Chronic pain is the leading cause of morbidity in pediatrics, affecting some 25-30% of children, where 1 in 20 experience limitation to social participation and incur a high risk for chronic/recurrent pain, psychological disorders, and opioid abuse later in life. In-clinic treatment adopts an integrative mind-body intervention (MBI) approach that includes yoga therapy as a means of relaxation, reduced hyper arousal state, and graded exposure to gentle whole-body exercises designed to reverse fear of movement and catastrophizing. However, limited access to in-clinic treatment, due to the scarcity of specialized pain treatment centers and disruption to school/family life, prevents the majority of these children from achieving efficient reintegration into normal family/school activities. There is a need for innovative solutions offering remote access to MBIs, such as yoga therapy, that are sufficiently engaging for children to overcome their typical poor adherence to home programs. These should support therapist-patient interaction to allow supervision, facilitate compliance, and encourage movement while providing quantitative measures of performance (range of motion), adherence, and physiologic response (heart and respiratory rate) in support of evidence-based MBIs. Our solution leverages recent advances in low-cost Virtual Reality (VR) systems and computer vision technologies from the gaming and cellphone industries that will be adapted to develop the first VR system with whole-body tracking to instruct and monitor yoga poses through patient-therapist avatar interaction in an engaging immersive environment that supports tracking of clinical outcomes. Our research group has experience integrating computer vision algorithms for whole-body tracking from smartphone cameras into Augmented and Virtual environments. In Phase I, we will partner with pediatric pain and MBI rehabilitation experts from Boston's Children's Hospital and Mass General Hospital to test the feasibility of tracking and faithfully rendering real time whole-body yoga poses for relaxation and mind-body movements from child/therapist sharing a virtual environment. Aim 1 will build upon our pilot work to develop real-time algorithms that can estimate 3D whole-body core and limb movements from a depth- enabled camera while children and adults enact yoga poses used clinically. In Aim 2 we will translate this tracking capability to provide a VR architecture that renders these poses as biomechanically driven whole-body 3D avatars involving two interactive participants, while tracking range of motion and heart/respiratory rate. Aim 3 will test the VR prototype among pediatric patients and therapists to demonstrate the feasibility of safely and effectively achieving whole-body yoga poses through immersed interaction. Phase II will expand the platform to support patient-therapist and autonomous modes of VR yoga therapy that includes a dashboard for configuring additional yoga modules, movement scaling, and providing secure cloud-based outcomes of performance, adherence, and physiology. This innovation will provide the first MBI device to offer home-based yoga therapy that leverages VR to overcome current barriers for transferring an MBI from in-clinic to home use.
Public Health Relevance Statement: PROJECT NARRATIVE Children and adolescents who require integrative mind-body rehabilitation for chronic pain disorders have an unmet need for effective and engaging remote solutions to maintain/improve outcomes after discharge from in- clinic treatments. This project addresses the need by developing a Virtual Reality system for pediatric yoga therapy that uniquely provides a shared, interactive, and engaging immersive environment that allows a therapist to guide and supervise a child in performing whole-body yoga poses for relaxation and mind-body movements designed to overcome pain and facilitate graded exposure to gentle exercises. This project aligns with NIH/NCCIH interest to advance pain management technologies for mind-body interventions that include quantitative outcomes for adherence and fidelity of use and provide more accessible forms of rehabilitation for children in the home or schools that overcome socioeconomic or racial barriers.
Project Terms: Adult; 21+ years old; Adult Human; adulthood; Affect; Algorithms; Pain management; Pain Control; Pain Therapy; pain treatment; Anxiety; Architecture; Engineering / Architecture; Arousal; Breathing; Respiratory Aspiration; Respiratory Inspiration; inspiration; Attention; Mental disorders; Mental health disorders; Psychiatric Disease; Psychiatric Disorder; mental illness; psychiatric illness; psychological disorder; Biomechanics; biomechanical; Boredom; Boston; Child; 0-11 years old; Child Youth; Children (0-21); youngster; Computer Vision Systems; computer vision; Continuity of Patient Care; Continuity of Care; Continuum of Care; Elbow joint structure; Elbow Joint; Environment; Exercise; Limb structure; Extremities; Limbs; Non-Trunk; Family; Fright; Fear; Focus Groups; Gold; Heart; Heart Rate; Cardiac Chronotropism; Hip Joint; General Hospitals; Pediatric Hospitals; Children's Hospital; Industry; Interview; Joints; Knee joint; Massachusetts; Morbidity - disease rate; Morbidity; Motion; Movement; body movement; Persons; NIH; National Institutes of Health; United States National Institutes of Health; Nervous System; Neurologic Body System; Neurologic Organ System; Nervous system structure; opiate abuse; opiate drug abuse; opioid drug abuse; opioid abuse; Painful; Pain; Patients; Pediatrics; Physiology; Psychological Factors; Medical Rehabilitation; Rehabilitation; rehab therapy; rehabilitative; rehabilitative therapy; Rehabilitation therapy; Relaxation; Research; social role; Role; Schools; Glenohumeral Joint; Shoulder Joint; Joint structure of shoulder region; Spinal Column; Spine; backbone; Vertebral column; Supervision; Technology; Testing; Time; Translating; Work; Yoga; Measures; Articular Range of Motion; Joint Range of Motion; range of motion; Family member; Outcome Measure; chronic pain; base; Chronic; Clinical; Phase; Physiological; Physiologic; Adolescent; Adolescent Youth; juvenile; juvenile human; Evaluation; pediatric; Childhood; Individual; Pain Centers; Pain Relief Units; Pain Clinics; Exposure to; Nature; Life; programs; Adopted; Home environment; Clinic; 3-D; 3D; three dimensional; 3-Dimensional; Location; respiratory; Best Practice Analysis; Benchmarking; interest; instructor; experience; limb movement; Performance; Rehabilitation Outcome; Structure; Participant; Self-Report; Patient Self-Report; body-mind; Devices; Position; Positioning Attribute; Social Support System; Support System; response; virtual reality; Intervention Strategies; interventional strategy; Intervention; Cell Phone; Cellular Telephone; iPhone; smart phone; smartphone; Cellular Phone; Effectiveness; preventing; prevent; Address; Adherence; mind body approach; mind body medicine skills; mind body techniques; mind body therapy; mind body treatments; mind body wellness; Mind-Body Medicine; Mind-Body Intervention; NCCAM; NCCIH; National Center for Complementary and Integrative Medicine; National Center for Complementary and Integrative Health; Update; Monitor; socioeconomics; socio-economic; socio-economically; socioeconomically; Development; developmental; Behavioral; Instruction; cost; treatment center; virtual; design; designing; Outcome; Recurrent pain; innovation; innovate; innovative; usability; rehabilitation strategy; rehab strategy; prototype; high risk; community setting; evidence base; Secure; cloud based; pediatric patients; child patients; Industry Standard; improved outcome; pain rehabilitation; pain rehab; motor rehabilitation; motor rehab; physical therapist; physiotherapist; dashboard; social engagement; social involvement; social participation; chronic painful condition; chronic pain condition; chronic pain disorder; real time monitoring; realtime monitoring; virtual reality environment; immersive digital environment; immersive environment; immersive virtual environment; immersive virtual reality; virtual environment; virtual reality system; Immersion; data fusion; feasibility testing; Home; post-COVID-19; post-COVID; post-coronavirus disease 2019; intervention delivery
