Looking fear in the eye: Gamified virtual reality exposure towards spiders for children using attention based feedback.

Many children around the globe suffer from spider phobia. Virtual reality exposure therapy is an effective phobia treatment, but so far predominantly tailored for adults. A gamified approach utilizing gaze interaction would allow for a more child-friendly and engaging experience, and provide the possibility to foster working mechanisms of exposure therapy. We developed an application in which children make spiders change in positively connoted ways (e.g., make them dance or shrink) if sufficient visual attention towards them is captured via eye tracking. Thereby, motivation for and positive affects during exposure towards spiders are aspired. In this pilot study on 21 children without (n = 11) and with fear of spiders (n = 10), we examined positive and negative affect during exposure to a virtual spider and to different gaze-related transformations of the spider within a quasi-experimental design. Within a one-group design, we additionally examined fear of spiders in spider fearful children before and one week after the intervention. We found that significantly more positive than negative affect was induced by the spiders' transformations in children without and with fear of spiders. Fear of spiders was furthermore significantly reduced in spider-fearful children, showing large effect sizes (d > .80). Findings indicate eligibility for future clinical use and evaluation in children with spider phobia.

Changes of Somatosensory Phenotype in the Course of Disease in Osteoarthritis Patients.

To investigate sensory changes, physical function (pF), quality of life (QoL) and pain intensity of patients with osteoarthritis (OA) in the natural course of disease, and patients undergoing total joint replacement therapy (TJR) 31 (20 females, mean age 64.6 ± 10.4 years), patients with OA were investigated with questionnaires and quantitative sensory testing (QST) in the area of referred pain at the thigh at baseline and follow-up 22-49 weeks later; changes were analyzed separately for patients with (n = 13) and without TJR (n = 18). In patients without TJR pain intensity, pF, QoL did not improve, and increased pain sensitivity to cold and a stronger loss of detection were observed. In patients after TJR, however, a reduction in mechanical pain sensitivity and allodynia occurred in accordance with a reduction of pain intensity and improvement of functionality while QoL did not improve. Additionally, an increased sensitivity to heat pain and a more pronounced loss of mechanical detection could be observed in this group. TJR seems to stop peripheral pain input leading to a reduction of pain intensity and central sensitization, but surgery-induced sensory changes such as peripheral sensitization and loss of detection occur. Furthermore, TJR has favorable effects on pain intensity and functionality but not QoL.

Sensory symptoms in low back pain-how do they matter?

OBJECTIVE: Successful treatment of chronic low back pain (LBP) is difficult in clinical practice and hard to measure in trials. One reason might be the use of insufficient outcome parameters. The aim was to investigate the importance of typical clinical characteristics of chronic LBP on QoL and functionality. METHODS: A total of 51 patients with chronic LBP (19 with, 32 without radiculopathy) were investigated with different questionnaires. RESULTS: Burdening symptoms differed in frequency, intensity and impairment of QoL and functionality between patients with and without radiculopathy and between the area of pain within the same patient, i.e. between back and leg. Symptoms of nerve affection such as prickling pain and numbness were rated higher in the area of radiating pain than on the back in radiculopathy, and typical neuropathic pain symptoms such as burning pain, prickling, spontaneous pain, and feeling of deep pressure and pain at the beginning of movement were rated with a higher impairment of QoL and functionality in patients with compared to those without radiculopathy. Furthermore, intensity, impairment of QoL, and functionality were not necessarily reported in association with one another: some patients were highly impaired in QoL or functionality, despite a moderate-to-low pain intensity, whereas others suffered from severe pain, but were less impaired in QoL or functionality. CONCLUSION: Results suggest the consideration of impairment of QoL and functionality in addition to symptom intensity for treatment evaluation of chronic LBP. This can help to improve overall well-being of the patients and enhance efficacy in clinical pain trials and patient-centered treatment.

The objective determination of compliance in treatment of adolescent idiopathic scoliosis with spinal orthoses.

STUDY DESIGN: Prospective study using a specifically developed microelectronic technology. OBJECTIVE: To establish new technical methods for the objective measurement of brace use without patient involvement. SUMMARY OF BACKGROUND DATA: Effectiveness of spinal bracing clearly depends on the compliance of the patient. For further improvement of spinal bracing, reliable data are needed concerning the brace use. Questionnaires or clinical judgment usually estimates subjectively the compliance, which ranges from 20% to 90%. So far, only 1 study with 10 patients has investigated the compliance by objective time-stamped logging in a daily life environment, showing an average brace use of 65%. METHODS: There were 9 female patients (age 14.2 years, standard deviation 1.5) with adolescent idiopathic scoliosis who took part in the study. Their thoracolumbosacral orthoses (Chêneau braces OT-Kiel, Kiel, Germany) were equipped with a specifically developed discrete data logger to record temperature at the skin-brace interface over a period of 5.4 weeks (standard deviation 3.1), at 2-minute date/time-stamped intervals. RESULTS: Brace use ranged from 4.2 to 22.4 hours per day (average 15.4 hours). Underlying the recommended bracing time of 23 hours, average compliance rate was 67.5% (range 19.0% to 97.1%). No patient reached a complete 23-hour bracing. Patients with poor compliance usually removed the brace during the daytime. The individual bracing pattern did not change over the course of an evaluation period, and the compliance can be estimated after 2 weeks. CONCLUSIONS: Long-term logging of temperature within a spinal orthosis is a reliable and simple way to measure objectively the compliance. Thus, comparison of full-time and part-time bracing is made possible on an objective basis. Furthermore, knowing the bracing pattern provides a better focus on other variables of spinal bracing, such as the force distribution within the brace. This knowledge may help to improve further the shape and effectiveness of bracing.