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This article reports the results of two experimental studies which investigated 1) differences in how virtual reality (VR) -induced cybersickness is experienced between men and women, and 2) how video game players experience cybersickness when using two generations of developing VR technology. Grounded in sensory conflict theory; the study discusses cybersickness as a function of the differing technical specifications of the VR head-mounted displays (HMDs) used in the experiments. In Study 1, 223 players played either a first-person shooter or a first-person space flight game on the Oculus Rift DK-1. Results indicated that women experienced more severe cybersickness symptoms than men, and that shooter players experienced more severe symptoms than space flight players. In Study 2, 136 players played Minecraft on either the Oculus Rift DK1 or its successor, the DK2 n m. Players in both headset conditions were compared on cybersickness and sense of presence. Results indicated that the advanced VR technology did not improve the experience of cybersickness or presence over the basic technology. Differences between the headsets were not significant. Both studies show that cybersickness affects women more than men; however, the reasons for the difference bear further investigation. More importantly, advanced VR technology made no significant difference to users in terms of cybersickness or sense of presence. DK2 users experienced cybersickness symptoms just as severe as their counterparts using the DK1 did. Further research will delve into cybersickness, presence and the newest consumer VR headsets; and will investigate the neuropsychological processes associated with the VR experience.
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1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
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Home / Featured / Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender
Modern Virtual Reality Technology: Cybersickness, Sense of
Presence, and Gender
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Daniel M. Shafer, Ph.D.
Baylor University Department of Film and Digital Media
Corey P. Carbonara, Ph.D.
Baylor University Department of Film and Digital Media
Michael F. Korpi, Ph.D.
Baylor University Department of Film and Digital Media
Abstract
This article reports the results of two experimental studies which
investigated 1) differences in how virtual reality (VR) -induced
cybersickness is experienced between men and women, and 2) how
video game players experience cybersickness when using two
generations of developing VR technology. Grounded in sensory conflict
theory; the study discusses cybersickness as a function of the differing
technical specifications of the VR head-mounted displays (HMDs) used in
the experiments.
In Study 1, 223 players played either a first-person shooter or a first-person space flight game on the
Oculus Rift DK-1. Results indicated that women experienced more severe cybersickness symptoms than
men, and that shooter players experienced more severe symptoms than space flight players. In Study 2,
136 players played Minecraft on either the Oculus Rift DK1 or its successor, the DK2 n m. Players in both
headset conditions were compared on cybersickness and sense of presence. Results indicated that the
advanced VR technology did not improve the experience of cybersickness or presence over the basic
technology. Differences between the headsets were not significant.
T
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1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
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AuthorsCitation
Both studies show that cybersickness affects women more than men; however, the reasons for the
difference bear further investigation. More importantly, advanced VR technology made no significant
difference to users in terms of cybersickness or sense of presence. DK2 users experienced cybersickness
symptoms just as severe as their counterparts using the DK1 did. Further research will delve into
cybersickness, presence and the newest consumer VR headsets; and will investigate the neuropsychological
processes associated with the VR experience.
Acknowledgements:
Shafer, D. M., Carbonara, C. P. & Korpi, M. F. (2017). Modern Virtual Reality Technology:
Cybersickness, Sense of Presence, and Gender. Vol. 11(2)
Introduction
A number of companies are participating in the creation of a consumer market for Virtual Reality (VR)
Head-Mounted Displays (HMDs) and the content to view on these displays. Oculus (Facebook), HTC,
Samsung, Sony, and Google are prominent in this group. This fresh attempt to develop VR for consumers is
largely enabled by advances in technologies originally developed for smartphones, like displays, GPS, low-
power processors, GPUs, sensors, and so on. Many are enthusiastic about the prospects for VR, especially
Oculus and HTC, who released their consumer devices in early 2016.
Much of the current enthusiasm for consumer VR is due to high quality and affordable technology now
available from the smartphone parts bin (Nield, 2016). Higher resolution, wider viewing angles, better
motion tracking, decreased latency, and other advancements promise to significantly improve the VR
experience as well as make modern devices more affordable. Thus, many – including developers,
technology enthusiasts, and companies like Oculus, Valve, and Sony — have renewed hope that the new
form of this technology will revolutionize user engagement and presence in virtual environments. Oculus, in
particular, released two development kits intended to encourage the development of software that would
work with their technology. Released in 2013, the Oculus Rift DK1, while rudimentary by comparison to
currently available commercial HMDs, was a significant achievement. Its successor, the DK2, followed in
2016 and marked a significant advancement as well. Table 1 compares the technical specifications of each
headset. The reader will note that at the time of this writing, the primary investigators did not have access
to the consumer Oculus Rift or the HTC Vive. More research using these headsets is forthcoming.
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One possible barrier to this VR revolution may be cybersickness. Cybersickness, a term often thought to be
interchangeable in popular usage and in the press with “motion sickness,” has symptoms similar to, but not
the same as, motion sickness. It has always been an unwelcome factor in VR. In addition, research shows
that gender is a factor in cybersickness; females are more likely to experience symptoms (Biocca, 1992).
Since women comprise 44% of gamers in the U.S. (“Essential Facts About the Computer and Video Game
Industry,” 2014), this gender difference may be particularly problematic for consumer adoption of VR. The
present article considers cybersickness and gender in relation to technological improvements between
Oculus’s Development Kit 1 and Development Kit 2.
Definition of VR
Virtual reality (VR) is a technology that allows for immersion of a user in a multisensory virtual environment
(VE). Using a combination of hardware and software systems, virtual reality creates a three dimensional,
interactive world. There are two primary types: CAVE Automatic Virtual Environment (CAVE) and Head
Mounted Display (HMD). A CAVE consists of a room with projection screens lining the walls, floor and
ceiling. The user typically wears a headset in order to view 3-D imagery in the environment (Rouse, 2016).
HMD VR, on the other hand, currently consists of a headset and, for some applications, motion controllers
1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
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which stand in as proxies for the user’s hands. HMD VR has spurred the recently revived interest in
consumer VR, and is the focus of this research. Gigante (1993), writing in Virtual Reality Systems
(Earnshaw, Gigante, & Jones, 1993) defines HMD VR as “the illusion of participation in a synthetic
environment rather than external observation of such an environment. VR relies on three-dimensional (3D),
stereoscopic, head tracked displays, hand/body tracking and binaural sound. VR is an immersive, multi-
sensory experience” (p. 3). Although this definition can also be used in describing virtual worlds or
environments, in the popular vernacular, VR has come to embody a stereoscopic 3D virtual environment
that uses some sort of HMD; either tethered or as a stand-alone device using some sort of mobile device
interface.
