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Eye-deas Ideas for our eyes. Food for open minded brains. This forum is dedicated to Diane.

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Old 01-03-2012, 05:01 AM   #1
garydiny
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Default virtual reality training in rehab

Wondering if anyone knows if there have been any studies using a virtual reality device in rehabilitation?? Could be with stroke, and other neurological type conditions.

I have a few ideas in my head that I would like to read up on if anything exists. Will do some searching tomorrow at work, but thought I might ask here (typically a better resource that pubmed itself)

Thanks!!

Gary
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Old 01-03-2012, 05:23 AM   #2
Elanchaim
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I recently did a lit. search on virtual reality in rehab after reading a Herta Flor article, and there is quite a bit out there regarding pain, burns and other. I will try to post some articles here
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Old 01-03-2012, 05:24 AM   #3
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Free access


Pain Manag. 2011 Mar;1(2):147-157.
Virtual reality and pain management: current trends and future directions.
Li A, Montaño Z, Chen VJ, Gold JI.
Source
Children's Hospital Los Angeles, Departments of Anesthesiology Critical Care Medicine & Radiology, 4650 West Sunset Boulevard, MS#12, Los Angeles, CA 90027, USA.
Abstract
Virtual reality (VR) has been used to manage pain and distress associated with a wide variety of known painful medical procedures. In clinical settings and experimental studies, participants immersed in VR experience reduced levels of pain, general distress/unpleasantness and report a desire to use VR again during painful medical procedures. Investigators hypothesize that VR acts as a nonpharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body's intricate pain modulation system. While the exact neurobiological mechanisms behind VR's action remain unclear, investigations are currently underway to examine the complex interplay of cortical activity associated with immersive VR. Recently, new applications, including VR, have been developed to augment evidenced-based interventions, such as hypnosis and biofeedback, for the treatment of chronic pain. This article provides a comprehensive review of the literature, exploring clinical and experimental applications of VR for acute and chronic pain management, focusing specifically on current trends and recent developments. In addition, we propose mechanistic theories highlighting VR distraction and neurobiological explanations, and conclude with new directions in VR research, implications and clinical significance.
PMID: 21779307 [PubMed] PMCID: PMC3138477 Free PMC Article
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Old 01-03-2012, 05:27 AM   #4
Elanchaim
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Does using a nintendo Wii for training count as virtual reality?

Here a just a few articles. The Herta Flor one is fantastic

Burns. 2012 Feb 18. [Epub ahead of print]
Virtual reality for acute pain reduction in adolescents undergoing burn wound care: A prospective randomized controlled trial.
Kipping B, Rodger S, Miller K, Kimble RM.
Source
The Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The Department of Paediatrics and Child Health, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; The University of Queensland, School of Health and Rehabilitation, Division of Occupational Therapy, Brisbane, Australia; The University of Queensland, School of Medicine, Department of Paediatrics and Child Health, Brisbane, Australia; Department of Occupational Therapy and Music Therapy, Royal Children's Hospital, Brisbane, Australia.
Abstract
BACKGROUND:
Effective pain management remains a challenge for adolescents during conscious burn wound care procedures. Virtual reality (VR) shows promise as a non-pharmacological adjunct in reducing pain.
AIMS:
This study assessed off-the-shelf VR for (1) its effect on reducing acute pain intensity during adolescent burn wound care, and (2) its clinical utility in a busy hospital setting.
METHODS:
Forty-one adolescents (11-17 years) participated in this prospective randomized controlled trial. Acute pain outcomes including adolescent self-report, nursing staff behavioral observation, caregiver observation and physiological measures were collected. Length of procedure times and adolescent reactions were also recorded to inform clinical utility.
RESULTS:
Nursing staff reported a statistically significant reduction in pain scores during dressing removal, and significantly less rescue doses of Entonox given to those receiving VR, compared to those receiving standard distraction. For all other pain outcomes and length of treatment, there was a trend for lower pain scores and treatment times for those receiving VR, but these differences were not statistically significant.
CONCLUSION:
Despite only minimal pain reduction achieved using off-the-shelf VR, other results from this trial and previous research on younger children with burns suggest a customized, adolescent and hospital friendly device may be more effective in pain reduction.
Copyright © 2012. Published by Elsevier Ltd.




Curr Opin Psychiatry. 2012 Mar;25(2):109-13.
New developments in the understanding and management of persistent pain.
Flor H.
Source
Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Abstract
PURPOSE OF REVIEW:
It is proposed that central rather than peripheral factors may be important in pain chronicity. We review recent empirical findings on these processes and discuss implications for treatment and prevention.
RECENT FINDINGS:
The literature on neuroimaging of pain and on learning processes shows that learning-induced functional and structural brain changes involving sensorimotor, as well as limbic and frontal, areas are important in the transition from acute to chronic pain. These alterations share many similarities with brain changes in emotional disorders and the specificity for pain needs to be determined. Further important contributors to chronic pain may be disturbed processing of the body image, impaired multisensory integration and faulty feedback from interoceptive processes. These findings have led to new treatment approaches that focus on the extinction of aversive memories, restoration of the body image and normal brain function and include approaches such as brain stimulation, mirror training, virtual reality applications or behavioral extinction training.
SUMMARY:
We propose that chronic pain is characterized by learning-related and memory-related plastic changes of the central nervous system with concomitant maladaptive changes in body perception. These alterations require new treatments that focus on the alteration of central pain memories and maladaptive body perception.



J Trauma. 2011 Jul;71(1 Suppl):S125-30.
Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles.
Maani CV, Hoffman HG, Morrow M, Maiers A, Gaylord K, McGhee LL, DeSocio PA.
Source
US Army Institute of Surgical Research, Brooke Army Medical Center, Fort Sam, Houston, Texas, USA. christopher.maani@us.army.mil
Abstract
BACKGROUND:
This is the first controlled study to explore whether adjunctive immersive virtual reality (VR) can reduce excessive pain of soldiers with combat-related burn injuries during wound debridement.
METHODS:
Patients were US soldiers burned in combat attacks involving explosive devices in Iraq or Afghanistan. During the same wound care session using a within-subject experimental design, 12 patients received half of their severe burn wound cleaning procedure (~6 minutes) with standard of care pharmacologies and half while in VR (treatment order randomized). Three 0 to 10 Graphic Rating Scale pain scores for each of the treatment conditions served as the primary variables.
RESULTS:
Patients reported significantly less pain when distracted with VR. "Worst pain" (pain intensity) dropped from 6.25 of 10 to 4.50 of 10. "Pain unpleasantness" ratings dropped from "moderate" (6.25 of 10) to "mild" (2.83 of 10). "Time spent thinking about pain" dropped from 76% during no VR to 22% during VR. Patients rated "no VR" as "no fun at all" (<1 of 10) and rated VR as "pretty fun" (7.5 of 10). Follow-up analyses showed VR was especially effective for the six patients who scored 7 of 10 or higher (severe to excruciating) on the "worst pain" (pain intensity) ratings.
CONCLUSIONS:
These preliminary results provide the first evidence from a controlled study that adjunctive immersive VR reduced pain of patients with combat-related burn injuries during severe burn wound debridement. Pain reduction during VR was greatest in patients with the highest pain during no VR. These patients were the first to use a unique custom robot-like arm mounted VR goggle system.
PMID: 21795888 [PubMed - indexed for MEDLINE]
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