Positive Technology Journal

Using avatars to model weight loss behaviors: participant attitudes and technology development.

J Diabetes Sci Technol. 2013;7(4):1057-65

Authors: Napolitano MA, Hayes S, Russo G, Muresu D, Giordano A, Foster GD

BACKGROUND: Virtual reality and other avatar-based technologies are potential methods for demonstrating and modeling weight loss behaviors. This study examined avatar-based technology as a tool for modeling weight loss behaviors. METHODS: This study consisted of two phases: (1) an online survey to obtain feedback about using avatars for modeling weight loss behaviors and (2) technology development and usability testing to create an avatar-based technology program for modeling weight loss behaviors. RESULTS: Results of phase 1 (n = 128) revealed that interest was high, with 88.3% stating that they would participate in a program that used an avatar to help practice weight loss skills in a virtual environment. In phase 2, avatars and modules to model weight loss skills were developed. Eight women were recruited to participate in a 4-week usability test, with 100% reporting they would recommend the program and that it influenced their diet/exercise behavior. Most women (87.5%) indicated that the virtual models were helpful. After 4 weeks, average weight loss was 1.6 kg (standard deviation = 1.7). CONCLUSIONS: This investigation revealed a high level of interest in an avatar-based program, with formative work indicating promise. Given the high costs associated with in vivo exposure and practice, this study demonstrates the potential use of avatar-based technology as a tool for modeling weight loss behaviors.Abstract

Via MIT Technology Review

Adolescents with mental health problems are particularly hard for therapists to engage. But a new computer game is providing a healthy conduit for effective communication between them.

Read the full story on MIT Technology Review

With the rapid adoption of mobile technologies and the proliferation of smartphones, new opportunities are emerging for the delivery of mental health services. And indeed, psychologists are starting to realize this potential: a recent survey by Luxton and coll. (2011) identified over 200 smartphone apps focused on behavioral health, covering a wide range of disorders, including developmental disorders, cognitive disorders, substance-related disorders as well as psychotic and mood disorders. These applications are used in behavioral health for several purposes, the most common of which are health education, assessment, homework and monitoring progress of treatment.    

For example, T2 MoodTracker  is an application that allows users to self-monitor, track and reference their emotional experience over a period of days, weeks and months using a visual analogue rating scale. Using this application, patients can self-monitor emotional experiences associated with common deployment-related behavioral health issues like post-traumatic stress, brain injury, life stress, depression and anxiety. Self-monitoring results can be used as self-help tool or they shared with a therapist or health care professional, providing a record of the patient’s emotional experience over a selected time frame.

Measuring objective correlatives of subjectively-reported emotional states is an important concern in research and clinical applications. Physiological and physical activity information provide mental health professionals with integrative measures, which can be used to improve understanding of patients’ self-reported feelings and emotions.

The combined use of wearable biosensors and smart phones offers unprecedented opportunities to collect, elaborate and transmit real-time body signals to the remote therapist. This approach is also useful to allow the patient collecting real-time information related to his/her health conditions and identifying specific trends. Insights gained by means of this feedback can empower the user to self-engage and manage his/her own health status, minimizing any interaction with other health care actors. One such tool is MyExperience, an open-source mobile platform that allows the combination of sensing and self-report to collect both quantitative and qualitative data on user experience and activity.

Other applications are designed to empower users with information for making better decisions, preventing life-style related conditions and preserving/enhancing cognitive performance. For example, BeWell monitors different user activities (sleep, physical activity, social interaction) and provides feedback to promote healthier lifestyle decisions.  

Besides applications in mental health and wellbeing, smartphones are increasingly used in psychological research. The potential of this approach has been recently discussed by Geoffrey Miller in a review entitled “The Smartphone Psychology Manifesto”. According to Miller, smartphones can be effectively used to collect large quantities of ecologically valid data, in a easier and quicker way than other available research methodologies. Since the smartphone is becoming one of the most pervasive devices in our lives, it provides access to domains of behavioral data not previously available without either constant observation or reliance on self-reports only.