The fast start of Oculus and the rapid emergence of other VR and AR startups like Magic Leap ($542 million
of funding) have been accompanied by announcements of VR and/or AR projects from major corporate
players like Google, Sony, Microsoft, and Samsung (Hixon, 2015; Huet, 2014). Despite all this momentum
and enthusiasm, there is caution. John Carmack, well-known game designer and CTO of Oculus,
referencing the difficulties consumer VR experienced in the 1990s said: “It left a huge, smoking crater in
the landscape. We’ve had people afraid to touch VR for 20 years” (Wingfield, 2015).
Cybersickness
One of the primary problems VR has had historically is cybersickness. Cybersickness is a repeatedly
observed side effect of VR. There are numerous symptoms associated with cybersickness which include
tiredness, drowsiness, nausea, disorientation, postural instability, sweating, headaches, eye strain, and
sometimes even vomiting (Burdea & Coiffet, 2003; Davis, Nesbitt, & Nalivaiko, 2014; LaViola, 2000). The
issue is complex as there can be variability between individual responses to the stimuli, the type of
technology used and the overall design of the virtual environment, and the tasks performed (Davis, Nesbitt,
& Nalivaiko, 2015; Johnson, 2005) As Vinson and colleagues (2012) state: “Cybersickness is essentially a
barrier to both adoption and production of VR technologies” (p. 69). There are a significant number of
studies examining cybersickness in virtual environments (Robert S. Kennedy, Stanney, & Dunlap, 2000;
LaViola, 2000; Stanney & Hash, 1998; Vinson et al., 2012).
Cybersickness can be caused solely by visual input (LaViola, 2000). Vestibular stimulation is often absent in
occurrences of cybersickness because the individual is sitting still, and therefore there may be a significant
mismatch between movement in the VE and the lack of movement from sitting. This visual versus
vestibular conflict results in an experience known as vection (LaViola, 2000). Vection is the experience of
self-motion even when you are not actually moving. As So, Ho and Lo (2001) put it, vection is a “visually
induced self-motion illusion” (p. 195). Many of us have experienced vection in the real world; while sitting
at a traffic light next to a large truck, you suddenly feel like you are moving backwards. In reality, the
truck’s wheel, which fills your field of view to the side, is moving forward slightly (LaViola, 2000; Riecke,
Väljamäe, & Schulte-Pelkum, 2009). Vection, then, is one contributor to cybersickness symptoms, but it is
insufficient to predict cybersickness in all cases. Several theories have been posited that attempt to predict
the conditions under which cybersickness will occur. Three of the leading perspectives are poison theory
(LaViola 2000; Kennedy and Frank 1985), postural instability theory (Riccio and Stoffregen 1991), and
sensory conflict theory (Brand 1978; Reason and Brand 1975).
Poison Theory
Poison theory posits that when the body encounters events that cause dissonance between what is felt and
what is being processed visually, the central nervous system interprets this dissonance as toxic (Kennedy
and Frank, 1985).. This perception of toxicity is thought to bring about symptoms of motion sickness. As
LaViola (2000) puts it, poison theory suggests that the body reacts to the ingestion of poison by disrupting
the coordination between the visual and vestibular systems (among others). One natural reaction to this
disruption is to vomit; which also serves as a way to expel the toxic substance that has been ingested
(LaViola 2000). For the purposes of this study, we do not consider the poison theory applicable, since it
cannot predict who will become ill to the point of vomiting, and cannot explain why some experience
sickness symptoms, and others do not (LaViola 2000).
Postural Instability Theory
The postural instability theory proposed by Riccio and Stoffregen (1991) posits that motion sickness occurs
when an entity (human or animal) experiences a loss of posture control. The theory is based in work on
control of self-motion and orientation, and is a departure from sensory conflict theory which focuses on
motion-sensing systems such as the vestibular system. To put it very simply; if postural instability (the
feeling that one is not in control of their own motion or orientation) is prolonged, motion sickness will
occur. Riccio and Stoffregen (1991) categorically reject the arguments of Reason and Brand (1975) which
attempt to explain motion sickness; instead proposing that motion sickness stems from loss of motion
control. However, it seems to us that sensory conflict theory is more suited to explaining the phenomenon
of cybersickness than postural instability theory, because many experiences of cybersickness occur when
1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
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the body is at rest, not in motion. Results of research investigating postural instability theory have been
mixed (e.g., Smart et al 2002; Wang Kenyon and Keshner 2010), but recent research shows that the
relationship between postural instability and cybersickness is weak in some cases (Dennison and D’Zmura
2017) We therefore turn to sensory conflict theory and our application of it to the investigation of
cybersickness.
Sensory Conflict Theory
Sensory conflict theory (Reason, 1978; Reason & Brand, 1975) was proposed in order to predict incidence
and severity of motion sickness. The basic principle of the theory asserts that motion sickness is likely to
occur when motion sensing systems (namely the eyes, the vestibular system, and the nonvestibular
proprioceptors) send signals that conflict with 1) each other or 2) what is expected based on previous
experiences (Bles, Bos, de Graaf, Groen, & Wertheim, 1998). According to the theory, motion sickness
occurs when a person fails to experience an expected physiological response to a certain visual stimulus
(Reason, 1978). Relevant examples for the purposes of the present study might be using a VR flight
simulator or a driving simulator that includes a great deal of surrounding movement. Turning one’s head in
such an environment may result in a conflict between the visual input and what one’s brain would normally
expect in real flight or driving because the simulator is fixed in place. The same conflict might be expected
when playing a first-person shooter video game or a space dogfighting game in VR. This is because in
reality, you are sitting still in a chair, while your avatar in-game appears to be making rapid movements or
moving through space quickly. The strength of the motion sickness response, Reason (1978) argues, is
dependent upon 1) how severe the conflict is between the perceived and expected stimulus, and 2)
exposure time to the same stimulus. The thrust of Reason’s (1978) argument is that symptoms of sickness
can be reduced by adaptation to the conflict perceived between the observed visual stimulus and expected
result of exposure to such stimulus (Reason, 1978).
While we may expect, then, that VR video game players might experience fewer symptoms the longer they
play, this may, in fact, be unlikely. Video game scenery and events change constantly, while the stimulus
material Reason (1978) used was repetitive and constant. In a video game, player attention can be drawn
suddenly to diverse portions of the display, causing sudden and erratic head and even body motion.
