Download 63 Kinetosis: All You Need To Know Ukaegbu Chinonso Ishmael

Journal of Biotechnology Science Research.2014;1(3):63-74
Journal of Biotechnology Science Research (JBSR)
Journal homepage: www.jbsr.issres.net
Review paper
Kinetosis: All You Need To Know
a,b
Ukaegbu Chinonso Ishmael*, aShah Samiur Rashid, bUkaegbu Benjamin Chibuike
a Faculty of industrial science and technology, Universiti Malaysia Pahang (UMP), 26300 Gambang, Kuantan, Malaysia.
b Department of Medical Laboratory Science, Imo State University Owerri, Nigeria
ARTICLE INFO:
Article history:
Received: 11 September 2014
Received in revised form:
25 November 2014
Accepted: 1 December 2014 2014
Available online: 5 December 2014
Keywords
Kinetosis
Causes
Inorganic
Effects
Management
ABSTRACT
One of the major fears that grips about 50% of travelers, either by air, road ,sea
or any other means of transportation is a very uncompromising situation know
as motion sickness. This condition is branded ―uncompromising‖ because ones
it sets in, nothing else matters, all attention must be focused on how to resolve it.
In medicine, it is called ―kinetosis‖ because it is associated with movements.
This condition has made so many people to think a lot whenever they are going
to make any form of travelling, and has ultimately reduced some people to
limited distances and short destinations. It is also a source of worry to
commuters and passengers because a sufferer must be made to get him/herself if
the situation gets bad and everybody has to wait until the situation is calmed.
This review is aimed at checking the possible cause of kinetosis, its effects on
the sufferer and how to manage it. It also reviewed the prevalence of the
sickness among adult and children travelers.
*Corresponding author
E-mail:[email protected]
Mobile: +601126653991, +234803898479
Introduction
It has been accepted that the vestibular system
Motion sickness or kinetosis, also known as travel
influences
sickness, is a condition in which a disagreement
susceptibility (MSS) since patients with bilateral
exists between visually felt movement and the
vestibular
sense of movement in the middle ear. ―Sensory
susceptibility or do not become motion sick at
conflict‖ theory is one of the most established
all.2,3 This sensory mismatch leads to an activation
theories to explain in which circumstances motion
of vestibule autonomic pathways, which have been
sickness arises1. This theory assumed that motion
shown to be also involved in producing nausea and
sickness originates from a sensory disagreement
vomiting during motion sickness and those that
between real versus expected invariant patterns of
generate
vestibular, visual and somato -sensory inputs1.
Depending on the cause, it can also be referred to
individual
deficit
illness
motion
have
after
sickness
greatly
ingestion
of
reduced
toxins3.
as sea sickness, simulation sickness, car sickness,
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Ishmael UC, Rashid SS, Chibuike UB / Journal of Biotechnology Science Research.2014;1(3):63-74
or airsickness4,
are
are usually perceived to be neurotoxins7. The
dizziness, tiredness, fatigue, and nausea and
chemoreceptor trigger zone (CTZ) which lies in
vomiting.
In some case, headache has been a
the area postrema in the brain stem made up the
symptom of kinetosis. Sopite syndrome in which a
vomiting center which is responsible for inducing
person feels fatigue or tiredness is also associated
vomiting when poisons are felt in the gastro
with motion sickness. Nausea in Greek means
intestinal system, and for resolving conflicts
seasickness (naus means ship) according to
between vision and balance. A conflict between
Woodhouse's English-Greek Dictionary5. If the
the sense of sight and sense of balancing usually
motion causing nausea is not resolved, the sufferer
puts the whole body in trouble and this is usually
will usually vomit. Vomiting won't relieve the
resolved through the induction of vomit by the
feeling of weakness and nausea, which means the
vomit center in the brain. When motion is felt but
person could vomit until the cause of nausea is
not seen (for example, in a ship with no windows),
found. The person will even be feeling more tired
the inner ear sends signals to the brain that it
and tends to vomit more unless the cause of nausea
senses motion, but the eyes tell the brain that
is resolved.
