"Do I have to have an injection today?" - this is probably the most frequent question asked by young patients in paediatric medicine. And the fear of needles should be taken seriously. Treatments are delayed and the fears formed in childhood can later have a lifelong effect on adults. Virtual reality opens up completely new possibilities for paediatrics in terms of stress management and opens up ever new fields of application.
According to US studies, almost two-thirds of children and a quarter of adults are afraid of needles. Poorly handled blood draws, vaccinations, injections and procedures in childhood also cause many people to avoid medically important treatments later on. This costs the US an estimated $1.5 billion every year. It is obvious that a way out of this dilemma is being sought here.
Virtual reality, of all things, could play a major role in solving the problem. In contrast to AR, whose great strength lies in supporting medical staff, the potential of VR on the patient side is enormous. When immersed in the virtual world, there is no longer any contact with the environment - and that makes VR the ideal tool for paediatrics.
Smileyscope is the name of the VR glasses developed by Dr. Evelyn Chan with their own VR software. According to her own information, Smileyscope reduces sixty per cent of the pain and forty per cent of the fear of children who have to receive injections or have an IV inserted. How does something like this work?
VR software can be targeted to how children's brains recognise pain. Smileyscope replaces negative, frightening, real stimuli with positive, friendly, virtual stimuli. This technique, called "procedural choreography", substitutes real experiences with a virtual story. Maximum immersive distraction.
In everyday hospital life, it looks like this: Smileyscope is put on by the children and Puggles, an animated penguin, first gives important tips for the following treatment. Then it starts and Puggles says: "You are about to experience an exciting underwater adventure. Three. Two. One..." The children jump into the water. Waves splash over their arms - a dab of antiseptic in the parallel real world. Fish swim up. The children can choose the fish they like best. A fish nibbles on the arm when the needle is inserted.
The children's brains design something completely new to think about the feeling of the actually scary needle in a completely different way. "Essentially VR takes up more of the brain and the brain's processing, so you're actually less able to process the pain and fear," Chan explains. Founded as a start-up in Australia, Smileyscope is used in every children's hospital there, and Chan now works with over forty US hospitals.
No medical discipline is currently inspiring the imagination around VR applications as much as paediatrics and paediatric surgery. This is partly because young patients are growing up with digital media and gaming, and partly because paediatrics faces challenges for which VR technology provides effective support.
"Magnetic resonance imaging is a classic examination that can definitely scare children in the run-up and during the procedure," says Peter Blaurock at Dr von Hauner's Children's Hospital in Munich. The examination in a tube is loud, the equipment is large and complicated. But the child has to keep absolutely still so that the images are not taken in vain. With the VR glasses, the child can walk through a digitally generated radiology station, the simulation ends with the child being driven into the tube himself and playfully practising lying still.
This means: the child hears the knocking, characteristic sounds of the MRI around him, but sees a peaceful night sky above him in which stars are gradually connected to form images. As soon as the child moves his head, however, this process is stopped by the app. "So if I lie still, I manage to get all the stars connected with lines," says Peter Blaurock. Perfect play training through "serious games" - with the benefit for the examination afterwards, which then also usually works right away.
As the Smileyscope example makes clear, VR glasses can also be useful during prolonged treatment that is unpleasant for children, for example when a wound is being stitched. They get to play a VR game during the procedure. "By experiencing virtual reality, the child is fully taken out of the situation - so the technology offers a lot of potential to help by distracting them," Blaurock explains. VR games that the child controls with head movements alone are suitable for this, so that the treated body part remains absolutely still.
The VR glasses also help children with chronic illnesses and pain and are used in this way at the Belgian Zeepreventorium De Haan, a renowned rehabilitation centre for chronically ill children. Immediately before the next treatment, the children go on a relaxing journey in virtual reality, where they can forget the pain and fear that sometimes rise before every new, necessary treatment.
The children choose from different settings, for example outer space or the sea, which then represent the environment in the virtual world. A voice accompanies the journey, so that the little patients calm down. However, the VR glasses are not only used before painful examinations, but increasingly also in pain therapy for chronic diseases. With the help of the VR glasses, children learn, among other things, relaxation exercises that help to alleviate anxiety and pain in the long term.
The possibilities of VR, for all their progress, are still in their infancy, but beyond paediatrics there are already the first examples of successful applications. Not only for autistic children, but also for adults with autism, VR applications can help in coping with the sensory overload during an MRI examination. The Protestant Hospital in Bergisch Gladbach is currently treating anxiety disorders with extreme symptoms with a new procedure.
Those affected are accompanied therapeutically with VR glasses. In this way, patients learn how to deal with anxiety-provoking situations such as great heights. They are confronted virtually with the fear-triggering situation, as head physician PD Dr. med. Fritz-Georg Lehnhardt explains: "The aim is to convey to the patient that the fear-triggering situation is not dangerous and that he will lose his fear of it through regular and gradual confrontation with these harmless triggers." The procedure is said to be similarly successful to classical behavioural therapy.
While VR can put little patients at ease, the other technology - augmented reality - is an increasingly exciting option on the part of doctors. Already by the middle of the 21st century, AR-assisted surgery will be standard, predicts Professor Dr. Thomas Neumuth, Technical Director of the Innovation Centre for Computer-Assisted Surgery at the University Hospital in Leipzig in the "Red Bulletin".
Paediatric surgery is already testing AR-assisted procedures: Cardiac surgery is one of the most difficult procedures, and it becomes even more complex when it comes to operating on small, walnut-sized children's hearts. Visualisation techniques such as cinematic rendering do provide a detailed 3D view of the patient's heart and surrounding anatomy. A hologram, on the other hand, can be rotated, zoomed and viewed from all possible perspectives.
Text: Ron Voigt