Therefore, it is more unlikely that VR video game players would become accustomed to the environment
and experience reduced cybersickness systems simply due to exposure time. However, based on the
arguments of sensory conflict theory, we might expect that games which produce more conflict between
the motion-detecting senses and the player’s expectations will be more sickness-inducing than games in
which the motion experienced and expected is more congruent. Reason (1978) asserted that the brain
compares incoming motion stimuli (e.g., immersive visual information) with previous responses experienced
under similar real-life conditions, now stored in a memory bank of “paired sensory and motor memory
traces” (Oman, 1993, p. 365). When the signals received do not align with the stored memory trace of that
stimulus, sensory conflict results. The longer one experiences this sensory conflict, the more likely sickness
is to occur. However, it is not possible to measure the level of conflict between the senses and the
physiological expectations an individual is experiencing.
Oman (1993) developed a mathematical formula designed to determine the intensity of sickness responses
based on a variety of measurable factors. The key element in both Oman’s (1993) and Reason’s (1978)
work is that the more the stimuli (e.g., the visual stimuli produced by a VR video game) sends motion cues
that are expected (by our physiological systems) to produce certain responses but in fact do not, the more
severe cybersickness systems are likely to be. “Increased sensory conflict is noted to result not only from
sensory rearrangement but also from exogenous disturbance forces acting on the body” (Oman, 1993, p.
367). These exogenous disturbance forces could be an involuntary movement made in response to intense
or surprising visual or auditory stimuli; which are common in action-packed video games.
Still, different VR games may produce widely varying levels of sensory conflict. Some games, such as a
virtual hunting game, for instance, would be unlikely to produce a great deal of sensory conflict because
the action on screen and the visual stimulus provided would generally match with what the body might
expect in real life. Similarly, a flight simulator may not produce extraordinary sensory conflict because the
player’s avatar is seated in a cockpit, with the action taking place around it. Being seated in real life would
lend some degree of similarity between the virtual and the real world. However, a first-person shooter, with
a great deal of running and turning, should produce a high level of sensory conflict because of the
discrepancy between the running action on screen and being seated in a chair in real life
Therefore, we predict that:
H1: A VR video game that is higher in sensory conflict (i.e., a first-person shooter) will produce more
cybersickness symptoms in players than a VR video game that is lower in sensory conflict (i.e., a
space dogfighting game).
Cybersickness and Gender
1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
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The finding that women are more susceptible to cybersickness symptoms than men is common in the VR
literature. In fact, one study only used men as test subjects in order to better isolate the effects of VR on
cybersickness (Lo & So, 2001). A study by Kim and colleagues (2005) reported that over 78% of
participants who reported cybersickness symptoms were women. Kennedy and Frank (1985) and Biocca
(1992) also note that women are more likely to experience cybersickness than their male counterparts. In
one study, cybersickness scores were obtained after exposing participants to either a virtual environment
that provided coaching and direction intended to relieve or blunt the onset of cybersickness symptoms (a
cybersickness relief virtual environment, or CRVE); or by having participants use a non-CRVE environment
(Kim et al., 2008). Women in the study reported significantly greater cybersickness than men across
conditions; in fact, the average female cybersickness frequency score was over two times greater (10.5
times during exposure) than the average male frequency score (4.1). This means that women expressed
feelings of cybersickness verbally an average of 10.5 times during their exposure, whereas men verbally
expressed their symptoms an average of 4.1 times during exposure (Kim et al., 2008). Another study by
Stanney and colleagues (2003) analyzed men and women’s scores on the subscales of the SSQ. They found
that women experienced significantly higher levels of disorientation, oculomotor symptoms, and higher
total severity scores than men did. Men and women did report similar levels of nausea in that study
(Stanney et al., 2003).
On the other hand, a few studies have found that women and men do not differ in their experience of
cybersickness in VR. Knight and Arns (2006) report that men and women experienced similar levels of
cybersickness in the CAVE virtual reality environment. Larson and colleagues (1999), in their study of men
and women’s performance in a virtual reality spatial rotation (VRSR) test, found that men and women did
not differ in their post-exposure cybersickness symptoms. Other studies (e.g., Bonato, Bubka, & Palmisano,
2009; Howarth & Finch, 1999; Stanney & Hash, 1998) simply do not mention gender as a factor. Given this
evidence, it would appear that, despite some mixed results, women generally experience cybersickness
more frequently and/or more severely than men while using VR. Therefore, it is predicted that:
H2: Women will score higher than men across conditions on a measure of post-exposure
cybersickness after playing a VR video game.
In order to test these hypotheses, data was collected via a 2 condition randomized between-subjects
experiment (see Shadish, Cook, & Campbell, 2002).
This research re-examines cybersickness with the latest readily available VR technology, the Oculus Rift.
(We used Oculus in favor of other VR HMDs because two distinct generations were available to developers
and scholars such as ourselves.) We also re-examine the notion that women are more susceptible to
cybersickness than men. In addition, we empirically test the notion that advanced VR technology reduces
cybersickness and increases the sense of presence for users. To these ends, this study employs Developer
Kit Version 1 (DK-1) and Developer Kit Version 2 (DK-2). Table 1 describes the technical specifications of
each headset.
Study 1 Methodology
Participants in Study 1 were 223 undergraduate students recruited via email and Internet announcements
from various courses at a research university in the southern-central United States. Participants were
offered extra credit for their participation, among other options for extra credit. The gender breakdown for
the sample was 48.4% male (n = 108) and 51.6% female (n = 115). Average age was 20.4 years.
Participants were randomly assigned to play either a first-person shooter (Half Life 2) or a space
dogfighting video game (Strike Suit Zero) using a VR HMD – the Oculus Rift DK-1.
Stimulus and Systems
Via random assignment, participants were selected to play in one of two conditions. The high sensory
conflict condition utilized Half Life 2. The game involves navigating through an obstacle-laden virtual
environment. The avatar in the game walks or runs through the environment, and the hand or weapon that
is recognizable as the player’s own digital self in the game makes a “bobbing” motion as movement takes
place. Players played a portion of the game which involved navigating through an area with obstacles, and
finally engaging some hostile non-player characters (NPCs) in combat with various weapons. Players are
able to command the avatar to move forward, backward, side-to-side, and up and down. The HMD gives
them the freedom to look in a 180-degree arc to either side, potentially giving a 360-degree view of the
environment no matter what the avatar is doing.