everything is still. As a result of the mismatch, the
Causes of kinetosis
brain will come to the conclusion that one of them
One of the best hypotheses for the explanation of
is seriously not sound and further conclude that the
the cause of motion sickness is that it functions as
hallucination is due to poison ingestion. The brain
a normal way the body defends itself from toxins
responds by inducing vomiting, to clear the
through the help of the neurological centers in the
supposed toxin. This is the real cause of vomiting
brain. The centers produce neurotransmitters such
which will tend to remove the toxin from the body.
as acetylcholine and dopamine which stimulates
An alternative theory, also known as the
the chemoreceptor trigger zone (CTZ) in the brain
Nystagmus Hypothesis8, has been proposed based
stem. The activation of the CTZ receptors sends
on activation of the vagus nerves resulting from
signals to other vomit control centers to induce
the stretching or traction of extra-ocular muscles
vomiting. Various chemicals such as serotonin,
co-occurring with eye movements caused by
dopamin, and /or muscarinic and cholinergic
vestibular stimulation. There are three aspects of
receptors in the CTZ are stimulated which leads to
the theory: first is the remarkably close linkage
induction of vomit through the coordinated
between activity in the vestibular system, i.e.,
generation of action potentials with the vomit
semicircular canals and otolith organs in the
control area that ends up in vomiting6. The toxins
middle ear, and a change in tonus among each of
its common symptoms
4
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the eye's six extra-ocular muscles. Thus, with the
2. Motion sickness caused by motion that is seen
exception of voluntary eye movements, the
but not felt.
vestibular and oculomotor systems are thoroughly
3. Motion sickness caused by mismatch of the
linked.
senses.
Second is the operation of Sherrington's Law9
Motion is felt but not seen
which describes reciprocal prevention between
In these cases, motion is sensed by the vestibular
agonist/antagonist muscle pairs, and by implication
system in the middle ear and hence the motion is
the stretching of extra-ocular muscle that must
felt, but no motion or little motion is detected by
occur whenever Sherrington's Law is made to fail,
the visual system. Examples of such situation
thereby causing an un-relaxed (contracted) muscle
include;
to be stretched.
Carsickness
Finally is the critical presence of afferent output to
Car sickness is very common and often shown by
the Vagus nerves as a direct result of eye muscle
ones inability to read a map or book during travel.
stretch or traction10. Thus, stimulation of the 10th
Trying to read a book, a map, even from an
nerve resulting from eye muscle stretch is
electronic device, down to watching a movie inside
proposed as the cause of motion sickness.
a moving car worsens the situation. Car sickness
This theory is supported with the fact that people
results from the sensory conflict arising in the
without Labyrinthine are immune to motion
brain from differing sensory inputs-sight and
sickness and also why symptoms emerge when
balance. The eyes mostly see the interior of the car
undergoing various body/head accelerations; why
which is stable while the vestibular system of the
combinations of voluntary and reflexive eye
inner ear senses motion as the vehicle goes around
movements may challenge the proper operation of
corners or over hills and even small bumps. This is
Sherrington's Law; and why many drugs that
more encountered when travelling a long distance
suppress eye movements also serve to suppress
on poorly maintained roads. Therefore the effect is
motion sickness symptoms.
worse when looking down but may be lessened by
Types of motion sickness
looking outside of the vehicle or ahead of a driver,
Motion sickness can be divided into three types
making sights and gazes of far objects as
depending on presentation
movement advances towards them.
1. Motion sickness caused by motion that is felt
Airsickness
but not seen.
