Immersive technologies (ImT) such as virtual reality (VR), augmented reality (AR) and 360° video have been gaining momentum. These technologies create a feeling of submersion (immersion) in an artificial environment that replaces or changes (augments) the real environment, causing users to get immersed in the newly created environment.
Similar to a real environment, ImT can exert a strong influence on a person’s health and wellbeing1,2. Internationally, the use of ImT in healthcare is rising, but in Flanders use of ImT is limited. On the one hand, companies with technological know-how concerning ImT have insufficient insight into (i) how patients experience ImT, (ii) ImT’s impact on wellbeing, (iii) how this impact can be measured, and (iv) to what extent ImT can become part of a patient’s treatment program. On the other hand, healthcare facilities have insufficient knowledge of the opportunities of ImT to improve services as an addition to the existing heathcare services.
With the Immersive Care project we wish to optimize patients’ wellbeing during their treatment and/or stay in a care facility. To achieve this goal, we have set up multiple use cases in collaboration with different care facilities and companies specialized in ImT, in order to implement several forms of ImT in different healthcare branches.
In this use case Thomas More collaborates with residential aged care facilities (RACF, nursing homes) Residentie Halmolen (Vulpia) en Salvator Welzijnscentrum, and with visual content creation studio Uncanny.
Results of a Flemish government-ordered study show that residents without cognitive disabilities report a high quality of life concerning their basic needs (e.g., privacy, safety and respect), but that there is still room for improvement concerning personal relations and recreation (e.g., social contact with fellow residents, choice of activities, bonding with staff). In short, RACF residents experience a need for recreation and social contact.
A 360° video VR application could provide an answer to abovementioned needs by stimulating social contact with fellow residents and staff through reminiscence. Reminiscence is defined as the (in)voluntary recollection of either specific or general memories, either individually or in group, by means of triggers, such as questions, stories, photo’s, music or objects[2,3]. Reminiscence (therapy) is a well-known method in care for individuals living with dementia, and is applied as a separate activity or embedded in daily activities. Reminiscence is also used spontaneously by elderly without a cognitive disability, for example, during a reunion of during conversations with family or friends. Reminiscence serves multiple functions, including a social function. Mutually sharing personal and common experiences helps to form meaningful relationships and to grow a friendship. Studies already showed positive short term and long term effects of reminiscence (therapy) in elderly individuals living with dementia and elderly individuals living without dementia in multiple areas: quality of life, communication, loneliness, psychological wellbeing and cognitive skills[6,7,8].
360° video VR
In this use case, residents of two RACF will view different 360° videos under supervision of a researcher and/or a care worker. These 360° videos will show recordings of nature scenes, meaningful places from the resident’s past and family members. The researcher and/or care worker will also stimulate the residents to interact with them or other residents, in addition to reactions to the videos (if necessary). The use of 360° video VR in this use case is specifically intended to stimulate residents both on a cognitive level (e.g., reminiscence) and on a social level (e.g., sharing memories and stories about family with care staff or other residents).
We aim to assess the experience, acceptability, feasibility and tolerability of 360° video VR of residents and health care professionals in RACF. With this pilot study, we aim to answer the following research questions: Do RACF residents and health care professionals accept the use of VR as a part of recreational activities? Is the use of 360° video VR feasible for residents and health care professionals? Can 360° video VR improve the residents’ wellbeing? We aim to answer these questions through questionnaires and focus groups.
- Agentschap Zorg & Gezondheid. (2017). Sectorrapport 2017. Geraadpleegd van https://www.zorg-en-gezondheid.be/resultaten-van-de-bevraging-in-woonzorgcentra-over-de-kwaliteit-van-leven
- Bohlmeijer, E., Steunenberg, B. & Westerhof, G. (2011). Reminiscentie en geestelijke gezondheid: empirische onderbouwing van interventies.. TIJDSCHR. GERONTOLOGIE GER. 42, 7–16. https://doi.org/10.1007/s12439-011-0002-9.
- Kasl-Godley, J., & Gatz, M. (2000). Psychosocial interventions for individuals with dementia: an integration of theory, therapy, and a clinical understanding of dementia. Clinical Psychology Review, 20, 755-782.
- Dely, H. (2016). Reminiscentie bij personen met dementie: (niet) zomaar terug naar het verleden? In Expertisecentrum dementie, Dementie, van begrijpen naar begeleiden (afl.9).