The low sensory conflict condition utilized Strike Suit Zero. The game involves flying a space fighter to
various coordinates, doing target practice on space junk, and finally, engaging hostile NPCs’ ships in a
dogfight. The avatar in the game sits still in the cockpit of the ship. Its hands grip the control sticks, and its
legs are visible and unmoving. Pitch, roll, and yaw are all represented in the game, and the player is able to
fly their ship in any direction. As with Half Life 2, the HMD gave players the ability to look in a 180-degree
1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
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arc to either side, potentially giving a 360-degree view of the environment. However, it is clearly
represented that the avatar is sitting motionless in the cockpit of a ship.
Procedure
After giving informed consent, participants were asked to watch a 5-minute video tutorial (Half Life 2) or
follow a built-in tutorial for the game (Strike Suit Zero). The function of each tutorial was to explain the
controls of the game and how to make progress. Upon completion of the tutorials, players played the game
for 20 minutes. Immediately after exposure, participants were directed to the 30-question online
questionnaire which assessed their level of cybersickness, spatial presence, and demographics. Total
experiment time was approximately 45 minutes.
Measures
Cybersickness was assessed using the negative feelings subscale of the ITC-Sense of Presence Inventory
(Lessiter, Freeman, Keogh, & Davidoff, 2001). The subscale assesses the level of virtually all symptoms of
cybersickness. Specifically, the items measured disorientation, tiredness, dizziness, eyestrain, headache,
and nausea on a 5-point Likert-type scale. While these may not cover the entire scope of symptoms of
cybersickness, they certainly assess those symptoms that are most salient to players (Kolasinski, 1995;
Lang, 2013; LaViola, 2000). This measure had an observed Cronbach’s α = .86. Gender was assessed via a
simple single-item question: “Sex”, with “Male” and “Female” as answer choices.
Study 1 Results
Hypothesis 1 predicted that a high sensory conflict VR game (Half-Life 2, a first-person shooter) would
produce more cybersickness symptoms in players than a low sensory conflict VR game (Strike Suit Zero, a
space dogfighting game). Results of a one-way analysis of variance (ANOVA) show that H1 was supported.
Half-Life 2 players experienced significantly higher levels of cybersickness (M = 4.02, SD = 0.91) than
Strike Suit Zero players (M = 3.30, SD = 0.94), F (1, 210) = 31.54, p < .001, η2part = .13. Results of
Levene’s test of equality of error variances indicated that error variances were statistically equal across
groups, F (1, 210) = 2.68, p = .103.
A follow-up ANOVA analyzed players according to gender. Results indicated that men who played Half-Life
2 reported significantly more cybersickness (M = 3.68, SD = 1.05) than men who played Strike Suit Zero
(M = 3.01, SD = 0.95), F (1, 100) = 11.03, p = .001, η2part = .10 (Levene’s F (1, 100) = 0.001, p =
.970). Women who played Half-Life 2 reported significantly more cybersickness (M = 4.30, SD = 0.67) than
women who played Strike Suit Zero (M = 3.59, SD = 0.83), F (1, 108) = 23.88, p < .001, η2part = .18. For
the women, Levene’s test was significant (F (1, 108) = 4.46, p = .037), indicating unequal error variances,
however GLM procedures including ANOVA are robust to violations of the equal error variances assumption
when group sizes are relatively equal (Howell, 2012). For this test, 51 women were in the Half-Life 2
condition and 59 women were in the Strike Suit Zero condition. Half-Life 2 produced more cybersickness
both generally and when broken down by gender.
Hypothesis 2 predicted that women would report higher levels of cybersickness than men in both the high
sensory conflict (Half-Life 2) and low sensory conflict (Strike Suit Zero) conditions. Results of a one-way
ANOVA show that H2 was supported. Women who played Half-Life 2 reported significantly more
cybersickness (M = 4.30, SD = 0.67) than men who played Half-Life 2 (M = 3.68, SD = 1.05), F (1, 91) =
12.03, p = .001, η2part = .12 (Levene’s F (1, 91) = 6.28, p = .014). Women who played Strike Suit Zero
reported significantly more cybersickness (M = 3.59, SD = 0.83) than men who played Strike Suit Zero (M
= 3.01, SD = 0.96), F (1, 117) = 12.30, p = .001 η2part = .10 (Levene’s F (1, 117) = 1.32, p = .252).
However, further follow-up correlation analysis revealed that playing computer games more often is
negatively related to cybersickness (r = -0.28, p < .001), as is knowledge of how VR works (r = -0.19, p =
.005). Those with more gaming experience and more in-depth knowledge of how VR works tended to
experience less severe cybersickness than their counterparts.
Study 2: Cybersickness and VR Technology
In Study 1 we investigated the problem of cybersickness as it relates to virtual reality. In Study 2, we focus
on the potential for improvements in VR technology to reduce the symptoms of cybersickness. The general
notion among VR device developers is that a higher resolution display, increased framerate, increased
refresh rate, decreased latency, and a low persistence display will all contribute to reduced cybersickness.
As of the writing of this article, there were only two available headsets that allow a direct comparison of
these factors: the Oculus Rift DK-1 and DK-2. In all cases, the DK-2 is superior technologically. Table 1
compares the technical specifications of the two headsets, and demonstrates that the DK-2 outstrips the
DK-1 in each area of interest (as it was designed to do).
What cannot be said simply by looking at the technical specifications is how users react to VR experiences
using the DK-2 as compared to the DK-1. In order to make such a comparison, we designed an experiment
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that held the virtual environment and control method constant, and only varied the Oculus Rift version used
by the participants.
Our primary goal for this experiment was to determine if DK-2 produced significantly less cybersickness
than DK-1, as the technological advancements suggest it should. Oculus developers themselves that the
DK-2 would reduce cybersickness in their announcement of the release of the device: “Like the Crystal
Cove prototype, DK-2 uses a low persistence OLED display to eliminate motion blur and judder, two of the
biggest contributors to simulator sickness. Low persistence also makes the scene appear more visually
stable, increasing the potential for presence” (“Announcing the Oculus Rift Development Kit 2 (DK2),”
2014). Therefore, we propose the following hypotheses:
H3: Users of the Oculus Rift DK-1 will report significantly more cybersickness than users of the DK-2.
H4: Users of the DK-2 will report significantly higher levels of spatial presence than users of the DK-1.
H5: Users of the Oculus Rift DK-1 will drop out of the study significantly more frequently than users of
the DK-2.