For example, the INTERSTRESS project, which I am coordinating, developed PsychLog, a psycho-physiological mobile data collection platform for mental health research. This free, open source experience sampling platform for Windows mobile allows collecting self-reported psychological data as well as ECG data via a bluetooth ECG sensor unit worn by the user. Althought PsychLog provides less features with respect to more advanced experience sampling platform, it can be easily configured also by researchers with no programming skills.

In summary, the use of smartphones can have a significant impact on both psychological research and practice. However, there is still limited evidence of the effectiveness of this approach. As for other mHealth applications, few controlled trials have tested the potential of mobile technology interventions in improving mental health care delivery processes. Therefore, further research is needed in order to determine the real cost-effectiveness of mobile cybertherapy applications.

Via MedGadget

Researchers at Vanderbilt University are studying the potential benefits of using human-looking robots as tools to help kids with autism spectrum disorder (ASD) improve their communication skills. The programmable NAO robot used in the study was developed by Aldebaran Robotics out of Paris, France, and offers the ability to be part of a larger, smarter system.

Though a child might feel like the pink eyed humanoid is an autonomous being, the NAO robot that the team is using is actually hooked up to computers and external cameras that track the kid’s movements. Using the newly developed ARIA (Adaptive Robot-Mediated Intervention Architecture) protocol, they found that children paid more attention to NAO and followed in exercises almost as well as with a human adult therapist.

Is virtual reality always an effective stressors for exposure treatments? Some insights from a controlled trial.

BMC psychiatry, 13(1) p. 52, 2013

Federica Pallavicini, Pietro Cipresso, Simona Raspelli, Alessandra Grassi, Silvia Serino, Cinzia Vigna, Stefano Triberti, Marco Villamira, Andrea Gaggioli, Giuseppe Riva

Abstract. Several research studies investigating the effectiveness of the different treatments have demonstrated that exposure-based therapies are more suitable and effective than others for the treatment of anxiety disorders. Traditionally, exposure may be achieved in two manners: in vivo, with direct contact to the stimulus, or by imagery, in the person’s imagination. However, despite its effectiveness, both types of exposure present some limitations that supported the use of Virtual Reality (VR). But is VR always an effective stressor? Are the technological breakdowns that may appear during such an experience a possible risk for its effectiveness? (...)

Full paper available here (open access)

Thanks to the accellerated diffusion of smartphones, the number of mobile healthcare apps has been growing exponentially in the past few years. Applications now exist to help patients managing diabetes, sharing information with peers, and monitoring mood, just to name a few examples.

Such “applification” of health is part of a larger trend called “mobile health” (or mHealth), which broadly refers to the provision of health-related services via wireless communications. Mobile health is a fast-growing market: according to a report by PEW Research as early as in 2011, 17 percent of mobile users were using their phones to look up health and medical information, and Juniper recently estimated that in the same year 44 million health apps were downloaded.

The field of mHealth has received a great deal of attention by the scientific community over the past few years, as evidenced by the number of conferences, workshops and publications dedicated to this subject; international healthcare institutions and organizations are also taking mHealth seriously.

For example, the UK Department of Health recently launched the crowdsourcing project Maps and Apps, to support the use of existing mobile phone apps and health information maps, as well as encourage people to put forward ideas for new ones. The initiative resulted in the collection of 500 health apps voted most popular by the public and health professionals, as well as a list of their ideas for new apps. At the moment of writing this post, the top-rated app is Moodscope, an application that allows users to measure, track and record comments on their mood. Other popular apps include HealthUnlocked, an online support network that connects people, volunteers and professionals to help learn, share and give practical support to one another, and FoodWiz.co, an application created by a mother of children with food allergies that which allows users to scan the bar codes on food to instantly find out which allergens are present. An app to help patients manage diabetes could not be missing from the list: Diabetes UK Tracker allows the patient to enter measurements such as blood glucose, caloric intake and weight, which can be displayed as graphs and shared with doctors; the software also features an area where patients can annotate medical information, personal feelings and thoughts.

