Innovation of transportand industry have extended the range of provocative motion environments, tocars, tilting trains, funfair rides, aircraft, and simulators.1 ThusMotion sickness is a common problem in people travelling by train, airplane,boat and especially cars.

Also people experience motion sickness from virtualreality, head-mounted displays and also smart phones with sophisticatedgraphics.2 Susceptibility to motion sickness is significantly higherin individuals who suffered from spatial disorientation (35.05%), migraine(26.31%), gastrointestinal disorders (26.82%) and those who were more sensitiveto unpleasant odors (24.64%).

Females (27.3%) are more susceptible to motionsickness than males (16.8%).6 Initial symptoms is discomfort aroundstomach, followed by nausea. With rapid worsening of symptoms there can besalivation changes, dizziness, retching and sopite related symptoms.

3,4The primary functionsof the vestibular system are spatial orientation, maintenance of balance, andstabilizing of vision through vestibular–ocular reflexes.15Motion issensed by the brain through three different pathways of nervous system thatsend signals coming from inner ear( sensing motion, acceleration, gravity), theeyes(vision),and the deeper tissues of body surface(proprioceptors). When thereis an unintentional movement of the body, the brain responds to unfamiliarmotion stimuli which are transmitted to vestibular nuclei. This unfamiliarmotion stimuli is sensed by vestibular labyrinth, the eyes and proprioceptorsand travel to vestibular nuclei, then through cerebellum to vomiting centrelocated in the parvicellular formation of medulla oblongata, this conflict amongthe brain and the three pathways lead to motion sickness.

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16Currently the “neural mismatch theory” states that motion sickness canoriginate from within a single sensory system (e.g., canal-otolithinteraction), or between two or more sensory systems (e.

g. visual-vestibularinteraction).19,20 As the vestibular system plays a crucial role in the inducement ofmotion sickness, vestibular habituation exercises will help reduced motionsickness. Repetitive vestibular stimulation can therefore cause changes inVestibulo-Ocular Reflex (VOR) and at the same time a reduction in sensitivityto motion sickness.30 Habituation exercisesare based on the idea that repeated exposure to a provocative stimulus (e.g.head movements) will lead to a reduction of the motion-provoked symptoms.

32These exercises cause a habituation effectcharacterized by decreased sensitivity and duration of symptoms canoccur in as quickly as 2 weeks but may take as long as 6 months.31Effects of breathing strategy have explored by number of experts. Paul Lehrer aleading researcher in area of relaxation training showed that breathingapproach can be quite successful in in reducing physiologic activation of thesympathetic nervous systems.33A commonly usedDiagnostic Criteria for Identifying the Severity of acute motion sickness andthe Diagnostic Scale, referred to as Motion Sickness Assessment Questionnairewhich is a reliable method for scoring overall motion sickness with the use offour subscales is used in this study for rating these symptoms of motion and todifferentiate motion sickness symptoms along four dimensions: gastrointestinal,central, peripheral, and sopite-related.

36Although motionsickness affects nearly one third of all people who travel by land, sea, orair, little documentation exists regarding prevention and management. Repeatedrecurrence of sickness is not desirable or practical to daily living. Limitedevidence is available for Controlled breathing and visual-vestibularhabituation training for motion sickness that does not provoke the undesirablesymptoms and can last for upwards of a year.

Thus aim of this study was to helpdetermine the effectiveness of visual vestibular habituation and controlledbreathing for motion sickness. The research questions were: Is visual-vestibularhabituation and controlled breathing effective for motion sickness? Will therebe any difference in severity of motion sickness when treated with visualvestibular habituation and controlled breathing for motion sickness?