Document Type : Letter to the Editor
Authors
- Maryam Zavarmousavi 1
- Fatemeh Eslamdoust-Siahestalkhi 1
- Alireza Feizkhah 2
- MohammadReza Mobayen 3
- Seyed Armin Fazeli Masouleh 4
- Mahshid Badrikoohi 5
- Parissa Bagheri 6
1 Kavosh Cognitive Behavior Sciences and Addiction Research Center, Department of Psychiatry, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
2 Department of Medical Physics, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
3 Burn and Regenerative Medicine Research center, Guilan University of Medical Sciences,Rasht, Iran.
4 Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran.
5 Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences, Rasht, Iran
6 burn and regenerative medicine research center
Abstract
Some non-pharmacological techniques have been shown to effectively reduce pain, including cognitive-behavioral therapy, hypnosis, relaxation techniques, and interaction through television, music, and storytelling. Recently, new advanced technologies such as virtual reality immersion therapy (VRIT) and simulation for therapy (SFT) have been used in post-burn rehabilitation. Immersive VR is a cognitive–behavioral technique based on distraction used for treating physical and psychological pain. A comprehensive evaluation of nine clinical trials demonstrated that VR technology combined with pharmaceutical analgesics was significantly more effective in reducing pain and anxiety in burn patients. On the other hand, to improve therapeutic effectiveness in rehabilitation settings such as post-burn conditions, the combined use of related methods such as interactive game consoles (IGC) is increasingly used. IGCs are more favored for use in burn rehabilitation because they are less cumbersome than other forms of VR. Virtual reality games can provide practical and attractive therapy that allows the child to amuse by artificial scenes that appear and feel similar to real-world scenes.
In general, it can be said that new technological developments, such as interactive virtual reality, gamification, powerful computers, and portable tablets, and their universal popularity, now offer the chance to integrate knowledge from clinical practice, neuroscience knowledge, and design ideas. In addition, the wide range of virtual communication options and computer games provide physicians to choose appropriate tools that help in treatment. This perspective aims to explain the potential of game design principles to generate more motivation and content for therapy integrated with the proper technological context, like virtual reality.
Keywords
Dear Editor
Approximately 265,000 die from fires worldwide. In the United States, burn care services cost an estimated $480,000 annually. Despite significant advances in burn treatment approaches, burns remain one of the leading causes of complications due to long hospitalization, disfigurement, and disabilities [1, 2]. Due to medical advancements, the number of burn survivors with severe burns is growing. Every year, over 9,000 patients are discharged from the intensive care unit and require inpatient rehabilitation care, making it the second most prevalent condition following hospital discharge [3]. Physical stress and psychological suffering will be experienced by burn trauma patients as a result of hospital treatments such as surgical debridement and changing wound dressings [2].
when considering the physical and emotional aspects, non-pharmacological approaches for treating the burnt patient are complementary to medicinal therapy, providing an integrated approach to care. Several non-pharmacological techniques such as cognitive-behavioral therapy, hypnosis, relaxation techniques, and interaction through television, music, and storytelling, have been demonstrated to have an excellent therapeutic effect on pain reduction [4, 5].
In post-burn rehabilitation, new advanced technologies such as virtual reality immersion therapy (VRIT) and simulation for therapy (SFT) have recently been used. Immersion therapy (VRIT) is a distraction-based cognitive–behavioral technique used to alleviate physical and psychological pain. Experimental studies showed that VR reduces anxiety and depressive symptoms and improves adherence to treatment in burn patients [2]. A meta-analysis of nine clinical trials demonstrated that VR technology with pharmaceutical analgesics was significantly more effective in reducing pain and anxiety in burned patients. Furthermore, the findings of this study revealed that VR distracts patients’ minds from anxiety and tension, thus, facilitating treatment and physical therapy [6].
