The consent was obtained from all participants.

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The design was
randomized, within-in participants, experimental study. The study duration was
for 2 months (10 Sep2017- 27 Nov2017), with intervention of 5 days per week for
2 weeks. The outcome measures, Motion Sickness Assessment Questionnaire (MSAQ)
and Diagnostic criteria for identifying the severity of acute motion sickness
was re-assessed at Baseline and at the end 2nd week of intervention
also a follow up was taken at the end of 8th week. The study was
approved (Ref. No. PIMS/CPT/IEC/2017/511) from the Institutional Ethical
Committee of  Dr. A.P.J. Abdul Kalam
College of Physiotherapy, Pravara Rural Hospital. Written informed consent was
obtained from all participants.


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Young adults of Pravara
Rural Hospital, Loni susceptible to motion sickness were eligible to
participate in study if they had visual acuity 6/6 on Snellen chart and those
diagnosed with motion sickness according to criteria for identifying the
severity of acute motion sickness. Participants between age group 18-30 years
and road travellers were included. Participants diagnosed with postural
instability, vestibular disorders, migraine with neurological deficit and
orthopedic condition, cognitive and perceptual deficit. Also Participants with
any respiratory problems and Pregnant females were excluded from the study.


  Total 46 subjects were screened out
of which 5 did not fit in
inclusion criteria. Then written informed consent was obtained
from the participants.

Pre training baseline scores were obtained for Motion Sickness
Assessment Questionnaire (MSAQ) and Criteria for identifying the severity of
acute motion sickness. Instructions were given to fill the questionnaire on the
basis of road travelling experience. Before starting with the training session,
few trials were given to the participants for the visual vestibular habituation
exercises and controlled breathing technique. Out of the remaining 41
participants 4 were not
willing to participate in the intervention programme and 7 discontinued the treatment on 3rd
day of 1st week of intervention.

The participants performed the exercises in a well-ventilated, spacious
exercise therapy unit of the physiotherapy department of Pravara Rural
Hospital.  Instructions to turn off their
mobile phones or keep them on silent mode, to maintain silence, to concentrate
on the breathing pattern, and to concentrate on visual vestibular exercises
throughout the session were given to them prior to each intervention.
Participants were told that while doing the exercises they might experience
symptoms of motion sickness and were also reminded that they could discontinue
the exercise at any time, for any reason (see Table 1 and 2 for Visual
vestibular habituation and Controlled breathing Protocol).

The total interventional protocol was conducted for 45 min, i.e. 30 min
of Visual vestibular habituation exercises and 15 min for controlled breathing
techniques. Intervention was given for 5
days per week for 2 weeks under supervision of researcher. Also Home
exercise program was taught which will be twice per week for remaining 8 weeks.
To rule out the bias participants were requested to avoid travel during 2 weeks
of intervention.

The participants demonstrated an ability to safely
complete stage 1 visual vestibular exercises, step 1 through 5 for 10 sec for
first two days of intervention without any increase in symptoms along with
diaphragmatic breathing. Then they were asked to continue the same exercises
for 30 sec for the remaining 3 days if they experience no increase in symptoms.
Those who could not continue the exercises for 30 sec or if they felt increase
in symptoms were asked to do the exercises for 10 sec until they felt decrease
in symptoms or were instructed to stop if the symptoms were alleviated. They
were instructed to monitor their reactions to exercises (e.g. An increase or
decrease in symptoms) and to note them in a daily log book. They were to
proceed to stage 2 activities as instructed for the 2 week of intervention when
they could complete all stage 1 exercises without symptoms. They were asked to
perform the exercises for 30 sec, if they experience any severe reactions they
were told to stop the exercises and contact the therapist. Exercises were to be
performed daily

After the end of 2 week re-assessment using, the MSAQ questionnaire and
severity of acute motion sickness criteria was done.



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