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Journal of Vestibular Research 23 (2013) 203–210 DOI 10.3233/VES-130501 IOS Press

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Motion sickness susceptibility in healthy subjects and vestibular patients: Effects of gender, age and trait-anxiety A.C. Paillarda,c,∗ , G. Quarckb,c,d, F. Paolinoe, P. Deniseb,c,d , M. Paolinoe, J.F. Goldingf and V. Ghulyan-Bedikiane a

School of Psychological Sciences, University of Manchester, Manchester, UK UNICAEN, COMETE, Caen, France c INSERM, U 1075, Caen, France d Normandie University, Caen, France e Department of Oto-Neurology, Hospital Clairval, Marseille, France f Department of Psychology, University of Westminster, London, UK b

Accepted 4 September 2013

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Received 26 March 2013

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Abstract. Several studies have suggested that anxiety may play a role in motion sickness susceptibility (MSS) variability. This study aimed to assess motion sickness susceptibility in healthy subjects and chronic vestibular patients and to investigate its relationship to gender, age and trait-anxiety. Healthy subjects (n = 167) and chronic dizzy patients with various vestibulopathies (n = 94), aged from 20 to 92 years old, were asked to complete Motion Sickness Susceptibility questionnaire (MSSQ) and trait-anxiety questionnaire (STAI-B). When patients were divided into those who had vestibular loss (n = 51) vs. patients without vestibular loss (n = 43), the MSSQ scores (mean ± SD) for patients with vestibular loss (18.8 ± 30.9) were lower than healthy subjects (36.4 ± 34.8), who were lower than vestibular patients without vestibular loss (59.0 ± 39.7). These significant differences could not be explained by gender, age, trait-anxiety, or interaction. Women had higher MSS than men, and MSS declined with age for healthy subjects and vestibular patients. The overall relationship between anxiety and MSS scores was weak and only reached significance in healthy subjects. These results support the conclusion that the vestibular system is heavily involved in MSS and that trait-anxiety may play a role in MSS but only in healthy subjects. Keywords: Anxiety, vestibular, dizziness, age, gender

1. Introduction

Technological progress has led to an increasing complexity of modern vehicles, which can provoke a pattern of symptoms such as headache, nausea, postural discomfort and vomiting. These symptoms provoked by motion are defined as motion sickness [8]. ∗ Corresponding author: Dr. Aurore Paillard, UNICAEN, COMETE, Caen, 14032, France. E-mail: aurore.paillard@gmail. com.

A large range of motion environments such as cars, boats, planes, tilting trains, funfair rides, space, virtual reality, can induce motion sickness. There are several factors influencing individual motion sickness susceptibility (MSS) such as gender and age. Regarding gender, it is known that women are more susceptible to motion sickness than men [8,12,13]. With respect to age, an onset of MSS around 6 or 7 years old has been suggested [14] with a susceptibility peak at around 9 or 10 years old [22]. Thereafter MSS decreases during the teenage years into adulthood. However there is a

c 2013 – IOS Press and the authors. All rights reserved ISSN 0957-4271/13/$27.50 

A.C. Paillard et al. / Motion sickness susceptibility in healthy subjects and vestibular patients

