VR to reduce anxiety of young patients

In this blog by Sin Fai Lam, Constantinos Panayi discusses virtual reality to reduce anxiety and isolation of young patients, his projects and hopes for the technology.

Admission into hospital for children can often be an intimidating process. The potent mix of being in an unfamiliar environment along with the uncertainties of the unknown can lead fear and uncertainty. Furthermore, if children receive insufficient information regarding the various procedures within the hospital, they may experience elevated levels of anxiety¹.

In one particular area, attempts have been made to alleviate this distress. Magnetic resonance imaging (MRI) scans can be intimidating, due to the nature of the procedure with its loud noises, large machine and relatively confined space.

Some children find it hard to tolerate such a procedure and this sometimes necessitates the scan being conducted with the child under sedation, which is not ideal. Therefore attempts have been made either via mock MRI scanners² or via virtual reality (VR) mock-ups³, to help prepare children for the scan, with initial evidence suggesting they have a benefit in reducing agitation and anxiety.

I was fortunate to attend a Middlesex University end of year showcase and was able to interview Constantinos Panayi a 3D Environment Artist specialising in VR Technology who was collaborating with Great Ormond Street Hospital (GOSH) in developing a similar VR mock-up for them. The aim would be to use VR to show the child the MRI procedure and in the process help the child become aware and informed.

In theory, this should be a more informative experience than simply receiving a verbal description of the procedure from healthcare staff. This in turn would hopefully reduce the child's anxiety before the scan.

Initial inspiration

Constantinos explained his initial inspiration: 'I was initially stuck for ideas on what to do for my final year project,' he said, 'however my teacher mentioned that his friend had an MRI scan once, then I got thinking about showing an MRI procedure in VR. I had spent many years in Great Ormond Street Hospital and I remembered how stressful the whole experience was. I had many MRIs and CT (computerised tomography) scans and I could remember the noise and being alone in the room by yourself. It can be quite daunting. I then decided to read up about MRI and to research more on it. I was able to find information online and was able to talk to the people in the hospital who agreed for me to look at the machine.'

Constantinos then developed and designed the VR model. He drew inspiration from the video game 'That Dragon, Cancer' and designed the mock-up with a similar 'low-poly' look to that game ('low-poly' refers to 3D objects being constructed from a relatively low number of polygons, which can result in objects having a clean, blocky aesthetic; an intentional stylistic choice).

He integrated additional features to the VR model, such as having visual stimulation like fish swimming within the model to allow greater engagement for the child and to reduce the intimidation of the entire process.

Discussion with Clare Simcock, the lead radiographer for GOSH, also highlighted how the joint work between individuals with different expertise helped to develop a more polished product. Claire said 'Constantinos approached us about this project and it was something which we were interested in.'

She highlighted how the team fed back regarding the technical aspects of the procedure as well as regarding visual considerations. This included considerations for younger children and children with special needs and how they would interact with the environment. However she did note that this project was still a work in progress and further research is needed into the field.

Coming alive

Running concurrent with the MRI project, Constantinos was also developing a VR simulation of one of the gardens within GOSH. The idea being that patients would be sitting in the garden through the use of VR and it would ,'come alive through the use of animals and plants'. Additionally, 'reassuring and thoughtful letters that have been written by former patients are brought to the table. A narrative then reads them out to the patient.'

Constantinos said 'When I was a patient, I spent some time in isolation. I remembered that as a patient, I was not allowed to go out; I was not allowed to go outside. It can be very lonely. This is a relaxing garden' and he hoped that patients experiencing it in VR would help them feel less isolated, if only for a while.

I asked him whether he thought that children would be able to engage with the VR models. He felt that the visual nature of VR can appeal to young patients and he had seen children use it during his demonstrations at shows. Through their feedback he found that they felt happy and relaxed.

Constantinos stated the ability to immerse the child in the VR world was another important factor. 'On one occasion,' he said, 'the young child pointed out to their younger sister 'look at the fishes' whilst wearing the VR headset, and the sister replied, 'but its not there, only you can see it.' The smiles and their looks just made me feel it was worth it.'

Constantinos continues to be actively involved in GOSH both as a guide and as member of the GOSH Young People's Forum, which looks at ways to make hospital life better for young patients. 'I have spent much of my childhood involved with GOSH,' he said, 'both as a patient and a sibling of a patient. It's almost like it is my second home and I am giving something back to improve patient experience.'

Final thoughts

Overall, I find Constantinos project exciting on two different levels. One aspect is the usage of technology to improve patient experiences. The promise is that VR technology could potentially be a non-pharmacological/low-risk method of reducing anxiety and distress amongst children in hospital.

However, what I think his project highlights even more is the need for hospitals to engage better with patient and relative groups in trying to improve experiences within our services. Patients often have their own unique experiences of healthcare services that clinicians may not always be aware of. Projects like this help bridge that gap of knowledge and allow us to work more collaboratively in achieving desired outcomes.

Authored by Sin Fai Lam

References

1. Wilson, Margaret E., B. S. N. Kimberly Carlson, and B. S. N. Laura Enenbach. "Children's Experience of Hospitalization." The 18th International Nursing Research Congress Focusing on Evidence-Based Practice. 2007.
2. de Bie, Henrica MA, et al. "Preparing children with a mock scanner training protocol results in high quality structural and functional MRI scans." European journal of pediatrics 169.9 (2010): 1079-1085.
3. Liszio, Stefan, and Maic Masuch. "Virtual Reality MRI: Playful Reduction of Children's Anxiety in MRI Exams." (2017).