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Interviewees: Samuel Brown,U.S. Army
A Burning Nightmare
By Heather Mayer
The roar of the truck engine had ceased, the voices on the radio gone, there was an instant silence. Sam Brown could see the orange flames engulfing his entire humvee. He felt the truck being thrown into the air.
“That was all in just a moment, and the first thing that came to mind was, ‘We just hit an IED,’” recalls U.S. Army 1st Lieutenant Brown, referring to an improvised explosive device. Brown had been rushing to the aid of a fellow platoon under attack in southern Afghanistan on September 4, 2008, when the blast occurred.
The next thing Brown knew was that he was somehow outside of the truck.
“I have no physical explanation for how I got outside the truck,” he says. “I was on fire. I couldn’t see to unbuckle my seatbelt or open the door. I believe my guardian angel just took me out of the truck.”
Brown says he can’t explain the pain he felt. “The sensation was quite interesting — nothing I could’ve imagined if someone had asked me, ‘What do you think it feels like to be blown up?’” he says.
And Brown has felt pain before. He pummeled his body on the crew team at West Point Academy and has been through Army Ranger school and jump school.
“As far as the pain of being burned alive, I’ve experienced pain that most people will never experience as far as just physically exerting yourself,” Brown says. “Being on fire definitely puts all those to shame.”
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Cold Virtual Reality
Then at the U.S. Army Institute of Surgical Research (USAISR) Burn Center in San Antonio, Texas, Brown learned his pain was far from over. He’s been through rounds of skin grafts, surgery to remove his left index finger, and still faces daily, painful wound care and physical therapy to stretch his scarred skin.
“It’s a constant battle and a painful battle,” Brown says. “This isn’t a two-week or a month-long therapy exercise. This is a battle that’s going to take years to get back to being how it was.”
So when his mom Tanya, got an email from a friend about a virtual reality game designed specifically for burn victims called "Snow World," he wanted to give it a try. Coincidentally, Burn Center RN Michelle Morrow was just about to offer it.
The Institute is collaborating with researchers at the University of Washington to investigate whether Snow World can help lessen the pain of treatment for combat burns.
The game was created by Hunter Hoffman, director of the UW’s VR Analgesia Research Center, with fellow psychologist David Patterson, Head
of Psychology, Rehabilitation Medicine at Harborview Burn Center, and
created by Worldbuilders Ari Hollander and Howard Rose from Imprint Interactive Technology Inc. using VR tools.
“‘Snow World’s’ the opposite of fire,” explains Hoffman. “Snow, snowy, cold, it’s supposed to cancel out and help distract them from remembering their original injury.”
Snow World has already been proven to help pediatric burn victims, but Hoffman and Christopher Maani, chief of anesthesia at the USAISR, are conducting the
first clinical trial of Snow World for combat burn patients.
The previous research showed that not only do patients report less pain while playing Snow World, but fMRI scans also show that virtual reality reduces the brain’s pain signals.
Early results with two combat burn patients were published in the
"Journal of Cyber Therapy and Rehabilitation" this summer. The researchers found huge reductions in the patients’ reported pain levels and the amount of time they spent thinking about their pain. The soldiers even reported a fun quotient.
While "fun" seems a counterintuitive association with wound care, Hoffman says it’s a byproduct of the pain-distracting effects of VR.
“The patients don’t associate Snow World with pain because they’re not in pain when they’re in Snow World,” he explains. “They associated Snow World with fun.”
In this early study, the researchers didn’t quantify whether patients’ progress in rehabilitation was actually improved by Snow World, but because they noticed that patients immersed in VR seemed to get better range of motion during physical therapy, they plan to record this as an objective measure of effectiveness.
“What we saw was marked improvement in the range of motion that we were able to achieve, and most importantly, an increased level of comfort that Sam had during the physical therapy itself,” says Maani.
Brown says the game exceeded his expectations and, even though he is a already a highly motivated athlete, it’s improved his physical therapy workouts.
“It blew me away,” he says. “The expectations I had for it were definitely surpassed. It’s interesting because if you allow yourself to become involved in virtual reality, you really don’t feel the pain that you would otherwise.”
“The virtual reality is definitely a very positive experience, and I really do a better physical therapy session as a result,” he says.
Limiting the amount of pain victims experience on a regular basis helps the medical staff as well.