Study 2 Methodology
Participants in Study 2 were 136 undergraduate students recruited via email and digital announcements
from various courses at a research university in the southern-central United States. Participants were
offered extra credit for their participation, among other options for extra credit. The gender breakdown for
the sample was 56% male (n = 76) and 44% female (n = 60). Average age was 20.6 years. Via random
assignment, 56.6% of participants were assigned to the DK-1 condition, and 43.6% of participants were
assigned to the DK-2 condition.
Stimulus and Systems
The technical specifications of the DK-1 and the DK-2 have been summarized in Table 1. The two headsets
comprised the two conditions for the experiment. Participants played a modified version of the popular
sandbox game Minecraft . Minecraft was chosen as stimulus material for this study (just as Half Life 2 and
Strike Suit Zero were chosen for Study 1). Specifically, participants played Minecrift 1.7.10 Pre5; a
modification of Minecraft that adapts the game for use with the Oculus Rift DK-2, and is backward
compatible with the DK-1. The participants were randomly assigned to play using the DK-1 (basic VR) or
the DK-2 (advanced VR). They played in a pre-constructed tutorial world originally created for
MinecraftEdu. The tutorial world is a valid stimulus for both experienced players and players new to
Minecraft, because it covers all the basics of the mechanics of the game, yet is in-depth enough to offer
experienced players small challenges to complete as they make their way through the environment.
Players controlled their avatar using an XBOX 360 USB controller, which interfaced with Minecraft via a
piece of software called Keysticks (Keysticks.net n.d.). Keysticks allows users to customize each button on
the controller. Using an XBOX 360 controller allowed players to control their avatars without the need to
look at their hands on the keyboard; particularly useful when using a visually occlusive VR HMD like the
Oculus Rift.
Procedure
After giving informed consent, participants were asked to play Minecraft in VR for 20 minutes. They were
told they could end their participation at any time for any reason. Sixty-six participants (37.5%) reported
that they ended their play session early (4.7% did not answer the question). Ending the play session early
was positively and significantly associated with cybersickness scores (r = .383, p < .01), indicating that
cybersickness symptoms may have been related to ending play sessions early.
Measures
Spatial presence was measured using the Spatial Presence subscale of the ITC-Sense of Presence Inventory
(ITC-SOPI; Lessiter et al., 2001). Some example items include: “I had a sense of being in the scenes
displayed”; “I felt as though I was in the same space as the characters and/or objects”; “I felt surrounded
by the displayed environment”. Observed Cronbach’s α = .92.
Cybersickness was assessed using the Simulator Sickness Questionnaire (Robert S. Kennedy, Lane,
Berbaum, & Lilienthal, 1993). This measure improves upon the negative feelings portion of the ITC-SOPI in
measuring possible negative reactions to virtual reality environments. The scale had an observed
Cronbach’s α = .93. Gender was assessed via a simple single-item question: “Sex”, with “Male” and
“Female” as answer choices.
Study 2 Results
The hypotheses for Study 2 were tested using an analysis of variance (ANOVA) procedure. Hypothesis 3
predicted that DK-1 users would experience higher levels of cybersickness than DK-2 users. The results
1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
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indicate that H3 was not supported. DK-1 users reported an average cybersickness score of 0.93 (on a
scale from 0-3, SD = 0.64), while DK-2 users reported an average score of 0.78 (SD = 0.66). This
difference was not statistically significant, F(1, 134) = 1.79, p = 0.18, η2part = .013 (Levene’s F(1, 134) =
.051, p = 0.82).
Hypothesis 4 predicted that DK-2 users would experience significantly higher levels of spatial presence than
users than DK-1 users. This hypothesis was also not supported. DK-2 users (M = 3.44, SD = 0.60) did not
experience a significantly greater sense of spatial presence than DK-1 users (M = 3.42, SD = 0.64), F(1,
134) = 0.02, p = 0.90 η2part = .00 (Levene’s F(1, 134) = .035, p = 0.85).
Hypothesis 5 predicted that DK-1 users would drop out of the study significantly more frequently than DK-2
users. A frequencies comparison indicated that both conditions had nearly the same dropout rate. For DK-1
users, 36.4% reported that they had to end their play session early, while 39% of DK-2 users reported
having to drop out early. A t-test analysis indicated that these values were not significantly different t =
-0.311, p = 0.76. H5 is not supported.
Follow-up ANOVA analyses were conducted to explore possible alternative explanations of cybersickness.
Comparisons were made based on gender, which Study 1 indicated is an important factor in understanding
cybersickness. We also compared players with experience playing Minecraft and games like it with those
without such experience. Results of the gender comparison indicate that males reported significantly less
severe cybersickness symptoms (M = 0.74, SD = 0.66) than women (M = 1.03, SD = 0.61), F(1, 134) =
7.01, p = .009 η2part = .05 (Levene’s F(1, 134) = .603, p = 0.44). However, gender only explained about
5% of the variance in cybersickness, indicating several other factors at play. In terms of previous exposure,
players who had previously played Minecraft reported significantly less severe cybersickness symptoms (M
= 0.70, SD = 0.62) than those who had not (M = 1.03, SD = 0.64), F(1, 134) = 9.02, p = .003. Players
who had played a game similar to Minecraft before reported significantly less severe cybersickness
symptoms (M = 0.71, SD = 0.65) than those who had not (M = 1.00, SD = 0.62), F(1, 134) = 7.27, p =
.008 η2part = .06 (Levene’s F(1, 133) = .488, p = 0.49). Previous exposure also explained a small portion
of the variance (6%) in cybersickness scores.
Discussion
In this article, we have investigated how players react to playing games in virtual environments; both from
an individual differences (i.e., gender) and a technological standpoint. Results of our first experiment show
that a high sensory conflict game (Half Life 2) produced more severe cybersickness symptoms than a low
sensory conflict game (Strike Suit Zero). This finding supports our arguments that sensory conflict theory
as formulated by Reason and Brand (1975) and modified by Oman (1993) can help explain the occurrence
and severity of cybersickness.
Our results also show that women experience higher levels of cybersickness than men in both low sensory
conflict and high sensory conflict games. However, it is unclear that the difference can simply be explained
away by gender. In fact, our follow-up analysis suggests that video game playing experience and previous
knowledge of how VR works (or the lack thereof) may contribute to cybersickness just as much as gender.