Airsickness is a sensation which is induced by air
travel4. It is a specific form of motion sickness and
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is considered a normal response in healthy
Rotating devices such as centrifuges used in astronaut
individuals.
as
training and amusement park rides such as the Rotor,
carsickness but occurs in an airplane. However,
Mission Space and the Graviton can cause motion
some significant differences are that an airplane
sickness in many people. While the interior of the
may bank and tilt sharply and due to the small
centrifuge does not appear to move, one will
window sizes, unless the passenger is at a window
experience a sense of movement. In addition,
seat he is likely to see only the stationary interior
centrifugal force can cause the vestibular system to
of the plane. Another factor is that while in flight,
give one the sense that downward is in the direction
the view out of windows may be blocked by
away from the center of the centrifuge rather than the
clouds, preventing a passenger at the window from
true downward direction. Centrifugal movements set
seeing the moving ground or moving lower clouds.
the fluid in the middle ear into motion and if this
It is actually less severe in air plane as the tires of
motion is not supported by sighting the motion,
the aircraft are not making much contact with the
kinetosis is imminent. When one spins and stops
ground but tilts and bends may cause kinetosis.
suddenly, fluid in the inner ear continues to rotate
Sea-sickness
causing a sense of continued spinning while one's
Seasickness is a form of motion sickness
visual system no longer detects motion.
characterized by a feeling of nausea and, in
Motion that is seen but not felt
extreme cases, vertigo experienced after spending
In these cases, motion is detected by the visual system
time on a craft on water4. It is, again, essentially
and hence the motion is seen, but no motion or little
the same as carsickness, though the motion of a
motion is sensed by the vestibular system. When
watercraft tends to be more constant. It is typically
motion sickness is caused by imbalance from visually
brought on by the rocking motion of the craft11, or
perceived motion but poorly felt, it is called Visually
movement while immersed in water12. As with
Induced Motion Sickness (VIMS)13.
airsickness, it can be difficult to visually detect
Motion sickness due to films and other video
motion even if one looks outside of the boat as
This type of sickness is particularly prevalent when
water does not offer fixed points with which to
people are watching films on large screens but may
visually judge motion. Poor visibility conditions,
also occur in regular format theaters or even when
such as fog, may worsen seasickness. Some
watching TV. They feel the movements on screen as
sufferers of carsickness are resistant to seasickness
if they are being involved thereby seeing movement
and vice-versa.
but actually they are not feeling it. This imbalance
Centrifuges
leads to perception that one organ is actually in a
It
is
essentially
the
same
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Ishmael UC, Rashid SS, Chibuike UB / Journal of Biotechnology Science Research.2014;1(3):63-74
hallucinating condition and needs to be resolved. In
The phenomenon was well known in popular culture
regular format theaters, an example of a movie that
before it was known as simulation sickness. In the
caused motion sickness in many people is The Blair
1983 comedy film Joysticks, the manager of a local
Witch Project. Theaters warned patrons of its possible
video arcade says, "The reason why I never play any
nauseating effects, cautioning pregnant women in
of these games, well, they make me physically ill. I
particular. Motion than the average movie camera.
mean, every time I look in one of the screens, they
Home movies, often filmed with a hand-held camera,
make me dizzy."
also tend to cause motion sickness in those that view
Motions that are seen and felt but do not
correspond
When moving within a rotating reference frame such
them. The camera-person rarely notices this during
filming since his/her sense of motion matches the
motion seen through the camera viewfinder. Those
who view the film afterward only see the movement,
which may be considerable, without any sense of
movement. Using the zoom function seems to
contribute to motion sickness as well as zooming is
not a normal function of the eye. The use of a tripod
or a camcorder with image stabilization technology
while filming can minimize this effect.
condition where a person exhibits symptoms similar
sickness
causes a sense of motion in the vestibular system that
does not match the motion that is seen.
Sometimes when riding a vehicle for a long time on a
badly maintained road at a very slow (10–20 km/h)
speed the two senses fail to correspond. Due to the
poor road quality the vehicle will jerk too much
due to the slow speed the eye doesn't sense a
Simulation sickness, or simulator sickness, is a
motion
simulated with centrifugal force, the Coriolis Effect
giving a sense of severe motion to the inner ear, but
Simulation sickness
to
as in a centrifuge or environment where gravity is
caused
by
playing
computer/simulation/video games.
