Effect of the Application of Virtual Reality on Pain Reduction and Cerebral Blood Flow in Robot-Assisted Gait Training in Burn Patients

Abstract

Burn injuries and their treatment are extremely painful. This study aimed to determine whether virtual reality (VR) could reduce pain during robot-assisted gait training (RAGT) in burn patients by analyzing the cerebral blood flow (CBF) in the prefrontal cortex over time using functional near-infrared spectroscopy (fNIRS). The patients included in this study complained of a pain score ≥5 on a visual analog scale (VAS) during RAGT, which was performed 10 times for 2 weeks. Each session consisted of 15 min of VR application, with a 2-min break, and 15 min without VR. The average values of oxyhemoglobin and deoxyhemoglobin concentrations in the prefrontal cortex on fNIRS were calculated at four stages: temporal delay time with only RAGT, RAGT without VR, temporal delay time with RAGT and VR, and RAGT with VR. The pain scores and CBF were evaluated in sessions 1, 5, and 10 of the RAGT. The mean VAS pain scores were significantly lower (p < 0.05) in the experimental condition than in the control condition. Oxyhemoglobin in the prefrontal lobe significantly increased when RAGT was performed with VR. In conclusion, VR may be a strong nonpharmacological pain reduction technique for burn patients during physical therapy.

A Systematic Review of the Effectiveness of Virtual Reality-Based Interventions on Pain and Range of Joint Movement Associated with Burn Injuries

“…Regarding the sociodemographic characteristics of the participants of the studies, the ages ranged from children of 5 years to adults of 78, with the mean age of all studies [ 17 , 21 , 24 , 26 , 27 , 29 , 30 , 31 , 32 , 33 ] being 23.44. In terms of sample size, the number of participants ranged from 23 [ 20 ] to 66 [ 24 ].…”

“…This same study conducted a minimum of 2 weekly Xbox Kinect sessions of 15–30 min each. Finally, in the study conducted by Lee et al [ 30 ], 30 min robot-assisted gait-training (RAGT) sessions were performed 10 times for 2 weeks. Robotic training alone, without VR, was performed for 15 min, and VR and RAGT were performed simultaneously for 15 min each.…”

“…In two of the trials [ 16 , 29 ], an occupational therapist also carried out both virtual-reality therapy and the others. Yohannan et al [ 20 ] and Soltani et al and Lee et al [ 25 , 30 ] did not specify the professionals involved in the intervention as they only addressed them as “therapists” without going into further detail. In the study by Hoffman et al [ 28 ], it was the nursing staff who carried out the treatment, while Kamel et al [ 17 ] did not specify.…”

“…The most important outcome measures analysed by the studies were the range of motion and pain, since both were assessed in four studies included in this review [ 20 , 25 , 26 , 29 ]. Pain was analysed as a single outcome measure in the studies by Kamel et al [ 27 ], Hoffman et al [ 28 ] and Lee et al [ 30 ], while the range of joint movement was measured as a single measure in three of the studies [ 17 , 24 , 31 ].…”

“…For the assessment of pain, the visual analogue thermometer (VAT) or the visual analogue scale (VAS) was also used in two studies [ 20 , 27 ] and in the study by Hoffman et al [ 28 ] the Pain Catastrophizing Scale for Children (PSC-C) was used. In the Lee et al study [ 30 ], the portable functional near-infrared spectroscopy (fNIRS) measurement system, which was attached to the head with elastic straps inside a plastic cap, was used. This system uses 24 laser sources to measure cerebral blood flow (CBF) analysis in the prefrontal cortex throughout the intervention.…”