At the University of Washington (UW) Harborview Burn Center, Hunter Hoffman, a research scientist at the UW Human Interface Technology (HIT) Laboratory, is forming a team with psychologist David Patterson, UW associate professor of rehabilitation medicine. Together, they developed an innovative pain management programme with use of virtual reality as a new way to help reduce burn pain to a more tolerable level, by immersing burn patients, particularly children and teenagers, into a VR environment during wound care and physical therapy. The interdisciplinary research team has already received grants from the National Institute of Health, the Washington Technology Center, and the International Firefighters Association.
Burn wounds are often extremely painful, especially when they are being cleaned to prevent infection or when stretching the newly healing skin during physical therapy. The rehabilitation process now can be eased in the pilot project at Harborview. The team of Hoffman and Patterson have built a virtual reality world with a loaner Octane MXE from Silicon Graphics. The software package SpiderWorld from the Division Ltd. company is being used to immerse the patient into a virtual kitchen in which he can open the drawers and cabinets, pick up teapots, as well as physically grope the plump furry body of a Guyana bird-eating tarantula. The programme was originally designed to treat spider phobics.
Paradigm Simulations has created a second software programme, especially for burn victims, which is called SnowWorld. Here, the patient flies through an icy canyon with a river and a frigid waterfall, in order to shoot snowballs at snowmen and igloos. During wound treatment or physical therapy, the patient wears a virtual reality helmet. Since the victims tend to relive their original burn experience, SnowWorld has been designed to help put out the fire. The patients are just so absorbed in the virtual reality experience that there's less consciousness available for pain. In fact, pain really constitutes a psychological experience. As such, the amount of pain the patient thinks he is experiencing equals the level of pain he is actually going through.
Patterson and Hoffman say the pain reduction has been dramatic in the six patients who have tried the virtual reality therapy. Pain requires conscious attention. Virtual Reality is also very attention demanding. Thus by focusing the spotlight of the patient's attention on the virtual world, he is distracted from the pain and experiences the wound care or therapy sessions rather as an annoyance. The use of tactile augmentation gives the patient the illusion of physically touching the virtual object. This special technique has recently been used by burn patients to physically eat virtual chocolate bars.
The Hunter and Patterson team has received a grant from the Washington Firefighters Association to build a water-friendly VR helmet which applies optic fiber image guides, allowing the patient to sit in a tub of water during wound care. Only light travels to the patient, not electricity. This will largely increase the number of patients who can be treated with virtual reality. In any case, it should be stressed that immersive VR technique is applied as a non-pharmacological analgesic in addition to, and certainly not instead of, the traditional doses of opioids in order to reduce the pain.
So far, the physical therapists at Harborview have been impressed with the results. The team actually had one patient who didn't even know his therapy had started, according to occupational therapist Dana Yoko Nakamura. The outcomes show substantial reductions in pain levels during physical therapy for patients immersed into the VR environment, in comparison to those who had no VR experience. Hoffman and Patterson hope that other burn centers will gradually become interested in testing virtual reality techniques for pain control. Perhaps, this innovative non-pharmacological analgesia might be of great use to other suffering patient populations as well. For more details on virtual reality treatment for burn pain, please visit the Web site of the Human Interface Technology Laboratory.