“Sometimes patients are crying or screaming or begging for you to stop or pleading to God for mercy,” says clinical nurse specialist Morrow. “It can be quite intense, and as a nurse, it breaks your heart because the soldiers are here because of someone else doing harm to them…. It’s not because they were doing something silly, or some bad decision they made… They were protecting our country.”
More Fun, Less Drugs
Maani says being able to reduce patients’ pain medication with the help of VR improves other, psychological, aspects of their care. The high doses of narcotics given to burn victims sometimes sedate them so much they’re unaware of what’s going on in terms of other support from caregivers and family members.
“The extension of this work into our combat burn population was worth investigating because we had situations where every single day patients had to be sedated so much with their necessary medications that they weren’t able to interact meaningfully,” explains Maani.
“Decreasing that narcotic load and opiate requirement, we’ll be able to make sure the patient is doing better, both in terms of their alertness and their ability to enjoy and remember and recall, ” Maani says.
He appreciates how that allows him to get to know and interact with heroes like Brown.
"When they’re more awake and interacting, you really get to be aware of how special these patients are," he says. "It really changes the nature of what we do."
Every Day Could Be a Snow Day
Because Snow World has been so effective with burn patients, the researchers hope to make the virtual reality game part of everyday practice. For use with combat veterans, who may have burns on their heads and faces, they built an articulated arm to position the VR goggles the patients use, instead of having to wear a helmet, Hoffman says.
The goggles “really increase the number of patients that will be able to use Snow World and makes it a lot easier to get in there and just position quickly,” Hoffman explains. “So that will help, I think, to increase how quickly we’re able to start using this is in everyday practice.”
Hoffman notes that the more a person gets immersed in the virtual world, the more effective is their pain relief. He’s looking forward to the future of virtual reality technology.
“In some ways this is a futuristic step, so we’re taking a first step with the research we’ve done so far, and we’re getting great results already,” says Hoffman. “What I’m looking forward to is five or 10 or 15 years from now, the technology that will be available will just be breathtaking, and this will be even better and will be much more widely distributed.”
Hobnobbing with Paul Simon
When Paul Simon experienced Snow World, he was impressed except for one thing. Snow World definitely needed some hoppin tunes.
When Simon "was on tour in 2005, one of his friends invited him to come to the Human Interface Technology Lab [HITLab] where I work, and I had waited and waited for several hours to finally give him a demo," says Hoffman, a big fan of the music legend. "Out of all the things Paul saw at HITLab, he was very smitten by Snow World."
Simon has a children’s health charity based in New York, so it was a natural fit. "Paul offered to let us use his music free of charge," Hoffman recounts. "Paul Simon said, ‘You need to use some music in Snow World’ — and the truth is, I think the Paul Simon music really enhances the effectiveness of the treatment of Snow World for pain distraction."
Faith and Attitude
For Sam, Snow World’s "winter wonderland aspect" carries memories of childhood fun on the ski slopes of Colorado. His mother, Tanya Brown, looks forward to revisiting that real snow world with her son.
"I tried skiing once… my legs gave out," Tanya recalls. "So he had to stand behind me and guide me down the mountain. And it felt like we were dancing… He will be dancing me down a mountain again on skis” she says.
And her son believes there’s a reason and purpose to his survival. He’s thought a lot about it, because while four soldiers made it out of that burning humvee, one didn’t.
"We’re all down here in San Antonio receiving treatment and trying to spend time together, and that’s part of the healing process," Brown says. "And his life and his contribution are definitely not forgotten. And we try to keep him alive through our conversations, and let people know he was a true hero who gave his life. We may have been hurt, but he gave the ultimate sacrifice… I’m grateful and honored to have served with him and wish he was here with us today, but God took him home, so he’s where he’s supposed to be."
"There’s a couple of things I’ve really taken from that. One of those things is a person’s faith and attitude can be a huge contributor in the recovery process," Brown says. "It’s been very comforting to me to know that there are people out there who care about me, and people who don’t know me, who pray for me to get better.
"I can tell you personally, I make a decision to keep up a good attitude and understand this fight, the pain I experience, and the setbacks that I have, that I can still have a good life, and impact people in ways that I couldn’t have done otherwise. And to me, that’s positive. I maintain a positive attitude about this because I know there’s some good that can come out of this. So, faith and attitude have been something I’ve personally taken away from this as basically a life application. It’s not just about my burns and injuries, but I think that other people can apply that to their life and have a better life for it."
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