- Vranic´ A, J. M. (2018). Functions of autobiographical Memory in Younger and Older Adults. Frontiers in psychology, 9, 1-10. doi: 10.3389/fpsyg.2018.00219.
- Chiang, K.‐J., Chu, H., Chang, H.‐J., Chung, M.‐H., Chen, C.‐H., Chiou, H.‐Y. and Chou, K.‐R. (2010), The effects of reminiscence therapy on psychological well‐being, depression, and loneliness among the institutionalized aged. Int. J. Geriat. Psychiatry, 25: 380-388. doi:10.1002/gps.2350.
- Pinquart, M. & Forstmeier, S. (2012). Effects of reminiscence interventions on psychosocial outcomes: A meta-analysis. Aging & Mental Health, 16 (5), 541-558. DOI: doi.org/10.1080/13607863.2011.651434.
- Woods, B., O’Philbin, L., Farrell, E.M., Spector, A.E., Orrell, M. (2018). Reminiscence therapy for dementia. Cochrane Database of Systematic Reviews, Issue 3. Art. No.: CD001120. DOI: 10.1002/14651858.CD001120.pub3.
In Europe alone, 1.1 million people fell victim to a CVA (Cerebro Vascular Accident) or stroke in 2000. The World Health Organization expects this number to increase by 36% by 2025, due to an aging population. The motor impairments of a stroke are usually marked by paralysis of one whole side of the body (hemiplegia). The majority of these hemiplegic patients show a functional disability in the hemiplegic arm after the stroke and only 5 to 20% of them show a complete recovery (Kwakkel et al, 2003). Mirror therapy is often used in an attempt to reactivate the hemiplegic arm. During this therapy, the patient performs exercises with the healthy limb, but by using a mirror, the patient appears to be using the affected limb, in order to ‘reprogram’ the brain. However, the range of possible movements in these exercises is limited and a high number of repetitions is essential, causing therapy to quickly become monotonous for the patient. These obstacles can be overcome with VR. By focusing on virtual mirror therapy by means of a VR headset, therapists hope to create a more pleasant and more realistic experience for the patients (e.g., picking apples instead of only moving the arm up and down). For this use case, a virtual mirror therapy by means of a cooking simulation was chosen in consultation with our care and technology partners.
VR application and use
In this VR application, patients will be able to perform daily activities (e.g., different steps of the cooking process), which can increase their motivation and boost their self-confidence and self-worth. A VR headset immerses the patients in a virtual kitchen, where they have to perform various actions in order to successfully complete a cooking program. These actions must be performed with the unaffected side and include only upper limb ADL activities such as grasping ingredients or kitchen utensils, cutting vegetables, putting ingredients in a cooking pot and stirring in the cooking pot. The movements of the unaffected side are projected to the affected side (mirrored), so that the patient appears to be performing the actions with the affected side. For this use case, the VR mirror therapy (prototype) developed by OneBonsai will be tested in up to 20 stroke patients spread across two rehabilitation centers, Rehabilitation hospital RevArte and the To Walk Again REVAlution Center.
In this use case, we specifically want to investigate the acceptance, feasibility and tolerance of the use of virtual mirror therapy among the patients and healthcare professionals of rehabilitation centers. In addition, we also make a preliminary estimate of the effectiveness of virtual mirror therapy, in particular on the functionality of, and the pain in the upper limb. We try to achieve these goals by means of the analysis of questionnaires and functional tests.
People with severe intellectual disabilities have a mainly bodily experience of the world around them. In specific circumstances, elementary associations can be made, therefore activities in daycare are mainly experience-oriented. The focus is on experiencing sensory stimuli such as Snoezelen, Experience Theatre, Basal Stimulation, the ‘Ervaar het maar’ method, Multi-sensory storytelling, ‘Tovertafel’… In the past, technology has been used to develop sensory stimulation material[2,3], and more recently, an adapted Tovertafel has been developed for people with severe (multiple) intellectual disabilities[4,5]. Immersive technology could complement the existing range of experience activities. For this, applications that match the interests of the person with a disability, that are tailored to the sensory experience of this person and that lead to pleasant experiences must be used. The person with a severe intellectual disability could experience the immersive experiences together with a caretaker or with family. The attendant or family member would be able to follow the experience on an external screen and encourage the person or alert them on specific stimuli. In addition, one could anticipate positive or negative reactions, mood swings and expressions of pleasure. Research literature on the effect of experience activities for persons with severe intellectual disabilities in general is very limited. Moreover, literature research into the use of VR glasses and Virtual Reality in persons with severe intellectual disabilities did not yield any useful information. On the whole, new technology is aimed at an average audience, although there is a clear need to develop systems and applications that meet the needs of people with intellectual disabilities, as well as a clear demand for such applications from the care partner involved (Het GielsBos).
