Mobius Floe

Dr.Diane Gromala, Dr.Chris Shaw, Xin Tong, with Ari Hollander and Howard Rose

VR is well-known as a “nonpharmacological analgesic” for short-term or acute pain. Acute pain is the kind of pain we are all familiar with: a symptom that subsides as we heal. For this kind of pain, VR is thought to be effective because it distracts us. In other words, we can only consciously pay attention to a certain number of things, and being immersed in VR is thought to relegate pain to the background of our attention or cognitive capacity.

 

Description: An immersive, upbeat VR game designed as a fun tool to help chronic pain patients lower their pain and anxiety. As a form of pain distraction for breakthrough chronic pain, it was designed using pain metaphors and the theory of cognitive capacity. 

Mobius Floe is unique in that its design is inspired by pain patients’ embodied social and cultural  experiences and was co-designed with chronic pain patients in 2013 and multiply tested 2014–2018. 

The design. Patients are immersed in a captivating wintery forest. Many tasks consume their working memory and seek their constant attention, drawing their focus away from their pain. Most importantly, we examined how the ‘pain distraction’ strategy, usually used to alleviate acute pain, may be useful for specific times of breakthrough pain among people who live with chronic pain.

Informed by contemporary game design theory to strengthen its cognitively distractive effects, Mobius Floe differs from ordinary games by connecting with the lived experiences of people with chronic pain (eg., “patients”). They hear the sound of footfalls crunching in the snow behind them, and can glimpse <an entity> that is following them. <A dysfunctional neuron> is the stalker, but is initially hard to distinguish from leafless trees. Once recognized, users see and can use ‘ammo’ to stop or slow the neuron. <Opioids> were immediately successful, but more and more were required to achieve the same result, and little was on hand. In contrast, <gabapentin> was limitless but less quickly effective. Depending on a user’s behavior, the neuron became less ferocious — and sometimes downright friendly. 

Mobius Floe Users walk through a wintry forest with a pond, ice arch and mysterious cave. Gameplay is learned in the cabin. Dysfunctional neurons are camouflaged as a leafless tree; users have a limited cache of opioids and a larger cache of gabapentin to keep them at bay.

Educational information.  “Ammo” was what patients called their analgesics, as well as <fish> that they could throw to otters to catch and eat. Such <glowing objects> were interactive, and triggered <audio information> such as the suspected role of some foods on inflammatory processes and possibly on pain. Other objects triggered info about how important it is to keep active. Playful otters beckoned users to visit the <mysterious cave> for information about techniques known to help with insomnia. 

Mobius Floe. Glowing objects and mythic symbols indicate areas that can be mined for information about how others cope with their chronic pain (top left, lower right). Mischievous otters (top middle & right, bottom left) routinely pop in, acting as intelligent agents for navigation.   

Users can throw fish to them; when eaten, the otters briefly turn polka-dotted or display neon stripes and somersault in delight.

Results: Results from our modest studies were generally consistent with other VR research re: acute pain. The game-like design was perceived as “more appropriate for children and young adults.” All patients reported being charmed by the playful otters, and liked the audio information and metaphor of a dysfunctional neuron posing as a leafless tree.

Several small usability studies of 10–15 chronic pain patients revealed a marked negative reaction to gamification as perceived by others, fearing it denigrated “the reality of pain.” We cannot claim statistical validity, but all patients in semi-structured interviews reported that though they generally liked the idea of play, the reality of chronic pain means they have far less time or functional capacity to actually do so. Older adults living with chronic pain for more than 5 years were especially concerned.

To see how such a project develops from scratch, see video links:

Older version: Overview of landscape:  https://www.youtube.com/watch?v=trYobzWgm2w

Newer version: tests of dysfunctional neurons: https://www.youtube.com/watch?v=MKq9wKdVKV4

Video of the updated (latest) version with otters and caves is available upon request.

Publications:

Gromala, D., Tong, X., Shaw, C., Amin, A., Ulas, S., Ramsay, G. (2016). “Mobius Floe: an Immersive Virtual Reality Game for Pain Distraction” in SPIE Proceedings, Vol. 9392, San Francisco. http://www.imaging.org/ist/conferences/ei2016/C-ERVR.cfm in publication. [Accessed May 10 2016].

Choo, A., Tong, X., Gromala, D. and Hollander, A. (2014). “A Virtual Reality and Mobius Floe: Cognitive Distraction as Non-Pharmacological Analgesic for Pain Management.” Peer-reviewed paper presented at Games for Health Europe, October 27–28, 2014. Utrecht, the Netherlands. Peer-reviewed paper published in the Proceedings of the 3rd European Conference on Gaming and Playful Interaction in Health Care, NYC: Springer, pp. 8–12.