data-driven educational technique that continuously monitors and adjusts instruction to achieve specific, measurable learning outcomes. This research applies PT principles to train drivers in improving lane maintenance behaviour, focusing on the comparison between feedback delivery modalities, to fill a gap in prior literature due to limited and somewhat conflicting findings.
This study builds upon a previous study, expanding the analysis to encompass a larger cohort of drivers and introducing a new experimental condition. Overall, 80 participants were involved in a driving simulator study in which they were asked to perform four consecutive trials, the first without feedback and others with feedback delivery.
Participants were divided into three groups, each assigned to an experimental condition based on feedback administration: Auditory (A), Visual (V), and combined (VA). All systems provided contingent negative/positive feedback based on participants’ lateral position.
A MANOVA was conducted, with feedback type and trials serving as independent variables. The analysis considered six dependent variables, incorporating four indicators for lane maintenance, along with two variables, mean speed and acceleration, to assess potential indirect effects.
Results reveal that all tested conditions were effective. However, conditions A and VA demonstrated greater effectiveness in reducing the standard deviation of lateral position. The auditory feedback system seems to emerge as the most promising option, likely being less intrusive since it delivered fewer stimuli compared to VA. These findings could be valuable in shaping the design of PT protocols for real-time coaching programs for eco-driving or within usage-based insurance schemes.
Pusher syndrome is a disorder of postural control after stroke. Patients show a mismatch in their perception of (almost preserved) visual and (pathologically tilted) postural verticality. In order to reduce this mismatch, we developed a novel head-mounted Tilted Reality Device (TRD). It presents patients visual footage of their actual surroundings but tilted to one side rather than upright. We investigated its usability and possible limitations in its use for the treatment of pusher patients in two samples of healthy participants with an average age of 26.4 years and 63.9 years respectively. Individuals from both age groups showed similar levels of tolerance to prolonged exposure to the tilted visual environment for an average of 40.4 min while walking around in the hospital. The TRD was found to be comfortable and not frustrating whilst wearing, but somewhat challenging in terms of technical handling, particularly for older participants. At the end of the maximally tolerated exposure time participants of both groups experienced some feelings of discomfort, like dizziness or increased stomach awareness, which disappeared rapidly after terminating TRD exposure. Our TRD appears to be a practical device especially for an older population, like pusher patients. While users must be aware of the possibility of side effects, these should be balanced against the benefits of future use for rehabilitation purposes.
Anxiety disorders are the most prevalent mental health conditions. Besides psycho-pharmacotherapy, cognitive behavioral therapy with an exposure-based approach is considered the gold standard. However, not all patients benefit from this approach. Here, we aimed to translate laboratory findings on enhanced fear extinction with repetitive transcranial magnetic stimulation (TMS) to the clinic. In this double-blind, randomized, placebo-controlled clinical trial, 76 participants with acrophobia received an activating intermittent theta burst stimulation (iTBS) targeting the left posterior prefrontal cortex immediately before two virtual reality exposure therapy sessions. Phobic symptoms were assessed at baseline, post-intervention, and a 6-month follow-up. Results revealed a significant reduction in phobic symptoms from baseline to post-assessment and follow-up and confirmed the efficacy of virtual reality exposure therapy as a treatment for specific phobias. Interestingly, no additional effect was observed for active iTBS compared to sham iTBS. Our post-hoc analyses argue for an individualized TMS application. Further research is needed to determine optimal TMS parameters and validate these results in clinical trials, accounting for methodological and inter- and intra-individual variability, as well as alternative therapeutic processes.
Introduction
With the growing older adult population, the European Union emphasizes the need to promote research in healthy aging trough multidisciplinary and innovative approaches, including the integration of advanced technologies like virtual reality (VR) in cognitive rehabilitation. This reflects the increasing awareness of the importance of addressing challenges related to neurodegenerative diseases in the older adult population. Our study aims to present a protocol that will assess the feasibility and provide a preliminary measure of effectiveness for an intervention using immersive CR technology for cognitive remediation (CR) in individuals with Mild Cognitive Impairment (MCI).
