11/27. Control of simulator sickness in an AH-64 aviator. An active 33-year-old Army AH-64 aviator with simulator sickness refractory to routine preventive measures was successfully managed with transdermal scopolamine. Although adaptation is the ultimate means for control of simulator sickness, the use of anti-motion sickness medication, specifically transdermal scopolamine, may be a useful adjuvant in selected aviators. ( info) |
12/27. Transdermal scopolamine-induced psychosis. Transdermal scopolamine (Transderm-Scop) is being increasingly used for effective prophylaxis of motion sickness. It is reported to have a lower incidence of CNS side effects than orally administered scopolamine. Although uncommon, such side effects occur more often in the elderly, in those with preexisting psychiatric disease, and in patients concurrently taking other medications with anticholinergic activity. Correct diagnosis may be delayed by the occult location of the delivery system, delayed onset of symptoms, prolonged action, absence of peripheral manifestations, and negative toxicologic screening tests. Treatment is usually supportive. physostigmine should be reserved for the treatment of severe symptoms. ( info) |
13/27. Simulator sickness: a problem for Army aviation. "Simulator Sickness" describes a symptom complex frequently reported by pilots during or after flight simulator training. There were 112 helicopter pilots at a U.S. Army AH-1 Cobra Flight weapons Simulator (FWS) who completed a symptom-oriented subjective questionnaire. Of these, 40% reported symptoms of dysequilibrium; pilots developing simulator sickness had significantly more total and AH-1 flight time. Adaptation to the syndrome occurred with increasing FWS experience. The history and aeromedical significance of simulator sickness are briefly reviewed, and a case report presented. A mandatory grounding policy in use locally is described. Potential treatment strategies are briefly discussed. ( info) |
14/27. Persistent mal de debarquement syndrome: a motion-induced subjective disorder of balance. Six patients with a distinct syndrome of persistent sensations of imbalance are presented. Common features included onset following a period of motion exposure, symptoms lasting months to years, mild unsteadiness and anxiety, minimal relief from antivertiginous medication, and normal neurologic and quantitative vestibulo-ocular examinations. One patient experienced recurrent episodes. Mal de debarquement refers to sensations of motion experienced on return to stable land after adaptation to motion lasting from hours to days in normal individuals. The presented patients exemplify a syndrome of persistent mal de debarquement. The entity is found in a relatively small number of dizzy patients. Persistent mal de debarquement is discussed in the context of what is known about long-term vestibulo-ocular adaptation to alterations of visual or vestibular environments. ( info) |
15/27. Vision therapy as a treatment for motion sickness. A case of visually-induced motion sickness (VIMS) is presented. The patient underwent a program of dynamic adaptive vision therapy which relieved her symptoms of motion sickness. Symptoms of VIMS may include photophobia, an inability to read in a moving auto, and nausea, dizziness, headache, eye strain and anxiety following provocative visual stimuli. The neural mismatch theory is discussed. ( info) |
16/27. Remote cerebral hemisphere symptoms from surgically treated patients with posterior fossa brain tumors; vascular factors: a basis for a theory concerning space sickness. Three case histories of patients with large tumors in the posterior fossa who were operated on in a sitting position subsequently developed 1 or more symptoms referable to the temporoparietooccipital regions of the brain 24 to 48 hours postoperatively. Initially, it was believed that such symptoms were due to a stimulation of the association pathways causing firing of remote association areas (See Ch. 4). Subsequent studies of the rotation of blood vessels of the brain in the developing embryo and a review of the anatomical location of the arteries supplying the temporoparietooccipital region led to the conclusion that some compromise of the posterior cerebral artery was responsible for the symptoms. The symptomatology in these brain tumor patients was not unlike that seen in the cosmonauts and astronauts in space flight, designated as "motion sickness" in the space literature. A suggestion was made as to clarification of the definitions. This author advocated that the term "motion sickness" be confined to those symptoms of dizziness, nausea, and vomiting, due to involvement of the peripheral end organ, the inner ear. "Space sickness" might include these symptoms but also might have the addition of disorientation or the inversion of image in space and formed or unformed hallucinations. These relate to the temporoparietooccipital area, the midtemporal, and the occipital regions. In such instances, there must be central involvement or a stimulation of this interpretive cortex of the brain. The remote symptoms from the supratentorial cotex were believed to be due to hypoxia related to the posterior cerebral artery compromise, resulting in delayed "luxury perfusion" and the development of local lactic acidosis. Transaxial transmission of force with an uncal tentorial herniation causing compression of the posterior cerebral artery was suggested as a mechanism responsible for the vascular compression. ( info) |
17/27. Self-control desensitization with cue-controlled relaxation for treatment of a conditioned vomiting response to air travel. A 33 yr old female with a flying phobia which involved frequent conditioned vomiting and fainting was successfully treated by a combination of self-control desensitization and cue-controlled relaxation. A 12 and 18 month follow-up indicated that treatment effects were maintained. Implications are discussed of this procedure for the treatment of conditioned nausea and vomiting resulting from cancer chemotherapy. ( info) |
18/27. Transdermal scopolamine delivery system (TRANSDERM-V) and acute angle-closure glaucoma. A 58-year-old woman developed unilateral acute angle-closure glaucoma four days after the application of a patch of transdermal scopolamine delivery system (TRANSDERM-V). ( info) |
19/27. Prevention of motion sickness in flight maneuvers, aided by transfer of adaptation effects acquired in the laboratory: ten consecutive referrals. Ten flyers, grounded because of nausea and vomiting, were referred as potential candidates for adaptation to cross-coupled angular accelerations in a slow-rotation room; such adaptation has been shown to "transfer" to flight maneuvers. There was no opportunity to attempt treatment in two candidates. Among the remaining eight, five regained flight status (62.5%); follow-up periods of those five candidates ranged from 10 to 27 months. In one of the three remaining candidates, a satisfactory level of adaptation was achieved but more than 4 months elapsed before his assignment to a duty squadron. After becoming sick in his first flight (F-104), he submitted a request to be removed from duty involving flying. In the remaining two candidates, the rate of their acquisition of adaptation not only was very slow but also, after leveling off, actually declined. In other words, poor as well as good performance is demonstrable in the slow-rotation room. ( info) |
20/27. Antimotion-sickness efficacy of scopolamine 12 and 72 hours after transdermal administration. The antimotion sickness remedy, transdermal therapeutic system-scopolamine, administered in this experiment was scheduled to deliver 1.0 mg of scopolamine over a period of 3 d, and this paper compares its efficacy 12 and 72 h after administration. In a double-blind study, six male college students were individually exposed to a standardized provocative test in a slow rotation room after six apparently identical treatments comprising four placebos and two medications. Efficacy was categorized as beneficial, inconsequential, or detrimental. None of the responses was detrimental. Following the first administration of the therapeutic system, there were four beneficial responses after 12 h but none was beneficial after 72 h. Following the second treatment regimen, there were four beneficial responses after 12 h and three beneficial responses after 72 h. Great individual differences were demonstrated, two subjects accounting for six beneficial responses and two accounting for only one beneficial response. The difference in efficacy after 12 and 72 h has practical and theoretical significance. ( info) |