Making a VR Game for Pediatric Pain Management

Let there be no mistake, I’ve always known first hand just how (delightfully) distracting video games can be. But what I didn’t realize was that if you couple that effect with a focused design, you can turn a potentially traumatic medical procedure into something fun that a kid might actually look forward to. At the time of writing this, clinical trials are in progress at Nationwide Children’s Hospital to test the benefits and feasibility of Voxel Bay, a VR game specifically designed and produced at the hospital to distract and comfort kids during infusions and other procedures.

About two years ago, Jeremy Patterson, lead of User Experience Technology R&D at Nationwide Children’s Hospital, approached Alice Grishchenko (MFA candidate in Design) and me with the proposal to create what would become Voxel Bay. We met Jeremy through The Ohio State University’s Advance Computing Center for the Arts and Design (ACCAD), where Alice and I research digital animation and interaction design for application both within and beyond our respective degree granting disciplines. Alice and I had been working with Unity to study game design and were excited to use and develop our skills in a practical application. Jeremy and Dr. Amy Dunn, director of Pediatric Hematology and the Hemophilia Treatment Center in the Division of Hematology, Oncology and BMT at Nationwide Children’s, wanted to create a VR experience to help alleviate the pain and anxiety of infusions for kids with hemophilia. With their prompt, to make a game that was engaging and visually stimulating for kids, we set out to design a seafaring adventure where the player would use their head movements and breathing to capture tree spirits, escape from pirates, launch crabs at seagulls, and many other fun, wacky activities as they sail from island to island during their procedure.

The road from ideation to delivery was filled to the brim with consideration and adaptation. Alice, Jeremy, and I would meet regularly with nurses and doctors that offered us invaluable insights regarding the circumstances of procedures and existing methods for calming upset children. We reflected on all of their information and feedback to guide our design choices by incorporating new features and modifying existing play and visuals. For example, one nurse explained to us that some children like to watch what the phlebotomist is up to during a blood infusion, so we incorporated a pop up camera that gives the children an in game window out to the real world around them. The kids can always just take the headset off if they want to, but we wanted them to have the option to access their surroundings without interrupting their immersion in the game.


Alice and John developing Voxel Bay at Nationwide Children’s Hospital

Alice and I had spent the prior semester at ACCAD researching game mechanics, use of unconventional input devices like microphones, and different visual aesthetics. We brought the knowledge and skills that we developed from that research to the design and production of Voxel Bay. Right at the start of the project we recommended using a microphone as a way to interact with the game. This hands free input device affords the kids a calming physical in game activity that doesn’t rely on haptic feedback to tether them to the virtual world. For the visuals, we went with a low poly Minecraft/Lego aesthetic in an attempt to appeal to a large age range and to help optimize graphics rendering for VR (and eventually for VR on mobile devices).

vr-doctor-hemophilia-shotsThough virtual reality was uncharted territory for both of us, Unity’s cross platform development and integrated VR support made it quick and easy to start developing our own VR aesthetics and sensibilities. Using our interdisciplinary backgrounds, we created some unique modes of VR play as well as identifying some novel methods of minimizing the potential of VR sickness. For instance, in one of the mini games, the player peers into an empty treasure chest that has a virtual screen on its base. Their gaze on the screen guides a little treasure hauling avatar through a pirate’s maze. So, when the player looks to the left side of the virtual screen the character would follow and run to the left. This encourages the player to keep their head forward and focus their attention to a narrow cone of space in front of their head.


Player’s use their gaze to navigate a pirate’s maze

Encouraging limited head movement was one of the methods we used to minimize virtual reality sickness. During parts of the game where it made sense, we restricted the player’s field of view with an in game virtual headset. The virtual headset has a tunneling effect, which has been shown to decrease VR sickness, but also gives narrative justification for the player’s limited field of view by reiterating their physical sensation (that of wearing a headset).


Banish troublesome tree spirits with a special headset

Coming up with creative design solutions for the VR paradigm has been satisfying work, but being a part of this project has had other unexpected and humbling rewards. Working as an artist, you produce this personal/cultural artifact and hope that maybe your work reaches someone and positively affects their worldview. Games, with their procedularized systems of rewards and consequences, have the unique ability to provide an internal experience of different ideologies which has the remarkable potential to create a little more empathy in the world. It’s a “shoot for the stars” hope with results that most designers may never have access to. With this project though, we have the luxury of seeing the immediate impact of our work. Kids who would normally be crying and squirming during a needle procedure instead get to go on a funny little (calming, engaging, distracting) adventure. Maybe even in a best case scenario, the game steps in as an alternative to addiction forming opioids. That first hand access to the impact of this work has expanded my perception of what games can do and makes me hold my future endeavors to that standard.


About the Scout

John Luna

Interdisciplinary artist and interactive designer John Luna is a Dance MFA candidate at the Ohio State University and a virtual environment design/development intern at Nationwide Children’s Hospital.

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