During this pilot study, we will gather information about characteristics that healthcare providers consider as necessary for the development and implementation of VR applications, by the means of focus groups. In addition, clients of Het GielsBos will test various VR applications under the supervision of a person of the coaching team that they know well. For each client, there will be a registration of how he/she anticipates the applications, how he/she experiences the VR environment/application and for how long he/she can focus on the activity. Registration is done based on observation forms.
- Daems J. & Op de Beeck K., (2018). Zintuiglijk leren. In: Denolf & Daems, Ergotherapie en Ontwikkelingsproblemen p.67-101. Leuven: Acco.
- Hogg, J., Cavet, J., Lambe, L., & Smeddle, M. (2001). The use of ‘Snoezelen’ as multisensory stimulation with people with intellectual disabilities: a review of the research. Research in developmental disabilities, 22(5), 353–372. https://doi.org/10.1016/s0891-4222(01)00077-4
- Lotan, M. & Gold, C. (2009). Meta-analysis of the effectiveness of individual intervention in the controlled multisensory environment (Snoezelen 1) for individuals with intellectual disability. Journal of Intellectual & Developmental Disability, 34(3), 207-215.
- Talman L. and Gustafsson C. (2020). Evaluation of Tovertafel UP. SwedenVästerås : Mälardanen University, Academy of Health, Care and Social Welfare February 2020
Autism spectrum disorder (ASD) is characterized by difficulties with social interaction and communication, and repetitive behaviors and a restricted pattern of behaviors, interests and activities. These characteristics are also associated with less developed daily life skills,, in other words the group of activities an individual needs to master in order to maintain a reasonable level of health and safety in everyday life. These skills include phone use, housekeeping (e.g., meal preparation, cleaning, grocery shopping), budget management, mobility, etc. Although these skills come naturally to many, for individuals with ASD acquiring these skills can be very scary and overwhelming. Moreover, studies have shown that these skills are preferably acquired at a younger age to promote independence in adulthood,,. Another population that needs more help to acquire these daily life skills are individuals with an intellectual disability.
An intellectual disability is characterized by significant deficits in intellectual functioning and adaptive behavior, on a conceptual, social and practical level[1,7].
For children with an ASD, there are some VR applications available focusing on police interaction, learning of social gestures, and learning of joint attention. However, despite clear interest from the field, this technology is only scarcely available for individuals with an intellectual disability, specifically in the form of (semi)immersive snoezelen (e.g., Snoezle) rather than to acquire a specific skill. The use of VR, however, has great potential to improve and enlarge the existing range of counseling activities for these individuals. VR allows training of specific skills to improve independence in an artificial environment, that would be too time consuming or practically unachievable (e.g., learning grocery shopping, learning to take a bus, etc.). VR offers an immersive, educational experience that can be repeated endlessly, but during which the counselor can be present. The goal is not to replace the existing range of counseling activities, but to assess the potential of VR as an addition to the counseling activities of this population.
VR application and use
In collaboration with Thomas More, Flegado and BSBO Den Anker, Digimedical developed a (prototype) VR application that will be assessed in the current study. With this VR application, we aim to prepare the user to learn how to go grocery shopping independently. Together with their counselor/teacher, the client/student will prepare a grocery list, after which they put on the headset. While in the virtual environment, they will (learn to) conduct different steps of grocery shopping (e.g., grabbing a shopping basket, looking for products, asking for help, paying at the register,…). The counselor/teacher is able to follow their steps in the virtual environment via a laptop and will help them, if necessary. Afterwards, the they will discuss their experience, e.g., what they have learned and still have to learn.
In this use case, we aim to assess the experience, acceptability, feasibility and tolerability of using a Virtual Reality (VR) application via a head-mounted device (VR goggles) to learn children with autism spectrum disorder (ASD) and young adults with intellectual disabilities to go grocery shopping, as addition to their activity schedule. To do so, participating children with ASD and young adults with intellectual disabilities – under supervision of their teacher/coach – will use the VR application for multiple weeks, will be administered multiple questionnaires and will participate in focus groups.
