Medical procedures are upsetting and anxiety provoking in all ages, but particularly in children. Drs. Anne Dubin, Professor of Pediatrics, and Lauren Schneider, Clinical Assistant Professor of Psychology, at Stanford University School of Medicine believe that facing the unknown can help relieve some of that anxiety. Virtual reality (VR) is an extremely powerful tool that can be used to address these issues. Drs. Dubin, and Schneider, are using the power of VR to deliver care in a novel way for children with chronic illness. Though their focus is to use this innovative VR technology to address quality of life issues in children with heart disease, it has broad implications for all children with various medical conditions. Pioneers in this field, Drs. Dubin and Schneider are currently just one of a handful of groups using VR to help pediatric patients.

Drs. Dubin and Schneider have several areas they are planning on studying.  These include exposing children to anxiety provoking scenarios, such as undergoing a medical procedure in the hospital, and providing them with relaxation tools through VR prior to stressful procedures. They also plan on using VR to help cardiac patients overcome fears related to exercise, which understandably prevent them from being active and having a full and healthy life. Their research is driven by the clinical needs and observations their multidisciplinary clinical team encounters daily. Their unique research team combines experts in healthcare, as well as in technology. This interdisciplinary team is well poised to address many of the clinical issues surrounding quality of life in children utilizing advancements in technology.

Current Projects Include:

Decreasing Anxiety Around Pediatric Cardiac Procedures – When a child requires a medical procedure, they and their family often experience overwhelming anxiety and fear. Drs. Dubin, Schneider, and their team have produced a Virtual Reality 360 degree tour of the hospital for patients to experience prior to their procedure. This unique experience combines the VR tour and exposure to anxiety provoking aspects of the day, such as IV placements or undergoing anesthesia, with effective relaxation and mindfulness techniques. The tour captures the entire process from entry through the front door of the hospital, through each of the hospital locations involved in the procedure and finally out the front door.  Drs. Dubin and Schneider are presently performing a study comparing patients who have undergone this program to children who are preparing for their hospital trip in typical ways to see whether this product will actually reduce anxiety captured by self report measures and cortisol levels. Patients will receive the VR equipment one week prior to their procedure and will practice the relaxation techniques at home during the week. Once proven effective, this program can be customized and adapted to help children with a variety of procedures.

Encouraging Exercise in Patients with Heart Disease – Children with congenital heart disease often have a fear of exercise; they and their parents often worry about their safety when they exert themselves. Drs. Dubin and Schneider are utilizing VR to encourage children with heart problems to exercise by showing them they’re capable, while making exercise more fun. They will use VR exercise programs to not only reduce the fear associated with exercise, but also increase their engagement. To accomplish this, they are overlaying a commercially available VR exercise bike with biometric data, such as heart rate, respiratory rate, and saturation. This will enable them to identify particular exercise goals for their patients, insuring that they are safe to exercise. The VR exercise bike immerses the child in a VR experience, such as car racing, flying on a winged horse, or roping cattle during a stampede. The more active they are on the stationary bike the further they will progress in the VR experience.  The team plans on linking wearable activity monitors to the VR system so that exercise off of the bike will also further their progress in the VR game. Again, once proven effective, this program could be expanded to children with other medical conditions, including overweight children who face challenges that prevent them from getting adequate exercise.

Experiencing Future Events Through a Personalized Avatar – Children with medical conditions often require specialized and demanding treatment regimens. They often feel isolated and different from other children. The treatment regimens can be burdensome and challenging to follow, but the consequences of not following these regimens can be a matter of life and death. It’s difficult for clinicians to help them cognitively understand the importance of medical adherence. Drs. Dubin and Schneider are creating a VR program in which a patient creates a personal avatar who experiences important events in a virtual environment. By making certain choices in this environment, they can visualize the sequelae of their choices. For example, Avatars who follow their treatment plans will have the opportunity to experience rewarding life events such as graduating high school or going to the prom. Avatars who do not follow the regimen will experience the consequences of being sick in the hospital during these important events. The investigators will explore the impact of this tool in heart transplant patients, where medical adherence is imperative.