the oto-neurological department of the Clairval Hospital (Marseille, France). Only chronic dizzy patients with symptoms that lasted longer than six months were selected. It was their primary complaint and the principal motive of consultation. Patient sample was divided into vestibular loss (VL) and non-vestibular loss (nVL) subgroups according to the bithermalcaloric and rotating-chair tests performed by videonystagmography (VNG-Ulmer, Synapsys, Marseille, France). The VL subgroup (mean age: 67.7 ± 15; 26 women and 25 men) regrouped patients presenting unilateral (21 women and 21 men) or bilateral vestibular losses (5 women and 4 men) ranging from profound unilateral hyporeflexia to bilateral areflexia. These vestibular losses were either uncompensated or poorly compensated to the rotary-chair test and resulted from peripheral vestibulopathies (labyrinthitis, vestibular neuritis or ototoxicity). Patients included in the nVL subgroup (mean age: 67.2 ± 14.7; 24 women and 19 men) were free of vestibular losses. They presented intermittent vertigo or unsteadiness resulting from Benign Paroxysmal Positional Vertigo (BPPV, 11 women and 17 men), vestibular migraine (13 women and 1 man) or Ménière’s disease (1 man). All the vestibular losses (labyrinthitis, neuritis or ototoxicity) as well as the BPPV and MD had peripheral ethology and localisation. The vestibular migraine was a central vestibulopathy. Both healthy subjects and vestibular patients did not present any linguistic problems likely to compromise their capacities to answer French questionnaires. All participants gave their informed written consent to the study and were free to withdraw their participation at any time. The University of Caen Ethics Committee approved the testing of healthy subjects and the Clairval Hospital Ethics Committee approved the testing of vestibular patients.

2. Methods

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lack of data concerning the evolution of MSS across adulthood particularly for older people. Other psychological variables such as anxiety may play a role in MSS variability. Studying pilots, Fox and Arnon [6] highlighted a correlation between both state- and trait-anxiety scores and MSS. Tucker and Reinhardt [21] showed higher state-anxiety in airsick students during flight training compared to non-airsick subjects. Testing in healthy adults (18–39 years old), Collins and Lentz [4] suggested a higher trait-anxiety in motion sickness susceptible subjects. Interestingly, a parallel could be drawn between gender influence on motion sickness susceptibility as well as trait-anxiety as women report both higher trait-anxiety [16] and also higher MSS than men [8]. One of the most established theories to explain in motion sickness is the “sensory conflict” theory [14]: this theory postulates that motion sickness originates from a sensory mismatch between actual versus expected invariant patterns of vestibular, visual and somatosensory inputs. It has been accepted that the vestibular system influences individual MSS since patients with bilateral vestibular deficit have greatly reduced susceptibility or do not become motion sick at all [11,24]. This sensory mismatch leads to an activation of vestibuloautonomic pathways that is typically involved in homeostasis [24]. Yates et al. [24] also underlined the similarity between the neural pathways that produce nausea and vomiting during motion sickness and those that generate illness after ingestion of toxins. Johnson et al. [11] showed that patients with partial labyrinthine lesions have reduced visually induced nausea, whereas Boldingh et al. [2] reported that patients with vestibular migraines have higher MSS than healthy controls. Patients with vestibular disease often report anxiety symptoms [5], which may suggest the possibility of a relationship between anxiety and MSS in vestibular patients.

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2.1. Subjects 167 healthy subjects took part in this study (mean age: 52.9 ± 19.2; 84 women and 83 men). They did not report any history of vertigo or dizziness and were free of severe neurological conditions. 94 patients (mean age: 66.3 ± 14.5; 49 women and 45 men) suffering from chronic dizziness associated with peripheral and/or central vestibulopathies were recruited in

2.2. Study design Healthy subjects and patients were tested for their MSS and trait-anxiety. Since all participants were French native, the French version of STAI-B questionnaire was used to assess the participants’ traitanxiety [3]. MSS was evaluated using the Motion Sickness Susceptibility Questionnaire Short-form (MSSQshort [9]). This is a reliable tool predicting individual differences in MSS caused by a variety of transportation motion stimuli and also has been further validated against controlled laboratory motion stimuli. However, the lack of a French version of MSSQ-short led us

A.C. Paillard et al. / Motion sickness susceptibility in healthy subjects and vestibular patients

