Simulator sickness in patients with neck pain and vestibular pathology during virtual reality tasks

Immersion in virtual environments can cause simulator sickness (SS). Further, head and neck movement in interactive virtual reality (VR) assessment and training stimulates the vestibular and cervical afferent systems that can cause dizziness in subjects with neck pain and vestibular pathology. This cross-sectional, observational, study investigated SS and factors that may influence this between 20 neck pain, 14 vestibular pathology and 20 asymptomatic control subjects. Pre-VR questionnaires included a visual symptom scale and dizziness intensity. SS measures included the simulator sickness visual analogue scale and the simulator sickness questionnaire. Significantly greater incidence of any SS and higher values were found in the vestibular and neck pain groups compared to the control group in selected SS measures. No significant differences were found when comparing SS measures between the vestibular and neck pain groups. Significant mild-to-moderate correlations for the entire population were found between both SS measures to pre-VR visual symptoms and dizziness intensity. SS levels in neck pain and vestibular populations are comparable and higher than asymptomatic individuals. Dizziness and visual disturbances may be associated with an increase in severity of SS in these clinical populations.