Methods
A feasibility randomized controlled clinical study will involve 30 individuals who are over 65 years old, both sex, who meet the diagnostic criteria for MCI from the University Hospital of Cagliari, randomly assigned to either the experimental condition or control group. Both groups will continue to receive standard pharmacological therapy. The experimental group will undergo a 3-months cognitive remediation program using fully immersive VR with two sessions per week. Each session will last a maximum of 60 min and will be supervised by expert health professionals. In contrast, the control group will continue with standard care. The intervention program will be carried out by s psychiatric rehabilitation technicians and speech therapists, emphasizing a comprehensive framework aligned with healthcare needs. Feasibility will be assessed based on tolerability, including dropout rates and acceptability, which considers the proportion of recruited participants among those considered eligible and on side effects and level of satisfaction. The preliminary measures of effectiveness will be evaluated on quality of life, cognitive functions, biological and social rhythms, depressive symptoms and anxiety.
Results
The trial findings will be submitted for publication in international peer-reviewed journals and shared at international meetings and conferences.
Discussion
This study aiming to assess the feasibility and preliminary effectiveness of a fully immersive VR/CR program for MCI in order to give data for a subsequent confirmatory trial. The results of the pilot RCT are expected to significantly contribute to research on the prevention of neurocognitive degeneration, with a specific emphasis on enhancing the application of technologies. The strengths of this work are the high technological innovation program for mental health treatments for healthy aging and multidisciplinary approach emphasizing a holistic framework aligned with health needs.
While physical injuries are generally treated comprehensively after an accident, it is currently not al-ways ensured that psychological distress resulting from the accident is recognized and treated at an early stage. However, as the comprehensive literature analysis at the beginning of the project showed, traffic accidents very often lead to psychological distress in addition to physical injuries. Psychologi-cal distress can in turn have a negative impact on driving competence.
The present project systematically investigated to what extent persons with a previous accident expe-rience and persons who have never been involved in accidents differ with regard to their psychological distress and whether this psychological distress is associated with a poorer driving competence. Fur-thermore, it was investigated whether the driving behaviour of persons with accident experience differs from the driving behaviour of persons without accident experience.
The present study compared the psychological distress and driving competence of n1 = 41 persons who had been involved in a severe motor vehicle accident (MVA) in the 4–32 months before participat-ing in the experiment with n2 = 41 persons who had never been involved in an MVA. The two quasi-experimental groups were paralleled with respect to their age, gender, annual mileage, and the road knowledge in Würzburg.
An online pre-screening and a psychological interview were used to determine the participants’ symp-toms of psychological distress. Following the interview, the participants completed a test drive in real traffic in which their driving competence was evaluated using the Standardized Application for Fitness to Drive Evaluations (S.A.F.E.). In addition to comparing the quasi-experimental groups, it was ana-lysed to which extent psychological distress is associated with driving competence.
The results show that the majority of both quasi-experimental groups (with and without MVA experi-ence) perceived little psychological distress in their everyday life. However, participants who had been involved in an accident showed on average a higher level of anxiety and post-traumatic symptoms than participants who had not been involved in an accident. There was no difference in driving compe-tence between participants with and without MVA experience. Descriptive differences were only evi-dent in individual driving mistakes (e. g., blinking, safety glances), which should be specifically inves-tigated in further studies to enable more meaningful findings. In addition to the large number of indi-viduals who are resilient to psychological consequences of accidents, psychological distress itself does not appear to be necessarily related to safety-related limitations in driving competence.