The astounding popularity of Maps and Apps initiative suggests the beginning of a new era in medical informatics, yet this emerging vision is not without caveats. As recently emphasized by Niall Boyce on the June issue of The Lancet Technology, the main concern associated with the use of apps as a self-management tool is the limited evidence of their effectivenes in improving health. Differently from other health interventions, mHealth apps have not been subject to rigorous testing. A potential reason for the lack of randomized evaluations is the fact that most of these apps reach consumers/patients directly, without passing through the traditional medical gatekeepers. However, as Boyce suggests, the availability of trial data would not only benefit patients, but also app developers, who could bring to the market more effective and reliable products. A further concern is related to privacy and security of medical data. Although most smartphone-based medical applications apply state-of-the-art secure protocols, the wireless utilization of these devices opens up new vulnerabilities to patients and medical facilities. A recent bulletin issued by the U.S. Department of Homeland Security lists five of the top mobile medical device security risks: 

1. Insider: The most common ways employees steal data involves network transfer, be that email, remote access, or file transfer;


2. Malware: These include keystroke loggers and Trojans, tailored to harvest easily accessible data once inside the network;


3. Spearphishing: This highly-customized technique involves an email-based attack carrying malicious attack disguised as coming from a legitimate source, and seeking specific information;


4. Web: DHS lists silent redirection, obfuscated JavaScript and search engine optimization poisoning among ways to penetrate a network then, ultimately, access an organization’s data;


5. Lost equipment: A significant problem because it happens so frequently, even a smartphone in the wrong hands can be a gateway into a health entity’s network and records. And the more that patient information is stored electronically, the greater the number of people potentially affected when equipment is lost or stolen.

In conclusion, the “applification of healthcare” is at the same time a great opportunity for patients and a great responsibility medical professionals and developers. In order to exploit this opportunity while mitigating risks, it is essential to put in place quality evaluation procedures, which allow to monitor and optimize the effectiveness of these applications according to evidence-based standards. For example, iMedicalApps, provides independent reviews of mobile medical technology and applications by a team of physicians and medical students. Founded by founded by Dr. Iltifat Husain, an emergency medical resident at the Wake Forest University School of Medicine, iMedicalApps has been referred by Cochrane Collaboration as an evidence-based trusted Web 2.0 website.

More to explore:

Read the PVC report: Current and future state of mhealth (PDF FULL TEXT)

Watch the MobiHealthNews video report: What is mHealth?

Telemed J E Health. 2012 Jul 23;

Authors: Yellowlees PM, Holloway KM, Parish MB

Abstract. Background: As virtual reality and computer-assisted therapy strategies are increasingly implemented for the treatment of psychological disorders, ethical standards and guidelines must be considered. This study determined a set of ethical and legal guidelines for treatment of post-traumatic stress disorder (PTSD)/traumatic brain injury (TBI) in a virtual environment incorporating the rights of an individual who is represented by an avatar. Materials and Methods: A comprehensive literature review was undertaken. An example of a case study of therapy in Second Life (a popular online virtual world developed by Linden Labs) was described. Results: Ethical and legal considerations regarding psychiatric treatment of PTSD/TBI in a virtual environment were examined. The following issues were described and discussed: authentication of providers and patients, informed consent, patient confidentiality, patient well-being, clinician competence (licensing and credentialing), training of providers, insurance for providers, the therapeutic environment, and emergencies. Ethical and legal guidelines relevant to these issues in a virtual environment were proposed. Conclusions: Ethical and legal issues in virtual environments are similar to those that occur in the in-person world. Individuals represented by an avatar have the rights equivalent to the individual and should be treated as such.

J Med Internet Res. 2012;14(4):e110

Authors: Sucala M, Schnur JB, Constantino MJ, Miller SJ, Brackman EH, Montgomery GH

Abstract BACKGROUND: E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. OBJECTIVE: Our objective in this study was to systematically review the therapeutic relationship in e-therapy. METHODS: We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form.
RESULTS: From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance-a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. CONCLUSIONS: Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments.