These findings resonate with past research on gender differences and video game performance (Brown,
Hall, Holtzer, Brown, & Brown, 1997) which suggests that men perform better in video game competitions
than women across a variety of conditions. In fact, susceptibility or resistance to cybersickness may stem
from life experiences that are merely associated with typical (or stereotypical) gender roles such as
participation in sports (Selby & Lewko, 1976). Some research suggests that athletes develop better object
tracking skills than non-athletes; which transfers well to skillful video game play (Cavanagh & Alvarez,
2005). Other research by NASA suggests that familiarity and experience with motion-sickness causing
stimuli reduces symptoms during spacecraft test flights (Cowings, Toscano, Reschke, Gebreyesus & Rocha,
2017). This study aligns with our findings that familiarity with cybersickness-inducing VR games helps to
mitigate cybersickness symptoms. Such considerations are rich ground for future research.
Findings of our second experiment have serious implications for VR developers. We designed the study to
determine whether the technological improvements of the Oculus Rift DK-2 over the DK-1 would improve
user’s experiences in terms of cybersickness. Our findings show that despite the evolution of VR technology
used in the DK-2 over the DK-1, this made no significant difference to users in terms of cybersickness.
Users of the DK-2 experienced cybersickness symptoms just as severe as their counterparts using the DK-1.
The DK-2 also failed to produce a greater sense of spatial presence than the DK-1. In fact, users of both
headsets reported the same rate of dropout during their play sessions. For all intents and purposes, the
two headsets seemed to perform nearly the same in terms of cybersickness and spatial presence.
Limitations
One notable limitation to our study is that none of the games used were originally designed with the Oculus
Rift in mind. Instead, all three games utilized in these experiments were retrofitted to support the binocular
display of the Rift. It is possible that other games, designed to work natively with the Oculus Rift DK-1 or
1/8/2018 Modern Virtual Reality Technology: Cybersickness, Sense of Presence, and Gender – Media Psychology Review
http://mprcenter.org/review/modern-virtual-reality-technology-cybersickness-sense-of-presence-and-gender/ 10/13
DK-2 would have produced better user experiences, or perhaps more distinct differences between DK-1 and
DK-2 users. However, in experiment 1, users reported very similar experiences between high and low
sensory conflict games; indicating that games of different types and (arguably) different quality produce
similar user experiences. Further, simply from an anecdotal standpoint, the adaptations of all three games
(Half Life 2, Strike Suit Zero, and Minecraft) were very good. The representations of the environments as
displayed in the Oculus Rift’s field of view were seamless. The only moments of strangeness may have
been when players moved their heads in certain extreme ways while using the DK-2, their in-game avatars
appeared as decapitated bodies. This was no doubt due to the Oculus DK-2’s ability to sense depth and
movement along the Z-axis. The avatar’s bodies, particularly in Strike Suit Zero and Minecraft, failed to
respond to movement along the Z-axis. This may have caused some discomfort for players that may not
have been experienced in games specifically designed for the Oculus Rift.
One additional consideration here is that there may be a certain technological threshold where technology
ceases to make a significant impact of users’ sense of cybersickness. It is possible that both headsets used
in this study exceed that threshold. Finally, we were also unable to manipulate frame rate to truly test the
DK-2’s latency reduction capability.
Conclusions and Future Research
Despite these limitations, our results have a few implications. First, we may be seeing evidence that men
and women experience different degrees of cybersickness due to the physiological differences in the way
the eye and brain process the VR experience. This finding leads us to advocate for more research to test
for these differences. In addition, work needs to be done across more samples of emerging VR technology.
Consumer versions of the Oculus Rift, the HTC Vive, and the Sony PSVR have now been released, and
other competitors are close to unleashing their products.
It will soon be possible to judge whether claims that the issue of cybersickness has been solved are valid.
Not only are we determined to continue our work in this realm, but we are now poised to venture into the
investigation of the motion imaging characteristics of games designed specifically for the newest VR HMDs
(such as Lucky’s Tale; “Playful,” n.d.), as well as VR narratives and simulations.
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... Simulation sickness may vary according to gender with the use of HMDs. Schafer et al. [41] studied the role of gender, technology, and their potential contribution towards simulation sickness. Using the data obtained from about 223 individuals (108 male and 115 female) they examined the levels of simulation sickness with regards to gender, sensory conflict, and improvements in VR technology. ...
... Similar symptoms were experienced by 61% of users after twenty minutes of exposure to immersive virtual content from a DVisor HMD [46]. Technical advancements in VR display hardware, comparing Oculus VR DK1 to Oculus VR DK2, for example, did not have a significant impact on decreased cybersickness [41]. Some symptoms are more likely to occur in virtual environments. ...
... User Age Younger and middle-aged people are more resistant to sickness than older adults [39,40] Gender Females are more prone to motion sickness than Males [41,42] Exposure to VR Longer VR exposure durations are directly proportional to the severity of sickness. [43] Control Users navigating with virtual controls might experience higher levels of cybersickness than those who use physical navigation [15,44] Display Head-Mounted Displays Produce high levels of cyber sickness. ...
Article
Full-text available
Virtual reality (VR) is an emerging technology with a broad range of applications in training, entertainment, and business. To maximize the potentials of virtual reality as a medium, the unwelcome feeling of cybersickness needs to be minimized. Cybersickness is a type of simulation sickness that is experienced in virtual reality. It is a significant challenge for the usability of virtual reality systems. Even with advancements in virtual reality, the usability concerns are barriers for a wide-spread acceptance. Several factors (hardware, software, human) play a part towards a pleasant virtual reality experience. In this paper, we review the potential factors which cause sickness and minimize the usability of virtual reality systems. The reviewed scientific articles are mostly part of documents indexed in digital libraries. We review the best practices from a developer’s perspective and some of the safety measures a user must follow while using the virtual reality systems from existing research. Even after following some of the guidelines and best practices virtual reality environments do not guarantee a pleasant experience for users. Limited research in virtual reality environments towards requirements specification, design, and development for maximum usability and adaptability was the main motive for this work.
... However, Maneuvrier et al. (2020) found an association between the feminine gender and cybersickness. Indeed, women often report more symptoms of cybersickness than men (Shafer et al., 2017;Stanney et al., 2003), even though this effect is not systematic (Gamito et al., 2008;Ling et al., 2013;Weech, Kenny, et al., 2020). Of note, it is unsure if this effect should be attributed to the culturally gendered education or to biological differences. ...