The symptoms are often described as quite similar to
that of motion sickness, and can range from headache,
drowsiness, nausea, dizziness, vomiting and sweating.
Research done at the University of Minnesota had
students play Halo for less than an hour, and found
that up to 50 percent felt sick afterwards. This usually
affects people who already have a tendency to get car
proportional amount of motion leading to a sensation
of toxicity and subsequent nausea.
Motion sickness caused by strong offensive smell
Among factors that may contribute to motion
sickness, such as alcohol or hunger, the presence of
strong smells is very often reported by individuals
who are sensitive to motion sickness15.
General susceptibility
90% of individuals are reported having experienced
motion sickness at least once in their lifetime. Indeed,
motion sickness has been described as a normal
14
sick or sea sick .
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response to an abnormal situation, it’s never a disease
One of the greatest effects of kinetosis on sufferer is
per se.
the feeling of dizziness long after the situation has
Table 1. Motion sickness experienced by adults and
children when reading in passenger vehicles
16
been resolved. Dizziness is an impairment in spatial
perception
and
stability.
(Dorland's
Medical
Dictionary)dizziness does not have a direct meaning
QUESTION
Frequency
of
motion
sickness
when
reading
Severity of
motion
sickness
when
reading
Never
Rarely
Sometimes
Often
Usually
Always
None
Mild
Moderate
Severe
ADULT
(%)
43
15
17
9
8
9
43
25
22
10
CHILDREN
(%)
69
9
9
3
6
3
69
22
3
6
and can be referred to as vertigo, presyncope,
disequilibrium(Reeves et al 2008) or a non-specific
feeling such as giddiness or foolishness18.
Fatigue
Fatigue
(also
called
exhaustion,
tiredness,
languidness, languor, lassitude, and listlessness) is a
subjective feeling of tiredness which is distinct from
weakness, and has a gradual onset. Unlike weakness,
fatigue can be alleviated by periods of rest. Fatigue
Individual differences in susceptibility
can have physical or mental causes. Physical fatigue
Age
is the transient inability of a muscle to maintain
Motion sickness does not affect children who has a
optimal physical performance, and is made more
less developed sense organs, within two years of age,
severe by intense physical exercise19,20,21. Mental
and the elderly ones with a defective sense organs4,1.
fatigue is a transient decrease in maximal cognitive
Gender
performance resulting from prolonged periods of
In general, women are more prone to motion sickness
cognitive activity. It can manifest as somnolence,
than are men4,1 but, female astronauts do not report
lethargy, or directed attention fatigue. Medically,
more frequent motion sickness than do male
fatigue is a non-specific symptom, which means that
astronauts4, meaning that there is no gender
it has many possible causes including kinetosis.
differences in susceptibility.
Vomiting
Behavioral styles
Vomiting (known medically as emesis and informally
Introverted individuals and field-dependent persons
as throwing up and numerous other terms) is the
appear to be more susceptible to motion sickness than
involuntary, forceful evacuation of the contents of the
other individuals 4,1.
content of the gut through the mouth and the nose22.
Effects of Kinetosis
Vomiting can be caused by a wide variety of
Dizziness
conditions; it may present as a specific response to
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ailments like gastritis or poisoning, or as a non-
Although it is said that either eaten or not does not
specific outcomes of disorders ranging from malaria,
have effect on the occurrence of kinetosis, it is
typhoid fever and brain tumors. The feeling that one
strongly suggested that sufferers eat at least 30
is about to vomit is called nausea, which often
minutes before setting up for their journey, sense or
presents first, but does not always lead to vomiting in
feeling of hunger aggravates the possibility of having
most cases if the offending situation is solved, but if
an episode of kinetosis. Oily foods do give a great
not resolved, about 80% of nauseated conditions leads
quenching effect to the onset of kinetosis.