Overall, it can thus be stated that, in the present sample, a majority of persons who experienced a severe MVA exhibited neither conspicuous psychological distress nor safety-relevant impairments in their driving behaviour. However, up to two and a half years after the accident, a subgroup of the par-ticipants with MVA experience continued to suffer from increased general anxiety, fears when driving or in specific traffic situations, or post-traumatic stress symptoms, including Post Traumatic Stress Disorder. This applies especially for those who have experienced the accident with severe anxiety and a loss of control. General measures with regard to the psychological state or driving behaviour are therefore not indicated for persons with severe MVA experience. However, it seems advisable to in-form accident victims about possible psychological distress and to offer timely professional support and therapy to those who react with clinically relevant psychological distress or specific fears while driving.
Methodological limitations in this study arise, among other things, from the quasi-experimental design and the self-selection of the participants. The results therefore only allow statements about correla-tions and not causalities.
One of the primary impediments hindering the widespread acceptance of autonomous vehicles (AVs) among pedestrians is their limited comprehension of AVs. This study employs virtual reality (VR) to provide pedestrians with an immersive environment for engaging with and comprehending AVs during unmarked midblock multilane crossings. Diverse AV driving behaviors were modeled: negotiation behavior with a yellow signal indication and non-yielding behavior with a blue signal indication. This paper aims to investigate the impacts of various factors, such as AV behavior and signaling and pedestrian past behavior, on pedestrians’ perception of AVs. Before and after the VR experiment, participants completed surveys that assessed their perceptions of AVs and focused on two main aspects: attitude and system effectiveness. The Wilcoxon signed-rank test results demonstrated that both the pedestrians’ overall attitude score toward AVs and their trust in the effectiveness of AV systems significantly increased following the VR experiment. Notably, individuals who exhibited a greater trust in the yellow signals were more inclined to display a higher attitude score toward AVs and to augment their trust in the effectiveness of AV systems. This indicates that the design of the yellow signal instills pedestrians with greater confidence in their interactions with AVs. Further, pedestrians who exhibit more aggressive crossing behavior are less likely to change their perception toward AVs as compared with pedestrians with more positive crossing behaviors. It is concluded that integrating the AV behavior and signaling devised in this paper within an immersive VR setting facilitated pedestrian engagement with AVs, thereby changing their perception of AVs.
The prevalence of drugged driving has increased in the United States. Some drugged driving may be unintentional as prescription medications used as sleeping aids, like zolpidem, cause impairment after the predicted duration of therapeutic action has elapsed. The aim of this study was to determine if nighttime administration of alprazolam, a drug commonly prescribed off-label as a sleeping aid, impacts driving performance the following day. Participants were healthy adults (n = 15) who completed a double-blind, double-dummy, within-subjects inpatient study examining the effects of nighttime administration of alprazolam (0.5, 1, and 2 mg), zolpidem (10 mg), and placebo on driving performance the following day. Alprazolam (1 mg; morning) and zolpidem (nighttime) both served as positive control conditions. Driving simulator measures, cognitive and psychomotor tasks, and questionnaires querying drug effects were collected the afternoon before drug administration and for 5.5 hr the next day and analyzed using symmetry and mixed-model approaches. Morning alprazolam significantly impaired driving performance. Driving impairment was observed up to 12.5 hr after nighttime alprazolam 2 mg and for 8.5 hr after nighttime zolpidem 10 mg. Participant reports on driving ability indicated that they were not aware of their level of impairment. These results suggest that alprazolam used before bed may pose a yet unrecognized public safety risk in the form of next-day drugged driving.
Immersive virtual reality (VR) is recently being explored as a therapeutic alternative for the treatment of amblyopia. This pilot study aimed to evaluate the preliminary efficacy, safety, usability and satisfaction obtained with the use of a novel VR system (NEIVATECH) to provide binocular vision training in previously treated older amblyopic children with non-compliance or non-response to patching. A prospective, multicentre, open-label, single-arm, pilot study was conducted in which the intervention under study was 9 h of therapy with the NEIVATECH system, distributed in 18 half-hour sessions spread over 1 month. A comprehensive visual assessment was conducted before and after the intervention, and at the end of the intervention the safety and usability of the system and patient satisfaction were evaluated. After therapy, statistically significant differences were observed in the near best-corrected visual acuity (BCVA) of the dominant (p = 0.022) and non-dominant (p = 0.022) eye, in stereopsis based on the Binocular Function Score (p = 0.045) and in the break (p = 0.012) and recovery (p = 0.009) points of negative fusional vergence for distance vision. The safety and usability of the system and patient satisfaction with the therapy were adequate. These findings support further investigation of this treatment option in future studies incorporating a control group with which to compare the results obtained. Trial registration: NCT04819386.