... To sum up, this cognitive profile is made up of all the interacting acquired and innate behaviors, in particular (i) the construction of multisensory integration (field dependence, sensitivity to perceptual conflict), (ii) certain executive functions (inhibition, flexibility, visuospatial skills) and their supporting attentional resources (Diamond, 2013;Navon & Gopher, 1977), and (iii) his/her relationship to human-computer interaction: practice of video games, sensorimotor skills, self-evaluation of performance, susceptibility to stereotypes threat (Bonnot & Croizet, 2011;Koch et al., 2008; McGlone & Aron- Figure 2. A graphical representation of the major intertwined human factors impacting virtual reality experience and some suggested relationships in the literature. 1: (Weech et al., 2019); 2: (Felnhofer et al., 2012;Gamito et al., 2008;Slater et al., 1998); 3: (Gamito et al., 2008;Maneuvrier et al., 2020); 4: (Hecht & Reiner, 2007;Maneuvrier et al., 2021); 5: (Cian et al., 2011;Maneuvrier et al., 2021); 6: (Maneuvrier et al., 2020;Shafer et al., 2017); 7: (Maneuvrier et al., 2020;Weech, Kenny, et al., 2020); 8: (Onyekuru, 2015); 9: inferred from (Evans et al., 2013;Levine et al., 2016;Pithers, 2002); 10: (Entertainment software association, 2019; Rosa et al., 2016). son, 2006). ...
Article
The question of the relationship between the sense of presence and performance in virtual reality is fundamental for anyone wishing to use the tool methodologically. Indeed, if the sense of presence can modify performance per se, then individual factors affecting the human-computer interaction might have repercussions on performance, despite being unrelated to it. After a discussion on the sense of presence and the particularities it provokes, this work studies the psychophysiology of virtual reality. This in virtuo experience is understood according to a constitutive and reciprocal relationship with the subject's cognitive profile, made up of all the human, contextual and motivational factors impacting the processing of immersion. The role and importance of performance in virtual reality is described in this framework in such a way as to be studied methodologically. The presence-performance relationship is discussed based on previous works and analyzed in terms of attentional resources. Finally, the degree of ecological validity of the performance is described as the factor modulating the relationship between the sense of presence and performance (the Phi Angle). Limitations, applications and test hypotheses of the model are presented. This work aims to help the conceptualization of virtual reality, but also to improve its methodological framework.
... The reliability of the scale was satisfactory (Cronbach's α = 0.93; M = 3.63, SD = 1.46). Similar to recent research (e.g., Seibert and Shafer 2018;Shafer et al. 2017), participants' experience of cybersickness was measured using four items of the negative feelings subscale of the ITC-Sense of Presence inventory by Lessiter et al. (2001), which assesses different symptoms of cybersickness (α = 0.81; M = 2.61, SD = 1.51) ranging on a 7-point scale. For instance, participants were asked to indicate how dizzy or nauseous they currently felt. ...
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Faced with the ongoing diversification and commercial success of highly immersive media technologies (e.g., VR headsets), both content producers and scientific scholars have become highly invested in understanding the psychological consequences of experiencing media in these new and lifelike ways. While many studies underscore positive effects of high media immersivity—such as increased enjoyment or persuasive success—others warn about the intense cognitive load that technologies such as VR might put on their users. In a laboratory experiment with N = 121 participants, we compare the cognitive load experienced while watching a 360° video on a laptop screen or via an immersive VR head-mounted display. Furthermore, we scrutinize two prominent explanations for the additional cognitive load in immersive media settings, i.e., the role of spatial presence and cybersickness. As expected, the VR condition results in higher cognitive load, spatial presence, and cybersickness than the 2D condition. However, by means of a parallel mediation model, we observe that only cybersickness emerges as a meaningful mediator of participants' strained cognitive capacity; spatial presence, on the other hand, remains statistically irrelevant in this regard. We discuss our findings considering implications for media producers and future research.
... The intensity of symptoms varies from one individual to another (Bockelman and Lingum 2017). Some factors have been shown to be negatively related to cybersickness, such as higher experience with video games (De Leo et al. 2014) or sense of presence (Maneuvrier et al. 2020;Weech et al. 2019), while more severe symptoms were shown in women (Shafer et al. 2017;Stanney et al. 2020), and individuals with higher sensitivity to visual cues (Barrett and Thornton 1968;Fulvio et al., 2021). Regarding the latter, Hecht and Reiner (2007) argued that high FD may be related to a lower ability to ignore flaws of the visual scene, hence contributing to discomfort. ...
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Accurately perceiving the gravitational direction is key to successful interaction in our terrestrial environment. In this context field dependence (FD), the importance given to static and/or dynamic visual cues has largely been discussed. Although first considered a trait, several studies suggest FD be flexible in response to postural or visual contexts and to poor virtual reality user experience. The aim of this study was therefore to determine the influence of a disruptive virtual immersion on the level of static and dynamic FD. Forty-five participants were exposed to a virtual maritime environment for up to 14 min. Cybersickness and sense of presence were measured. Before and after virtual immersion, the rod and frame test and the rod and disk test were performed to assess static and dynamic FD, respectively. We demonstrated a significant decrease in both levels of FD after immersion in initially more dependent participants. Decrease in static FD was explained by high initial static FD and severe cybersickness, while decrease in dynamic FD was only explained by the initial level of dynamic FD. In this study, we provide evidence confirming FD flexibility, likely reflecting an adaptation process to environmental or individual-related constraints. Yet, static and dynamic FD seems to rely on separate mechanisms, highlighting the necessity to specify which characteristic of visual information (static or dynamic) individuals depend on when assessing their FD. Our results question the reliability of virtual reality for perceptive or motor diagnoses without considering its consequences, specifically in vulnerable populations such as the elderly.
... It is well known that elements of VR content, VR hardware, and the interface between them influence cybersickness outcomes [18,19]. Certain demographic and within-person factors have also been connected with propensity to experience cybersickness, such as age [18,[20][21][22][23], sex and gender [18,22,[24][25][26], BMI [27], and health and health history [28][29][30]. A large meta-analysis of existing literature (k=137) recently found that various individual differences predict cybersickness propensity, including gender, real-world experience, technological experience, possessing a neurological disorder, and possessing a relevant phobia [31]. ...