to vomiting. Antiemetics, which are drugs that
Have a beverage handy
inhibits vomiting are sometimes necessary to suppress
While travelling, make sure to have a bottle of
nausea and vomiting. In severe cases, where
beverage with you which you have to be taking as
dehydration develops, intravenous fluid may be
often as possible. Water is a common beverage that
required.
does this magic so often. Drink as often as you could
Loss of appetite
because when you keep having water in your tummy,
Food is not a matter of interest within two or three
the feeling of a toxin which the brain detects during
hours post kinetosis. Sufferers usually complain of
sensory conflicts between the eyes and the sense of
not being able to eat after about two hours of kinetotic
balance will be minimized, thereby delaying the
episodes and tend to regain appetite after a long time
brains response to initiate vomit as a cautioning
of rest and possibly a short nap. Appetite and strength
effect. Get a good night's sleep before you travel, eat a
lost during the episodes of nausea and correspondent
light lunch, avoid alcohol, coffee and nicotine.
vomiting that follows kinetosis is a major contributor
Have some candy
to the loss of appetite and exhaustive feeling.
Taking some candies made of either ginger or garlic
Prevention and mitigation of motion sickness
has proved good to reduce or delay the possibility of
Many have not come across the different ways of
having kinetosis during travelling23, although the
preventing kinetosis when embarking on long
mechanism of this action has not been fully
distance travels and it is very necessary that those that
understood. Adding distractions such as listening to
have suffered this sickness know some of the things
music or using aromatherapy scents such as mint or
to do when embarking on their journeys, because
lavender also helps. Flavored lozenges may also help,
once a sufferer is always prone to it. Some of the
in particular ginger-flavored. Lozenges may also
basic things to do include.
function as distractions or, in the case of ginger, may
Have something in your tummy
hasten gastric emptying.
Have no memory of past episodes
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vehicles4,25,26.
Having thoughts of the past episode of kinetosis
passenger
However,
one
study
usually raises the chances of an attack and it is
concluded that fore-aft pitch motion contributes twice
recommended that sufferers try as much as possible
as much to motion sickness as does lateral roll
not remembering how the past experience was,
motion25. These findings are consistent with the
because this is going to trigger the brains’ vomit
notion that lying down flat and facing up (i.e.,
center to feel the body is undergoing same conditions
supine), generally helps to lessen the effects of
as before and, an episode is always the next thing to
motion sickness1,4,28. Not only does this position
follow. To avoid a repeat episode, always try to forget
modify the main axes of the body relative to the
the last experience you had during travelling and have
motions and forces of the vehicle, but it may also lead
a positive mindset towards your journey.
to better overall postural stability, especially for the
Avoid movies and reading onboard vehicles
head. Conversely, the standard vertical seating
Watching movies and reading articles on a moving
position found in passenger vehicles is associated
vehicle contributes to kinetosis. Viewing video is less
with a significantly higher incidence of motion
often the cause of motion sickness than is reading.
sickness4,25. However, postural adjustments are not
Similarly, viewing video is less often the cause of
always possible or practical in passenger vehicles,
severe motion sickness than is reading. However, if
especially in the case of the driver or when an
one considers only those respondents who do
individual is attempting to view video on a screen that
experience motion sickness, then the severity levels
is mounted in a fixed location. If adopting the supine
for both activities are similar. Motion sickness while
position is not possible, restricting head motion is a
viewing video is less likely to occur for children than
good alternative postural adjustment25. Optimizing
for adults. When it does occur, it is less severe in
position to reduce motion or motion perception—for
children than adults1.
example, driving a vehicle instead of riding in it,
Posture
sitting in the front seat of a car or bus, or sitting over
Varying posture can affect the incidence and severity
the wing of an aircraft is important. Cabin location on
of motion sickness symptoms. Recent research24
a cruise ship does not appear to influence the
suggests that postural instability is one of the factors
likelihood of motion sickness25.