The data were analysed using STATISTICA v8.0. Statistical difference was regarded as significant at p < 0.05. fMSSQ internal reliability was assessed using Cronbach’s Alpha. This item varies between 0 and 1, internal reliability being considered to be satisfactory for alpha > 0.8. The relationship between MSA, MSB and MSV scores was investigated by Pearson correlation analysis and t-test. MSSQ score was converted into percentiles using a fitted polynomial [9]. The relationship between MSSQ percentiles, age, gender and STAI-B was investigated using ANOVAs where the factor “Group” refers to healthy, VL, and nVL subgroups. Fisher post-hoc analyses were carried out when necessary. ANOVAs using the factor “Symptoms”, which refers to Healthy, BVL, UVL, BBPV, VM, has also been carried out. Fisher posthoc analyses were carried out comparing Health with each vestibular symptoms subgroup. Linear regressions were carried out, as well as Loess (locally weighted scatterplot smoothing) where relevant. The relationship between MSSQ and STAI-B scores was investigated by Pearson correlation analysis.

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2.2.1. Motion Sickness Susceptibility Questionnaire (MSSQ) The fMSSQ is divided into two parts: Part A assessing MSS during childhood (MSA score) and Part B evaluating MSS during adulthood (MSB score), see Appendix. MSA and MSB raw scores range from 0 (no susceptibility to motion sickness) to 27 (maximal level of motion sickness susceptibility). The total of MSA and MSB scores gives the global MSS score (MSSQ score ranging from 0 to 54). Exclusively for patients testing, MSB score represented MSS before the onset of vestibular symptoms. A third part was added to the initial fMSSQ to assess the patients’ MSS since their dizziness onset (MSV score). It was identical to Part B. Only the item “Over the last 10 years, how often you felt sick or nauseated” has been changed to “Since your dizziness onset, how often you felt sick or nauseated”.

2.3. Statistical analysis

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first to translate this questionnaire into French. The French version of MSSQ-short (fMSSQ, Appendix 1) was processed according to the Vallerand method [23]. First, a preliminary version was prepared with the help of four collaborators fluent in both English and French. Two of them separately proposed an initial Englishto-French translation of the MSSQ-short version [9]. Then, two other collaborators were separately asked to translate the preliminary version back into English. This back-translation was then compared to the original questionnaire. In order to validate the fMSSQ, healthy subjects were also required to note if the questionnaire was clearly understandable. In case there was a negative answer, subjects had to specify which item was not understandable. Despite the presence of the experimenter in the room, both fMSSQ and STAIB questionnaires were self-reported and anonymous. Participants were aware that the experimenter taking their consent form and questionnaires was not the one analysing their data.

2.2.2. Trait-Anxiety questionnaire (STAI-B) Trait-Anxiety was evaluated using the Spielberger State-Trait Anxiety Inventory (STAI [19]; French version [3]). The STAI questionnaire consisted of two parts, evaluating a subject’s state-anxiety (STAI-A) and trait-anxiety (STAI-B). For this study, the 20-items STAI-B scale was used assessing the subject’s general anxiety level. Each item had a varied score from 1 to 4, contributing then to a global score with a minimum of 20 (no trait-anxiety) to a maximum of 80 (high level of trait-anxiety).

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3. Results

All the healthy subjects defined the fMSSQ as clearly understandable. Cronbach’s alpha for fMSSQ was 0.87. For healthy, VL and nVL samples, MSA was significantly higher than MSB (6.1 ± 7.2 vs. 4.1 ± 5.8 for healthy; 3.4 ± 7 vs. 2.2 ± 4.9 for VL; 10.9 ± 8.9 vs. 8.3 ± 7.4 for nVL, p < 0.05). These two sub-scores, MSA and MSB, positively correlated with each other (r = 0.67; r = 0.76 and r = 0.80 for healthy, VL and nVL respectively, p < 0.001 for all). MSV mean scores were 5.6 ± 11.2 for VL patients and 19.1 ± 39.7 for nVL patients. MSB and MSV scores were not significantly different (p > 0.05) but positively correlated with each other (r = 0.88, p < 0.05 for VL and r = 0.84, p < 0.05 for nVL subgroups). Mean ± SD MSSQ percentile scores were 36.4 ± 34.8 for healthy subjects, 18.8 ± 30.9 for VL patients and 59 ± 39.7 for nVL patients (see Fig. 1 with 95%CI bars). The ANOVA of MSSQ percentile showed a main effect of Group [F(2,258) = 15.43, p < 0.001]. Posthoc analysis showed MSSQ was significantly lower for VL patients than healthy subjects (p < 0.01), and healthy MSSQ scores were significantly lower compared to nVL patients (p < 0.001). These Group dif-

