VIRTUAL REALITY FOR PEDIATRIC BURN PAIN/REHABILITATION

皮肤烧伤导致各年龄段患者解剖学、生理学和心理学上的病态。儿童的生理和心理发病率特别成问题，这在很大程度上是由于需要反复（日常）疼痛程序-包括烧伤伤口护理和康复治疗-在卫生保健提供者手中，以及提供安全和令人满意的药物镇痛的相对挑战（与成人相比）。儿童临床烧伤疼痛管理具有挑战性，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，这个项目研究了一种新的认知/分散镇痛技术-虚拟现实（VR） 在两个常见的和同样具有挑战性的，但相对未研究的设置：烧伤后康复治疗和门诊烧伤伤口护理。由于在这两种情况下经常需要长期护理，因此改善镇痛管理具有显著改善患者依从性、功能性伤口愈合和心理发病率的潜力，以及早期出院的潜在经济效益。本项目的目标是：1）确定适合视频技术饥渴的学龄和青少年的虚拟现实硬件和软件的设计（8-18岁）烧伤受害者，其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、非药物镇痛技术，可以补充或可能取代更多的侵入性药物镇痛技术在这一人群中。该试点项目的预期益处包括开发活动特定和年龄适当的虚拟现实硬件和软件，可以促进这一具有挑战性的患者人群的镇痛管理，以及虚拟现实镇痛疗效的重要初步数据，用于在后续研究中设计更有针对性的研究方案。最后，由于烧伤提供了一个管理急性疼痛的范例，这些研究的结果可能会推广到其他原因的急性和康复疼痛，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.