VIRTUAL REALITY FOR PEDIATRIC BURN PAIN/REHABILITATION

皮肤烧伤在各个年龄段的患者中都会导致长期的解剖学、生理学和心理学方面的发病率。儿童的生理和心理发病率问题尤其严重，这在很大程度上是因为需要医疗保健提供者进行反复的(日常)痛苦程序--包括烧伤伤口护理和康复治疗，以及(与成人相比)提供安全和令人满意的药物止痛的相对挑战。儿童的临床烧伤疼痛管理是具有挑战性的，目前的研究主要集中在对急性受伤和住院儿童的背景和伤口护理疼痛的药物管理上。然而，这个项目研究了一种新的认知/分散注意力的止痛技术--虚拟现实(VR)，在两个常见且同样具有挑战性但相对未被研究的环境中：烧伤后康复治疗和门诊烧伤创面护理。由于在这两个环境中经常需要长期护理，改进的止痛药管理具有显著改善患者依从性、功能伤口愈合和心理发病率的潜力，以及更早出院的潜在经济效益。该项目的目标是：1)为渴望视频技术的学龄儿童和青少年(8-18岁)烧伤患者确定适当的虚拟现实硬件和软件设计，他们的受伤需要痛苦的康复治疗或门诊伤口护理；以及2)确定虚拟现实作为一种非侵入性、非药物止痛技术，在多大程度上可以补充或可能取代这一人群中更具侵入性的药物止痛技术。这一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，以促进在这一具有挑战性的患者群体中进行止痛管理，以及关于虚拟现实止痛效果的重要初步数据，用于在后续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管理提供了一个范例，这些调查的结果可能会推广到其他急性和康复性疼痛的原因，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.