Motion Sickness Therapy
This page is primarily intended to be a reference for patients
who have been referred for therapy for motion sickness
Timothy C. Hain,
Page last modified:
June 3, 2015
Motion sickness exercises
Motion sickness is mainly treated with habituation. This means repeated exposure to motion, in an attempt to reduce brain responses as well as make it less provocative of anxiety and more predictable.
Habituation is the method used by the military to treat motion sickness in aviators (Sharma and Aparna, 1997; Ressiot et al, 2013; Lucertin et al, 2013; Golding and Gresty, 2015). Sophisticated motion paradigms including both head movement and visual stimulation, are reported to be very effective (Dai et al, 2011). The response rate in highly motivated subjects (i.e. military personnel) is generally about 75%.
Treatment should be "batched", meaning that treatment should be done every day, and not once/week or less frequently. Response to treatment correlates better with the number of treatments than the vigor with which the treatment is delivered (Golding et al, 1995). Motion stimulation should be gradually "progressed", starting with as little movement that just triggers dizziness or nausea, and gradually increasing each day.
- Repetitive head movements can be used to stimulate the inner ear. The emphasis with these exercises is not to improve visual with head movement, as in the "gaze stabilization" protocol, but rather simply to move the head repetitively about the horizontal and vertical axes. There is also no need to challenge balance. The "Puma" exercises, which were developed to treat motion sickness in aviators, can be used for this purpose. We suggest having a physical therapist coach you with these exercises, which can be very stimulating.
- Optokinetic stimulation can be used to stimulate visual systems. This is preferably done with a large moving surround, such as a drum. A large television at home can be used when paired up with the appropriate video or bar generator software.
- It is also very useful to combine head movement and optokinetic stimulation. This is difficult to do unless one is in a clinic setting where there is a large moving visual surround. With a large visual surround, stimulation creates a signal in the vestibular system resembling actual head movement. When one tilts the head forward/backwards or rolls it from side to side, this creates a conflict -- a "pseudocoriolis" effect. (Bos and Bles, 2004). This conflict is helpful in accomplishing habituation. (Dai et al, 2014)
No studies are available regarding the effect of medications on this type of protocol. This reflects the author's experience and "common sense" neurophysiology.
- Sedatives should be avoided (such as valium type medications, antihistamines, and "phenergan" or "compazine").
- Activating medications such as caffeine and/or venlafaxine may be helpful.
- Ondansetron can be used for nausea.
- Bos, J. E. and W. Bles (2004). "Motion sickness induced by optokinetic drums." Aviat Space Environ Med 75(2): 172-174.
- Dai, M., et al. (2011). "Prolonged reduction of motion sickness sensitivity by visual-vestibular interaction." Exp Brain Res 210(3-4): 503-513.
- Dai, M., et al. (2014). "Readaptation of the vestibulo-ocular reflex relieves the mal de debarquement syndrome." Front Neurol 5: 124.
- Golding, J. F. and J. R. Stott (1995). "Effect of sickness severity on habituation to repeated motion challenges in aircrew referred for airsickness treatment." Aviat Space Environ Med 66(7): 625-630.
- Golding, J. F. and M. A. Gresty (2015). "Pathophysiology and treatment of motion sickness." Curr Opin Neurol 28(1): 83-88.
- Lucertini, M., et al. (2013). "Rehabilitation from airsickness in military pilots: long-term treatment effectiveness." Aviat Space Environ Med 84(11): 1196-1200.
- Ressiot, E., et al. (2013). "Prospective study on the efficacy of optokinetic training in the treatment of seasickness." Eur Ann Otorhinolaryngol Head Neck Dis 130(5): 263-268.
- Sharma, K. and Aparna (1997). "Prevalence and correlates of susceptibility to motion sickness." Acta Genet Med Gemellol (Roma) 46(2): 105-121.
August 3, 2016
, Timothy C. Hain, M.D.
All rights reserved.
Last saved on
August 3, 2016