On the other hand, the combined use of related methods such as interactive game consoles (IGC) is increasingly being employed to improve therapeutic effectiveness in rehabilitation settings such as post-burn conditions [1, 2]. IGCs are preferred over other forms of VR [5], since they are less demanding to utilize in burn rehabilitation and VR rehabilitative settings [7]. Modern IGCs combine virtual reality features with patients’ favorite imagery to create a more immersive experience than previous consoles [7]. It plays a constructive function in the content and process of rehabilitation and treatment, such as providing a distraction for the children or encouraging patient self-treatment. Virtual reality games can be used as effective and appealing therapy that enables the child to be entertained by artificial scenes, with objects and events, that appear and feel like real-world scenes. It can help with concentration and motivation for therapeutic objectives [8]. A randomized trial found those who received gamified-VR rehabilitation therapy experienced a greater pain reduction, particularly those who had severe pain at baseline [7].
In conclusion, burn rehabilitation is one of the essential treatment steps for these patients, considering both physical and emotional aspects. Therefore, non-pharmacological approaches to treating burned patients can provide an integrated system of treatment. Some of the applications for virtual reality that are based on gamification are reducing pain, stress, and distraction in children and assisting in proper rehabilitation, particularly for the elderly. Another application for virtual reality based on gamification is cognitive-behavioral rehabilitation for those suffering from PTSD as a result of trauma.
In general, new technological developments such as interactive virtual reality, gamification, powerful computers, and portable tablets, as well as their widespread adoption, presently offer an opportunity to integrate clinical practice knowledge, neuroscience information, and design ideas. In addition, the wide range of virtual communication options and computer games provide physicians the opportunity to select appropriate instruments to aid in treatment.
In fact, due to its flexibility and various cognitive science elements, including a wide range of neuroscience designs and components, gamification can have a perspective that evaluates the challenges and opportunities to connect neuroscience knowledge, game design thinking, and physical therapy in clinical practice to create an additional toolkit for therapists. This perspective aims to illustrate the potential of game design principles to provide more motivation and content for integrated therapy in an appropriate technological context, such as virtual reality.
Declaration
Ethics approval and consent to participate: Not applicable.
Conflict of Interest: None declared.
Consent for publication: Not applicable.
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors’ contributions: All authors contributed to the study design and implementation and the manuscript's writing.
Acknowledgment: We thank the Burn and Regenerative Medicine Research Center, Guilan University of Medical Sciences for their assistance in this study.
- Jeschke MG, van Baar ME, Choudhry MA, Chung KK, Gibran NS, Logsetty S. Burn injury. Nat Rev Dis Prim. 2020;6(1):1–25.
- Scapin S, Echevarría-Guanilo ME, Boeira Fuculo Junior PR, Gonçalves N, Rocha PK, Coimbra R. Virtual Reality in the treatment of burn patients: A systematic review. Vol. 44, Burns. 2018. p. 1403–16.
- Tan WH, Goldstein R, Gerrard P, Ryan CM, Niewczyk P, Kowalske K, et al. Outcomes and predictors in burn rehabilitation. J Burn Care Res. 2012;33(1):110–7.
- Mobayen M, Ghazanfari MJ, Feizkhah A, Ezzati K, Mehrabian F, Aboutaleb E, et al. Parental adjustment after pediatric burn injury. 2022;
- Miri S, Mobayen M, Mazloum SMH, Rahimzadeh N, Mehrabi A, Abd Sonboli R, et al. The role of a structured rehabilitative exercise program as a safe and effective strategy for restoring the physiological function of burn survivors. Burn J Int Soc Burn Inj. 2022;48(6):1521–3.
- Morris LD, Louw QA, Grimmer-Somers K. The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review. Clin J Pain. 2009;25(9):815–26.
- Parker M, Delahunty B, Heberlein N, Devenish N, Wood FM, Jackson T, et al. Interactive gaming consoles reduced pain during acute minor burn rehabilitation: A randomized, pilot trial. 2016;42(1):91–6.
- Janssen J, Verschuren O, Renger WJ, Ermers J, Ketelaar M, Van Ee R. Gamification in physical therapy: More than using games. Vol. 29, Pediatric Physical Therapy. 2017. p. 95–9.
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