A.C. Paillard et al. / Motion sickness susceptibility in healthy subjects and vestibular patients

Fig. 3. MSSQ (percentile scores) as a function of age for healthy subjects (black dots), VL patients (grey square) and nVL patients (white and grey squares). Linear regression lines with Age are shown for each of the 3 groups where the black line represent healthy subjects, the grey line represents VL patients and the grey dotted line represents nVL patients.

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Fig. 1. Means and 95% CIs error bars for MSSQ percentile scores as a function of Groups (healthy subjects, VL patients, nVL patients). VL represents the patients with Vestibular Loss whereas nVL represents patients with no Vestibular Loss. Stars represent statistical significance of comparisons between each patient group vs. healthy subjects where ∗ p < 0.05, ∗∗ p < 0.01, ∗∗∗ p < 0.001.

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Fig. 2. Means and 95% CIs error bars for MSSQ percentile scores as a function of vestibular symptoms: BVL (bilateral vestibular loss), UVL (unilateral vestibular loss), BPPV (Benign Paroxysmal Positional Vertigo), VM (vestibular migraine). MSSQ of healthy subjects is represented as well. As there is only one patient with Meniere’s disease, this patient is not reprensented in the figure. Stars represent statistical significance of comparisons between each patient group vs. healthy subjects where ∗ p < 0.05, ∗∗ p < 0.01, ∗∗∗ p < 0.001.

ferences were shown not to be affected when age, gender and trait-anxiety were considered in the analyses. The ANOVA of MSSQ percentile showed a main effect of Vestibular symptoms [F(5,255) = 9.20, p < 0.001]. Post-hoc analysis showed MSSQ in healthy subjects was significantly higher than UVL and BVL as well as significantly lower than VM (Fig. 2). Post-hoc analysis failed to show a difference between UVL and BVL patients’ MSSQ scores but showed a higher MSSQ score

Fig. 4. MSSQ (percentile scores) as a function of age, for women and men, where linear regression lines and Loess plots are represented. Black lines and dots represent women; grey lines and dots represent men. Both sets of plots show reductions with age, but the Loess plots highlight the maximal separation between genders around 50 to 60 years. See text for details.

for VM compared to BPPV patients. Figure 3 shows MSSQ declines across age for healthy subjects, as well as for VL and nVL patients. The regression line for healthy subjects is almost perfectly on the 50th percentile for the young adult age group in the 20 to 30 or so years of age range on which age group the original MSSQ-short questionnaire as well as the MSSQ percentile polynomial formula was based (see Fig. 2). As shown in Fig. 4, MSSQ reduces across age for both women and for men, women showing higher

A.C. Paillard et al. / Motion sickness susceptibility in healthy subjects and vestibular patients

