Virtual Reality Sickness = Real Virtual Sickness
Using the struggles of technology to address and inform what we do in PRIME for patients with dizziness, dysautonomic issues, and difficulty with upright function.
While I am not a big technology or game freak there has been some recent news that was interesting to people in those circles. Earlier this month Microsoft released specifications for its newest game system. The buzz going in (apparently) was that it would be able to utilize virtual reality technology. However, they did not mention one thing about virtual reality and focused on other things instead.
The big question (I guess) is why? In other news the founder of Facebook, Mark Zuckerberg, initially bought some Virtual Reality technology for $2 billion and is losing that money hand over fist because people aren’t buying the virtual reality products (The Oculus Rift is the product). Oh and he lost another $500 million in a lawsuit. Why isn’t Microsoft releasing the Virtual Reality in its gaming system and why is Mark Zuckerberg losing millions? I think the answer is pretty simple. Virtual Reality makes people (not everyone, but enough people) sick to their stomach… Like actually puke your guts out sick to your stomach. For an example see this review of VR games ranking them from least to most sickness provoking.
Virtual Reality Sickness–Costing rich people Millions!
If you don’t know what virtual reality is Wikipedia says that, “Virtual reality (VR) is a computer technology that uses headsets, sometimes in combination with physical spaces or multi-projected environments, to generate realistic images, sounds and other sensations that simulates a user’s physical presence in a virtual or imaginary environment. A person using virtual reality equipment is able to “look around” the artificial world, and with high quality VR move about in it and interact with virtual features or items. VR headsets are head-mounted goggles with a screen in front of the eyes. Programs may include audio and sounds through speakers or headphones.” So basically it is a headset you put over your eyes that gives you a visual input that you are in an environment, and interacting with an environment that you are not actually in. Virtual Reality sickness is when exposure to virtual reality technology causes symptoms consistent with motion sickness including general discomfort, headache, stomach awareness, nausea, vomiting, pallor, sweating, fatigue, drowsiness, disorientation, and apathy. Other symptoms can even include postural instability and retching.
Virtual reality sickness is often explained by what is known as Sensory Conflict Theory. Sensory conflict theory proposes that symptoms occur when a user’s perception of self-motion or orientation is based on incongruent sensory inputs from the visual system, vestibular system, and non-vestibular proprioceptors, and particularly so when these inputs are at odds with the user’s expectation based on prior experience. Basically when what you sense and feel, especially in relation to movement or upright posture, does not match up with reality, you will feel sick. So if your eyes are being shown an image that you are moving through space and maybe you hear objects move by you through earphones yet your inner ear and the rest of your body does not sense that you are moving forward because they are not stimulated there is a mismatch of input. Your brain has to filter out which inputs are accurate and which are inaccurate and make “sense” of it. When it cannot the response is a feeling of uneasiness at best and extreme dizziness and disorientation at worst.
“Basically when what you sense and feel, especially in relation to movement or upright posture, does not match up with reality, you will feel sick”
Another limitation I see in improving the “Feel” of virtual reality is the fact that our brain makes decisions based on prior experience (hopefully good, valid sensory experience) and uses that experience in conjunction with sensory input to make feed forward postural/motor decisions as we move. What that means is that we are anticipating what we are going to sense and do before it even happens. When we take a step and feel our legs swing forward we are anticipating that our heel will strike the ground at a predetermined time and our muscles and body is prepared for that contact. When the step isn’t there (think of stepping off a curb) but your body is ready for it, it doesn’t usually go well. When you start moving your eyes will predict and expect the world to start to move by it or get closer etc. and will be prepared to react appropriately. This give and take between what is expected and anticipated for and what is actually felt is an important thing for controlled efficient movement and balance. In a VR world everything is feedback because you are not in control of propelling or initiating the movement. If you don’t feel your feet push you forward when you move forward you have a mismatch on information, have no feedforward input and are relying solely on feedback. In this situation it is easy to become disoriented. This is why the easiest VR games to get used to (and make you least sick to your stomach) involve “controlling yourself in flying or floating situations as if you were in space rather than walking on the ground. The least sick game in the review of VR games referenced above is “a moon-walk in zero gravity”)
“A Moonwalk in zero-gravite- The easiest Virtual Reality game to not feel sick… and how a lot of our patients feel every day!
Now you may ask why I am bothering to write about Virtual Reality and Virtual Reality Sickness. Well the truth is that a large percentage of people we see especially in our PRIME program have complaints ranging from dizziness, headaches, and neck tension, to full blown dysautonomia and POTS. The symptoms they present with are the very same symptoms reported with virtual reality sickness. They are currently living their entire life as if they were in a virtual reality world because they can’t do in real life the 2 things that make virtual reality challenging. These are to 1: get their sensory systems (feet, eyes, vestibular system and body awareness/proprioceptors) to match with each other and with reality, and 2: have normal interaction between feedforward activity and feedback activity (an inability to properly predict what is going to happen based on the information currently receiving) to efficiently move and hold one’s self up against gravity. For patients living in a real state of virtual reality sickness, the constant struggle to figure out how to stand and move without symptoms or pain is real. Most often they have not been helped by traditional treatment or have been told the only thing they can do is manage their symptoms.
Our PRIME program is designed to help this type of issue and therefore the varied symptoms that may result because of it. These include all of the above “Virtual Reality Sickness” symptoms, but also things such as back pain, hip pain, neck pain, poor breathing and sleeping, and other postural related symptoms. We take the tenets of sensory conflict theory and try to improve appropriate sensory input from all factors needed (feet, teeth(neck), eyes, ears etc.) to improve upright function, while at the same time we match that input with activities that assist in relearning appropriate feed forward (or unconsciously competent) movement strategies. There are quite a few studies that are trying to address what the primary factor for motion sickness is. They are looking at the sensory conflict theory issues as well as motor and postural control strategies as factors for dizziness symptoms. (for example see here for a summary of a study done by a researcher that spoke at a recent PRI symposium about motion sickness. Of course in the real world the answers are often dependent on the person, which is why we aim to address both. Once we can match appropriate sensory input with appropriate motor control issues and the 2 become so well learned that they are normal once again, a large percentage of these symptoms can be helped if not eliminated. Then our real life patients can stop living as an avatar in the virtual reality world they are living in and return to Earth as a grounded, in control, human being.