Innovations In Clinical Neuroscience

JAN-FEB 2017

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

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[ 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 ] Innovations in CLINICAL NEUROSCIENCE 19 management may be achieved by blocking sensory information via opioid analgesics or by creating a distraction from pain by immersing a patient in a virtual environment. 11,31 Previous studies have demonstrated that opioid analgesics may lead to undesirable consequences, such as nausea, increased length of hospitalizations, and inadequate pain alleviation. 32 VR presents a useful alternative with minimal side effects, although nausea may be reported from either treatment. Five of seven studies demonstrated that VR is an efficacious non- pharmacologic adjunct to standard opioid analgesic treatments to reduce pain, distress, and anxiety in adult and pediatric patients undergoing unpleasant medical procedures. Highlighting the psychological components of pain, VR distraction treatments reduce self- reported unpleasantness, time spent thinking about pain, and levels of worst pain experienced. 15,17 These patient- reported observations are corroborated by neuroimaging studies that have highlighted five brain regions showing reduced activity during VR interventions—thalamus, insula, primary and secondary somatosensory cortices, and the anterior cingulate cortex. 17 Overall, both physiological and psychological measures suggest that VR is a helpful clinical tool in pain distraction. EDs and obesity. VR is used in eating disorders to improve patient body image experiences, increase self-efficacy, and practice healthy decision-making. 7 Participants may navigate a virtual supermarket to make healthy food choices or they may be encouraged to adopt less harmful perceptions of body image through repeated exposure to images of diverse body types. 1 In conjunction with other psychological therapies (e.g., graded exposure or cognitive-behavioral therapy), patients develop skills that carry over into the real world. VR therapies are useful not only for replicating a desired environment, but also for altering reality (e.g., an avatar that no longer resembles the patient). 9 This strategy is consistent with Bem's (1972) self-perception theory, 39 which T ABLE 2. Summary of measures used in various studies in the present review S OURCE S CALE/MEASURE D ESCRIPTION Kipping et al 18 (2012) F aces, Legs, Activity, Cry, Consolability Scale (FLACC) V isual Analogue Scale (VAS) S elf-reported pain measure and caregiver observation. Nursing staff reported scores on a s cale of 0–2 for 5 measurement categories: faces, legs, activity, cry, and consolability (e.g., f ace: no particular expression [0], occasional frown [1], frequent quivering chin [2]. A total score out of 10 is then created) 1 0cm horizontal line measuring pain (0=no pain; 10=pain as bad as could be), presence ( 0=not at all, 10=totally went into game world), and nausea (0=no sick tummy; 10=as bad as could be) M orris et al 1 9 (2010) Numeric Pain Rating Scale (NPRS) B urn Specific Pain Anxiety Scale (BSPAS) S elf-reported pain scale ranging from none (0), mild (1–3), moderate (4–6), and severe (7–10) 9 -item self-report scale highly correlated with the State-Trait Anxiety Inventory (STAI-S, r = 0.58, p < 0.005) Li et al 25 (2011) Chinese Version of the State Anxiety for Children (CSAS-C) C enter for Epidemiologic Studies Depression Scale (CES-D) 10-items scored ranging from 1–3 with a maximum total score of 10–30; higher scores r epresent higher anxiety 20-item test with short statements regarding cognitive, behavioral, and emotional a spects of depression; responses are measured on a 4-point Likert scale (0=not at all, 1 =a little, 2=some, 3=a lot) C esa et al 2 6 ( 2013) Body Image Avoidance Questionnaire (BIAQ) 1 9-item self-reported scale measuring the likelihood of a patient to situations and habits p rovoking negative body image Manzoni et al 27 (2009) W eight Efficacy Life-Style Questionnaire (WELSQ) Emotional Overeating Questionnaire (EOQ) State-Trait Anxiety Inventory (STAI) Beck Depression Inventory (BDI) 20-item questionnaire measuring self-efficacy across 5 situational factors: negative e motions, availability, social pressure, physical discomfort, and positive activities 6 -items; each begins with "on how many days out of the past 28 days have you eaten an unusually large amount of food of…" followed by 6 emotions; participants must indicate which one describes their reasoning most accurately (e.g., anxiety: worry, jittery, nervous); other emotions include sadness, loneliness, tiredness, anger, and happiness 40-item test on a 4-point Likert scale; 20 items measure state anxiety (current feelings) and 20 items measure trait anxiety (more stable over time and situations 21-item test ranging from 1–20 (normal) to over 40 (extreme depression); items inquire about feelings of sadness, thoughts about the future, self-image Larson et al 23 (2011) Virtual Reality and Robotic Optical Operations Machine (VRROOM) A 3-D system that allows patients to view virtual objects super-imposed onto the real world Yin et al 22 (2014) Fugl-Meyer Assessment (FMA) 33 items that measure upper extremity motor impairement on a 3-point rating scale; performance-based index that assesses balance, sensation, and motor functioning

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