Motion Sickness Flashcards
Define motion sickness
Is a normal response to real or apparent motion to which a person in unfamiliar and hence un-adapted
What are the symptoms of motion sickness
Cardinal - highly predictable - Pallor > cold sweats > Nausea > Vomiting Variable symptoms - salivation - belching/flatulence - Stomach awareness - sighing/yawning - warm flushes - Drowsiness - lightheaded ness - Headache - Depression and apathy - Long term may cause dehydration, anorexia
What causes motion sickness
Neural mismatach theory
- Conflict between different sensory inputs or between sensory input and expect motion. Can adapt if unadaptiing internal model.
Treisman’s theory
- Is motion sickness similar to the physiological response to poisoning?
- getting out of favour
Examples of visual-vestibular mismatches
Using binoculars
Reading in flight
Fixed base simulators/VR games
Examples of canal-otolith mismatches
Head movement in rotation
Microgravity/space sickness
Flight turbulence
Pressure vertigo
Who is at risk of aviation
Student pilots Back-Enders Paratroopers Passengers Sea survival Experience Role Aircraft characteristics Flying environment Motion environment
Impact during flying training from motion sickness
Modify or about sorties Delay progress Affects - enthusiasm - performance - Self esteem - motivation
Impact on flying operation
Trained aircrew
- loss of performance and effectiveness
- aborted mission
- flying safety hazard
- loss of motivation
Passengers
- Nuisance value
- dehydration
- “ contagious”
- decreased effectiveness of airdrop force
Who get simulator sickness
Trained aircrew
Can be atypical symptoms
What factor increase risk of motion sickkness
Linear acceleration
- horizontal 0.2 Hz maximally provocative
- Higher and lower frequencies less provocative
Rotation
- constant rotation, hardly provocative
- head movement during constant rotation (Coriolis) Most provocative
What predicts susceptibility
Receptivity,
Retentivity
Adaptability
Summary contributing factors
Individual
- anxiety, lack of experience, out of practice, lack of tx, Age <12 or >60, female gender,
Environmental
- lack of visual cues, weather, sea state, aircraft manoeuvres, other vomiting
Descrease susceptibility
- activity/distraction
- Cold air
Treatment of motion sickness - step wise approach
Behavioural strategies Self adaptation Medical/psychological tests Medication Desensitisation
Phase 0: Behavioural strategies
Don’t fly if unwel Tell someone Minimise head movements Stay occupied - fly the plane Close eyes or view horizon Lie down Cool air Try to relax
Allow time for adaption
Freq exposure and re exposure
Start with gentle manoeuvres
Progress to aerobatics
Phase 1 medical assessment
History AE 849
- motion stimulus: provocation, frequency, severity, duration
- RF: susceptibility factors, anxiety, stress, compliance with prevention strategies
Clinical examination (ENT, Psych)
- ENT pathology
- Fear of flying, anxiety, adjustment
How to rate motion sickness
No symptoms = 0 Any symptoms, no nausea = 1 Nausea - mild = 2 Nausea - moderate but can continue = 3 Nausea - severe, want to stop = 4 Vomiting = 5
Score 4 or more for 3 identical flight: seek medical advice
Rules around using medication
Combine with behavioural strategies
Only for initial trainees on a temporary basis
Maximum 8 sorties with QFI or as pax
No solo flying or in command
48 hr ground trial required
Failure of medication trial requires referral to RAAF IAM
Which of the following decreases susceptibility to motion sickness A. Keeping busy/occupied B. Anxiety C. Hot environments D. Poor outside visual cues
A keeping busy/occupied
Pharmacology approved for motion sickness
Central anticholinergics - Hyoscine - scopolamine —- Tavacalm original - onset 15-30min last 8 hours —- Kwells - short acting drug, action last 4 hours - Cinnarizine - Promethazine Antihistaminics - Promethazine HCI - phenergan -Promethazine theoclate - avomine —-in combination with pseudoephidrine to counter the sediation Sympathomimetics - Ephedrine - pseudoephedrine - dexamphetamine
Alternative therapies
Little proven benefit
- acupressure
- acupuncture
- magnetotherapy
- Herbal preparations
Some proven benefit
- ginger tablets
Phase 2
SAVMO review
- assess compliance with preventative strategies
- Assess motivation
- Liaise with SQN regarding suitability
- Refer to ENT and Psychological support if not already done
Phase 3
Ground based desensitisation
- At ESL
- 3 days of desensitisation using cross-couple coriolis
- record on AE 850
- return to flying within 48h
Phase 4
Ongoing desensitisation
- provocative flight in the morning the
- cross-coupled coriolis in the afternoon
- 3 further days
- return to flying within 48 hr
Phase 5
Referral to institute of aviation medicine
Motion sickness desensitisation program
- forces adaptation with cross-coupled stimuli
- 5 week program
— 3 week ground phase - 4 session/day with 2 hr intervals
— increase rpm based on vertigo and symptoms.
— frequent coriolis stimulation
— 10 sortie PC-21 airborne phase
——aileron roll, Cuban eights, slow roll, vertical roll
— immediate return to flying
Which of the following decreases susceptibility to motion sickness A. Keeping busy/occupied B. Anxiety C. Hot environments D. Poor outside visual cues
A keeping bus/occupied
