Simulator Adaptation Syndrome (SAS) and the Vestibular System: An Exploratory Study

Driving simulators are increasingly being used for the evaluation and rehabilitation of fitness-to-drive. However, difficulties with Simulator Adaptation Syndrome (SAS) are commonly reported in the literature. In this study, the authors investigated the relationship between SAS and incongruences between vestibular and visual inputs. Fifteen individuals (age = 61±13 years, 9 females) who developed SAS (SAS+) and 10 individuals (age = 58±13 years, 4 females) who did not develop SAS (SAS-) during two recently completed simulator-based driving studies participated in this study. Participants were each administered the six conditions of the Sensory Organization Test (SOT), made to rest for 30 minutes, and then drove four Wii®-based programs. Performance on the six SOT conditions and on the four the Wii®-based driving programs by SAS+ participants were compared to those of the SAS- participants. No participant reported feeling sick during the SOT. Participants in the SAS+ group performed better (p = 0.0053) than those in the SAS- group only on the SOT fifth condition, which required reliance on vestibular input for maintaining balance control. Four participants in the SAS+ versus one in the SAS- group experienced SAS during the Wii®-based driving (chi-square = 4.63, p = .0314). The results of the study suggest that individuals who developed SAS in the driving simulator probably relied more heavily on their vestibular system than individuals who did not develop SAS, and thus performed better when in situations that required significant integration of vestibular input for maintenance of equilibrium. The independent effect of the driving simulator versus the Wii driving game also suggests that specific characteristics of simulator environment immersion also likely played a role in eliciting SAS. Individuals who rely heavily on their vestibular system for balance control may be more prone to developing SAS in virtual environments that provide only minimal vestibular feedback. More studies are needed to better understand SAS and develop more effective strategies to mitigate it.

[1]  Robert S. Kennedy,et al.  Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness. , 1993 .

[2]  Michael W. Haas,et al.  Postural Instability and Motion Sickness in a Fixed-Base Flight Simulator , 2000, Hum. Factors.

[3]  R. P. Fabio.  Sensitivity and Specificity of Platform Posturography for Identifying Patients With Vestibular Dysfunction , 1995 .

[4]  Matthew Rizzo,et al.  DRIVER REHABILITATION IN PARKINSON'S DISEASE USING A DRIVING SIMULATOR: A PILOT STUDY. , 2017, Proceedings of the ... International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle Design.

[5]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[6]  M. Hoehn,et al.  Parkinsonism , 1967, Neurology.

[7]  Rita Formisano,et al.  Return to Driving After Severe Traumatic Brain Injury: Increased Risk of Traffic Accidents and Personal Responsibility , 2012, The Journal of head trauma rehabilitation.

[8]  S. Anderson,et al.  Road safety in drivers with Parkinson disease , 2009, Neurology.

[9]  Noriaki Takeda,et al.  Effects of immersion in virtual reality on postural control , 2005, Neuroscience Letters.

[10]  John R. Wilson,et al.  Virtual Reality-Induced Symptoms and Effects (VRISE) , 1999, Presence: Teleoperators & Virtual Environments.

[11]  J. Wachtel,et al.  Driving simulation for evaluation and rehabilitation of driving after stroke. , 2012, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[12]  A. Shupak,et al.  Postural dynamics and habituation to seasickness , 2010, Neuroscience Letters.

[13]  J D Dawson,et al.  Predictors of driving safety in early Alzheimer disease , 2009, Neurology.

[14]  W. D. De Weerdt,et al.  Screening for fitness to drive after stroke , 2011, Neurology.

[15]  Johnell O Brooks,et al.  Simulator sickness during driving simulation studies. , 2010, Accident; analysis and prevention.

[16]  Lara M. Stepleman,et al.  Predictors of driving in individuals with relapsing–remitting multiple sclerosis , 2013, Multiple sclerosis.

[17]  W. D. De Weerdt,et al.  Predictors of fitness to drive in people with Parkinson disease , 2007, Neurology.

[18]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[19]  W. Bles,et al.  Motion sickness: only one provocative conflict? , 1998, Brain Research Bulletin.

[20]  Hannes Devos,et al.  Determinants of fitness to drive in Huntington disease , 2012, Neurology.

[21]  Sheldon M. Ebenholtz,et al.  Oculomotor Systems and Perception , 2001 .

[22]  Akiko Noda,et al.  Slower adaptation to driving simulator and simulator sickness in older adults , 2013 .

[23]  David C Schwebel,et al.  Using virtual reality to train children in safe street-crossing skills , 2010, Injury Prevention.

[24]  T. Stoffregen,et al.  Postural instability precedes motion sickness , 1998, Brain Research Bulletin.

[25]  F. Bonato,et al.  Combined pitch and roll and cybersickness in a virtual environment. , 2009, Aviation, space, and environmental medicine.

[26]  Robert J Peterka,et al.  Dynamic regulation of sensorimotor integration in human postural control. , 2004, Journal of neurophysiology.

[27]  S J Mercer,et al.  Simulation training for the Frontline- realistic preparation for Role 1 doctors , 2010, Journal of the Royal Army Medical Corps.

[28]  Henry Been-Lirn Duh,et al.  An Independent Visual Background Reduced Simulator Sickness in a Driving Simulator , 2004, Presence: Teleoperators & Virtual Environments.

[29]  Ginger S. Watson,et al.  Factors Associated with Simulator Sickness in a High-Fidelity Simulator , 2007 .

[30]  Kay M. Stanney,et al.  Duration and Exposure to Virtual Environments: Sickness Curves During and Across Sessions , 2000, Presence: Teleoperators & Virtual Environments.

[31]  R. Chong,et al.  Specific interference between a cognitive task and sensory organization for stance balance control in healthy young adults: Visuospatial effects , 2010, Neuropsychologia.

[32]  Avi Shupak,et al.  Mal de Debarquement and Posture: Reduced Reliance on Vestibular and Visual Cues , 2004, The Laryngoscope.

[33]  L. Nashner,et al.  Postural instability in idiopathic Parkinson's disease: the role of medication and unilateral pallidotomy. , 2002, Brain : a journal of neurology.

[34]  Sherrilene Classen,et al.  Driving simulator sickness: an evidence-based review of the literature. , 2011, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.