4. Discussion

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on a large sample corroborates previous studies reporting reduced MSS in patients with unilateral or bilateral vestibular losses compared with healthy subjects for experimentally induced motion sickness, confirming that a functional vestibular system is necessary for motion sickness to occur [11]. However, we can underline the lack of difference between patients with unilateral and bilateral vestibular losses. This can be explained by the small number of tested patients with bilateral deficit. The higher MSS in vestibular patients without vestibular loss (nVL), in particular for vestibular migraine, confirmed the existing findings [7,18]. Regarding the effect of gender and age on MSS, our results with healthy subjects replicated previous results [9] confirming that MSS is higher for women than men, and that MSS is higher in childhood before 12 years than in adulthood. Our study highlighted a possible MSS peak for women compared with men around 50–60 years old. This age-period corresponds to the menopause, known to induce hormonal changes that could influence MSS in women. It has been shown that the MSS fluctuates across menstrual cycle [10]. Golding et al. [10] demonstrated, however, that the hormonal status could not exclusively explain the high MSS in women, so the maximal sex differences in MSS around the age of 50–60 years old may be related to hormonal changes whereas the overall gender differences across all ages may reflect a ‘hard-wired’ greater emetic and nausea susceptibility in females. The present study underlined that MSS declines across adulthood and that women present greater MSS than men at all ages. There is a paucity of systematic data on MSS in older age. To our knowledge, only Turner and Griffin [22] who assessed healthy subjects from 8 to 80 years old showed an aging effect on MSS that is different from our results. They showed a higher female MSS compared to male up to 40 years old but then no gender difference from subjects older than 40 years old. However, two differences could be underlined between our study and Turner and Griffin’s work which may explain this difference: (i) those authors assessed MSS for bus passengers whereas our study assessed all kinds of transport modes, (ii) they tested fewer subjects in older age (i.e. their subjects were 28.3 years old on average whereas our subjects were 52.9 years old on average). Our study reflects a global measure of MSS with a more balanced population across the older age groups. In our study the decline in MSS continued into older age. Several explanations can be suggested for this. Firstly, this might reflect further habituation to motion sickness from adult-

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scores at all ages. The ANOVA of MSSQ percentile showed a main effect of gender [F(1,259) = 10.59; p < 0.001]. Linear regression analysis highlighted that the effect of age on MSSQ is significant for women and for men (p < 0.001). However further scrutiny this effect indicated that there appeared to be a peak of MSSQ in women who showed maximal separation from men at the ages around 50–60 years old. To highlight this, we also showed the Loess regression plots in addition to the linear regression lines in Fig. 3. Mean STAI-B score was 38.8 ± 8.7 for healthy subjects, 40.6 ± 9.7 for VL and 42.4 ± 10.2 for nVL patients. The ANOVA of STAI-B failed to show a significant effect of Groups (p > 0.05) but a significant main effect of gender [F(1,259) = 8.89, p < 0.01]. Post-hoc analysis of all data showed STAI-B was significantly higher for women (41.4 ± 9.6) than men (38.1 ± 8.6). By contrast, there was no significant overall relationship between MSSQ percentile and STAI-B. However, a small positive correlation between MSSQ and STAIB (r = 0.28, p < 0.001) could be shown if the data were analysed selectively but only for healthy participants

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The present study aimed to assess motion sickness susceptibility (MSS) in healthy subjects and chronic vestibular patients and to investigate its relationship to gender, age and trait-anxiety. Firstly, the French version of the MSSQ (fMSSQ) was validated, providing a reliable tool for MSS evaluation in French-speaking people. All the subjects reported that the fMSSQ was clearly understandable. Cronbach’s alpha calculated in this study showed that the fMSSQ has good internal reliability, comparable to that of the original MSSQshort version [9]. The original normalisation and standardisation of MSSQ for younger people perfectly matched our group of subjects in France. Moreover our study provided much more extensive information on MSSQ norms for the old age groups which were relatively under-represented in the original MSSQ publication [9]. In the present study, patients with vestibular loss (VL) reported lower MSS than healthy subjects, whereas vestibular patients without vestibular loss (nVL) reported higher MSS than healthy subjects. Our analysis underlined that these significant differences between the patient and healthy groups could not be explained by gender, age, trait-anxiety, or interactions. Our data

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as well as Ms Lise TOURTELIER for their technical help regarding MSSQ testing and questionnaires translations.