that contribute to the overall sensory conflict that
Closing the eyes
underlies motion sickness. Making much head
Given the underlying conflict between the sense of
movements is a contributing factor. Additionally,
sight and sense of balance that can cause motion
there is evidence that lateral and fore-aft motion and
sickness, another potential method for reducing or
forces contribute significantly to motion sickness in
stopping symptoms is to reduce or stop the conflicting
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stimuli input by closing the eyes. Visual input is most
Natural medicine
easily ―turned off‖ by simply closing one’s eyes. If
Out of nature's medicine cabinet comes ginger, in
individuals are not able to set their gaze and posture
capsule form or as natural ginger root, which soothes
to allow for a clear view of the forward scene and/or
intestinal disorders without stressing the stomach.
peripheral view of the horizon, then closing of the
Massages using rosemary or basil oil or a few drops
eyes has been shown to be of some benefit for
of lemon balm taken the day before departure also
reducing symptoms of motion sickness1,4,30 Indeed,
help. During the journey itself you can chew gum or
research has shown that restricting the outside and/or
suck on a lemon or an ice cube made of ginger29.
forward view within a passenger vehicle can actually
Another form of natural ways of treating kinetosis is
30
exacerbate the symptoms of motion sickness .
taking a nap, lying comfortably and having good
Adaptation
source of natural air, and if nausea persists, find your
Adaptation over time to the sickness-inducing stimuli
way out of the vehicle for a while.
has been reported to be one of the most effective
Medications
methods for the long-term prevention of motion
Antihistamines
sickness
1,4,28
. When you get use to a particular
Antihistamines have been used to treat motions
situation over time, it will automatically stop having
sickness. Notably, the non-sedating antihistamines do
any effect on you perception of its presence. The
not seem to be effective for motion sickness
process of adaptation involves extended exposure to
treatment. Induction of sleep is one of the most
an
visual-
classified ways effective medications works. Sleeping
vestibular stimuli, usually on multiple occasions and
or taking a short nap is a way of solving the
over an extended length of time. The main
imbalance that exists between the motion seen and
disadvantages to this prevention method are (1)
motion felt. Drugs that does not induce effective sleep
persistent kinetosis until adaptation is achieved, and
within a short period of administration is usually not
(2) the need for frequent access and exposure to the
seen as an immediate treatment to kinetosis.
environment in question. Though relief is not as
Sedatives are better for the management of kinetosis
immediate when compared to effective drugs or other
because they works in various ways-it will induce
countermeasures, adaptation generally provides more
sleep, and also takes care of the mucosal membranes
complete, innate and lasting relief which is naturally
for effective vomit control. Examples of antihistamine
established from motion sickness symptoms and has
medications
no side effects28.
chlorpheniramine (Aller-Chlor), cyclizine (Marezine),
Treatment of kinetosis/motion sickness
cyclizine HCI (Bonine for Kids),dimenhydrinate
environment
containing
conflicting
to
treat
motion
sickness
include:
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(Dramamine, Dramamine Chewable, Driminate),
Ephedrine and some amphetamines have been used
diphenhydramine (Benadryl), meclizine (Antivert,
both to treat motion sickness and to counteract the
Bonine, D-Vert, Dramamine II). Side effects may
sedating effects of other medical treatments. Studies
include significant sedation, drowsiness, dry mouth,
have also shown a beneficial effect of caffeine when
blurred vision, and confusion and urinary retention in
administered in combination with other medications
the elderly.
for motion sickness30. Benzodiazepines have also
Anticholinergic
been useful for some people with motion sickness.
Scopolamine (Transderm-Scop) is the most well-
Examples include: alprazolam (Xanax), and diazepam
known medication in this category. It has been shown
(Valium).
in clinical trials to be effective at preventing motion
Antiemetic (anti-nausea) medications have been used
sickness.
to control nausea and vomiting after motion sickness
Scopolamine
is
most
commonly
administered as a patch applied to the skin. Side
has developed. Examples include: prochlorperazine
effects are the same as those of the antihistamines
(Compazine), and ondansetron (Zofran)31.
(sedation, blurred vision, dry mouth, and confusion
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