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

描述（由申请人提供）：假设可以使用虚拟现实，以便同时：1）为乳房手术后患有慢性肩痛的女性提供非药物镇痛; 2）改善其上肢力量/活动范围; 3）改善其情绪状态和生活质量。这实现了“健康的身体健康的思想”的单点护理方法。该项目的长期目标是开发一种联合治疗，其上级于单独进行物理和认知/行为治疗作为非药物姑息性疼痛护理干预。本研究的目的是开发和可行性测试的原型EARMArm II系统集成双臂，适应性虚拟现实游戏，使患者接受重力梯度的帮助/阻力温和的肩膀训练。该系统应适应乳房手术后肩部慢性疼痛和虚弱的低功能患者，对他们来说，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用于改善手臂/肩部运动范围、肩部力量、耐力、抓握力量、记忆力、专注力、执行功能和与癌症引起的肩部疼痛的心理社会相关性的肩关节II系统。第二个目的是评估原型的可行性和接受度，用于乳房切除术后慢性疼痛的女性，通过为期8周的综合物理，认知和情感治疗，同时监测止痛药的摄入量和日常生活活动。方法1）通过创建一个视觉跟踪康复床，该康复床倾斜以允许对任一手臂进行辅助/阻力，并且可以同时跟踪双臂，来构建肩关节疼痛康复系统; 2）开发用于虚拟镇痛的康复游戏软件，模拟训练慢性肩关节疼痛的身体、认知和情感方面。这些游戏将自动适应手臂范围，握力和病人的痛苦程度; 3）开发一个安全的网络访问数据库模块，用于游戏数据存储和分析。数据将在游戏过程中以真实的时间透明地采样，并上传到Bright Cloud International Corp刀片服务器; 4）对4名无残疾成年女性进行可用性研究，以发现技术问题; 5）对6名患有乳腺癌切除术后慢性肩痛的成年女性进行可行性研究，参加为期8周的关于Arm II系统的培训计划。将在培训前、培训中和培训后使用标准化测试评价受试者的身体和认知/情感功能。其他措施将是药物摄入量，以及患者对疼痛水平、系统有用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，用于虚拟镇痛、手臂康复和认知/情感治疗，以综合的方式提供单点护理解决方案。同样的方法可以扩展到其他慢性肩痛患者人群和儿科护理。 公共卫生相关性：一种产品，同时减少妇女的慢性肩部疼痛，提高他们的手臂力量和范围，并打击抑郁症后乳房切除术提高他们的生活质量/参与，并降低医疗保健成本。通过整合双臂物理康复的肩膀/手臂/把握范围和力量与激励定制视频游戏，该产品通过促进单点团队护理治疗改善了获得医疗保健。该产品未来还可用于急性手术后康复，通过加速恢复生产生活进一步降低医疗保健成本。

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.