VR and Burn Wounds: Hydrotank Research

Researchers from University of Washington's HITLab have published a new study on virtual reality pain control during the removal of burnt tissue in The Clinical Journal of Pain. In burn treatment, patients often experience extreme pain during the earliest treatment sessions, which are often held in hydrotherapy tanks. Although medications are used to reduce pain, analgesics are not always effective and can lead to other side effects. Based on a model in which attention is a requirement for pain, the VR treatment used in this study attempts to distract users with images and sounds that are engaging and positive.

In this experiment, 11 patients (ranging in age from 9 to 40 years of age) were studied during the painful bandage removal and wound cleansing sessions. For part of the treatment, they received no distraction and were asked to report the worst pain they felt, the amount of time they spent thinking about pain, and the unpleasantness of their experience. Two additional ratings that measured 'fun' and 'presence' in the virtual world were also administered. In another part of the treatment, the patients were immersed in a world filled with icy, cool images called SnowWorld. During this phase, the participants were given the same ratings scales as in the other phase. However, treatment sequence was randomized, so some patients received the control treatment first, then the VR treatment; others received it in the opposite order.

The study demonstrated that in the VR condition, participants spent less time thinking about the pain and experienced lower pain intensity and less unpleasantness. The virtual reality condition was rated, unsurprisingly, as more 'fun' than the control condition, which involved no distraction. Interestingly, patients with higher presence ratings - the extent to which they became cognitively involved in the virtual environment - experienced less pain. Pain was reduced from 'severe' to 'moderate' on average, but in the group of the six most engaged participants, ratings dropped from 'severe' to 'mild.'

The study authors point out one possible bias of the study: the nurses providing care knew which treatment the patients were receiving, control or VR, because of the headset. Therefore, there is a chance they could have unknowingly treated the VR patients more gently throughout the treatment.

However, this is the first controlled multi-subject study to demonstrate that virtual reality allows pain reduction for patients undergoing treatment within the hydrotank, which is extremely promising news for burn care. Past pain-reducing options have failed to prove sustainable for many patients undergoing wound treatments, and virtual reality could offer new hope for this group.

• Hoffman, H. (2008). Virtual Reality Pain Control During Burn Wound Debridement in the Hydrotank. Clinical Journal of Pain, 24(4), 299.

Virtual Reality News April 2008

• Hunter Hoffman and David Patterson's SnowWorld, which I've written about before, is currently being used at Loyola University Hospital in Maywood, IL for burn victims. More than just a distracting media presentation, SnowWorld is an immersive VR video game that relies on the user to complete problem-solving tasks in the game, reducing their pain levels as evidenced by self-reports and MRI scans

• In stroke rehabilitation, researchers in Israel are using VR to enhance both diagnosis and therapeutic treatment selection for patients. Currently, the team of computer scientists and health professionals have designed a system that can differentiate between types of injuries - traumatic brain injuries vs. cerebrovascular accidents. Next, they will program the computers to generate models of patient recovery in order to select the best treatment for each specific patient. While diagnosis is an area that doctors can already do without the help of technology, projecting treatment outcomes with consistent accuracy is not something doctors can currently do with high consistency and accuracy. The VR is also used in patient therapy to demonstrate healthy movements of limbs without physical movement. The patient sees their limbs on a screen performing movements without pain, which can activate mirror neurons, which are frontal lobe neurons that fire when performing a task or seeing it performed. By seeing a natural movement, not experiencing pain, and having the typical motion pathway activated in your brain, pain is reduced and the patient's motility increased.

• London researchers recently used a VR headset to study paranoia in the general population, as subjects were transported via a virtual London Underground on a 4-minute ride. About 1 in 3 participants experienced paranoid thoughts about one or more of the neutral passengers populating the subway. People who experienced day-to-day thoughts of paranoia were more likely to experience it in the virtual underground. The next steps are to design a protocol that allows diagnosis and therapeutic sessions utilizing the technology. Read more here.
  

Citation:

Freeman D, Pugh K, Antley A, Slater M, Bebbington P, Gittins M, Dunn G, Kuipers E, Fowler D and Garety P (2008) Virtual reality study of paranoid thinking in the general population.
British Journal of Psychiatry, 192, 258-263.