# Relationship between age, postural balance and cybersickness during repeated exposure to virtual reality

Marie-Philippine Séba, Pauline Maillot, Sylvain Hanneton, Gilles Dietrich

► To cite this version:

Marie-Philippine Séba, Pauline Maillot, Sylvain Hanneton, Gilles Dietrich. Relationship between age, postural balance and cybersickness during repeated exposure to virtual reality. Congress on Motion sickness: Theories, models and empirical evidence, Jun 2022, Caen, France., 2022. hal-03776515

HAL Id: hal-03776515

https://hal.science/hal-03776515

Submitted on 13 Sep 2022

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## Key points

* Sensorimotor aging and VR HMD

* Cybersickness and postural sways outcomes

* Standing with HMD on a force platform while exposed 5 times to the same VE

* Higher cybersickness with repetition not correlated to age

* Decreased postural sways starting from the second repetition

* Significant negative correlation between postural oscillations and cybersickness at the 5th exposure.

* Towards postural stiffening also known as "VR lock"?

# Relationship between age, postural balance and cybersickness during repeated exposure to virtual reality

Marie-Philippine Séba*, Pauline Maillot*, Sylvain Hanneton*, Gilles Dietrich*

*Institut des Sciences du Sport-Santé, Université Paris Cité, F-75015 Paris, France

## BACKGROUND

Immersive Virtual Reality (VR) systems are attracting particular interest to modify postural dynamics at least in the short term (Fransson et al., 2019; Litleskare, 2021). The visuo-vestibular conflicts created are used to reduce the risk and the fear of falling in the elderly (Phu et al., 2019). Sensory-motor aging is characterized by larger body excursions. Indeed, Wiesmeier, Dalin & Maurer (2015) have shown that sways were more important in the anteroposterior axis in the elderly. Moreover with advancing age, a slowing down of sensory reweighting occurs during disturbances, notably visual (Eikema, et al. 2012).

According to Weech, Calderon & Barnett-Cowan (2020), an increase in postural oscillations would show a greater flexibility of the postural regulation system as well as a better ability to adapt to sensory disturbances. Individuals able to dissociate their postural oscillations from visual disturbances would be the most likely not to develop cybersickness. However cybersickness does not seem to increase with age (Dilanchian, Andringa and Boot, 2021; Saredakis et al., 2020). Cybersickness remains one of the major barriers to using VR systems. Studying the effects of aging on postural oscillations and cybersickness could enrich reflections on the interest of using virtual reality systems to stimulate sensory-motor adaptation.

## PURPOSE

To investigate the effects of sensorimotor aging on balance and cybersickness when using immersive virtual reality.

## METHODS & MATERIALS

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75 participants
Age 21 to 86
M: 42.40 SD: 17.82

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Oculus Rift (CV1)

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Wii Balance Board

<figure><img src="image_6.png" /><figcaption>Scan the VE with Halo AR app to see an accelerated video of the virtual environment</figcaption></figure>

### Independent variables

Age
Repeated exposure number x 5

### Dependent variables

Center of pressure trajectory length in the Anterior-Posterior (AP) axis

Cybersickness severity scores
Simulator Sickness Questionnaire 1 & 2 (SSQ)
Kennedy et al., 1993

## RESULTS

### Repetition
Cybersickness and postural sways

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#### Posture with cybersickness

Length AP and SSQ1: r(75) = -0.07, p = n.s.

