Aim: The aim of this study was to examine the effect of a water-friendly Projector-Based Hybrid Virtual Reality (VR) dome environment combined with standard pharmacological treatment on pain in young children undergoing burn wound care in hydrotherapy. Methods: This study was a prospective, within-subject crossover trial of 38 children aged 6 months to 7 years old (mean age =1.8 years old). Each hydrotherapy procedure was divided into two equivalent wound care segments (No hybrid VR during one segment vs. Hybrid VR during the other segment, treatment order was randomized). Pain was measured using the 0-10 FLACC (Face, Legs, Activity, Cry Consolability scale) and the 0-10 NRS-obs (Numerical Rating Scale-obs). Results: Projector-Based Hybrid VR significantly reduced procedural pain levels measured by the FLACC (p= 0.026) and significantly increased patients' comfort levels (p= 0.002). Patients' pain levels rated by the nurses using the NRS-obs were non-significant between both groups (p=0.135). No side effects were reported. Conclusion: Projector-Based Hybrid VR helped in reducing the pain related to hydrotherapy procedures in young children with burn wound injuries. This is the first study using virtual reality distraction with young children, and our findings are especially important because a large percentage of pediatric burn patients are very young. Additional research and development are recommended. (C) 2020 Elsevier Ltd and ISBI. All rights reserved.

BACKGROUND:Virtual reality (VR) is a non-pharmacological method to distract from pain during painful procedures. However, it was never tested in young children with burn injuries undergoing wound care.AIM:We aimed to assess the feasibility and acceptability of the study process and the use of VR for procedural pain management.METHODS:From June 2016 to January 2017, we recruited children from 2 months to 10 years of age with burn injuries requiring a hydrotherapy session in a pediatric university teaching hospital in Montreal. Each child received the projector-based VR intervention in addition to the standard pharmacological treatment. Data on intervention and study feasibility and acceptability in addition to measures on pain (Face, Legs, Activity, Cry, Consolability scale), baseline (Modified Smith Scale) and procedural (Procedure Behavior Check List) anxiety, comfort (OCCEB-BECCO [behavioral observational scale of comfort level for child burn victims]), and sedation (Ramsay Sedation Scale) were collected before, during, and after the procedure. Data analyses included descriptive and non-parametric inferential statistics.RESULTS:We recruited 15 children with a mean age of 2.2±2.1 years and a mean total body surface area of 5% (±4). Mean pain score during the procedure was low (2.9/10, ±3), as was the discomfort level (2.9/10, ±2.8). Most children were cooperative, oriented, and calm. Assessing anxiety was not feasible with our sample of participants. The prototype did not interfere with the procedure and was considered useful for procedural pain management by most health care professionals.CONCLUSION:The projector-based VR is a feasible and acceptable intervention for procedural pain management in young children with burn injuries. A larger trial with a control group is required to assess its efficacy.

The DREAM project is a joint venture between the medical world, university professors and developers with one goal in mind: create an efficient distraction tool to reduce pain and anxiety in children receiving medical treatments. Growing evidence in the medical literature suggests that virtual reality is a very potent and effective way of creating distraction. In turn, distraction has been shown to reduce pain and anxiety in children who are receiving painful medical procedures. The pediatric population offers quite a challenge when it comes to pain control, especially the pain caused by medical procedure. Anxiety and anticipation greatly modulates pain perception and can often jeopardize a treatment if a child's collaboration cannot be obtained. With those premises in mind, our team is trying to create an efficient virtual reality game for distracting kids from their pain. The DREAM game has been tailored for the very specific needs and characteristics of our target population. The experience is optimized for the oculus rift and the controls have been simplified to work in various medical settings with minimal preparation time. Our main concern was to create a game that delivers a potent distractive effect while inciting almost no side effects or cyber sickness. The DREAM project is currently being tested on children with burn injuries. The objective of this paper is to present the methodology used to validate our hypotheses.

The DREAM project is a joint venture between the medical world, university professors and developers with one goal in mind: create an efficient distraction tool to reduce pain and anxiety in children receiving medical treatments. Growing evidence in the medical literature suggests that virtual reality is a very potent and effective way of creating distraction. In turn, distraction has been shown to reduce pain and anxiety in children who are receiving painful medical procedures. The pediatric population offers quite a challenge when it comes to pain control, especially the pain caused by medical procedure. Anxiety and anticipation greatly modulates pain perception and can often jeopardize a treatment if a child's collaboration cannot be obtained. With those premises in mind, our team is trying to create an efficient virtual reality game for distracting kids from their pain. The DREAM game has been tailored for the very specific needs and characteristics of our target population. The experience is optimized for the oculus rift and the controls have been simplified to work in various medical settings with minimal preparation time. Our main concern was to create a game that delivers a potent distractive effect while inciting almost no side effects or cyber sickness. The DREAM project is currently being tested on children with burn injuries. The objective of this short paper is to present the methodology used to validate our hypotheses.