Effectiveness of virtual reality for pediatric pain distraction during i.v. placement.

The objective of this study was to test the efficacy and suitability of virtual reality (VR) as a pain distraction for pediatric intravenous (i.v.) placement. Twenty children (12 boys, 8 girls) requiring i.v. placement for a magnetic resonance imaging/computed tomography (MRI/CT) scan were randomly assigned to two conditions: (1) VR distraction using Street Luge (5DT), presented via a head-mounted display, or (2) standard of care (topical anesthetic) with no distraction. Children, their parents, and nurses completed self-report questionnaires that assessed numerous health-related outcomes. Responses from the Faces Pain Scale-Revised indicated a fourfold increase in affective pain within the control condition; by contrast, no significant differences were detected within the VR condition. Significant associations between multiple measures of anticipatory anxiety, affective pain, i.v. pain intensity, and measures of past procedural pain provided support for the complex interplay of a multimodal assessment of pain perception. There was also a sufficient amount of evidence supporting the efficacy of Street Luge as a pediatric pain distraction tool during i.v. placement: an adequate level of presence, no simulator sickness, and significantly more child-, parent-, and nurse-reported satisfaction with pain management. VR pain distraction was positively endorsed by all reporters and is a promising tool for decreasing pain, and anxiety in children undergoing acute medical interventions. However, further research with larger sample sizes and other routine medical procedures is warranted.     

The neurobiology of virtual reality pain attenuation.

During the past decade, virtual reality (VR) has gained recognition as a means of attenuating pain during medical procedures. However, while investigators have examined the effects of virtual environments on level of distraction, subjective pain intensity, and brain activity, there have been only a handful of investigations into the neurobiological mechanisms associated with VR's efficacy. In an effort to explain how VR may alter pain perception and produce analgesia, as well as to guide the development of novel and improved VR pain treatments, this review aims to link the wealth of empirical data examining the neurobiology of pain to the growing field of VR. This review is separated into three main sections: (a) a brief overview of the current literature on the use of VR for the treatment of pain; (b) a review of the basic neurobiology of how pain is detected, processed, and controlled by the brain; and (c) an exploration into how current VR pain treatments may impact the pain system to produce analgesia. In addition, the future of VR for pain treatment is discussed, including how current treatments might be improved and novel ways to use VR to treat pain might be developed. Speculation on future VR interventions is based on our current understanding of how the brain processes pain and how VR appears to alter this process and produce analgesia.     

Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients

The effectiveness of virtual reality (VR) as a behavioral intervention designed to decrease distress during port access procedure was examined in 20 7- to 14-year-old pediatric oncology patients. Children were randomized to either engage in an immersive VR environment during the procedure or to a no VR control condition. Children's distress was assessed through subjective self-ratings and objective physiological and behavioral ratings. Narrative accounts of the experience were used as a measure of how well the child coped with the procedure. VR was effective in reducing children's distress on all measures. Implications of these findings for intervention are discussed.     

How the eye measures reality and virtual reality

If virtual reality systems are to make good on their name, designers must know how people perceive space in natural environments, in photographs, and in cinema. Perceivers understand the layout of a cluttered natural environment through the use of nine or more sources of information, each based on different assumptions—occlusion, height in the visual field, relative size, relative density, aerial perspective, binocular disparities, accommodation, convergence, and motion perspective. The relative utility of these sources at different distances is compared, using their ordinal depth-threshold functions. From these, three classes of space around a moving observer are postulated: personal space, action space, and vista space. Within each, a smaller number of sources act in consort, with different relative strengths. Given the general ordinality of the sources, these spaces are likely to be affine in character, stretching and collapsing with viewing conditions. One of these conditions is controlled by lens length in photography and cinematography or by field-of-view commands in computer graphics. These have striking effects on many of these sources of information and, consequently, on how the layout of a scene is perceived.     

Age and active navigation effects on episodic memory: A virtual reality study

We investigated the navigation‐related age effects on learning, proactive interference semantic clustering, recognition hits, and false recognitions in a naturalistic situation using a virtual apartment‐based task. We also examined the neuropsychological correlates (executive functioning [EF] and episodic memory) of navigation‐related age effects on memory. Younger and older adults either actively navigated or passively followed the computer‐guided tour of an apartment. The results indicated that active navigation increased recognition hits compared with passive navigation, but it did not influence other memory measures (learning, proactive interference, and semantic clustering) to a similar extent in either age group. Furthermore, active navigation helped to reduce false recognitions in younger adults but increased those made by older adults. This differential effect of active navigation for younger and older adults was accounted for by EF score. Like for the subject‐performed task effects, the effects from the navigation manipulation were well accounted for by item‐specific/relational processing distinction, and they were also consistent with a source monitoring deficit in older adults.     

