A Pilot Prospective Randomized Control Trial Comparing Exercises Using Videogame Therapy to Standard Physical Therapy

Abstract

The objective of this study was to assess current practice patterns and attitudes toward pediatric sedation and analgesia in United States (US) burn centers for critically ill patients. Survey-based questionnaire was sent to 119 Directors at US burn centers that care for pediatric patients. Forty-one surveys (34%) were analyzed. 48.8% of responding centers mandate pediatric consultation for pediatric burn patients based on factors such as age and burn size. The most common sedation and analgesic agents used were midazolam, fentanyl, morphine, ketamine, and diphenhydramine. Written sedation policies exist at 63.4% of centers. 90.2% of centers employ scoring systems to guide agent titration. 60.9% of respondents practice sedation holidays "always" or "usually." 90.2% of centers perceive the medications they routinely use are "always" or "often" efficacious in pediatric sedation and analgesia. 53.7% of respondents reported the presence of withdrawal signs and symptoms in their patient population. The lack of consensus guidelines for sedation and analgesia delivery to pediatric intensive care unit patients results in practice variation. The majority of centers perceive their sedation and analgesia strategies to be efficacious despite the heavy reliance on propofol and midazolam, both of which have questionable safety profiles in critically ill children.

A systematic review of game technologies for pediatric patients

“…The second group corresponds to those patients with no specific pathology (pulmonary, chronic, burn-related, or other severe illness) but who must remain in hospital for long periods of time. The most frequently used technologies in this case are gesture-based commercial consoles that enable general physical exercise, such as Nintendo Wii [37,38], PlayStation EyeToy [39], or PlayStation Move [40]; and commercial handheld tablets or smartphones the children can carry with them as they move around the hospital [41] and are also able to provide disease-specific game contents to each patient [42].…”

Considerations for pediatric burn sedation and analgesia

“…Pediatric sedation and analgesia practices differ from adults due to characteristics inherent to children, including small size and cognitive immaturity [ 31 ]. Serious associated risks are associated with pediatric sedation including hypoventilation, apnea, airway obstruction, laryngospasm, and cardiopulmonary impairment [ 32 ].…”

“…In particular, children with developmental disabilities have a threefold increased incidence of desaturation compared with children without developmental disabilities [ 23 ]. Challenges for sedation in burned children, not presented in other population, include donor site pain and complex wound care, inhalation injury, presence of burn hypermetabolism, and pain associated with burn wounds [ 31 ]. Burn injury markedly alters the PK and pharmacodynamics (PD) of many drugs [ 33 ].…”

“…Common medications used for sedation in the ICU include opioids, benzodiazepines, ketamine, and alpha-agonists [ 7 ]. A survey of burn centers found that the most common sedative agents used by pediatric burn clinicians were midazolam, ketamine, and diphenhydramine [ 31 ].…”

Physical rehabilitation to treat neuropathic pain

“…In general, there is a gap in burned patients' care on part of professionals acting on function and motor autonomy gain. There are long descriptions and discussions on movement amplitude gain and contractures prevention 73 without addressing the frequent morbidity of peripheral neuropathy. The reflection on the subject is important since these are professionals with daily contact with patients, whose maneuvers for mobility gain in general induce pain and they should be alert for late, post-burn injury nervous compression signs.…”