A Real-Time fMRI-Based Spelling Device Immediately Enabling Robust Motor-Independent Communication.

Curr Biol. 2012 Jun 27

Authors: Sorger B, Reithler J, Dahmen B, Goebel R

Human communication entirely depends on the functional integrity of the neuromuscular system. This is devastatingly illustrated in clinical conditions such as the so-called locked-in syndrome (LIS) [1], in which severely motor-disabled patients become incapable to communicate naturally-while being fully conscious and awake. For the last 20 years, research on motor-independent communication has focused on developing brain-computer interfaces (BCIs) implementing neuroelectric signals for communication (e.g., [2-7]), and BCIs based on electroencephalography (EEG) have already been applied successfully to concerned patients [8-11]. However, not all patients achieve proficiency in EEG-based BCI control [12]. Thus, more recently, hemodynamic brain signals have also been explored for BCI purposes [13-16]. Here, we introduce the first spelling device based on fMRI. By exploiting spatiotemporal characteristics of hemodynamic responses, evoked by performing differently timed mental imagery tasks, our novel letter encoding technique allows translating any freely chosen answer (letter-by-letter) into reliable and differentiable single-trial fMRI signals. Most importantly, automated letter decoding in real time enables back-and-forth communication within a single scanning session. Because the suggested spelling device requires only little effort and pretraining, it is immediately operational and possesses high potential for clinical applications, both in terms of diagnostics and establishing short-term communication with nonresponsive and severely motor-impaired patients.

From the MIT press release

Researchers at MIT and two Boston hospitals provide early evidence that a simple, unobtrusive wrist sensor could gauge the severity of epileptic seizures as accurately as electroencephalograms (EEGs) do — but without the ungainly scalp electrodes and electrical leads. The device could make it possible to collect clinically useful data from epilepsy patients as they go about their daily lives, rather than requiring them to come to the hospital for observation. And if early results are borne out, it could even alert patients when their seizures are severe enough that they need to seek immediate medical attention.

Rosalind Picard, a professor of media arts and sciences at MIT, and her group originally designed the sensors to gauge the emotional states of children with autism, whose outward behavior can be at odds with what they’re feeling. The sensor measures the electrical conductance of the skin, an indicator of the state of the sympathetic nervous system, which controls the human fight-or-flight response.

In a study conducted at Children’s Hospital Boston, the research team — Picard, her student Ming-Zher Poh, neurologist Tobias Loddenkemper and four colleagues from MIT, Children’s Hospital and Brigham and Women’s Hospital — discovered that the higher a patient’s skin conductance during a seizure, the longer it took for the patient’s brain to resume the neural oscillations known as brain waves, which EEG measures.

At least one clinical study has shown a correlation between the duration of brain-wave suppression after seizures and the incidence of sudden unexplained death in epilepsy (SUDEP), a condition that claims thousands of lives each year in the United States alone. With SUDEP, death can occur hours after a seizure.

Currently, patients might use a range of criteria to determine whether a seizure is severe enough to warrant immediate medical attention. One of them is duration. But during the study at Children’s Hospital, Picard says, “what we found was that this severity measure had nothing to do with the length of the seizure.” Ultimately, data from wrist sensors could provide crucial information to patients deciding whether to roll over and go back to sleep or get to the emergency room.

Read the full press release

A combined robotic and cognitive training for locomotor rehabilitation: evidences of cerebral functional reorganization in two chronic traumatic brain injured patients.