The VR application allows users to practice different skills, such as planning, communication and independence, in a virtual world before practicing these skills in a real life situation. In this use case, we will specifically train skills related to grocery shopping.
- American Psychiatric Association (APA): Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
- Maenner MJ, Smith LE, Hong J, Makuch R, Greenberg JS, Mailick MR. Evaluation of an activities of daily living scale for adolescents and adults with developmental disabilities. Disabil Health J. 2013;6(1):8-17. doi:10.1016/j.dhjo.2012.08.005.
- Park CJ, Yelland GW, Taffe JR, Gray KM. Brief report: The relationship between language skills, adaptive behavior, and emotional and behavior problems in pre-schoolers with autism. J Autism Dev Disord. 2012;42(12):2761-2766. doi:10.1007/s10803-012-1534-8.
- Bal VH, Kim SH, Cheong D, Lord C. Daily living skills in individuals with autism spectrum disorder from 2 to 21 years of age. Autism. 2015;19(7):774-784. doi:10.1177/1362361315575840
- Smith LE, Maenner MJ, Seltzer MM. Developmental trajectories in adolescents and adults with autism: the case of daily living skills. J Am Acad Child Adolesc Psychiatry. 2012;51(6):622-631. doi:10.1016/j.jaac.2012.03.001
- Szatmari P, Bryson S, Duku E, et al. Similar developmental trajectories in autism and Asperger syndrome: from early childhood to adolescence. J Child Psychol Psychiatry. 2009;50(12):1459-1467. doi:10.1111/j.1469-7610.2009.02123.x
- AAIDD. (2019). Definition of Intellectual Disability. Opgeroepen op Maart 25, 2020, van American Association of Intellectual and Developmental Disabilities: http://aaidd.org/intellectual-disability/definition#.WXYKaIjyjIU
The prevalence of anxiety1,2 and pain3,4 in paediatric patients is high and impacts health outcomes. In the short term, extreme distress may compromise the completion of a required medical procedure, while, in the long term, it may discourage the use of medical treatments5-7. Anxiety prevalence differs considerably between procedures and reasons of hospitalisation. In general, hospital visits in context of medical procedures often evoke anxiety, distress and pain. Specifically, up to 70% of children (in the U.S.A.) experience elevated levels of anxiety and distress prior to surgery8. Especially in children, these anxious feelings not only severely affect comfort levels during medical procedures, but are also associated with adverse consequences9,10, such as attempts to escape11, poorer recovery12, eating and sleeping disturbances12, and posttraumatic stress symptoms13. Therefore, solutions are needed to alleviate these feelings of anxiety and pain in children in hospital.
Current pain and anxiety management for children in hospital includes pharmacological analgesia (e.g. opioid therapy) with potential negative side effects14. In addition, a non-pharmacological approach involves various distraction techniques, either passive (e.g., music15,16, movies17,18) or active (e.g., interactive toys, electronic games, storytelling by the nursing staff)19. However, these distraction techniques can often be time consuming for the already busy and even over-demanded nursing staff.
A combination of distraction, extinction learning, cognitive-behavioral principles, mindful meditation, stress reduction, gate-control theory, and the spotlight theory of attention is believed to be the mechanism behind VR’s effectiveness in pain management20,21. Accumulating evidence supports VR as a feasible and effective method to alleviate anxiety and pain for paediatric patients during lumbar punctures22, intravenous injection23–25, burn wound care26–28 and rehabilitation29 (and see 9,30–32 for review). In particular, a recent meta-analysis reported that the use of VR was significantly more effective in reducing pain (14 studies) and anxiety (7 studies) than care as usual (CAU), with large effect size9. Moreover, for chest radiography, the use of VR has also significantly reduced procedure time, while increasing patient satisfaction33. As such, adding the use of VR to standard pain and anxiety management methods might improve both effectiveness and efficiency of current practice.
VR application and use
While using the Relaxation-VR application, patients will be distracted and ‘pulled away’ from the real world. A VR headset immerses patients in a soothing, calming environment, and by using calming sounds, colors, verbal guidance, relaxing exercises, and interactive animations and objects, patients are guided to relax.
