Website Review 1

Website Review 1

Review of website Research & Development on Virtual “SnowWorld” Helps Burn Victims Cope with Extreme Pain.

Panjwani, L. (2017) Virtual “SnowWorld” Helps Burn Victims Cope with Extreme Pain. Available at: https://www.rdmag.com/article/2017/08/virtual-snowworld-helps-burn-victims-cope-extreme-pain (Accessed: May 2019)

The Research and Development article written by Laura Panjwani that is going to be reviewed discusses the immersive virtual reality (VR) game SnowWorld, developed by researchers at the University of Washington Human Interface Technology Laboratory. SnowWorld is described as an immersive experience that features a snowy scenery, the objective of the game is to score points by throwing snowballs at various characters within the game such as snowmen and penguins. In order to play the user must point their head slightly in whichever direction they wish to aim the snowball and press a button to launch it. This game was designed specifically for burn victims as a means of distraction when undergoing painful burn wound care during their healing process. Panjwani quoted one of the original creators of the game, Hunter Hoffman, Ph. D, who said ‘SnowWorld was designed around the concept of snow because cold and ice is the antithesis to burning fire.’ The creators took into consideration that this was a game being designed for burn patients without full cognitive ability, heavily medicated and in a copious amount of pain, therefore it had to be a simplistic game for them to be able to play it. The article presents research studies that evidence patients that have played the game during treatment have significantly reduced pain levels. Expanding on how VR works to reduce focus on the pain, as well as addressing the impact of technological advancements. The reason for reviewing this particular article is that it supports the basis of the website around the potential of VR technology, showing how VR can be used as an assistive technology outside of an educational classroom setting.

In the beginning Hoffman had been investigating into the potential of VR for pain reduction since the early 90’s. His interest spiked whilst working in collaboration with Thomas A. Furness, Ph. D., the Founding Director of the Human Interface Technology Lab. Furness had invented the first personal eyewear display, marketing the device through his company Virtual Vision. The device allowed the user to watch a film or play a game via eyewear headset, dentists showed the most interest in this device, Furness said, ‘Dentists were buying it to distract their patients during painful procedures…Kids could play video games while at the dentist and not complain as much.’ This is when a market was realised and it was recognised as a brilliant distraction from pain. Hoffman then eventually connected with David Patterson, Ph. D, ‘who studies psychological techniques for reducing severe acute burn pain of patients at Harborview Burn Center in Seattle.’ And together they came up with the concept for SnowWorld. Hoffman then worked with Jeff Magula to build a VR system that could be used during the water treatment of burn victims. Because electronic devices cannot be safely used in water, ‘this system features a custom fiberoptic VR helmet that carries light to the patients’ eyes via a light pipe.’ The studies conducted yielded exciting results for Hoffman who said ‘We’ve been really pleasantly surprised how well VR has been able to compete with incoming pain signals’. The first study that the team published in a medical journal in 2000 demonstrates the benefits of the SnowWorld VR game compared to standard video games, it shows a significant reduction in various subjective pain and anxiety ratings in a patient that underwent bedside burn wound care. Further studies conducted since then, that have been published confirm the efficacy of SnowWorld in reducing a burn victims pain when undergoing wound care or during other procedures.

A study published in 2007 assessed the efficacy and side effects of immersive VR distraction analgesia, ‘The inability to feel pain.’ (Oxford University Press, 2019). ‘as well as patient factors associated with VR analgesic efficacy in burn patients who require passive range-of-motion (ROM) physical therapy.’ This particular study included 88 subjects, 75% were children aged between 6-18 years. Comparing the results yielded with standard analgesic treatment alone, the addition of the VR as a distraction resulted in a 20% reduction in subjective pain ratings for the worst pain intensity, a 26% reduction in feelings of unpleasantness and a 37% reduction in time patients spent thinking about being in pain. In another study published in 2008, that looked at 11 hospitalized inpatients aged 9-40 years who had their burn wounds damaged tissue removed and redressed while partially submerged in a hydrotank. Each patient spent three minutes of the wound care without a distraction and three minutes of the procedure using the VR during a single session, patients reported back that they were in significantly less pain whilst distracted with VR, with their ‘’worst pain’’ ratings during the treatment dropping down from ‘’severe’’ to ‘’moderate’’. With six of the patients reporting the strongest illusion of ‘’going inside’’ the virtual world resulted in the greatest pain reduction effects, going from being in ‘’severe pain’’ with no VR to being in ‘’mild pain’’ whilst using VR.

Furness explained VR works in this setting because it reduces the brain’s concentration on the pain. ‘In order to experience pain you have to be conscious of pain’ he said. It is all about distracting the mind, if a patient is given something else to concentrate on that is immersive and consuming, it takes away from what else is going on around them. Hoffman adds ‘What we are doing is luring the spotlight of attention into the virtual world, so patients, instead of looking at their wounds and watching it and being there in the hospital room, they are now in SnowWorld and are basically less present in the hospital room’. But the benefits also go beyond just the patients perceived pain during the experience. Brain scans from patients playing VR whilst also experiencing pain showed a reduction in pain-related brain activity. This only further demonstrates that not only is VR changing how patients interpret incoming pain signals, it is actually also changing the way in which the brain processes pain signals Hoffman said. Roughly one-fourth of the brain is devoted to processing visual information, called the visual cortex, therefore when someone is in VR they are using up a lot of additional resources and this leaves limited attention available to process any incoming pain signal.

When the University of Washington team first started out investigating VR for pain reduction the technology was harder to acquire and very expensive, devices such as a wide field vision helmet used to cost $35,000, today however thanks to advancements in technology, wide field of vision goggles are more affordable, costing between 500 to 800$. After working at this for 52 years Furness stated, ‘This was a long time coming’. Recognising that the initial problem was that the hardware and technology did not exist. Now as a result of technology advancing SnowWorld has been updated and the team in 2014 were able to publish their first paper on the use of Oculus Rift goggles for any clinical applications. A newer version of SnowWorld has been made purposefully designed to be used with the Oculus Rift and HTC Vive helmets and work is going into incorporating these new helmets to wound care treatment for burn patients, Hoffman calling recent developments exciting and intense.

In conclusion, I believe the potential of VR technology is multifaceted, this example demonstrates how the technology can be used in a clinical application, evidencing the results produced that show the effectiveness of VR being used to help distract burn patients from painful treatment. With technological advancements, VR devises have received updates and become more affordable allowing more hospitals to be able to gain the technology to use to support their patients going through difficult treatments.