Although Virtual Reality (VR) holds massive potential, its applicability still faces challenges because some individuals experience cybersickness. This phenomenon includes general discomfort, disorientation, and/or nausea, and it threatens not only a pleasant user experience but also the user’s safety. Thus, predicting a user’s susceptibility without relying on screening questionnaires that focus on past experiences, would enable more pleasant, safer VR experiences, especially for first-time users. Hence, the current study uses the participant’s controller input in a virtual Rod and Frame Test (RFT) as an effortlessly trackable performance measure. The RFT is an established method for measuring an individual’s sense of verticality in visually displaced fields. It has been used in the context of simulator sickness and cybersickness. In line with the literature and the subjective vertical mismatch theory, a lower visual dependency is expected to be correlated positively with cybersickness. To evaluate the potential of the RFT as a screening method for cybersickness, a cybersickness-inducing virtual environment (the City) was deployed. In total, data from 76 participants were eligible for the statistical analysis. The study finds a positive correlation between lower visual dependency and cybersickness, but only for the group that took the RFT after experiencing the City and only for the post-RFT cybersickness ratings. As cybersickness symptoms were VR environment-specific, the predictive validity of the RFT considering the VR-specific attributes is limited. Further, other studies attributed different working mechanisms to explain the connection between visual dependence and cybersickness with conflicting evidence. Although the RFT is not applicable as a cybersickness screening method, the effect sizes suggest that the RFT could serve as an additional objective assessment of the individuals’ current state during VR exposure. Future research should systematically explore interconnections between the various factors that contribute to cybersickness, pursuing the idea of open science for context sensitivity.
Introduction
As research on cognitive training methods for older adults with mild cognitive impairment (MCI) progresses, fully immersive virtual reality cognitive training (fi-VRCT) has shown promise in enhancing cognitive function. However, its effectiveness in improving instrumental activities of daily living (IADL) and fostering independence is still unclear. This study aims to address these uncertainties by developing and validating a fi-VRCT program focused on IADL, with the goal of enhancing both cognitive function and IADL performance in older adults with MCI.
Methods and Analysis
This mixed methods program evaluation study consists of three phases: feasibility, intervention, and extension. In the feasibility phase, we will implement fi-VRCT in real-world community settings and invite 20 older adults with MCI to participate in a single training session. Participants will provide feedback through questionnaires and individual interviews. The intervention phase will involve a double-blind, cluster-randomized controlled trial with 52 older adults with MCI, who will be randomly assigned to either the fi-VRCT or control groups. Both groups will complete 16 sessions over eight weeks, with cognitive and functional performance assessed at various intervals. During the extension phase, feedback will be gathered from 26 participants who underwent fi-VRCT through focus group interviews and ongoing questionnaires. Quantitative and qualitative findings will be synthesized to refine the fi-VRCT program and elucidate training outcomes. Ultimately, fi-VRCT has the potential to enhance cognitive and functional abilities in older adults with MCI in community settings.
Ethics and Dissemination
Ethical approval has been obtained from the Research Ethics Committee at National Taiwan Normal University (202312EM009). The research findings will be disseminated through reputable, peer-reviewed journals and professional international conferences to engage and inform academic and clinical audiences.
Trial Registration
NCT06392412.
Seakeeping trials of a United States Coast Guard (USCG) cutter in March 1984 included a human factors engineering (HFE) evaluation having particular regard to problems of seasickness in certain work stations. Some motion sickness incidence and related data, and the derivation of human factors engineering principles from such data were reported by Bittner & Guignard in 1985: and some findings supporting the general utility of using magnitude estimation of motion sickness for operational comparisons were presented later (Bittner & Guignard, 1986).
