Cybersickness in Different Multisensory Conditions in Virtual Reality

Analysis of Cortical Activity in Individuals With Cybersickness Under the Influence of Multi-sensory Conditions in Virtual Reality: a Randomized Crossover Study

Cybersickness (CS) is characterized as a type of visually induced motion sickness, similar to traditional motion sickness, with specific clinical presentations such as dizziness, eyestrain, oculomotor disorders, blurred vision and spatial disorientation. It can be triggered when experiencing virtual reality (VR), and it affects approximately 20% to 80% of individuals who use these resources. Furthermore, the underlying mechanisms of CS are not fully understood and the use of virtual environments that have become increasingly recurrent in several sectors deserves attention, as VR is becoming commonplace in methods and techniques of assessment, diagnosis and treatment. Objective: to analyze cortical electrophysiological activity using electroencephalography (EEGq) in individuals with SC, under the influence of different audiovisual conditions. Methodology: The study is a double-blind randomized controlled clinical trial, the sample for survey satisfaction N= 42 participants, the public were university students from the Universidade Federal do Delta Parnaíba (UFDPar) of both sexes, aged between 18 to 28 years, those who agreed, underwent screening, those who met the criteria and fit, were randomized and allocated to one each of 02 conditions, (C1 - video only) and (C2 - associated with binaural audio), three times in each condition, with a duration of 10 minutes of immersion, with evaluation (pre) before (post) with QEEG and Sickness Questionnaire (SSQ), exposure to virtual content was on regular alternate days, with a 24-hour interval between each virtual exposure, at the end of each condition, there will be a 14-day washout and crossover between the conditions, and after the last intervention, there will be a 7-day follow-up and reassessment with qEEG and SSQ. The study will be carried out under all cleaning and prevention care in the fight against the Covid-19 pandemic, data collection will be at the Brain Mapping and Functionality Laboratory (LAMCEF) of the Federal University of Delta do Parnaíba, Piauí, Brazil. Results: The condition with binaural stimulation is expected to promote neuromodulation and reduction of CS symptoms, compared to the control condition.

OBJECTIVES General: To analyze whether the cortical activity of individuals with cybersickness is influenced by different multisensory conditions in virtual reality. Specific: To correlate if the oscillations of the absolute power of the alpha, delta and theta band frequencies of the frontal, parietal and occipital regions of the brain of individuals with cybersickness are influenced by different multisensory conditions; Check for differences in cortical activity between different conditions: visual only (VR) and visual binaural (VR+BB); To compare whether binaural beat induction can modulate cortical brain responses compared to the other conditions. ETHICAL ASPECTS: The study will be a randomized controlled double-blind clinical trial, with university students of both sexes in the city of Parnaíba - PI, volunteers who present cybersickness will be evaluated, those who meet the admission criteria will be randomized and allocated and will be immersed in three conditions, in these conditions the volunteers will be immersed in VR to induce symptoms, where bimodal conditions will be analyzed and compared to analyze the variable electrophysiological activity and the influence of multisensory conditions. The study will be developed under all cleaning and prevention care in the fight against the Covid-19 pandemic, data collection will be at the Brain Mapping and Functionality Laboratory (LAMCEF) of the Federal University of Delta Parnaíba, Piauí, Brazil. Patients who meet the inclusion criteria after the evaluation, if they agree with the experiment, will be informed about the procedures, will sign the Free and Informed Consent Term (ICF) after approval of the approval protocol by the Research Ethics Committee of the Federal University of Piaui. Everyone will be immersed in each of the conditions described. There will be the use of protective equipment from both parties, the evaluator with the proper use of gloves, masks, cap and lab coat, and the volunteer with the use of a mask. A minimum of 42 volunteers will be required, of both sexes, aged between 18 and 28 years, and they will not be able to present vestibulopathies, flu, claustrophobia and epilepsy, and musculoskeletal and neurological disorders. They will be instructed to abstain from the use of prescription drugs, alcoholic substances, and caffeinated beverages for at least 24 hours before each experiment. Sample To the satisfaction of the research, ANOVA with repeated measures, the sample size estimated a priori by power analysis, to detect the minimum clinically relevant difference between conditions, with an effect power of 0.5, alpha level of 0.05 two-tailed, statistical power of 80%. Starting with a primary outcome measure of 8% of the population of universities in Parnaíba, for the sample calculation there must be a total of 18 participants, assuming a dropout rate of 20%, the sample size of 20 participants in each condition is calculated.

The study will be a double-blind randomized controlled clinical trial, with university students of both sexes in the city of Parnaíba - PI, volunteers who present cybersickness will be evaluated, those who meet the admission criteria will be randomized and allocated and will be immersed in three conditions, in these conditions the volunteers will be immersed in VR to induce symptoms, where bimodal conditions will be analyzed and compared to analyze the variable electrophysiological activity and the influence of multisensory conditions.

Participants will not be aware of the intention of each of the immersion conditions, and will be randomized through a program for each of the conditions, by a researcher external to the research, and sorted through an opaque envelope, the participants and the researcher, not will know in which condition they will be allocated, only on the day of the draw, each participant will be allocated in the condition and the researcher will not be aware of which condition the participant will be immersed in (condition 01 - video only) or (condition 02 - video associated with binaural beat) .

Condition 01 - the participants will be induced to CS, they will be immersed in a roller coaster simulation video, lasting 10 minutes, there will be 05 sessions on alternate days with a 24-hour interval between each session, before and after each session will be applied the SSQ questionnaire subjective assessment and EEG objective assessment.

Condition 02 - the participants will be induced to CS, they will be immersed in a roller coaster simulation video associated with audio with binaural beat, lasting 10 minutes, there will be 05 sessions on alternate days with a 24-hour interval between each session, before and after each session, the SSQ subjective assessment questionnaire and the objective assessment EEG will be applied.

Condition 02- will be used binaural beats, since they are referred through studies with the ability to drive neural oscillations in the beat frequency through differential hemispheric synchronization frequencies, it is expected that a neuromodulation and repercussion of the symptomatological reduction of CS.

Analisys of absolute power of the alpha, delta and theta band frequencies of the frontal, parietal, temporal and occipital regions of the brain.

In pre-intervention procedures, the baseline cortical electroencephalography will be analyzed for 5 minutes. After immersion, the same procedures will be performed

Simulator Sickness Questionnaire (SSQ) is a widely used tool to assess the subjective severity of symptoms of simulator illness and cybersickness. It consists of 16 items, on a four-point scale (from 'none' to 'severe').

In the pre-intervention procedures, before the cortical analysis, the SSQ instrument will be applied, and immediately after each session, the subjective assessment instrument will be applied

Inclusion Criteria: Participants must have normal or corrected to normal vision Participant must have a history of visually induced motion sickness Exclusion Criteria: Cannot present vestibular disorders Claustrophobia Epileptic seizures Musculoskeletal disorders psychoactive drug use Neurological disorders Considerable hearing loss

https://www.scielo.br/j/jbpsiq/a/trfYrY8LfWzmpwh7Wqn9Cvr/?lang=pt#:~:text=O%20Simulator%20Sickness%20Questionnaire%20(SSQ,o%20n%C3%ADvel%20de%20cybersickness14.

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