Although on an international level, accumulating evidence supports the feasibility and effectiveness of VR for pain and anxiety management (see 11,32–34 for review), in Belgium, adoption of VR in clinical practice is limited and local trials are scarce. In order to improve translation from research to practice, the current study will focus on the feasibility, acceptability, tolerability and preliminary effectiveness of ‘Relaxation-VR’, a VR application developed by Psylaris (www.psylaris.com) aiming to reduce anxiety and pain for children admitted to hospital, as experienced by both patients and clinical staff. This study will take place at the paediatric wards of two hospitals interested in adopting this innovative technology for improving both patient care (e.g., anxiety and pain reduction) and staff workload (e.g., shorter procedure times), UZ Brussel and AZ Sint-Maarten.
- Lerwick JL. Psychosocial implications of pediatric surgical hospitalization. Semin Pediatr Surg. 2013;22(3):129-133. doi:10.1053/j.sempedsurg.2013.04.003
- Delvecchio E, Salcuni S, Lis A, Germani A, Di Riso D. Hospitalized Children: Anxiety, Coping Strategies, and Pretend Play. Front Public Heal. 2019;7:250. doi:10.3389/fpubh.2019.00250
- Walther-Larsen S, Pedersen MT, Friis SM, et al. Pain prevalence in hospitalized children: a prospective cross-sectional survey in four Danish university hospitals. Acta Anaesthesiol Scand. 2017;61(3):328-337. doi:10.1111/aas.12846
- Taylor MBChB FANZCA EM, Boyer KR, Campbell FRCA FA, et al. Pain in Hospitalized Children: A Prospective Cross-Sectional Survey of Pain Prevalence, Intensity, Assessment and Management in a Canadian Pediatric Teaching Hospital. Vol 13.
- Du S, Jaaniste T, Champion DG, Yap CSL. Theories of fear acquisition: The development of needle phobia in children. Pediatr Pain Lett. 2008;10(2):13-17. www.pediatric-pain.ca/ppl. Accessed July 1, 2020.
- Kennedy RM, Luhmann J, Zempsky WT. Clinical Implications of Unmanaged Needle-Insertion Pain and Distress in Children. Pediatrics. 2008;122(SUPPL. 3):S130-S133. doi:10.1542/peds.2008-1055e
- Noel M, Meghan McMurtry C, Chambers CT, McGrath PJ. Children’s Memory for Painful Procedures: The Relationship of Pain Intensity, Anxiety, and Adult Behaviors to Subsequent Recall. J Pediatr Psychol. 2010;35(6):626-636. doi:10.1093/jpepsy/jsp096
- Perry JN, Hooper VD, Masiongale J. Reduction of Preoperative Anxiety in Pediatric Surgery Patients Using Age-Appropriate Teaching Interventions. J Perianesthesia Nurs. 2012;27(2):69-81. doi:10.1016/j.jopan.2012.01.003
- Eijlers R, Utens EMWJ, Staals LM, et al. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth Analg. 2019;129(5):1344-1353. doi:10.1213/ANE.0000000000004165
- Johnston M, Carpenter L. Relationship between pre-operative anxiety and post-operative state. Psychol Med. 1980;10(2):361-367. doi:10.1017/S0033291700044135
- Chorney JML, Kain ZN. Behavioral analysis of children’s response to induction of anesthesia. Anesth Analg. 2009;109(5):1434-1440. doi:10.1213/ane.0b013e3181b412cf
- Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651-658. doi:10.1542/peds.2005-2920
- Meentken MG, van Beynum IM, Legerstee JS, Helbing WA, Utens EMWJ. Medically Related Post-traumatic Stress in Children and Adolescents with Congenital Heart Defects. Front Pediatr. 2017;5:20. doi:10.3389/fped.2017.00020
- Hartling L, Ali S, Dryden DM, et al. How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review. Pain Res Manag. 2016;2016. doi:10.1155/2016/5346819
- Whitehead-Pleaux AM, Baryza MJ, Sheridan RL. The Effects of Music Therapy on Pediatric Patients’ Pain and Anxiety During Donor Site Dressing Change. J Music Ther. 2006;43(2):136-153. doi:10.1093/JMT/43.2.136
- Aitken JC, Wilson S, Coury D, Moursi AM. The effect of music distraction on pain, anxiety and behavior in pediatric dental patients. Pediatr Dent. 2002;24(2):114-118.
