The utilization of commercially available virtual reality (VR) environments has increased over the last decade. Motion sickness that is commonly reported while using VR devices is still prevalent and reported at a higher than acceptable rate. The virtual reality induced symptoms and effects (VRISE) are considered the largest barrier to widespread usage. Current measurement methods have uniform use across studies but are subjective and are not designed for VR. VRISE and other motion sickness symptom profiles are similar but not exactly the same. Common objective physiological and biomechanical as well as subjective perception measures correlated with VRISE should be used instead. Many physiological biomechanical and subjective changes evoked by VRISE have been identified. There is a great difficulty in claiming that these changes are directly caused by VRISE due to numerous other factors that are known to alter these variables resting states. Several theories exist regarding the causation of VRISE. Among these is the sensory conflict theory resulting from differences in expected and actual sensory input. Reducing these conflicts has been shown to decrease VRISE. User characteristics contributing to VRISE severity have shown inconsistent results. Guidelines of field of view (FOV), resolution, and frame rate have been developed to prevent VRISE. Motion-to-photons latency movement also contributes to these symptoms and effects. Intensity of content is positively correlated to VRISE, as is the speed of navigation and oscillatory displays. Duration of immersion shows greater VRISE, though adaptation has been shown to occur from multiple immersions. The duration of post immersion VRISE is related to user history of motion sickness and speed of onset. Cognitive changes from VRISE include decreased reaction time and eye hand coordination. Methods to lower VRISE have shown some success. Postural control presents a potential objective variable for predicting and monitoring VRISE intensity. Further research is needed to lower the rate of VRISE symptom occurrence as a limitation of use.

Background: Taking inspiration from the classical 1974, “moving room experiment” by Lee and Aronson, a “virtual moving room paradigm (Vroom)” was designed using virtual reality (VR) to assess postural control behavior. Methods: Thirty healthy adults (age: 21 ± 1 years; height: 166.5 ± 7.3 cm; mass: 71.7 ± 16.2 kg) were tested for postural stability in a virtual moving room paradigm (Vroom). The Vroom consisted of randomized virtual and visual perturbations of the virtual room moving toward and away from the individual, during both unexpected and expected trials. Objective postural sway variables and subjective experiences to VR using the simulator sickness questionnaire as well as balance confidence scale were also assessed and analyzed using a two way (2 × 2 [2 moving room direction (Toward vs. Away) and 2 knowledge of moving room (unexpected vs. expected)] repeated measures analysis of variance (ANOVA), and a one-way repeated measures ANOVA and paired sample t-test, respectively at an alpha level of 0.05. Results: Significantly greater postural sway was observed when the virtual room moved toward the participant than when moving away, and when it moved unexpectedly, compared with the expected moving room. Significantly improved balance confidence with realistic immersion and without simulator sickness was also observed. Conclusions: Our findings provide evidence indicating that the virtual moving room induces postural perturbations that challenge the postural control system, especially when the moving room is unexpected and moves toward the individual. Additionally, increased balance confidence and realistic immersion in the virtual environment with no adverse effects of simulator sickness were observed, providing evidence for the beneficial effects of the Vroom. Thus, the Vroom can be an easy and cost-effective method to expose individuals to realistic, virtual, and visual perturbations that challenge the postural control system and increase balance confidence, with realistic immersion and without adverse effects.

Background: Changes in the visual environment and thereby, the spatial orientation, can induce postural instability leading to falls. Virtual reality (VR) has been used to expose individuals to virtual environments (VE) that increase postural threats. Claustrophobia is an anxiety disorder categorized under situational phobias and can induce such postural threats in a VE. Purpose: The purpose of the study was to investigate if VR-generated claustrophobic simulation has any impact on postural threats that might lead to postural instability. Methods: Thirty healthy men and women (age: 20.7 ± 1.2 years; height: 166.5 ± 7.3 cm; mass: 71.7 ± 16.2 kg) were tested for postural stability while standing on a force platform, upon exposure to five different testing trials, including a normal stance (NoVR), in stationary VE (VR), and three consecutive, randomly initiated, unexpected claustrophobia trials (VR CP1, VR CP2, VR CP3). The claustrophobia trials involved all four walls closing in towards the center of the room. Center of pressure (COP)-derived postural sway variables were analyzed with a one-way repeated measures analysis of variance at an alpha level of 0.05. Results: Significant main effect differences existed in all but one dependent COP-derived postural sway variables, at p < 0.05. Post-hoc pairwise comparisons with a Bonferroni correction revealed that, predominantly, postural sway excursions were significantly lower in claustrophobia trials compared to NoVR and VR, but only accomplished with significantly increased sway velocity. Conclusion: The VR CP trials induced lower postural sway magnitude, but with increased velocity, suggesting a bracing and co-contraction strategy when exposed to virtual claustrophobic postural threats. Additionally, postural sway decreased with subsequent claustrophobia trials, suggesting potential motor learning effects. Findings from the study offer insights to postural control behavior under virtual claustrophobic simulations and can aid in VR exposure therapy for claustrophobia.