Front Hum Neurosci. 2011;5:146

Authors: Sacco K, Cauda F, D'Agata F, Duca S, Zettin M, Virgilio R, Nascimbeni A, Belforte G, Eula G, Gastaldi L, Appendino S, Geminiani G

Abstract. It has been demonstrated that automated locomotor training can improve walking capabilities in spinal cord-injured subjects but its effectiveness on brain damaged patients has not been well established. A possible explanation of the discordant results on the efficacy of robotic training in patients with cerebral lesions could be that these patients, besides stimulation of physiological motor patterns through passive leg movements, also need to train the cognitive aspects of motor control. Indeed, another way to stimulate cerebral motor areas in paretic patients is to use the cognitive function of motor imagery. A promising possibility is thus to combine sensorimotor training with the use of motor imagery. The aim of this paper is to assess changes in brain activations after a combined sensorimotor and cognitive training for gait rehabilitation. The protocol consisted of the integrated use of a robotic gait orthosis prototype with locomotor imagery tasks. Assessment was conducted on two patients with chronic traumatic brain injury and major gait impairments, using functional magnetic resonance imaging. Physiatric functional scales were used to assess clinical outcomes. Results showed greater activation post-training in the sensorimotor and supplementary motor cortices, as well as enhanced functional connectivity within the motor network. Improvements in balance and, to a lesser extent, in gait outcomes were also found.

OPTIMI is a r&d project funded by the European Commission under funded by the European Union's 7th Framework Programme "Personal Health Systems - Mental Health" .

The project has two key goals goals: a) the development of new tools to monitor coping behavior in individuals exposed to high levels of stress; b) the development of online interventions to improve this behavior and reduce the incidence of depression.

To achieve its first goal, OPTIMI will develop technology-based tools to monitor the physiological state and the cognitive, motor and verbal behavior of high risk individuals over an extended period of time and to detect changes associated with stress, poor coping and depression.  

A series of “calibration trials” will allow the project will test a broad range of technologies. These will include wearable EEG and ECG sensors to detect subjects’ physiological and cognitive state, accelerometers to characterize their physical activity, and voice analysis to detect signs of depression. These automated measurements will be complemented with electronic diaries, in which subjects report their own behaviors and the stressful situations to which they are exposed. Further, the project will use machine learning to identify patterns in the behavioral and physiological data that predict the findings from the psychologist and the corticol measurements.

Although the project's objectives are very ambitious, OPTIMI represents one of the most advanced  initiatives in the field of Positive Technology, so I am very excited to follow its progresses and see how far it can go.

The Key to Unlocking the Virtual Body: Virtual Reality in the Treatment of Obesity and Eating Disorders

Giuseppe Riva, Journal of Diabetes Science and Technology, Volume 5, Issue 2, March 2011

Obesity and eating disorders are usually considered unrelated problems with different causes. However, various studies identify unhealthful weight-control behaviors (fasting, vomiting, or laxative abuse), induced by a negative experience of the body, as the common antecedents of both obesity and eating disorders. But how might negative body image—common to most adolescents, not only to medical patients—be behind the development of obesity and eating disorders? In this paper, I review the “allocentric lock theory” of negative body image as the possible antecedent of both obesity and eating disorders. Evidence from psychology and neuroscience indicates that our bodily experience involves the integration of different sensory inputs within two different reference frames: egocentric (first-person experience) and allocentric (third-person experience). Even though functional relations between these two frames are usually limited, they influence each other during the interaction between long- and short-term memory processes in spatial cognition. If this process is impaired either through exogenous (e.g., stress) or endogenous causes, the egocentric sensory inputs are unable to update the contents of the stored allocentric representation of the body. In other words, these patients are locked in an allocentric (observer view) negative image of their body, which their sensory inputs are no longer able to update even after a demanding diet and a significant weight loss. This article discusses the possible role of virtual reality in addressing this problem within an integrated treatment approach based on the allocentric lock theory.

June 19th to 22nd 2011 in Gatineau, Canada

This year the Interactive Media Institute (IMI) and Université du Québec en Outaouais (UQO) are organizing the 16th Annual CyberPsychology and CyberTherapy Conference (CT16), the official conference of the International Association of CyberPsychology, Training, & Rehabilitation (iACToR). The abstract submission deadline is January 15th, 2011.