- Landolt MA, Marti D, Widmer J, Meuli M. Does Cartoon Movie Distraction Decrease Burned Children’s Pain Behavior? J Burn Care Rehabil. 2002;23(1):61-65. doi:10.1097/00004630-200201000-00013
- Mifflin KA, Hackmann T, Chorney JML. Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia. Anesth Analg. 2012;115(5):1162-1167. doi:10.1213/ANE.0b013e31824d5224
- Koller D, Goldman RD. Distraction Techniques for Children Undergoing Procedures: A Critical Review of Pediatric Research. J Pediatr Nurs. 2012;27(6):652-681. doi:10.1016/j.pedn.2011.08.001
- McCaul KD, Malott JM. Distraction and coping with pain. Psychol Bull. 1984;95(3):516-533. doi:10.1037/0033-2909.95.3.516
- Li A, Montaño Z, Chen VJ, Gold JI. Virtual reality and pain management: current trends and future directions. Pain Manag. 2011;1(2):147-157. doi:10.2217/pmt.10.15
- Wint SS, Eshelman D, Steele J, Guzzetta CE. Effects of Distraction Using Virtual Reality Glasses During Lumbar Punctures in Adolescents With Cancer. 2002;29(1):8-15.
- Dunn A, Patterson J, Biega CF, et al. A novel clinician-orchestrated virtual reality platform for distraction during pediatric intravenous procedures in children with hemophilia: Randomized controlled trial. J Med Internet Res. 2019;21(1). doi:10.2196/10902
- Piskorz J, Czub M. Effectiveness of a virtual reality intervention to minimize pediatric stress and pain intensity during venipuncture. J Spec Pediatr Nurs. 2018;23(1):e12201. doi:10.1111/jspn.12201
- Gold JI, Kim SH, Kant AJ, Joseph MH, Skip A”, Rizzo “. Effectiveness of Virtual Reality for Pediatric Pain Distraction during IV Placement. Vol 9.; 2006. www.liebertpub.com. Accessed April 29, 2020.
- Faber AW, Patterson DR, Bremer M. Repeated Use of Immersive Virtual Reality Therapy to Control Pain during Wound Dressing Changes in Pediatric and Adult Burn Patients. J Burn Care Res. 2013;34(5):563-568. doi:10.1097/BCR.0b013e3182777904
- Miller K, Rodger S, Bucolo S, Greer R, Kimble RM. Multi-modal distraction. Using technology to combat pain in young children with burn injuries. Burns. 2010;36(5):647-658. doi:10.1016/j.burns.2009.06.199
- Jeffs D, Dorman D, Brown S, et al. Effect of Virtual Reality on Adolescent Pain During Burn Wound Care. J Burn Care Res. 2014;35(5):395-408. doi:10.1097/BCR.0000000000000019
- Hoffman HG, Meyer WJ, Ramirez M, et al. Feasibility of articulated arm mounted oculus rift virtual reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Cyberpsychology, Behav Soc Netw. 2014;17(6):397-401. doi:10.1089/cyber.2014.0058
- Arane K, Behboudi A, Goldman RD. Virtual reality for pain and anxiety management in children. Can Fam Physician. 2017;63(12):932. http://kindvr.com. Accessed July 1, 2020.
- Won A, Bailey J, Bailenson J, Tataru C, Yoon I, Golianu B. Immersive Virtual Reality for Pediatric Pain. Children. 2017;4(7):52. doi:10.3390/children4070052
- Malloy KM, Milling LS. The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin Psychol Rev. 2010;30(8):1011-1018. doi:10.1016/j.cpr.2010.07.001
- Han SH, Park JW, Choi S Il, et al. Effect of Immersive Virtual Reality Education before Chest Radiography on Anxiety and Distress among Pediatric Patients: A Randomized Clinical Trial. JAMA Pediatr. 2019;173(11):1026-1031. doi:10.1001/jamapediatrics.2019.3000
Fear1, 2 is common in children in a hospital setting and has consequences for their health. In the short term, extreme anxiety may hinder the completion of a required medical procedure, while in the long term, it may discourage children from using medical treatments3-5. The prevalence of anxiety varies significantly between procedures and reasons for hospitalisation. Often, hospital visits combined with medical procedures provoke fear and pain in children. For example, up to 70% of children (in the United States of America) experience increased levels of anxiety before surgery6. Especially in children, these anxiety feelings not only affect the level of comfort during medical procedures, but also have been associated with adverse health effects7 such as attempts to escape8, poor recovery9, eating and sleeping disorders9 and post-traumatic stress symptoms10. Therefore, solutions are needed to alleviate these feelings of anxiety in children in hospital. A specific problem related to anxiety in hospital care is pre-operative anxiety in children. Current methods to deal with preoperative anxiety in children are distraction and the best possible preparation for the surgery. Heilig Hart Ziekenhuis Lier uses the latter method by means of a preparation booklet (picture book) which explains the steps a child has to go through before the surgery. Preparation by means of VR 360° images has already been tested internationally (with varying results)11,12, but is less known in Belgium.
