Specialists See Tools to Treat Pain in Video Games

April 20, 2013

Specialists See Tools to Treat Pain in Video Games

By ASHLEY SOUTHALL

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Danica Zimmerman, 14, playing a game to measure her range of motion and pain triggers at Children’s National Medical Center.

WASHINGTON — Fifteen-year-old Reilly woke up one morning with a sharp, stabbing pain in his left leg that soon spread to other parts of his body. The pain, which started early last year, forced him to quit soccer, and he spent the next four months being poked, prodded and scanned by doctors.

The test results were inconclusive. “No one could tell him why he was in a ball on the floor unable to function,” said Nina, his mother, who agreed to be interviewed only on the condition that the family’s surname be withheld.

Finally, last June, Dr. Sarah Rebstock, a pediatric anesthesiologist at Children’s National Medical Center, gave Reilly a diagnosis of chronic regional pain syndrome. The nerve disorder is characterized by chronic and severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch.

Recently, Reilly stood in a half-lighted room of the hospital’s new Pain Medicine Care Complex, playing a video game called TubeRunner as part of his physical therapy routine.

The sight of the teenager reaching in the air and shuffling from side to side as his on-screen avatar hurled down an intergalactic tube racking up rings and gems seemed unremarkable. After all, game consoles like Microsoft’s Xbox and Nintendo’s Wii have become ubiquitous in American households, and many hospitals and clinics use them to add an element of fun to physical therapy.

But TubeRunner is one of four of galaxy-themed video games created specifically for this complex, where pain specialists and game developers are piloting an approach to measuring pain. Dr. Julia Finkel hopes that using technical data from games and interactive activities to objectively identify and monitor pain can help determine how to evaluate the techniques used to treat it.Central to their effort to quantify pain, said Dr. Finkel, the chief of pain medicine here, is a squat, rectangular black box with three eyes peering up from below the screen. It was a Kinect, a motion sensor device that allows users to control games using gestures and spoken commands.

More important for Dr. Finkel was the device’s tracking of 24 points on Reilly’s body in three dimensions, feeding data about his movements — angles, distance, speed, frequency — to a secure database. Custom software measures his heart rate and converts all of the data to graphics that a physical therapist can see on a tablet computer in real time.

“Since it’s digital information, we can manipulate it, understand it, analyze it,” Dr. Finkel said. “So from a research perspective, it’s a treasure trove of information that would help us formulate new metrics in order to treat these patients.”

Danica Zimmerman, 14, saw more than 20 doctors for the burning pain that started last year in her right hand and quickly spread to her other limbs. Many of the doctors told her that the pain, which forced her to quit swimming and refuse hugs, was all in her head. She finally received a diagnosis of reflex sympathetic disorder, another name for chronic regional pain syndrome.

As Danica walked around the complex recently, wearing smiley-faced pajama pants and attached to an IV containing ketamine, she stopped to play a game of Meteor Bounce.

Dr. Rebstock, the director of the complex, said it was normal for her teenage patients to see a handful of doctors before getting the right diagnosis. The National Academies estimates that about 100 million adults in the United States suffer from chronic pain; hospital officials say that between a quarter and a half of children under 18 experience chronic pain lasting more than three months.

“Physicians don’t often recognize pain as a pathology,” Dr. Rebstock said. “And so patients end up seeing a lot of doctors trying to figure out what’s wrong.”

The measures developed using the Kinect data could help reduce errors and could easily apply to pain treatment for adults, and even for other chronic conditions like autismcancer and diabetes, Dr. Rebstock said.

Microsoft released the Kinect for Windows last year as the company was encouraging researchers to explore health applications for the device, which was originally created for the Xbox game console.

Using technical data to assess and treat pain could allow clinicians to replace current methods that Dr. Finkel said were trial and error. Current therapy relies on the patients and doctors to gauge pain by feelings and observations.

The games draw on techniques from physical therapy and yoga to distract children from their pain, but also to increase their range of motion and strength. Clinicians will be able to use initial measurements to determine a baseline range of motions that each patient can perform in pain. By looking at how patients’ movements change over time, doctors will be able to determine whether a therapy works.

Dr. Hamid Ekbia, a research professor at Indiana University Bloomington, is developing a game system for stroke patients that would automatically document, maintain and analyze data on the patient’s condition and treatment. The option of in-home treatment would provide increased access to care and a way around insurance restrictions that cap therapy sessions at about 15 to 20 visits, limits that leave patients on their own after a few weeks, he said.

“If we can capture this data that shows the progress of the patient, and allow the therapist to document how the patient is doing and even generate automatic reports, that’s going to provide a lot of savings of money and time,” Dr. Ekbia said.

For the technology to really progress, he said, insurers and lawmakers must change policies to cover the cost of the consoles and to reimburse clinicians for time spent looking over patients’ data.

“Our fear is that we will develop all of this and finally we’ll hit this policy barrier or this reimbursement barrier,” Dr. Ekbia said. “And people might not be able to pick this up just because of those barriers.”

The clinicians at Children’s National Medical Center are working with developers from Interface Media Group to modify the game system for patients to buy and use at home. Relying on motion tracking and Internet cloud services, physical therapy administered through game consoles would allow clinicians to develop personalized exercise routines based on a patient’s condition.

“It’s just like your iPhone,” Dr. Rebstock said. “Generation one wasn’t nearly as cool as whatever we have now. So this is generation one.”

About bambooinnovator
Kee Koon Boon (“KB”) is the co-founder and director of HERO Investment Management which provides specialized fund management and investment advisory services to the ARCHEA Asia HERO Innovators Fund (www.heroinnovator.com), the only Asian SMID-cap tech-focused fund in the industry. KB is an internationally featured investor rooted in the principles of value investing for over a decade as a fund manager and analyst in the Asian capital markets who started his career at a boutique hedge fund in Singapore where he was with the firm since 2002 and was also part of the core investment committee in significantly outperforming the index in the 10-year-plus-old flagship Asian fund. He was also the portfolio manager for Asia-Pacific equities at Korea’s largest mutual fund company. Prior to setting up the H.E.R.O. Innovators Fund, KB was the Chief Investment Officer & CEO of a Singapore Registered Fund Management Company (RFMC) where he is responsible for listed Asian equity investments. KB had taught accounting at the Singapore Management University (SMU) as a faculty member and also pioneered the 15-week course on Accounting Fraud in Asia as an official module at SMU. KB remains grateful and honored to be invited by Singapore’s financial regulator Monetary Authority of Singapore (MAS) to present to their top management team about implementing a world’s first fact-based forward-looking fraud detection framework to bring about benefits for the capital markets in Singapore and for the public and investment community. KB also served the community in sharing his insights in writing articles about value investing and corporate governance in the media that include Business Times, Straits Times, Jakarta Post, Manual of Ideas, Investopedia, TedXWallStreet. He had also presented in top investment, banking and finance conferences in America, Italy, Sydney, Cape Town, HK, China. He has trained CEOs, entrepreneurs, CFOs, management executives in business strategy & business model innovation in Singapore, HK and China.

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