To submit your abstract, register for the conference or obtain additional information, please visit the CT16 website at http://www.interactivemediainstitute.com/CT16.

Note that abstracts will be published in a regular issue of the Journal of CyberTherapy & Rehabilitation (JCR).

Outstanding features this year:

• 12 hands-on / “how to” workshops
• Two and a half day of scientific presentations
• WorldViz offering one-day seminars on Virtual Reality development.
• Presence of experts in clinical therapy and rehabilitation, cognitive sciences, neurosciences, social sciences, and computer sciences.
• Interactive Cyberarium open to the general public.
• Representatives of funding agency, policymakers, and industrial partners present on site.

Conference website: http://www.interactivemediainstitute.com/CT16

We have just released a new video introducing the INTERSTRESS project, an EU-funded initiative that aims to design, develop and test an advanced ICT-based solution for the assessment and treatment of psychological stress. The specific objectives of the project are:

• Quantitative and objective assessment of symptoms using biosensors and behavioral analysis
• Decision support for treatment planning through data fusion and detection algorithms
• Provision of warnings and motivating feedback to improve compliance and long-term outcomes

Credits: Virtual Reality Medical Institute

Scientists at the University of Arizona in Tucson have developed a new form of holographic telepresence that projects a three-dimensional, full-color, moving image without viewers needing to use 3-D glasses. While the technology could be used in TV or movies, it also could be used in telemedicine and mapping, as well as in everyday corporate meetings, the report notes. The image is recorded using an array of regular cameras, each one viewing the object from a different angle. Then, using fast-pulsed laser beams, a holographic, or three-dimensional, pixel is created. Such technology could be a “game changer” in some industries, including telemedicine, lead researcher Nasser Peyghambarian said. “Holographic telepresence means we can record a three-dimensional image in one location and show it in another location, in real-time, anywhere in the world,” he added. “Surgeons at different locations around the world can observe in 3-D, in real time, and participate in the surgical procedure.

Full Story

Potential for new technologies in clinical practice.

Curr Opin Neurol. 2010 Oct 18;

Authors: Burridge JH, Hughes AM

PURPOSE OF REVIEW: Cost-effective neurorehabilitation is essential owing to financial constraints on healthcare resources. Technologies have the potential to contribute but without strong clinical evidence are unlikely to be widely reimbursed. This review presents evidence of new technologies since 2008 and identifies barriers to translation of technologies into clinical practice. RECENT FINDINGS: Technology has not been shown to be superior to intensively matched existing therapies. Research has been undertaken into the development and preliminary clinical testing of novel technologies including robotics, electrical stimulation, constraint-induced movement therapy, assistive orthoses, noninvasive brain stimulation, virtual reality and gaming devices. Translation of the research into clinical practice has been impeded by a lack of robust evidence of clinical effectiveness and usability. Underlying mechanisms associated with recovery are beginning to be explored, which may lead to more targeted interventions. Improvements in function have been demonstrated beyond the normal recovery period, but few trials demonstrate lasting effects. SUMMARY: Technologies, alone or combined, may offer a cost-effective way to deliver intensive neurorehabilitation therapy in clinical and community environments, and have the potential to empower patients to take more responsibility for their rehabilitation and continue with long-term exercise.

Change in brain activity through virtual reality-based brain-machine communication in a chronic tetraplegic subject with muscular dystrophy.

