VIRTUAL REALITY FOR PEDIATRIC BURN PAIN/REHABILITATION

皮肤烧伤在所有年龄的患者中导致长期的解剖、生理和心理上的发病率。儿童的生理和心理发病率尤其成问题，这在很大程度上是由于卫生保健提供者必须反复（每天）进行痛苦的手术——包括烧伤创面护理和康复治疗，以及（与成人相比）提供安全和令人满意的药物镇痛的相对挑战。儿童烧伤疼痛的临床管理具有挑战性，目前的研究工作主要集中在急性受伤和住院儿童的背景和伤口护理疼痛的药理学管理上。然而，本项目研究了一种新的认知/分心镇痛技术——虚拟现实（VR）在两种常见且同样具有挑战性但相对未被研究的情况下：烧伤后康复治疗和门诊烧伤创面护理。由于在这两种情况下经常需要长期护理，改进的镇痛管理具有显著改善患者依从性、伤口功能性愈合和心理发病率的潜力，以及早期出院的潜在经济效益。该项目的目标是：1)为急需视频技术的学龄和青少年（8-18岁）烧伤患者确定合适的虚拟现实硬件和软件设计，这些患者的损伤需要痛苦的康复治疗或门诊伤口护理；2)确定虚拟现实作为一种非侵入性、非药物性镇痛技术，在多大程度上可以补充或可能取代更有侵入性的药物性镇痛技术。该试点项目的预期好处包括开发特定活动和适合年龄的虚拟现实硬件和软件，可以促进这一具有挑战性的患者群体的镇痛管理，以及虚拟现实镇痛功效的重要初步数据，用于在随后的研究中设计更有针对性的研究方案。最后，由于烧伤为一般急性疼痛的治疗提供了一个范例，这些调查的结果可能会推广到其他急性疼痛和康复疼痛的原因，以及其他烧伤患者群体，包括成人和幼儿。

Cutaneous burn injuries result in prolonged anatomic, physiologic, and psychologic morbidity in patients of all ages,. Physiologic and psychologic morbidity are particularly problematic in children, in large part due to the necessity for recurrent (daily) painful procedures -- including burn wound care and rehabilitation therapy -- at the hands of health care providers, and the relative challenge (compared to adults) of providing safe and satisfactory pharmacologic analgesia. Clinical burn pain management in children is challenging, with current research efforts largely focused on the pharmacologic management of background and wound care pain in acutely injured and hospitalized children. This project, however, investigates a novel cognitive/distractive analgesic technique -- virtual reality (VR) in two common and equally challenging, yet relatively unstudied settings: postburn rehabilitation therapy and outpatient burn wound care. Because of the frequent need for long-term care in these two settings, improved analgesic management carries the potential for significant improvements in patient compliance, functional wound healing, and psychologic morbidity, as well as the potential economic benefit of earlier hospital discharge. The goals of this project are: 1) to determine the appropriate design of virtual reality hardware and software for video technology-hungry school-aged and adolescent (ages 8-18 years) burn victims whose injuries require painful rehabilitation therapy or outpatient wound care; and 2) to determine the degree to which virtual reality, as a non-invasive, non- pharmacologic analgesic technique, can supplement or possibly replace more invasive pharmacologic analgesic techniques in this population. The anticipated benefits of this pilot project include the development of activity-specific and age-appropriate virtual reality hardware and software that can facilitate analgesic management in this challenging patient population, as well as important preliminary data on the analgesic efficacy of virtual reality for use in designing more focused study protocols in subsequent investigations. Finally, because burn injuries offer a paradigm for the management of acute pain in general, the results of these investigations will likely be generalizable to other causes of acute and rehabilitation pain, and to other burn patient populations, including adults and young children.