Virtual reality system for cancer patients' shoulder pain and psychosocial impact

描述(申请人提供)：假设可以同时使用虚拟现实：1)为乳房手术后的慢性肩痛患者提供非药物止痛；2)改善她们的上肢力量/活动范围；以及3)改善她们的情绪状态和生活质量。这就实行了“健康的身体中有健康的心灵”的单点护理方法。该项目的长期目标是开发一种综合疗法，该疗法优于单独进行物理疗法和认知/行为疗法，作为非药物姑息性疼痛护理干预。本研究的目的是开发并测试BrightArm II原型系统，该系统集成了双臂、适应性强的虚拟现实游戏，使患者能够接受重力梯度辅助/阻力进行柔和的肩部训练。这个系统应该能适应胸部手术后肩部慢性疼痛和虚弱的低功能患者，对这些患者来说，现成的主动视频游戏是不实用的。具体目标第一个目标是开发BrightArm II系统，用于改善手臂/肩部的活动范围、肩部力量、耐力、握力、记忆力、注意力、执行功能以及与癌症引起的肩部疼痛有关的心理社会因素。第二个目标是通过为期8周的综合物理、认知和情绪治疗，同时监测止痛药的摄入量和日常生活活动，评估该原型用于乳房切除所致慢性疼痛的可行性和接受性。方法1)构建BrightArm II系统，创建一个视觉跟踪康复工作台，倾斜以允许帮助/抵抗任何一只手臂，并可以同时跟踪两只手臂；2)开发用于虚拟止痛的康复游戏软件，模拟训练慢性肩痛的物理、认知和情感方面。这些游戏将自动适应手臂的射程、握力和患者的痛苦程度；3)开发一个安全的网络访问数据库模块，用于游戏数据的存储和分析。在游戏过程中，数据将被实时透明地采样并上传到Bright Cloud International Corp刀片服务器；4)对4名非残疾成年女性进行可用性研究，以发现技术问题；5)对6名患有乳癌手术后慢性肩痛的成年女性进行可行性研究，参加为期8周的BrightArm II系统培训计划。受试者将在训练前、训练中和训练后使用标准化测试对身体和认知/情绪功能进行评估。其他措施将是药物摄入量，以及患者对疼痛程度、系统有效性和日常活动独立性的主观报告。该项目将开发一种新的设备和治疗方法，用于虚拟止痛、手臂康复和认知/情绪治疗，提供单点护理解决方案。同样的方法可以扩展到其他患有慢性肩痛的患者群体，以及儿科护理。 与公共健康相关：这款产品同时可以减轻女性的慢性肩痛，改善她们的手臂力量和伸展能力，并对抗乳房切除术后的抑郁，提高她们的生活质量/参与度，并降低医疗保健成本。通过将肩部/手臂/握力伸展和力量的双臂物理康复与激励定制视频游戏相结合，该产品通过促进单点团队护理疗法改善了获得医疗保健的机会。该产品未来还可以用于手术后的急性康复，通过加速恢复生产生活，进一步降低了医疗保健成本。

DESCRIPTION (provided by applicant): It is hypothesized that it is possible to use virtual reality such that it simultaneously: 1) provides non-medication analgesia for women with chronic shoulder pain following breast surgery; 2) improves their upper extremity strength/range of movement; and 3) improves their emotive state and quality of life. This implements "a healthy mind in a healthy body" single-point-of-care approach. The long-term objective of the project is to develop a combined therapy that is superior to separately doing physical and cognitive/behavioral therapies as non-medication palliative pain care interventions. The purpose of the present investigation is to develop and feasibility test the prototype BrightArm II system integrated with dual-arm, adaptable virtual reality games, such that the patient receives gravity-gradated assistance/resistance for gentle shoulder training. This system should accommodate low-functioning patients with chronic pain and weakness in their shoulder following breast surgery, patients for whom off-the-shelf active video games are not practical. SPECIFIC AIMS The first aim is to develop the BrightArm II system for improving arm/shoulder motion range, shoulder strength, endurance, grasp strength, memory, focusing, executive function and psycho-social correlates to shoulder pain due to cancer. The second aim is to evaluate the feasibility and acceptance of the prototype for women with chronic pain due to mastectomy, through an 8-week combined physical, cognitive and emotive therapy while simultaneously monitoring pain medication intake and activities of daily living. METHODS 1) Construct the BrightArm II system by creating a vision-tracked rehabilitation table that tilts to allow assistance/resistance to either arm and can track both arms simultaneously; 2) Develop rehabilitation game software for virtual analgesia with simulations training of the physical, cognitive and emotive aspects of chronic shoulder pain. These games will automatically adapt to arm range, grip strength and patient level of distress; 3) Develop a secure web-accessible database module for game data storage and analysis. Data will be sampled transparently in real time during play and uploaded to Bright Cloud International Corp blade server; 4) Usability study with 4 adult women without disability to uncover technical problems; 5) Feasibility study with 6 adult women with chronic shoulder pain following breast surgery to remove cancer, participating in a 8-week training program on the BrightArm II system. Subjects will be evaluated for physical and cognitive/emotive function using standardized tests pre-, mid- and post-training. Additional measures will be medication intake, and patients subjective reports of pain level, system usefulness, and independence in daily activities. This project will develop a new device and therapeutic method for virtual analgesia, arm rehabilitation and cognition/emotive therapy in an integrated way providing a single-point-of-care solution. The same approach can be extended to other patient populations with chronic shoulder pain, and to pediatric care. PUBLIC HEALTH RELEVANCE: A product that simultaneously reduces women's chronic shoulder pain, improves their arm strength and reach, and combats depression following mastectomy improves their quality of life/participation, and reduces health care costs. By integrating dual-arm physical rehabilitation for shoulder/arm/grasp reach and strength with motivating custom video games, the product improves access to health care by facilitating a single-point team-care therapy. The ability of the product to also be used in the future in acute post-surgery rehabilitation further reduces health care costs by accelerating return to productive life.