Health anxiety moderates the effects of distraction versus attention to pain

Little is known about the relationship between health anxiety and chronic pain. The present study explored whether individual differences in health anxiety would influence the response of chronic pain patients to physical therapy. Furthermore, the interaction of health anxiety with coping strategy usage (distraction versus attention) was studied. Participants were 81 chronic pain patients who were interviewed and completed measures of pain, anxiety and cognition following an active physiotherapy session in which they either: (1) attended to physical sensations; (2) distracted from physical sensations or (3) completed the session as usual. Health anxious, compared to non-health anxious, individuals worried more about their health and injury during the session and attended to and catastrophically misinterpreted sensations more frequently. A complex interaction between health anxiety and coping strategy emerged. Among health anxious patients, attention to sensations resulted in lower anxiety and pain than did distraction. It appears as though attention had a short-term anxiety reducing effect for health anxious patients. Among non-health anxious patients, attention resulted in greater worry about health than distraction. Clinical and theoretical implications are discussed.     

The use of virtual reality for episodic memory assessment: effects of active navigation

Episodic memory was assessed using Virtual Reality (VR). Forty-four (44) subjects visualized a target virtual apartment containing specific objects in each room. Then they visualized a second virtual apartment comprised of specific objects and objects shared by the two apartments. Subjects navigated in the virtual apartments in one of the following two conditions: active and passive. Four main episodic memory components were scored from the VR exposures: (1) learning effect; (2) active forgetting effect; (3) strategies at encoding and at retrieval; and (4) false recognitions (FRs). The effect of navigation mode (active vs. passive) on each memory component was examined. Active subjects had better learning and retrieval (recognition hits) performances compared to passive subjects. A beneficial effect of active navigation was also observed on the source-based FR rates. Active subjects made fewer source-based FRs compared to passive subjects. These overall results for the effect of active navigation are discussed in terms of the distinction between item-specific and relational processing.     

Impact of tasks and users' characteristics on virtual reality performance.

A better understanding of how users perform virtual reality (VR) tasks may help build better VR interfaces. In this study, we concentrated on the compensatory behavior in VR depending on the tasks and users' characteristics. The tasks characteristics considered were display size (large display vs. desktop monitor) and tasks types (manipulation and travel). The users' characteristics studied were the visual attention abilities and users' satisfaction. Ninety-five subjects participated in the experimentation composed of two parts: the first one consisted in cognitive tests used to evaluate visual attention abilities, and the second one was based on a set of VR tasks. Our result showed that large displays positively affect on performance for some kinds of VR tasks. Moreover, this impact was linked to users' satisfaction and visual attention abilities. Indeed, users with low-level attention abilities and users who preferred the large display took more advantage of large displays. We concluded that large displays can be considered cognitive aids depending on the tasks and users' characteristics.     

Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: a case report.

The present case series with two patients explored whether virtual reality (VR) distraction could reduce claustrophobia symptoms during a mock magnetic resonance imaging (MRI) brain scan. Two patients who met DSM-IV criteria for specific phobia, situational type (i.e., claustrophobia) reported high levels of anxiety during a mock 10-min MRI procedure with no VR, and asked to terminate the scan early. The patients were randomly assigned to receive either VR or music distraction for their second scan attempt. When immersed in an illusory three-dimensional (3D) virtual world named SnowWorld, patient 1 was able to complete a 10-min mock scan with low anxiety and reported an increase in self-efficacy afterwards. Patient 2 received "music only" distraction during her second scan but was still not able to complete a 10-min scan and asked to terminate her second scan early. These results suggest that immersive VR may prove effective at temporarily reducing claustrophobia symptoms during MRI scans and music may prove less effective.     

听觉刺激对虚拟环境中空间压缩的影响

人们往往会低估虚拟环境中空间的距离(空间压缩)。早期研究发现视听刺激的不一致会改善空间压缩,但听觉刺激在其中的作用及其影响效果需进一步研究。本研究首先探究了听觉刺激的有无对空间压缩的影响,接着操控视听刺激之间的物物距离进一步探究其对空间压缩的影响和改善。研究发现听觉刺激以两种方式影响空间压缩：听觉刺激的存在可以改善空间压缩;空间压缩与视听刺激的物物距离负相关。研究建议为了改善空间压缩,视听刺激应当同时呈现且物物距离至少为1 m。     

Immersion and the illusion of presence in virtual reality

This commentary briefly reviews the history of virtual reality and its use for psychology research, and clarifies the concepts of immersion and the illusion of presence.     

