Stanford Medicine Newsletter Updates For the Local Community


Virtual reality easing treatment for young patients

Blaine Baxter, who suffered an injury to his arm while racing a go-kart, has benefited from virtual reality to distract from the pain of dressing changes.


Zack Dwyer was training with his Hillsdale High School basketball team in San Mateo, running sprints back and forth along the court, when his heart began racing "really fast."

"I stopped and took some deep breaths," he said, then told his parents about it that night at home. His mother at first dismissed it as nerves. But Dwyer, an observant 17-year-old who until then had been healthy, said, "No, Mom, something's wrong."

It turned out to be supraventricular tachycardia, caused by abnormal electrical impulses in the heart. The treatment was surgery; though Dwyer hadn't been nervous when his heart rate soared, he was when he contemplated the upcoming procedure at Lucile Packard Children's Hospital Stanford.

But then he underwent a virtual reality experience that walked him through the process. Packard Children's had sent him the VR kit, including goggles and a smartphone with an app, and he experimented with the VR trip several times at home. When it came time for the surgery, in a room filled with physicians and nurses in scrubs and a bunch of scary-looking machines, Dwyer was composed. "It definitely would have been super-overwhelming if I didn't know that was coming," he said.

For years, psychologists have talked fearful youth through frightening procedures, and nurses have offered stickers to appease preschoolers receiving shots. But they are finding that new technologies, including virtual reality and portable video systems, are far more effective in calming and distracting patients — easing their jobs while also reducing trauma for kids. The new Packard Children's Hospital, scheduled to open in December, will incorporate many of these VR technologies to help soothe patients, as well as to educate them about their medical care.

Calming scenery

In the VR experience that Dwyer underwent, patients start by looking at a 3-D image of the entrance to Packard. They then move through the stages of their upcoming visit, viewing each station in the hospital, complete with equipment and the care team. They also hear teenage actors and physicians describe what will happen at each stage. At two points, the real-life video of the hospital switches to a tranquil, animated scene to help patients associate relaxation with the hospital; it also teaches them calming techniques.

Robert Nichols, a cardiovascular neonatl-pediatric respiratory therapist, uses virtual reality to explore a heart model. He can expand the model to look inside and rotate his view.


One of those scenes is a nighttime valley, surrounded by mountains, under a sky filled with stars. With slight head movements, patients can shift dots of light around the scene; if they place a dot on the ground, it grows into a tree. They can spend as much time as they like in the scene, building a forest, changing the color of the sky and meditating on the serene landscape.

"At key moments, when they're waiting, for example, and may start to feel nervous, they can bring up the memory of the forest-building," said Lauren Schneider, PsyD, a clinical assistant professor of psychiatry and behavioral sciences who helped create the VR experience. Simply familiarizing themselves with the physical hospital reduces some patients' anxiety, she added.

Pediatric electrophysiologist Anne Dubin, MD, professor of pediatrics, noted that while she can't point to data proving that calm patients do better than nervous ones, "Having surgery can traumatize kids. Later in life, they may not be willing to undergo procedures they need. It colors their entire medical involvement and interactions."

Dwyer's VR experience was designed for teenagers. Younger children present other challenges to nurses and physicians. They squirm when an intravenous line has to be inserted, scream during vaccinations and pull off anesthesia masks. For these children, Packard doctors and nurses have turned to VR goggles as well as video screens.

When pediatric surgeon Stephanie Chao, MD, needed to remove fluid from a cyst on the neck of her 9-year-old patient without pain medication, she numbed his neck with ice, then gave him VR goggles. "Most kids, just seeing the needle, would start crying," said Chao, an assistant professor of surgery. But her patient, engrossed in a 3-D animated underwater world of dolphins, shipwrecks and schools of fish, didn't even flinch when she poked him — twice. "He was so immersed in the VR, he had absolutely no anxiety," she said.

A team at Packard has been creating VR experiences precisely for situations like Chao's. They built games that allow kids to play with only head movement, that aren't likely to cause nausea, that lack violence and that are continuous, so the play doesn't end right when a needle is about to enter a vein. In one of the games, patients zap burgers flying in space; in another, they steer penguins down a snowy slope.

"We can provide a cool experience in a setting that is not cool at all," said Veronica Tuss, who as a child life specialist helps children cope with treatments in the hospital. "It really helps us get the child through the procedure."

Fun with anesthesia

For 3- to 4-year-old children who need to undergo general anesthesia, the Packard team has created a game, Sevo the Dragon, to persuade them to breathe in the gas in their anesthesia mask. With a video screen showing the Barney-like dragon attached to their bed, the tots learn that Sevo needs to cook pizza using fiery dragon breath, and they need to help! They blow into their mask, the child life specialist or the anesthesiologist surreptitiously taps a button, and Sevo blows fire onto the pizza slice.

"As soon as they blow out, they have to take a huge breath in," which causes them to inhale the anesthesia, said Tuss. Soon they're asleep. Without a distraction like Sevo, younger children often pull the mask off their face, forcing the anesthesiologist to hold them down, "which is very scary for them."

"Having a terrifying clinical experience can change behavior for weeks," said pediatric anesthesiologist Tom Caruso, MD, also part of the Packard team developing the games. "We see sleep disturbances and regression in children's behavior."

The VR program that calmed Zack Dwyer's nerves is part of a pilot study that Schneider and Dubin are conducting to see if it reduces anxiety for patients ages 8 to 25 undergoing cardiac catheterization surgery. If it does, Packard plans to produce VR experiences for young patients who require different cardiac treatments, and eventually, any stress-inducing procedure.

Dwyer, who was back on the basketball court 10 days after his surgery — the rapid heartbeat just a memory — said he would strongly recommend the VR experience to other teens. "It's crazy to think you have to have heart surgery," he said. "But I had something that made it seem like it was no big deal."

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