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May 24, 2005
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Burn Victim Center


Virtual Reality: a short introduction

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The pain of severe burns may be the most excruciating pain a person can experience. But, as this ScienCentral News video reports, pain researchers say the fantasy worlds of virtual reality can help alleviate the real, physical suffering of burn victims.

Real Relief

Six-year-old Nathan Neisinger suffered serious burns when he accidentally pulled a pot of boiling water onto himself.

"He had third degree burns and they were over 31 percent of his body," says his mother, Heidi. "His whole entire chest, his back, his legs, part of his foot, had third degree burns all over them. They had to do skin grafting; they had to take skin off of his behind, off of the back of his legs."

Besides skin grafts, Nathan has endured months of wound care and more pain than safe doses of narcotics can alleviate. "The care is very often more painful than the injury itself," says David Patterson, a psychologist and pain expert at Harborview Medical Center in Seattle, where Nathan spent 51 days after being airlifted there for his injuries. "Typical care involves removing bandages and then scrubbing the wound, and for some patients, you do that once or twice a day, for days, weeks, and even months."

And then there was the physical therapy to stretch his scarred skin. "The actual process of going through that physical therapy is often very extensive," says Patterson. "You can hear some ripping and cracking. It can be anxiety-producing to anyone, much less a six-year-old."

bear in game
SnowWorld image: Hunter Hoffman, University of Washington Seattle
But while Nathan's body is put through the wringer, his brain can cool off and play in a 3-D computer-generated environment called "SnowWorld." Patterson and Hunter Hoffman, director of the VR Analgesia Research Center at the University of Washington's Human Interface Technology Laboratory, created SnowWorld, a virtual reality (VR) game, especially for people like Nathan.

"SnowWorld is the first virtual environment that was specifically designed for treating burn patients," explains Hoffman. "We made snowflakes, snowmen, igloos, robots, [and] penguins, and you hear this soothing music. The idea is to help the patients take their mind off of their pain. The nice thing about SnowWorld is, all these images of cold hopefully counteract…the fires of their burn pain."

"What we're really trying to do is just to pull his attention away from what's happening in the therapy, to put his attention in the virtual world, and by virtue of that, have him experience less pain," adds Patterson.

Clinical studies with patients like Nathan are showing how effective virtual reality is at fighting burn pain. In an article in Scientific American, Hoffman described how they used a special virtual reality helmet that would work in a magnetic resonance imaging (MRI) scanner to confirm this. The team studied five regions of the brain that are known to be associated with pain processing. "We found that all five regions showed significant reductions, and the amount of reductions during VR, the amount of reductions in pain-related brain activity, ranged from 50 percent to 97 percent," says Hoffman. "The incoming pain signal is not even being processed during VR. There's much less pain being processed by the brain when the person's in VR."

snowman in game
SnowWorld image: Hunter Hoffman, University of Washington Seattle
When they tested SnowWorld against a more typical Nintendo home video game system, the virtual reality experience was much more effective at easing pain. Hoffman says the key to why VR seems to work so well is the feeling the patient has of going inside the computer-generated environment. "The person has the sensation of actually going into SnowWorld. And we've shown that there are correlations…the more they feel like they went into SnowWorld, the more pain reduction they show," he says. "So we're very keen on trying to make virtual worlds that are more convincing, that are more successful at luring the person into the virtual environment."

Heidi Neisinger says she feels lucky that her son gets to experience SnowWorld. "He had to go through a lot of pain which…was really hard on him, but that's where the virtual reality is good, because he was able to put that on and get his mind off of it when he was playing virtual reality," she says. "Your ears also are hearing what virtual reality is going on, they're not hearing the discussion between the nurses and doctors, so that helps a lot—you're not hearing what they're gonna do to you."

In fact, this is really just a high-tech version of an old technique: distraction. "People have used distraction techniques for a long time," says American Pain Society president Dennis Turk. "Virtual reality allows you to get totally immersed, and the more engaged and distracted they are, the higher the benefit will be."

Turk, who is also a professor at University of Washington, says he'd like to see more studies like this one with larger groups of subjects, but that the results confirm what he's felt for a long time: "The mind and the body are integrated, and that's how we need to keep thinking about pain."

Hoffman and Patterson, whose creations are also being used for people with phobias and post-traumatic stress disorder, hope virtual reality will soon be available to help many more patients' brains escape their real pain. This research appears in the August, 2004 issue of Scientific American, and the clinical study was published in the June, 2004 issue of NeuroReport. It was funded by Paul Allen, the co-founder of Microsoft, and the National Institutes of Health. The study comparing SnowWorld to Nintendo appeared in the March 2000 issue of the journal Pain.

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