Danica Zimmerman is in the zone. Set up in a game room in front of a big screen and a Kinect motion controller, she’s dodging and reaching to field rubber balls on the screen and bat them back to topple a wall of blocks. She’s focused on the game at hand and all but ignoring the IV in her arm or the handful of medical staff clustered just outside the door.
Zimmerman is participating in a new approach to pain therapy under development at the Children’s National Medical Center. The games are just part of Danica’s treatment, but provide welcome distraction from the pain she’s in. The desire to get through higher levels with better scores spurs her to push herself.
“When I’m engaged in something, it takes my mind off it,” she said.
But doctors are able to use the games as more than a simple distraction tactic, said Sarah Rebstock, a pediatric anesthesiologist and clinical director of the hospital’s pain medicine program.
In collaboration with D.C.-based Interface Media Group,Rebstock and others at the hospital designed games that can target specific muscle groups and measure progress as a part of the therapy. The games, which operated on Microsoft’s Xbox and its Kinect controller, include two games that work the upper body and one that players control by shifting their weight from side to side. The Kinect, which responds to players’ movements to control games, also allows medical staff to take exact data about how patients’ range or dexterity have improved over the course of a treatment. It measures movement on three axes — horizontal, vertical and back-and-forth — and looks at 20 other data points such as the angle of players’ arms to assess how they’re doing in treatment.
Having that data, Rebstock said, takes some of the guesswork out of the process, as medical staff can turn to that information as well as intuition in their assessments.
“The data comes back to us and tells us exactly where to target,” Rebstock said. “We can get information faster and more objectively.”
Christina Baxter, the complex’s clinical nurse manager also said that the clinic’s focus on technology seems to help put younger patients at ease.
“It’s their world,” Baxter said. “I see them come into the waiting room all the time with their own iPads and tablets — this makes [the clinic] a world that engages them.”
The pain complex is part of a larger innovation center at the hospital that uses lab tests and research to come up with faster solutions. Called the Sheikh Zayed Institute for Pediatric Surgical Innovation, the division is devoted to making procedures more precise, less invasive and less painful for children.
Incorporating data into pain treatments is particularly important in pain medicine, said Julia Finkel, the vice chief of the hospital’s division of anesthesiology and pain medicine, because physicians have had to measure pain by asking patients to rate pain on a 1-10 scale — an imprecise measure at best. Using data, such as the information collected by the Kinect, gives doctors more diagnostic tools.
“The pain clinic showcases what we’re all about: metrics, diagnostics and therapeutics,” Finkel said. “It makes objective what was subjective.”
This approach has done wonders for Danica, who has a painful condition called Reflex Sympathy Disorder and has seen dozens of doctors. When the 14-year-old came to the hospital’s Pain Medicine Care Complex, she could barely move her right arm and the pain had spread to her right leg and left arm. The slightest touch — air from a blow dryer, or a feather — made her feel like her skin was on fire. Her mother, Lori Zimmerman, turned to Children’s National Medical Center after hearing about new treatments from a Facebook discussion group.
The clinic’s unique relationship with the lab means that physicians there can try new things within the carefully restricted medical technology space. The hospital uses its know-how to make sure everything is above-board when it comes to health-care privacy laws and passes the rigor required for an institutional review board, but can also translate new research into treatments more quickly.
In the future, doctors would like to be able to have patients take Kinect controllers to do therapy at home, and beam those results back to the clinic, and maybe even use its facial recognition technology to get a better idea of how patients are feeling.
That would be great for Danica and her mother, who will drive back and forth from their home in Delaware for regular treatments in D.C once every six weeks. But so far, Danica’s progress has been worth that long commute.
After her gaming session, Danica and her mother sat to rest in one of the treatment rooms and called for Baxter, the nurse. As she comes in, she stops short to see Lori, beaming as she runs a hand lightly over Danica’s leg.
“It’s the first time I’ve been able to touch her like this for over a year,” Lori says, turning to her daughter. “Tonight, we might try a hug.”
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