Evaluation of the Effectiveness of Vestibular Rehabilitation With Virtual Reality Systems in Individuals With Visually Induced Motion Sickness
Phase: NA
Conditions: Motion Sickness, Space, Visually Induced Motion Sickness, Vestibular Rehabilitation in MS
Sponsor: Istanbul Aydın University

 
 
 
 
 
 
 
 
 
 
Evaluation of the Effectiveness of Vestibular Rehabilitation With Virtual Reality Systems in 
Individuals With Visually Induced Motion Sickness 
 
 
 
 
 
 
 
 
NCT: Pending 
 
 
 
 
 
 
 
 
 
Document Date: 
June 2025 
 
 
 
 
 
 
 
 
 
 
 

Study Protocol 
A test protocol was developed to provide vestibular rehabilitation using virtual reality systems 
for individuals with visually induced motion sickness (VIMS). 
The study protocol consists of three phases: 
 
In the first phase, all participants underwent the Simulator Sickness Questionnaire (SSQ) 
and static posturography tests, including Balance Screening and Limit of Stability assessments, 
prior to the initial evaluation. Subsequently, participants were exposed to 5 - minute YouTube 
open-access 360° virtual reality (VR) videos with varying difficulty levels determined 
beforehand. The initial evaluation lasted 30 minutes and was structured as follows: 5 minutes 
of easy stimulation followed by 5 minutes of rest, 5 minutes of moderate stimulation followed 
by 5 minutes of rest, and 5 minutes of high stimulation followed by 5 minutes of rest. During 
each 5-minute stimulation, heart rate and balance screening tests were measured at minutes 
1, 3, and 5. After the total 15 minutes of stimulation, final measurements including the SSQ, 
balance screening, and Limit of Stability tests were repeated (Table 1). 
Table 1 Phase I: Initial Evaluation Protocol 
 
Phase I 
Easy Level 
Moderate Level 
High Level 
 
 
 
 
 
Walking Video 
Driving Video 
Drone Video 
Pre-stimulation 
Simulator Sickness Questionnaire (SSQ) 
Balance Screening 
Limit of Stability 
Order 
of 
Stimulation 
During each 5- 
minute 
stimulation, 
Balance 
Screening 
(BS) 
and 
heart  rate 
measurements 
were  taken  at 
minutes 1, 3, and 
5. 
5-minute 
rest period 
During each 5- 
minute 
stimulation, 
Balance 
Screening (BS) 
and heart rate 
measurements 
were taken at 
minutes 
1,  3, 
and 5. 
5-minute 
rest period 
During each 5- 
minute 
stimulation, 
Balance Screening 
(BS) and heart rate 
measurements 
were 
taken 
at 
minutes 1, 3, and 
5. 
5-minute 
rest period 
Post-stimulation 
Simulator Sickness Questionnaire (SSQ) 
Balance Screening 
Limit of Stability 
Qualitative Data 
SSQ 
SSQ 
SSQ 
Collection Tool 
Stimulus 

Quantitative 
Data Collection 
Tool 
Balance Screening 
Heart Rate Monitor 
Balance Screening 
Heart Rate Monitor 
Balance Screening 
Heart Rate Monitor 
In the second phase, a four-week rehabilitation program was designed for individuals with 
VIMS, consisting of two 1-hour sessions per week (Table 2). The prepared rehabilitation 
program was administered to the study group using virtual reality systems. 
Table 2 4-week rehabilitation program 
 
Seans 
Seans 
Two sessions per week 
6 × 5-minute easy stimulations (with 
5-minute 
rest 
periods 
between 
stimulations) 
Two sessions per week 
6 × 5-minute moderate stimulations 
(with 5-minute rest periods between 
stimulations) 
Two sessions per week 
6 × 5-minute moderate stimulations 
(with 5-minute rest periods between 
stimulations) 
Two sessions per week 
6 × 5-minute high stimulations (with 
5-minute 
rest 
periods 
between 
stimulations) 
4 × 5-minute easy stimulations plus 2 × 5- 
minute moderate stimulations (with 5- 
minute rest periods between stimulations) 
2 × 5-minute easy stimulations plus 4 × 5- 
minute moderate stimulations (with 5- 
minute rest periods between stimulations) 
3 × 5-minute moderate stimulations plus 3 
× 5-minute high stimulations (with 5- 
minute rest periods between stimulations) 
30-minute final evaluation session: 1 × 5- 
minute easy stimulation + 2 × 5-minute 
moderate stimulations + 3 × 5-minute high 
stimulations 
In the third phase, following the rehabilitation program, participants were reassessed using the 
Simulator Sickness Questionnaire (SSQ), and static posturography tests, including Balance 
Screening and Limit of Stability assessments, were repeated. 
Statistical Analysis 
The data obtained in this study were analyzed using Statistical Package for Social Sciences 
(SPSS) for Windows, version 25.0. Descriptive statistical methods (number, percentage, 
minimum-maximum values, mean, and standard deviation) were used to summarize the data. 
The normality of the data was assessed using skewness and kurtosis values. For normally 
distributed data, independent-samples t-tests were used to compare quantitative variables 
between two independent groups, and paired-samples t-tests were used to compare two 
dependent groups. Pearson correlation was applied to examine relationships between numerical 
variables. For data that were not normally distributed, the Friedman test was used for 
comparisons of more than two dependent groups. When a significant difference was found, the 
adjusted Bonferroni test was used to identify the group causing the difference. Spearman 
correlation was used to assess relationships between numerical variables. The homogeneity of 
categorical variables was examined using the Chi-square test. 

Informed Volunteer Consent Form 
Dear Volunteer, 
This study is being conducted by Research Assistant and Audiologist Rukiye TANISIR DISCI 
under the supervision of Istanbul Aydın University, Assistant Professor, PhD Umit Can 
CETİNKAYA. 
In our study, the Visual-Induced Motion Sickness Susceptibility Questionnaire (GUHHYSA) 
will be administered, and audiological evaluations will be conducted for individuals over 18 
years of age. Based on the evaluations, individuals diagnosed with Visually Induced Motion 
Sickness will participate in a rehabilitation program using virtual reality systems. 
Participation in this study is entirely voluntary. Your personal information will not be shared 
with any third parties or institutions and will be kept strictly within the scope of this research. 
Any records that could reveal the identity of participants will be kept confidential and will not 
be disclosed to the public; even if the research results are published, the identities of participants 
will remain confidential. 
I have read and understood the information provided above, which must be given to the 
volunteer before starting the research. 
I have been given sufficient time to decide whether or not I want to participate in the study. 
Under these conditions, I authorize the research investigator to review, transfer, and process my 
medical information, and I voluntarily accept the invitation to participate in this research 
without any coercion or pressure. I declare that I freely consent to my personal data being used 
for scientific purposes, presented and published in accordance with confidentiality rules, 
without being subjected to any pressure or coercion. 
You are being asked to participate in a research study containing the information provided 
above. Participation is entirely your choice. It is important that you understand why the research 
is being conducted, how your information will be used, what the study involves, and any 
potential benefits, risks, or discomforts before deciding whether to participate. 
 
 
Researcher Name and Surname: 
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