Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain

Abstract

Introduction: Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products.

Purpose of the study: The purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist.

Discussion: The following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions-immersive VR embodiment therapy for phantom limb (chronic) pain.

Conclusion: VR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients' pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera-based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.

Keywords: Acute pain; Hand therapy; Immersive virtual reality; Pain distraction phantom limb pain; Persistent pain.

Conflict of interest statement

The authors do not have any conflicts of interest. The first author has joined the Scientific Advisory Board of BehaVR.com.

Although one author works for Johnson and Johnson and one works for GlaxoSmithKline (GSK), no products or funding from these sources were involved in the conduct of any of the studies in the current manuscript, and these are not considered competing interests.

Copyright © 2020 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1.

fMRI brain scans showed large reductions in pain related brain activity during virtual reality. Image copyrighted, used with permission.

Figure 2.

A pediatric burn patient using virtual reality during occupational therapy range of motion exercises. Photo copyrighted, used with permission.

Figure 3:

A pediatric burn patient using virtual reality pain distraction during physical/occupational therapy. Photo copyrighted, used with permission.

Figure 4.

SnowWorld: A screenshot. Patients float slowly through a 3D computer generated virtual world, during painful medical procedures. Image copyrighted, used with permission.

Figure 5.

Soldiers with combat-related burn injuries reported significant reductions in worst pain intensity during VR, and significantly more fun during VR. (Image copyrighted, used with permission).

Figure 6.

A soldier with combat-related burn injuries at Brooke Army Medical Center Institutes of Surgical Research in San Antonio Texas. The custom robot-like arm goggle holder holds the VR goggles near the patient with little or no contact with the patient, so the patient does not have to wear a VR helmet (image copyrighted, used with permission).

Figure 7.

Using optical camera hand tracking technology mounted on their virtual reality helmet (e.g., VRgineering.com XTAL as shown above) allows hand therapy patients to use their real hand gestures to control their cyberhand gestures allowing patients to interact with virtual objects in the virtual world. (copyrighted image, used with permission). Haptic feedback using sound waves can further enhance the illlusion, www.ultraleap.com/haptics/

Figure 8.

At the higher end of the new VR market, a new highly immersive VR helmet named XTAL is available at VRgineering.com, allowing high realism in VR. This helmet has 180 degrees field of view, and comes with magic leap optical hand tracking/cyberhand technology already integrated.