Virtual reality useful for pain reduction, cognitive rehab and medical training

Virtual reality (VR) can be used to reduce pain during wound care for burn patients, facilitate cognitive rehabilitation for patients with neurological or psychiatric disorders, and transform medical training for healthcare staff, according to data presented at the 2019 Hong Kong Hospital Authority Convention.

“In patients with burn injuries, wound care can cause excruciating pain inadequately controlled by morphine. SnowWorld, an immersive VR game developed by our team, is shown to be effective in pain control during burn wound care,” said Dr Hunter Hoffman of the Virtual Reality Research Center, University of Washington, US.

“Because the interactive 3D VR game is delivered via goggles, patients cannot see the wound during wound care. This not only provides distraction, but also helps patients stay still during wound care,” he explained.

In a study in 12 US soldiers with combat-related burn injuries, significant reductions were reported in pain intensity and time spent thinking about pain during wound debridement with the use of SnowWorld compared with no VR treatment. In addition, most patients reported having fun when SnowWorld was used during wound care. [J Trauma 2011;71(1 Suppl):S125-S130]

“The immersive VR treatment also demonstrated efficacy in pain reduction in patients with extensive burn injuries requiring wound care in a hydrotherapy tub,” said Hoffman. [J Clin Psychol 2004;60:189-195] “In patients with severe burn injuries undergoing rehabilitative skin stretching, SnowWorld continued to effectively reduce pain for up to 10 days.”

“The use of VR treatment together with opioid analgesics provided greater pain relief than opioid analgesics alone,” he added. [Anesth Analg 2007;105:1776-183]

In Hong Kong, VR has been applied in cognitive rehabilitation for patients with schizophrenia, traumatic brain injury (TBI), stroke, and mild cognitive impairment (MCI).

According to Professor David Man of the Department of Rehabilitation Sciences, Hong Kong Polytechnic University (HKPU), who led the development of numerous VR-based assessment and intervention programmes in Hong Kong, VR-based programmes promote neuroplasticity and are more effective than web-based programmes in transferring skills acquired to real-world environments.

Between 2006 and 2018, Man and colleagues had developed numerous VR-based cognitive rehabilitation programmes for various patient groups. These include vocational training programmes for patients with TBI or schizophrenia, training programmes on prospective memory and community living skills for patients with acquired brain injury, a stroke rehabilitation programme, a memory training programme for older adults with MCI, and a cognitive training programme for drug abusers. [Brain Inj 2013;27:1016-1025; NeuroRehabilitation 2013;32:103-115; Brain Inj 2009;23:1017-1026; NeuroRehabilitation 2006;21:245-253; Int J Geriatr Psychiatry 2012;27:513-520; Schizophr Res 2013;144:51-62; Hong Kong Med J 2012;18(Suppl 6):18-22; Neuropsychol Rehabil 2018:1-18]

“Our interactive VR boutique programme, which provides vocational training for various job functions, is now in use at some public psychiatric hospitals,” said Man. “We are also conducting a randomized controlled trial on an artificial intelligence, VR convenience store training programme for patients with first-episode schizophrenia.”