The present communication documents the previously unreported seasickness and related data from those trials; and the implications of the data for the planning of future seakeeping trials. It also reviews the general conclusions of the shipboard HFE evaluations.
The subjects were 16 male USCG officers and enlisted personnel assigned to duties in mission-critical workspaces, to whom two questionnaires were administered systematically: namely, Motion Sickness Symptoms and Prewatch Status. The latter instrument evaluated intervening variables including sleep and use of medication. Analyses including correlation of questionnaire and ship motion data led to the following conclusions: (1) Contrary to traditional assumptions, seasickness is characterized by at least two functionally independent factors, identified as F1 (symptomatic General Motion Illness) and F2 (Retching-Vomiting). (2) Both factors showed declines across days as well as similar carry-over and location effects within days. However, F1 reflected persistent individual differences and was strongly associated with the vertical component of the ship's motion; while F2 was transitory and associated with large transverse relative to vertical components of motion. (3) The results support previously published human factors engineering principles for minimizing seasickness incidence (Bittner & Guignard, 1985) (4) Validity of future sea trials requires (a) multiple-score scaling of motion sickness (eg, using F1 and F2); (b) control of subject crew movements about the ship during periods of observation; and (c) avoidance of steaming patterns that induce extraneous carry-over effects.
Examines procedures previously recommended by various authors for the estimation of "change" scores, "residual," or "basefree" measures of change, and other kinds of difference scores. A procedure proposed by F. M. Lord is extended to obtain more precise estimates, and an alternative to the L. R. Tucker, F. Damarin, and S. A. Messick (see 41:3) procedure is offered. A consideration of the purposes for which change measures have been sought in the past leads to a series of recommended procedures which solve research and personnel-decision problems without estimation of change scores for individuals. (22 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Drowsiness is one of the cardinal symptoms of motion sickness; therefore, a symptom-complex centering around "drowsiness" has been identified which, for convenience, has been termed the sopite syndrome. Generally, the symptoms characterizing this syndrome are interwoven with other symptoms but under two circumstances the sopite syndrome comprises the main or sole overt manifestation of motion sickness. One circumstance is that in which the intensity of the eliciting stimuli is closely matched to a person's susceptibility, and the sopite syndrome is evoked either before other symptoms of motion sickness appear or in their absence. The second circumstance occurs during prolonged exposure in a motion environment when adaptation results in the disappearance of motion sickness symptoms, except for responses characterizing the sopite syndrome. Typical symptoms of the syndrome are: 1) yawning, 2) drowsiness, 3) disinclination for work, either physical or mental, and 4) lack of participation in group activities. Phenomena derived from an analysis of the symptomatology of the sopite syndrome are qualitatively similar but may differ quantitatively from abstractions derived in other motion sickness responses. One example is the sometimes unique time course of the sopite syndrome. This implies that the immediate eliciting mechanisms not only differ from those involved in evoking other symptoms, but, also, that they must represent first order responses. Diagnosis is difficult unless the syndrome under discussion is kept in mind. Prevention poses a greater problem than treatment.
Pilots have experienced various adverse symptoms hours and even days following flight simulator training. This study surveyed pilots undergoing simulator training in an attempt to provide an initial gauge of the extent, severity, and possible risk factors of long-term (greater than 1 day) simulator aftereffects. A three-part voluntary and anonymous questionnaire was used to gather data. We studied pilots of varying experience undergoing advanced flight training which included the use of flight simulators. Some 238 pilots participated in the study, and 196 completed the follow-up survey concerning long-term effects. Nine (4.6%) pilots experienced adverse symptoms 24 h or more after completion of their last simulator training, which they attributed to their recent simulator experience. Symptoms reported included: recurrent visual flashbacks, continued balance disturbance, and hand-eye discoordination. Three pilots (1.5%) reported difficulties flying aircraft. Pilot flight experience level, total simulator time, length of simulator session, and sex were not predictive of risk. This study suggests that long-term (greater than 1 day) adverse aftereffects may occur following simulator training.
