To a patient recovering from severe burns, no place would be more soothing than a polar landscape of gently falling snowflakes, snowmen, penguins, igloos and icy rivers.
That's the thinking behind SnowWorld, an interactive, virtual-reality video game being used at Loyola University Hospital in Maywood, Ill., to manage pain felt by burn patients during wound care and physical therapy. Loyola is the first hospital in Illinois and only one of a handful across the nation that is employing this 21st century technology to help burn patients recover from their injuries.
“Severe burns are one of the most painful injuries a person can endure,” said Dr. Richard Gamelli, chairman of the department of surgery, Loyola University Chicago Stritch School of Medicine, Maywood. “Anything that we can do to lessen the pain and suffering of patients during treatment is a plus. This system is the next step in helping us to do that.”
Treatment of burn injuries can be excruciating. It often involves daily bandage changes, the cleaning of wounds and the removal of dead tissue in order to stave off infection and prevent scar tissue from forming. Also, a burn patient's skin must be stretched in order to restore and maintain the range of motion, minimize muscle atrophy and reduce the need for further grafts.
The virtual-reality system eases pain of treatment by immersing burn patients in a wintry, computer-generated environment. Its interactive, multi-sensory, features put patients in a deep freeze of distraction, leaving less attention for the processing of incoming pain signals. It's similar to what has been done with music, movies and even two-dimensional video games, but more effective because it involves problem-solving activities that emphasize coolness.
“The theory is solid. Think of a toothache,” said Gamelli, who is also chief of Loyola's Burn Center. “During the day it's less painful because you have more demands on your attention. However, when night comes and things quiet down, your pain can flair up because you have far less to focus on.”
Research related to these types of systems supports SnowWorld. Studies in Australia, Israel and Washington state have shown that “burn patients undergoing wound care report that their pain drops dramatically when they engage in virtual-reality programs.
A recent MRI study at the University of Washington in Seattle, found that “virtual reality actually reduces the amount of pain-related activity in the brain.”
During treatment, a patient wears a stereoscopic, position-tracking helmet that displays a world of three-dimensional graphics. The patient is also equipped with headphones and a mouse that allows the patient to throw snowballs. Along with sound effects, the system has the ability to let the patient pipe in their favorite music while the play the game.
Once the system is turned on, the patient enters a world of snowmen, penguins and polar bears that are perched on icy ledges or are floating in a frigid river. The snowmen use their spindly arms and hands to throw snowballs at the patient who can, with the click of the mouse, deflect the incoming ball of ice with a snowball of their own. Further clicks can unleash a torrent of snowballs that on contact cause the snowmen and igloos to explode in powdery puffs and the penguins to cartwheel over with a squawk. The system also has two high-resolution flat-screen monitors that display what the patient is seeing.
Para Brother Family Charitable Foundation donated $25,000 to help Loyola purchase the virtual-reality system, which costs about $50,000.
The SnowWorld software was designed by Hunter G. Hoffman, Ph.D., and David Patterson, Ph.D., research scientists in Seattle, who were both motivated by their concern for the pain, fear and anxiety that children and teenagers experience when undergoing therapy for burn injuries.
“Young people frequently anticipate the pain of therapy and cry and yell even before they're touched,” said Melissa Drews, occupational therapist, department of orthopaedic surgery and rehabilitation, Loyola. “Since this system blocks all outside sights and sounds, it takes them completely out of what is to them an anxiety-inducing setting and transports to a fun place with fun things to do.”
The virtual-reality system has further application beyond burn care. It's been used to help people overcome phobias and post traumatic stress syndrome. It's also been used in urological procedures, dentistry and to control pain during physical therapy for cystic fibrosis patients.