The effects of sub-threshold vibratory noise on visuomotor entrainment during human walking and standing in a virtual reality environment

Humans will naturally synchronize their posture to the motion of a visual surround, but it is unclear if this visuomotor entrainment can be attenuated with an increased sensitivity to somatosensory information. Sub-threshold vibratory noise applied to the Achilles tendons has proven to enhance ankle proprioception through the phenomenon of stochastic resonance. Our purpose was to compare visuomotor entrainment during walking and standing, and to understand how this entrainment might be attenuated by applying sub-threshold vibratory noise over the Achilles tendons. We induced visuomotor entrainment during standing and treadmill walking for ten subjects (24.5 ± 2.9 years) using a speed-matched virtual hallway with continuous mediolateral perturbations at three different frequencies. Vibrotactile motors over the Achilles tendons provided noise (0–400 Hz) with an amplitude set to 90% of each participant’s sensory threshold. Mediolateral sacrum, C7, and head motion was greatly amplified (4–8× on average) at the perturbation frequencies during walking, but was much less pronounced during standing. During walking, individuals with greater mediolateral head motion at the fastest perturbation frequency saw the greatest attenuation of that motion with applied noise. Similarly, during standing, individuals who exhibited greater postural sway (as measured by the center of pressure) also saw the greatest reductions in sway with sub-threshold noise applied in three of our summary metrics. Our results suggest that, at least for healthy young adults, sub-threshold vibratory noise over the Achilles tendons can slightly improve postural control during disruptive mediolateral visual perturbations, but the applied noise does not substantially attenuate visuomotor entrainment during walking or standing.     

Influence of cognitive stance and physical perspective on subjective and autonomic reactivity to observed pain and pleasure: An immersive virtual reality study

Observing others’ pain may induce a reaction called personal distress that may be influenced by top-down (imagine self or other in pain, i.e., self- vs other-oriented stance) and bottom-up (physical perspective of those who suffer, i.e., first vs third person perspective- 1PP vs 3PP) processes. The different contributions of these processes have not been teased apart. By capitalizing on the power of Immersive Virtual Reality, we explored how behavioural (subjective ratings) and physiological reactivity (skin conductance reactivity, SCR) to pain and pleasure delivered to an avatar was influenced by Cognitive stance and Physical perspective. Taking an Other-Oriented stance leads to attributing higher congruent valence (i.e. pain rated as unpleasant and pleasure as pleasant) and intensity to the stimuli and induces reduced SCR. Ownership over the virtual limb was maximal in 1PP where physiological reactivity to the stimuli was comparable. Our results highlight different components underpinning reactivity to pain and pleasure.     

Active and passive distraction using a head-mounted display helmet: effects on cold pressor pain in children.

OBJECTIVE: The current study tested the effectiveness of interactive versus passive distraction that was delivered via a virtual reality type head-mounted display helmet for children experiencing cold pressor pain. DESIGN: Forty children, aged 5 to 13 years, underwent 1 or 2 baseline cold pressor trials followed by interactive distraction and passive distraction trials in counterbalanced order. MAIN OUTCOME MEASURES: Pain threshold and pain tolerance. RESULTS: Children who experienced either passive or interactive distraction demonstrated significant improvements in both pain tolerance and pain threshold relative to their baseline scores. In contrast, children who underwent a second cold pressor trial without distraction showed no significant improvements in pain tolerance or threshold. CONCLUSION: Although both distraction conditions were effective, the interactive distraction condition was significantly more effective. Implications for the treatment of children's distress during painful medical procedures are discussed.     

The effects of context and subjects' perceived control in breaching posthypnotic amnesia

Subjects selected on the basis of being amnesic and experiencing their amnesia as “voluntary” or “involuntary” were subjected to two conditions designed to breach their amnesia: (1) lie detector, and (2) honesty instructions. A third group receiving relaxation instructions served as a control. Posthypnotic amnesia was breached under lie detection and honesty conditions. However, there appeared to be an interaction between how subjects reported their experience of amnesia (voluntary and involuntary) and the degree to which amnesia was breached. Voluntary subjects accounted for the majority of breaching. Implications for (1) studies on breaching, (2) theories and processes of breaching, Implications for (1) studies on breaching, (2) theories and processes of posthypnotic amnesia, and (3) studies in posthypnotic amnesia are discussed.