Length AP and SSQ2: r(75) = -0.24, p < .05

### Age correlations

#### ... with the control measure
(mean of 5 x 30 seconds without vection in the VE)

Length AP: r(75) = 0.28, p < .05

#### ... with cybersickness

<table><thead><tr><td>SSQ</td><td>r</td><td>p</td></tr></thead><tbody><tr><td>1</td><td>-0.13</td><td>n.s.</td></tr><tr><td>2</td><td>-0.13</td><td>n.s.</td></tr></tbody></table>

#### ... with posture for each repetition

<table><thead><tr><td>Postural parameter</td><td>Repetition</td><td>r</td><td>p</td></tr></thead><tbody><tr><td rowspan="5">Length AP</td><td>1</td><td>0.33</td><td>&lt;.01</td></tr><tr><td>2</td><td>0.39</td><td>&lt;.001</td></tr><tr><td>3</td><td>0.39</td><td>&lt;.001</td></tr><tr><td>4</td><td>0.36</td><td>&lt;.01</td></tr><tr><td>5</td><td>0.33</td><td>&lt;.01</td></tr></tbody></table>

#### Postural adaptation score

Length AP (5) - Length AP (1)

#### ... correlated with age

Length AP: r(75) = -0.12, p = n.s.

#### Cybersickness score

SSQ2 - SSQ1

#### ... with postural adaptation score

Length AP: r(75) = -0.05, p = n.s.

## DISCUSSION

Increase in body excursions were larger with age, particularly in the antero-posterior axis (Wiesmeier, Dalin & Maurer, 2015). Yet the elderly did not seem to be more affected by cybersickness, although sensory reweighting is slower with age. However a postural adaptation took place with the effect of repetition (Fransson et al., 2019) and this from the second repetition. Cybersickness severity is not related to postural sways at the first exposure but it is at the 5th exposure. Postural oscillations in the anteroposterior axis decrease with an increase in cybersickness. This postural stiffening phenomenon could correspond to that of "VR lock" (Dennison & D'Zmura, 2017). Neither the postural adaptation score nor the cybersickness score is related to age. Does VR have an impact on sensory reweighting, especially with aging? Is VR beneficial for training postural dynamics?

## CONCLUSION

Cybersickness severity increased with repetition while postural sways in the anteroposterior axis decreased with repetition.

## REFERENCES

Dennison, M. S., & D'Zmura, M. (2017). Cybersickness without the wobble: Experimental results speak against postural instability theory. Applied ergonomics, 58, 215-223.

Dilanchian, A. T., Andringa, R., & Boot, W. R. (2021). A Pilot Study Exploring Age Differences in Presence, Workload, and Cybersickness in the Experience of Immersive Virtual Reality Environments. Frontiers in Virtual Reality, 129.

Eikema, D. J. A., Hatzitaki, V., Tzovaras, D., & Papaxanthis, C. (2012). Age-dependent modulation of sensory reweighting for controlling posture in a dynamic virtual environment. Age, 34(6), 1381-1392.

Fransson, P. A., Patel, M., Jensen, H., Lundberg, M., Tjernström, F., Magnusson, M., & Ekvall Hansson, E. (2019). Postural instability in an immersive Virtual Reality adapts with repetition and includes directional and gender specific effects. Scientific reports, 9(1), 1-10.

Litleskare, S. (2021). The relationship between postural stability and cybersickness: It's complicated—An experimental trial assessing practical implications of cybersickness etiology. Physiology & Behavior, 236, 113422.

Phu, S., Vogrin, S., Al Saedi, A., & Duque, G. (2019). Balance training using virtual reality improves balance and physical performance in older adults at high risk of falls. Clinical interventions in aging, 14, 1567.

Saredakis, D., Szpak, A., Birckhead, B., Keage, H., Rizzo, A., & Loetscher, T. (2020). Factors Associated With Virtual Reality Sickness in Head-Mounted Displays: A Systematic Review and Meta-Analysis. Frontiers in human neuroscience, 14, 96.

https://doi.org/10.3389/fnhum.2020.00096

Weech, S., Calderon, C. M., & Barnett-Cowan, M. (2020). Sensory Down-Weighting in Visual-Postural Coupling Is Linked With Lower Cybersickness. Frontiers in Virtual Reality, 10.

Wiesmeier, I. K., Dalin, D., & Maurer, C. (2015). Elderly use proprioception rather than visual and vestibular cues for postural motor control. Frontiers in aging neuroscience, 7, 97.