BMC Neurosci. 2010 Sep 16;11(1):117

Authors: Hashimoto Y, Ushiba J, Kimura A, Liu M, Tomita Y

ABSTRACT: BACKGROUND: For severely paralyzed people, a brain-computer interface (BCI) provides a way of re-establishing communication. Although subjects with muscular dystrophy (MD) appear to be potential BCI users, the actual long-term effects of BCI use on brain activities in MD subjects have yet to be clarified. To investigate these effects, we followed BCI use by a chronic tetraplegic subject with MD over 5 months. The topographic changes in an electroencephalogram (EEG) after long-term use of the virtual reality (VR)-based BCI were also assessed. Our originally developed BCI system was used to classify an EEG recorded over the sensorimotor cortex in real time and estimate the user's motor intention (MI) in 3 different limb movements: feet, left hand, and right hand. An avatar in the internet-based VR was controlled in accordance with the results of the EEG classification by the BCI. The subject was trained to control his avatar via the BCI by strolling in the VR for 1 hour a day and then continued the same training twice a month at his home. RESULTS: After the training, the error rate of the EEG classification decreased from 40% to 28%. The subject successfully walked around in the VR using only his MI and chatted with other users through a voice-chat function embedded in the internet-based VR. With this improvement in BCI control, event-related desynchronization (ERD) following MI was significantly enhanced (p < 0.01) for feet MI (from -29% to -55%), left-hand MI (from -23% to -42%), and right-hand MI (from -22% to -51%). CONCLUSIONS: These results show that our subject with severe MD was able to learn to control his EEG signal and communicate with other users through use of VR navigation and suggest that an internet-based VR has the potential to provide paralyzed people with the opportunity for easy communication.

Using mirror visual feedback and virtual reality to treat fibromyalgia.

Med Hypotheses. 2010 Aug 5;

Authors: Ramachandran VS, Seckel EL

Fibromyalgia is a condition characterized by long term body-wide pain and tender points in joints, muscles and soft tissues. Other symptoms include chronic fatigue, morning stiffness, and depression. It is well known that these symptoms are exacerbated under periods of high stress. When pain becomes severe enough, the mind can enter what is known as a dissociative state, characterized by depersonalization - the feeling of detachment from one's physical body and the illusion of watching one's physical body from outside. In evolutionary terms, dissociative states are thought to be an adaptive mechanism to mentally distance oneself from pain, often during trauma. Similar dissociative experiences are reported by subjects who have used psychoactive drugs such as ketamine. We have previously used non-invasive mirror visual feedback to treat subjects with chronic pain from phantom limbs and suggested its use for complex regional pain syndrome: once considered intractable pain. We wondered whether such methods would work to alleviate the chronic pain of fibromyalgia. We tested mirror visual feedback on one fibromyalgia patient. On 15 trials, the patient's lower limb pain rating (on a scale from 1 to 10) decreased significantly. These preliminary results suggest that non-invasive dissociative anesthetics such as VR goggles, ketamine, and mirror visual feedback could be used to alleviate chronic pain from fibromyalgia. This would furnish us with a better understanding of the mechanism by which external visual feedback interacts with the internal physical manifestation of pain.

A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns.

Burns. 2010 Aug 6;

Authors: Schmitt YS, Hoffman HG, Blough DK, Patterson DR, Jensen MP, Soltani M, Carrougher GJ, Nakamura D, Sharar SR

This randomized, controlled, within-subjects (crossover design) study examined the effects of immersive virtual reality as an adjunctive analgesic technique for hospitalized pediatric burn inpatients undergoing painful physical therapy. Fifty-four subjects (6-19 years old) performed range-of-motion exercises under a therapist's direction for 1-5 days. During each session, subjects spent equivalent time in both the virtual reality and the control conditions (treatment order randomized and counterbalanced). Graphic rating scale scores assessing the sensory, affective, and cognitive components of pain were obtained for each treatment condition. Secondary outcomes assessed subjects' perception of the virtual reality experience and maximum range-of-motion. Results showed that on study day one, subjects reported significant decreases (27-44%) in pain ratings during virtual reality. They also reported improved affect ("fun") during virtual reality. The analgesia and affect improvements were maintained with repeated virtual reality use over multiple therapy sessions. Maximum range-of-motion was not different between treatment conditions, but was significantly greater after the second treatment condition (regardless of treatment order). These results suggest that immersive virtual reality is an effective nonpharmacologic, adjunctive pain reduction technique in the pediatric burn population undergoing painful rehabilitation therapy. The magnitude of the analgesic effect is clinically meaningful and is maintained with repeated use.