References [1]

B. Bergstrom, Morphology of the vestibular nerve. 2. Number of myelinated vestibular nerve fibers in man at various ages, Acta Oto-Laryngologica 76 (1973), 173–179. M.I. Boldingh, U. Ljøstad, A. Mygland and P. Monstad, Vestibular sensitivity in vestibular migraine: VEMPs and motion sickness susceptibility, Cephalalgia 31 (2011), 1211– 1219. M. Bruchon-Schweitzer and I. Paulhan, Manuel pour l’inventaire d’anxiété Trait-Etat forme Y), Bordeaux, 1990. W.E. Collins and J.M. Lentz, Some psychological correlates of motion sickness susceptibility, Aviat Space Environ Med 48 (1977), 587–594. S. Eagger, L.M. Luxon, R.A. Davies, A. Coelho and M.A. Ron, Psychiatric morbidity in patients with peripheral vestibular disorder: A clinical and neuro-otological study, J Neurol Neurosurg Psychiatry 55 (1992), 383–387. S. Fox and I. Arnon, Motion sickness and anxiety, Aviat Space Environ Med 59 (1988), 728–733. J.M. Furman and D.A. Marcus, Migraine and motion sensitivity, Continuum 18 (2012), 1102–1117. J.F. Golding, Motion sickness susceptibility, Auton Neurosci 129 (2006a), 67–76. J.F. Golding, Predicting individual differences in motion sickness susceptibility by questionnaire, Personality and Individual Differences 41 (2006b), 237–248. J.F. Golding, P. Kadzere and M.A. Gresty, Motion sickness susceptibility fluctuates through the menstrual cycle, Aviat Space Environ Med 76 (2005), 970–973. W.H. Johnson, F.A. Sunahara and J.P. Landolt, Importance of the vestibular system in visually induced nausea and selfvection, J Vestib Res 9 (1999), 83–87. M.D. Jokerst, M. Gatto, R. Fazio, P.J. Gianaros, R.M. Stern and K.L. Koch, Effects of gender of subjects and experimenter on susceptibility to motion sickness, Aviat Space Environ Med 70 (1999), 962–965. A.H. Park and S. Hu, Gender differences in motion sickness history and susceptibility to optokinetic rotation-induced motion sickness, Aviat Space Environ Med 70 (1999), 1077– 1080. J.T. Reason and J.J. Brand, Motion Sickness, Academic Press, London, 1975. E. Richter, Quantitative study of human Scarpa’s ganglion and vestibular sensory epithelia, Acta Otolaryngol Suppl 90 (1980), 199–208. O. Robin, H. Vinard, E. Vernet-Maury and J.L. Saumet, Influence of sex and anxiety on pain threshold and tolerance, Funct Neurol 2 (1987), 173–179. S.M. Rosengren, S. Govender and J.G. Colebatch, Ocular and cervical vestibular evoked myogenic potentials produced by air- and bone-conducted stimuli: comparative properties and effects of age, Clin Neurophysiol 122 (2011), 2282–2289. J.D. Sharon and T.E. Hullar, Motion sensitivity and caloric responsiveness in vestibular migraine and Meniere’s disease, Laryngoscope, 2013.

[2]

[3]

[4]

[5]

[6]