Reports of posteffects following training sessions in Navy and Army flight simulators were obtained from pilots to determine the time course of recovery from simulator sickness. Results imply that posteffects may be a more serious problem than previously considered; 45% of all those queried (N greater than 700) reported having experienced symptoms of simulator sickness; 25% of the symptoms lasted more than 1 h after leaving the simulator; and 8% lasted more than 6 h. Postexposure symptoms were classified into three categories: visuomotor (based on disturbances in oculomotor control; e.g., eyestrain), disorientation (based on disturbance in postural control; e.g., dizziness), and nausea (vagal/autonomic symptoms). A safety risk may be posed particularly by the moderately high frequency of symptoms involving postural disequilibrium. Guidelines for coping with risks are discussed.
Flight simulators have become a major factor in pilot training. A general finding from Navy research on simulator design is that equipment features that offer faithful representation improve pilot performance and promote pilot acceptance. To the extent that an aircraft produces motion sickness, its simulator should induce the same result. However, reports of simulator sickness appear to be increasing and a shortcoming in simulation is implied when these effects occur in simulators during maneuvers that do not occasion them in the aircraft. This article presents incidence data from surveys of the 10 simulators at 6 different Naval/Marine Corps Air Stations. Approximately 1,200 simulator flights were recorded. Some severe motion sickness symptoms were recorded and some simulators induced unsteadiness afterwards. Individuals experiencing effects may be at risk if they drive themselves home or return to demanding activities at work. The simulators which exhibited the highest incidences of sickness were helicopter simulators with cathode ray tube (CRT) infinity optics and six-degrees-of-freedom moving base systems. Of those studied, fixed-wing, fixed-base, dome displays had relatively low incidence of simulator sickness.
Motion sickness sympomatology of lnbyrinthine defective and nomral subjects during ztm gravity m a ~ e u v e r s . A ~ c Medicine
- R S Kellogg
- R S Kennedy
- A Graybiel
Results 4500 swing 1 ~ 1 s for invcsti& motion sifkness Randolf Field, TX: School of Aviation Medicine
- A Hemippway
Sinn&or sickness: Reaction to a tramfw~nedpurrpaurl world: I. Swpeof &eproblem (NAVTRAEQUIPCEN TN-65)
- L H Frank
- R S Kennedy
- R S Keuogg
- M E Mccpuley
Simulator sickness in U.S. Army and Navy Gxed- and rotary-wing flight simulators
- D W Gower
- M G Lilientbal
- R S Kennedy
- J E Fowlkes
T k e#kca visual depiwrion m daptafion to a rotaling atknmat (Naval S h l of Avlatim Medicine Tech
- R S Kennedy
- G C Tolhurst
- A Graybiel
Confribntions to c o r r l a t k l amlysir
- R Wherry
Etiolagiul significance of equipment features and pilot history in simulator slclraess. Pnncakngs of theAGARD M&lPenelSympsivrm err Maiun Cues in FlightSimctlcsriac and-I&ed Sickness @p. 1- 1-1-22)
- R S Kennedy
- K S Berbpura
- G O Ailgood
- N E Lane
- M G Lilienlbd
- D R Baltzley
Theodiurl &velqmetu for idenfifying underlying internalp*ocesses: V" 2. Modifications to hkmrehical fator analysis: Positive manr;fol 8 (POSMAN,) r m o ~ ~ ~ (NAMRL SR 86-l/NADC Rep. 86105-60)
- R J Wherry
- Jr
- Alexander S. J.
Vestibular, perceptual,andsubjective changes with extended VDU use: Amotion sickness syndrome?
- S J Monissey
- A C Bittner
- Jr
Results 4500 swing 1 ~ 1 s for invcsti& motion sifkness (Project No. 31
- A Hemippway