Innovation of transport
and industry have extended the range of provocative motion environments, to
cars, tilting trains, funfair rides, aircraft, and simulators.1 Thus
Motion sickness is a common problem in people travelling by train, airplane,
boat and especially cars. Also people experience motion sickness from virtual
reality, head-mounted displays and also smart phones with sophisticated
graphics.2 Susceptibility to motion sickness is significantly higher
in individuals who suffered from spatial disorientation (35.05%), migraine
(26.31%), gastrointestinal disorders (26.82%) and those who were more sensitive
to unpleasant odors (24.64%). Females (27.3%) are more susceptible to motion
sickness than males (16.8%).6 Initial symptoms is discomfort around
stomach, followed by nausea. With rapid worsening of symptoms there can be
salivation changes, dizziness, retching and sopite related symptoms.3,4

The primary functions
of the vestibular system are spatial orientation, maintenance of balance, and
stabilizing of vision through vestibular–ocular reflexes.15Motion is
sensed by the brain through three different pathways of nervous system that
send signals coming from inner ear( sensing motion, acceleration, gravity), the
eyes(vision),and the deeper tissues of body surface(proprioceptors). When there
is an unintentional movement of the body, the brain responds to unfamiliar
motion stimuli which are transmitted to vestibular nuclei. This unfamiliar
motion stimuli is sensed by vestibular labyrinth, the eyes and proprioceptors
and travel to vestibular nuclei, then through cerebellum to vomiting centre
located in the parvicellular formation of medulla oblongata, this conflict among
the brain and the three pathways lead to motion sickness.16
Currently the “neural mismatch theory” states that motion sickness can
originate from within a single sensory system (e.g., canal-otolith
interaction), or between two or more sensory systems (e.g. visual-vestibular
interaction).19,20

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As the vestibular system plays a crucial role in the inducement of
motion sickness, vestibular habituation exercises will help reduced motion
sickness. Repetitive vestibular stimulation can therefore cause changes in
Vestibulo-Ocular Reflex (VOR) and at the same time a reduction in sensitivity
to motion sickness.30 Habituation exercises
are based on the idea that repeated exposure to a provocative stimulus (e.g.
head movements) will lead to a reduction of the motion-provoked symptoms.32
These exercises cause a habituation effect
characterized by decreased sensitivity and duration of symptoms can
occur in as quickly as 2 weeks but may take as long as 6 months.31
Effects of breathing strategy have explored by number of experts. Paul Lehrer a
leading researcher in area of relaxation training showed that breathing
approach can be quite successful in in reducing physiologic activation of the
sympathetic nervous systems.33

A commonly used
Diagnostic Criteria for Identifying the Severity of acute motion sickness and
the Diagnostic Scale, referred to as Motion Sickness Assessment Questionnaire
which is a reliable method for scoring overall motion sickness with the use of
four subscales is used in this study for rating these symptoms of motion and to
differentiate motion sickness symptoms along four dimensions: gastrointestinal,
central, peripheral, and sopite-related.36

Although motion
sickness affects nearly one third of all people who travel by land, sea, or
air, little documentation exists regarding prevention and management. Repeated
recurrence of sickness is not desirable or practical to daily living. Limited
evidence is available for Controlled breathing and visual-vestibular
habituation training for motion sickness that does not provoke the undesirable
symptoms and can last for upwards of a year. Thus aim of this study was to help
determine the effectiveness of visual vestibular habituation and controlled
breathing for motion sickness. The research questions were: Is visual-vestibular
habituation and controlled breathing effective for motion sickness? Will there
be any difference in severity of motion sickness when treated with visual
vestibular habituation and controlled breathing for motion sickness?

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