Innovations In Clinical Neuroscience

JAN-FEB 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 1 – 2 , J A N U A R Y – F E B R U A R Y 2 0 1 7 ] 16 T ABLE 1. Studies using virtual reality (VR) as a tool for improving medical conditions A PPLICATION FIRST AUTHOR (YEAR) E QUIPMENT P ARTICIPANTS S TUDY DESIGN O UTCOME/ E FFECTIVENESS ( PRIMARY RESULT) SECONDARY OBSERVATIONS A VERAGE Q UALITY S CORE P ain distraction S chmitt et al 1 5 (2011) H ead-mounted d isolays (HMD) (Kaiser-Electro Optics) n=54; hospitalized pediatric burn i npatients aged 6 –19 years; not randomized. W ithin-subject: both VR and non-VR in each session. Each p atient was his own c ontrol. 30–40 min/ session; 1–5 days. VR as effective analgesic t reatment in conjunction w ith physical therapy: 2 7–44% decrease (p<0.05) in pain ratings during first session of VR condition, w as maintained in s ubsequent sessions. Improved affect, "fun," decreased time t hinking about pain. 1 6% reported mild nausea. 0 .96 P ain distraction Kipping et al 18 (2012) Low-cost, off-the- s helf HMD: eMagin Z 800 3DVisor n =41; adolescents (aged 11–17 years) in hospital/burn centers Randomized, controlled trial (RCT) w ith parallel group design: VR group and standard distraction group (SDG); watched T V, listened to music, etc No significant differences in self-reported pain in VR vs. S DG; however, nursing staff reported observing a statistically significant reduction in pain scores w hen helping patients with dress removal No side effects observed; no d ifferences b/t c onditions in reporting nausea 0 .94 P ain distraction Morris et al 19 ( 2010) Low-cost, off-the- shelf, HMD: eMagin Z800 3DVisor. Walt D isney's Chicken Little PC game s oftware n=11; adult burn p atients undergoing physiotherapy Within-subject, random assignment to V R (20min session) and non-VR. Marginally insignificant (p=0.06) difference between VR and non-VR conditions i n terms of pain reduction; no significant decrease ( p=0.58) in anxiety Low-cost VR therapy may be promising for d eveloping countries with stringent budgets. 0 .89 Pain distraction Hoffman et al 20 (2008) Fiberoptic water- friendly VR HMD system (SnowWorld) n=11; aged 9–40 years (M=27) hospitalized inpatients at a burn center Controlled, within- subject, order randomized; single wound care session: 3- min w/no distraction; 3- min with VR; used subjective pain ratings scales (GRS) from 0–10. Significant reduction in pain reported in VR sessions; those reporting highest pain (>7.6) in non-VR had 41% reduction in pain in VR condition Patients reporting strongest "immersion" in VR environment reported greatest analgesic effect and had greatest drop in pain ratings (from 7.2–3.7) 0.85 Pain distraction Patterson et al 21 (2010) HMD showing a virtual valley with a lake; hpnosis delivered by the experimenter to induce relaxation (e.g., "your body feels very good… you will only have positive experiences") n=21 patients (M=31.8 years old) at a trauma center; injuries included motor vehicle accidents, gunshot wounds, bone fractures, and joint dislocations All received analgesic care (opioids and benzodiazepines); 1 experimental condition: VR w/hypnotic distraction (VRH; 40min); and 2 controls: VR without hypnosis, and standard care alone. 0–10 GRS ratings for pain intensity and unpleasantness decreased Not Applicable 0.78 Pain distraction Li et al 25 (2011) PlayMotion system w/out HMD; video projectors capture body movements and transforms walls into play spaces n=122; children (8–16 years old) with cancer at a pediatric oncology ward in Hong Kong; not randomized Pre-/post-test between subjects design; 30-min therapeutic play interventions 5 days a week Fewer depressive symptoms in experimental group after 1 week; no significant differences in anxiety levels. Not Applicable 0.83 Pain pistraction Carrougher et al 17 (2009) HMD (Nvis Nvisor) SnowWorld software n=39 adult patients with burn injuries at a burn center Within-subjects crossover; 2-day study (randomize): standard medication given on both days (OxyContin or Methadone); VR day: 10-min treatment; self-reported pain scores and range of motion (ROM) assessed before and after each session Reductions in VR condition of 27% for worst pain, 37% for time spent thinking about pain, 31% for pain unpleasantness; no statistically significant improvements in ROM 2 patients withdrew; 97% reported none to mild nausea after using VR equipment 0.91

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