April 2006 Vol. 8 No. 1 www.pediatric-pain.ca/ppl Editor: Carl L. von Baeyer, carl.vonbaeyer@usask.ca © 2006, Patrick J. McGrath & G. Allen Finley Please visit the website for information on submission and review 6 Commentary Virtual Reality distraction during pediatric medical procedures Belinda Lange, Marie Williams and Ian Fulton Pediatric medical interventions are often associated with high levels of anticipatory fear and anxiety and procedural pain. Management of procedure-related distress commonly includes the use of distraction techniques which aim to divert attention away from the procedure and focus attention on an activity or task (Piira et al., 2002; Vessey et al., 1994). Distraction techniques can be provided in many forms (e.g. conversation, books, movies, computer games) which range from passive to active interventions. It has been suggested that the more active/interactive and interesting a distraction technique, the greater the potential for distraction, but this suggestion remains to be adequately tested (Dahlquist et al., 2002; MacLaren & Cohen, 2005; Mason et al., 1999). Virtual reality (VR) has become popular through the entertainment industries and the technology has only recently been applied in simulated and remote surgical techniques, rehabilitation and health applications. While research exploring the therapeutic use of VR as a distraction intervention for children and adults is sparse (Gold et al., 2005), theoretically this intervention has the potential to be an effective form of management for distress associated with medical procedures. What is Virtual Reality? Virtual Reality is an interactive computer-based system that immerses the user in a virtual environment (VE) (Heim, 1998). Commonly, VR systems used for distraction include a head mounted display (HMD) and 3-D tracking device connected to a computer. The HMD consists of an enclosed headset or helmet through which a VE can be viewed and manipulated using a mouse, joystick or dataglove. A tracking device, connected to the HMD, monitors the user’s head movements, giving the user a first person, 360 degree view of the VE. The VE can be abstract or realistic with cartoon based images of fantasy creatures or realistic human avatars (graphic representations of persons). Some pictures of VR equipment and VE images can be seen on the web pages referred to in endnote 1. The cost of a VR system (HMD, tracking device and VE) varies from US$400 to US$5000 (plus laptop/PC), depending on the quality of the hardware and complexity of the VR. VR systems are similar in many ways to computer games in that both systems allow the user to provide input into the VE using a mouse/joystick. However, VR differs from standard computer game applications due to the degree of interactivity and immersion provided. The interactivity of VR results from the tracking device attached to the HMD which tracks the user’s head movements and alters the first person view of the VE in real-time. This visual synchronicity permits the user to feel engaged or immersed in the VE, providing a sense of presence (the subjective experience of being in the VE, even when the user is physically situated outside the VE) (Burdea & Coiffet, 2003). The level of presence is dictated by the ability of the “outside world” to be blocked from providing sensory input and the degree of engagement with the VE. Within medical situations, patients still need information about what is