VR application and use
360° video VR offers the opportunity to reduce preoperative anxiety in children by already exposing them in a safe and supported way to the operating room and the route to the operating room. This allows them to get used to the environment and procedures related to surgery.
In this project we investigate how children and caregivers experience this technology in care. Are they satisfied? Are there side effects? Is it feasible for the caregivers? In addition, we investigate whether the VR 360° video (viewed through VR glasses) has a better effect on anxiety reduction in children before surgery compared to the current preparation (picture book). These are all important questions that are addressed in this research.
We aim to investigate the feasibility, acceptability and tolerability of this technology in both patients and healthcare providers. In addition, we compare the degree of anxiety reduction between a group of children receiving the 360° VR preparation and a group of children receiving care as usual. We aim to achieve these goals through the analysis of questionnaires, observations and anxiety scales.
- Larsen CR, Soerensen JL, Grantcharov TP, et al. Effect of virtual reality training
on laparoscopic surgery: randomised controlled trial. BMJ. 2009;338:b1802.
- Delvecchio E, Salcuni S, Lis A, et al. Hospitalized Children: Anxiety, Coping
Strategies, and Pretend Play. Frontiers in Public Health. 2019;7:250.
- Du S JT, Champion DG, Yap CSL. . Theories of fear acquisition: The
development of needle phobia in children. Pediatr Pain Lett. 2008 [Available from:
- Kennedy RM, Luhmann J, Zempsky WT. Clinical Implications of Unmanaged
Needle-Insertion Pain and Distress in Children. Pediatrics. 2008;122(Supplement 3):S130-S3.
- Noel M, McMurtry CM, Chambers CT, et al. Children’s Memory for Painful
Procedures: The Relationship of Pain Intensity, Anxiety, and Adult Behaviors to
Subsequent Recall. Journal of Pediatric Psychology. 2009;35(6):626-36.
- Perry JN, Hooper VD, Masiongale J. Reduction of preoperative anxiety in
pediatric surgery patients using age-appropriate teaching interventions. J Perianesth Nurs. 2012;27(2):69-81.
- Johnston M, Carpenter L. Relationship between pre-operative anxiety and postoperative state. Psychol Med. 1980;10(2):361-7.
- Chorney JM, Kain ZN. Behavioral analysis of children’s response to induction of
anesthesia. Anesth Analg. 2009;109(5):1434-40.
- Kain ZN, Mayes LC, Caldwell-Andrews AA, et al. Preoperative Anxiety,
Postoperative Pain, and Behavioral Recovery in Young Children Undergoing Surgery.
- Meentken MG, van Beynum IM, Legerstee JS, et al. Medically Related Posttraumatic
Stress in Children and Adolescents with Congenital Heart Defects. Frontiers in
- Eijlers R, Legerstee JS, Dierckx B, et al. Development of a Virtual Reality
Exposure Tool as Psychological Preparation for Elective Pediatric Day Care Surgery:
Methodological Approach for a Randomized Controlled Trial. JMIR Res Protoc.
- Ryu JH, Park SJ, Park JW, et al. Randomized clinical trial of immersive virtual
reality tour of the operating theatre in children before anaesthesia. Br J Surg.
Won, A.S.; Bailey, J.; Bailenson, J.; Tataru, C.; Yoon, I.A.; Golianu, B. (2017) Immersive Virtual Reality for Pediatric Pain. Children, 4, 52. DOI: 10.3390/children4070052.
Lohse KR, Hilderman CGE, Cheung KL, Tatla S, Van der Loos HFM (2014) Virtual Reality Therapy for Adults Post-Stroke: A Systematic Review and Meta-Analysis Exploring Virtual Environments and Commercial Games in Therapy. PLoS ONE 9(3): e93318. https://doi.org/10.1371/journal.pone.0093318