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hood through to old age over and above that MSS reduction seen from adolescence to adulthood [8]. Secondly, low MSS in older people could be due to the decline of the vestibular system across ageing. Indeed, increasing age lead to a loss of vestibular nerve fibres [1] and a reduction in the number of vestibular ganglion cells [15] with a significant drop occurring around 60 years of age. This hypothesis is supported by vestibular myogenic evoked potentials (VEMP) studies showing a decline in cervical VEMP and ocular VEMP [17], in particular from 60 years old [20]. We examined the hypothesis that anxiety may relate to high MSS. The evidence for this was limited to our healthy sample and the relationship was not strong. Differences of MSS between groups for healthy subjects and vestibular patients could not be explained by anxiety though. Our results showed higher traitanxiety in women than men; a finding consistent with previous reports that women have higher trait-anxiety than men [16]. However trait-anxiety could not explain higher MSS in women compared to men, as the MSS difference still remained after accounting for anxiety differences. Further studies are necessary to delve further into the relationship between gender, trait-anxiety and MSS. In particular, it would be interesting to further understand the mechanisms underlying in the MSS peak in women around 50–60 years old as well as the low MSS in older people. Further experiments are also necessary to delve further into MSS according to the different types of vestibular symptoms. To conclude, the present study showed reduced MSS in patients with vestibular loss compared to healthy subjects. By contrast, patients without vestibular loss reported elevated MSS compared with healthy. These significant differences could not be explained by gender, age, trait-anxiety, or interactions. Our results confirmed that women had higher MSS than men and that MSS decline with age for healthy subjects and for vestibular patients. The indication that anxiety related to higher MSS was small and limited to healthy subjects.

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Acknowledgments The authors would like to thanks the participants involved in this study for their sympathy. The authors are grateful to Mr Baptiste BARDEY, Ms Aurélie LAVIELLE, Dr Laurence JACQUOT (University of Besançon, France), Ms Aurélie COLLADO (University of Nancy, France), Ms Dominique PAILLARD

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transport: passenger behaviour and susceptibility, Ergonomics 42 (1999), 444–461. R. Vallerand, Vers une methodologie de validation transculturelle de questionnaires psychologiques: Implications pour la recherche en langue francaise, Canadian Psychology 30 (1989), 662–680. B.J. Yates, A.D. Miller and J.B. Lucot, Physiological basis and pharmacology of motion sickness: An update, Brain Res Bull 47 (1998), 395–406.

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C.D. Spielberger, R.L. Gorsuch, R. Lushene, P.R. Vagg and G.A. Jacobs, Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press, 1983. C.L. Tseng, C.H. Chou and Y.H. Young, Aging effect on the ocular vestibular-evoked myogenic potentials, Otol Neurotol 3 (2010), 959–963. G.J. Tucker and R.F. Reinhardt, Airsickness and anxiety, Aerosp Med 38 (1967), 855–858. M. Turner and M. Griffin, Motion sickness in public road

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Appendix French validated version of the Motion Sickness Susceptible Questionnaire-short version (fMSSQ). Ce questionnaire est destiné à déterminer votre degré de sensibilité au mal des transports ainsi que le mode de transport qui développe le plus ces troubles. NB: le mal des transports se traduit par une sensation physique de gêne, voire de nausée, pouvant aller jusqu’au vomissement.

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Votre Expérience au cours de L’ENFANCE Uniquement (avant l’âge de 12 ans) Pendant votre ENFANCE (avant l’âge de 12 ans), combien de fois vous êtes-vous senti barbouillé ou nauséeux dans les situations suivantes (Cocher la case correspondante): Moyen de transport jamais utilisé

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en voiture en bus/autocar en train en avion / helicoptère / . . . sur un bateau de petite taille (barque, vedette, voilier, . . . ) sur un bateau de grande taille (ferry, cargo, . . . ) sur une balançoire sur un tourniquet dans une fête foraine (montagnes russes, manèges , . . . )

Jamais malade

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Fréquemment malade

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Votre Expérience au cours des DIX DERNIERES ANNES

Au cours de ces DIX DERNIERES ANNEES, combien de fois vous êtes-vous senti barbouillé ou nauséeux dans les situations suivantes (Cocher la case correspondante): Moyen de transport jamais utilisé

Jamais malade

Rarement malade

Parfois malade

Fréquemment malade

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en voiture en bus/autocar en train en avion / helicoptère / . . . sur un bateau de petite taille (barque, vedette, voilier, . . . ) sur un bateau de grande taille (ferry, cargo, . . . ) sur une balançoire sur un tourniquet dans une fête foraine (montagnes russes, manèges , . . . )

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