A first-of-its-kind virtual reality experience from the hemophilia team and design experts at Nationwide Children’s Hospital and The Ohio State University distracts patients with an immersive environment of penguins, pirates and hermit crabs during infusions and other procedures. A pilot study is testing the feasibility of integrating the virtual reality technology into the clinic setting.
As a nurse clinician in the comprehensive hemophilia treatment center at Nationwide Children’s for nearly 30 years, Charmaine Biega, RN, has watched her patients endure hundreds of needle sticks for infusions and other procedures, which can mean tears, frustration, wiggling and – in some cases – lifelong anxiety about the medical system and treatments that patients with hemophilia need to survive. But when she administered six-year-old Brody Bowman’s infusion this month in clinic, he was doing something she had never seen him do before a needle stick: having fun.
That is because several of her patients are enrolled in a pilot study which is testing the virtual reality game, Voxel Bay, which was specifically created for her patient population to fully engage them in game play during procedures.
“Brody just started getting his treatments through IV on a regular basis and was having a really rough time,” says Biega. “But the first time he used the game in clinic, he was so completely engaged in the game when the IV was administered, he just barely flinched. The difference in how patients react during a procedure when they are playing these interactive games is remarkable.”
Biega uses a tablet to interact with the game and see exactly what her patients are seeing in their completely customized headset. Being able to have interaction between the nurse and patient was an important feature clinicians challenged the design team to create.
The pilot study, funded by a grant from the National Hemophilia Foundation, is currently testing the feasibility of integrating the virtual reality technology into the clinic setting. The team is also collecting preliminary data on usability and likability from parents, patients and nurses.
“I work with pediatric patients with bleeding disorders and know all too well the fears and anxiety that they and their families experience related to frequent needle sticks,” says Amy Dunn, MD, director of Hematology, Oncology and BMT at Nationwide Children’s. “I took this problem to our incredible design team and asked them to help our hemophilia team create a solution that would be cost-effective, friendly, safe, engaging for children of any age, and help with adherence to treatments ultimately leading to better outcomes.”
Jeremy Patterson, lead of User Experience Technology Research and Development and head designer for the project at Nationwide Children’s, rose to this challenge and his team created a virtual reality environment that is customized specifically for patients with hemophilia. And, he acknowledges, it is definitely fun.
“I have made lots of games and know what appeals to kids and what doesn’t, but creating something that has actually helped children have a better patient-experience, there is nothing greater than that,” says Patterson.
“The feedback we have gotten so far has been really positive,” says Dr. Dunn. “As “One Team” we designed an approach that is truly engaging and immersive for kids and is customized to their needs, and we believe it will really make a difference in their treatment and outcomes.”
The Headset: Unique Considerations for Medical Application
The attention to detail that the team committed to this project is apparent in every piece, from designing the game, headset and study, to considering the implications and applications beyond the current study.
The design of the disposable headset is exemplary of this.
Virtual reality headsets are typically big, bulky, wired and expensive. They are also impossible to clean to medical standards – an important consideration for use in clinics that may treat immunocompromised children.
The headset created by design experts at Nationwide Children’s, is a disposable, lightweight and child-friendly model that was thoughtfully meant to be safe, easy to use and, importantly for patients who need infusions, hands-free for the patients’ procedure.
“The headsets are easy to assemble. Patients can help to put them together, decorate them and take them home. The headsets become theirs,” says Patterson.
This sense of ownership and pride in something they helped to construct can promote positive feelings about going to the clinic or hospital for a procedure or treatment.
“As we continue learning how to effectively integrate VR in the clinic, the technologies and strategies we’re developing can be expanded to more patient populations,” says Dr. Dunn.
The Future of VR in Medicine
The team at Nationwide Children’s is currently exploring how this technology could be used in the home setting for the multiple infusions patients with hemophilia get each week. They are also testing how virtual reality technology can make a difference in educating clinicians.
Using technology to create virtual training opportunities for surgeons and other physicians is an application of gaming that is underdeveloped in the medical field. Among the challenges for this application is the interactive component of viewing a surgery, procedure or complex medical concept in virtual reality.
What are the most important interactive components to include? How do you recreate the tactile nature of surgery and other medical procedures? How do you tailor the environment for different learning styles and learners at different educational levels?
The applications of VR in the medical space are not limited to helping distract patients from painful or anxiety-inducing procedures.
The increase in the availability of three-dimensional (3D) printing has made the use of 3D models increasingly popular. Patterson and his team are looking at taking these 3D models into the virtual reality space.
“Physicians and researchers could view and manipulate these 3D models in virtual reality by wearing the headsets,” says Patterson. “Alternately, patients and families could view these models with the physician, interacting together in a way that helps educate and inform the family about a condition or procedure.”
Another application for using virtual reality in physician training is to film situations in which many different things are happening. Part of the interactivity of virtual reality is that you can choose what area of the experience deserves your focus. Consider this: You are on the sidelines at a high school football game. You have the band playing, cheerleaders getting the crowd excited and players on the field. Suddenly, you hear a call for a medic. One of the cheerleaders has fallen off the pyramid and suffered a head injury. In the virtual reality experience, the user could practice making important observations that would influence the care the cheerleader receives. Similar experiences could be built around surgeries, treatments or triage situations. The possibilities are as limited as your imagination.
“It’s exciting to be part of a team that is exploring and pushing the envelope of what we can do with virtual reality in the health care world,” says Patterson. “This has the potential to make a big difference to a lot of children.”
This study has been supported in part by Award Number Grant UL1TR001070 from the National Center For Advancing Translational Sciences.
Abbie Roth contributed to this story.
Photo credit: Nationwide Children’s