Article
Background With the influx of medical virtual reality (VR) technologies, cybersickness has transitioned from a nuisance experienced during leisure activities to a potential safety and efficacy concern for patients and clinicians. To improve health equity, it is important to understand any potential differences in cybersickness propensity among demographic groups, including racial groups. Objective This study aims to explore whether cybersickness propensity differs across racial groups. Methods We collected self-reported cybersickness ratings from 6 racially diverse independent samples within 1 laboratory group (N=931). In these studies, the participants were asked to perform tasks in VR such as traversing environments, pointing at and selecting objects, and interacting with virtual humans. Results Significant racial differences in cybersickness were found in 50% (3/6) of studies. A mini meta-analysis revealed that, on average, Black participants reported approximately one-third of SD less cybersickness than White participants (Cohen d=−0.31; P<.001), regardless of the nature of the VR experience. There was no overall difference in reported cybersickness between the Asian and White participants (Cohen d=−0.11; P=.51). Conclusions Racial differences in cybersickness indicate that researchers, practitioners, and regulators should consider patient demographics when evaluating VR health intervention outcomes. These findings lay the groundwork for future studies that may explore racial differences in cybersickness directly.
... Several factors have been identified to influence the inclusive experience in the virtual environment. For example, earlier studies have shown that an advantage of men over women with regards to cybersickness [63,98,106] and sense of presence [30,82] in virtual reality. A prior systematic review [42] also indicated that bring-your-own-device(BYOD) philosophy and personal traits for head-mounted VR would influence the learning experiences, and therefore raise questions of equity. ...
... With regard to age, it is reported that children aged under 12 have the highest sensitivity. The susceptibility declines sharply from 12 to 21 and beyond (Shafer et al. 2017). However, other studies observed that the elderly often showed more severe discomfort than younger ones (Rebenitsch and Owen 2014;Hildebrandt et al. 2018). ...
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Cybersickness still poses a significant challenge to the widespread usage of virtual reality, leading to different levels of discomfort and potentially breaking the immersive experience. Researchers have attempted to discover the possible fundamental causes of cybersickness for years. Despite the longstanding interest in the research field, inconsistent results have been drawn on the contributing factors and solutions to combating cybersickness. Moreover, little attention has been paid to individual susceptibility. A consolidated explanation remains under development, requiring more empirical studies with robust and reproducible methodologies. This review presents an integrated survey connecting the findings from previous review papers and the state of the art involving empirical studies and participants. A literature review is then presented, focusing on the practical studies of different contributing factors, the pros and cons of measurements, profiles of cybersickness, and solutions to reduce this phenomenon. Our findings suggest a lack of considerations regarding user susceptibility and gender balance in between groups studies. In addition, incongruities among empirical findings raised concerns. We conclude by suggesting points of insights for future empirical investigations.
... Although these symptoms were less than ideal, these were often tolerated by the few users of HMD-VR who would be experiencing VR for specialised training and short periods of time (Caserman et al., 2021). Although, new HMD-VR technologies afford greatly improved visual and tracking resolutions, recent research suggests that users may still suffer from cybersickness and postural instability (Seibert and Shafer, 2018;Shafer et al., 2017Shafer et al., , 2019Rangelova et al., 2020;Kim et al., 2015;Garcia-Agundez et al., 2017;Gavgani et al., 2017), likely caused by a combination of the HMD-VR hardware (e.g. display resolution, field of view, refresh rates, and tracking accuracy and latency), VR content (e.g. ...
Article
This study investigated symptoms of cybersickness and postural instability experienced by new users of head-mounted display virtual reality (HMD-VR), playing VR videogames over long and repeated sessions, and moderation of these symptoms by previous videogame experience and intensity of videogame stimulus. Cybersickness (SSQ) and postural stability (anterior-posterior path-velocity) of new users of VR (n = 80) was collected PRE-VR, POST-VR and 10 min after completing (POST-RECOVERY) a VR gaming experience. Users comprised of videogamers (n = 40) and non-videogamers (n = 40), who were randomly assigned to play either action (high-intensity stimuli) or adventure (low-intensity stimuli) games in VR for 30 min and repeated twice, one week apart. All participants, irrespective of gaming status and genre of game, experienced significant cybersickness after 30 min in VR using current-generation HMD-VR technology, and did not adapt (POST-VR) after two sessions. However videogamers were able to recover (POST-RECOVERY) from cybersickness induced in VR significantly better than non-videogamers. All participants experienced significantly better postural stability after 30 min in VR, irrespective of gaming experience or genre of game. Developers should create VR experiences that minimise negative symptoms of cybersickness and postural instability experience by new users of VR.
... However, no tendency could be synthesized, because the degree to which participants experienced discomfort had great diversity. Two factors might explain this difference in learners' experience of cybersickness between previous research and the findings in this review: first, the past years, VR-HMD has undergone rapid evolution, 20,72,73 and the review by Jensen and Konradsen 22 included articles dating from 2013 to 2016many of which were before the release of the Oculus Rift or Samsung Gear VR consumer available HMDs in 2015. 74,75 Jensen and Konradsen 22 found that the reports varied and reports seemed to go down by year (higher frequency of cybersickness reports in studies from 2014 than 2016). ...
Article
Summary statement: Simulation-based training using virtual reality head-mounted displays (VR-HMD) is increasingly being used within the field of medical education. This article systematically reviews and appraises the quality of the literature on the use of VR-HMDs in medical education. A search in the databases PubMed/MEDLINE, Embase, ERIC, Scopus, Web of Science, Cochrane Library, and PsychINFO was carried out. Studies were screened according to predefined exclusion criteria, and quality was assessed using the Medical Education Research Study Quality Instrument. In total, 41 articles were included and thematically divided into 5 groups: anatomy, procedural skills, surgical procedures, communication skills, and clinical decision making. Participants highly appreciated using VR-HMD and rated it better than most other training methods. Virtual reality head-mounted display outperformed traditional methods of learning surgical procedures. Although VR-HMD showed promising results when learning anatomy, it was not considered better than other available study materials. No conclusive findings could be synthesized regarding the remaining 3 groups.
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The uptake of new interface technologies, such as the Oculus Rift have generated renewed interest in virtual reality especially for private entertainment use. However, long standing issues with unwanted side effects, such as nausea from cybersickness, continue to impact on the general use of devices such as head mounted displays. This in turn has slowed the uptake of more immersive interfaces for computer gaming and indeed more serious applications in training and health. In this paper we report a systematic review in the area of cybersickness with a focus on measuring the diverse symptoms experienced. Indeed the related conditions of simulator sickness and motion sickness have previously been well studied and yet many of the issues are unresolved. Here we report on these issues along with a number of measures, both subjective and objective in nature, using either questionnaires or psychophysiological measures that have been used to study cybersickness. We also report on the factors, individual, device related and task dependent that impact on the condition. We conclude that there remains a need to develop more cost-effective and objective physiological measures of both the impact of cybersickness and a person's susceptibility to the condition.
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