Gamification: how penguins help children overcome their MRI fear

It's noisy, tight and scary - that's how children feel about a magnetic resonance imaging (MRI) machine. Because they are scared, they are often too fidgety and anxious during the procedure, causing the images to blur or the scan to be stopped. Researchers have now developed a VR app called Pingunauten Trainer that’s designed to gently prepare the little patients for MRI scans.

In this MEDICA-tradefair.com interview, Stefan Liszio talks about the problems that arise when children have to undergo an MRI scan, explains the importance of gamification in healthcare and describes how penguins help children overcome their fear of MRI exams.

Mr. Liszio, why is it so difficult for children to have an MRI scan?

Stefan Liszio: That's mostly because they don't fully understand the situation. It is noisy and tight in the MRI machine, yet it is crucial that children lie completely motionless in the scanner. And if they are unaware of what's happening, it's even more difficult for kids to cope with such a scary situation.

You developed the so-called Pingunauten Trainer app to tackle this difficult problem. How does your app help children overcome their fear of MRI exams?

Liszio: The simple, friendly and playful setting of our Pingunauten Trainer is able to communicate what happens in an MRI unit from a safe and nurturing space. The idea behind the app is to use virtual reality to teach the children what to expect, why this is so important and what their key responsibilities are, such as remaining motionless for example. We convey all of this in a casual and playful way and try to demystify the situation from the outset. Exposure therapy is the fundamental principle behind the idea. We approach the fear in a gradual step-by-step process. We start out in a typical waiting room, then slowly move closer and approach the MRI unit and ultimately watch our two companions, penguins Lars and Lotta have an MRI scan. In doing so, the children see how the characters react and behave and realize that they are not afraid of the exam. The culmination is when the children themselves are finally willing and able to get inside the MRI scanner.

So the goal is for the children to master their fear of the MRI scanner. What are the important factors needed to reach this goal?

Liszio: We believe that regular training is essential for success. That's also precisely what we intend to research in our current and ongoing study. From our perspective, we think it is important that the children keep exposing themselves to this issue. I would say that is the most effective way to successfully overcome this anxiety.

Children are the target audience for this app, but how do physicians benefit from this concept?

Liszio: Physicians get better images if the patients actively participate and this supports the diagnosis. The pictures are often blurry or the exam has to be stopped when the children are too afraid and anxious. Blurring impacts image quality and rescheduling an exam also causes issues in the organizational realm. That's why children often require sedation or anesthesia, which is associated with costs and difficult from an operational perspective. You need to have the respective on-site equipment, an anesthesiologist on standby, etc. If the Pingunauten Trainer helps children to be calmer during the MRI scan, it is less likely that the exam has to ultimately be rescheduled and repeated. What’s more, this also shortens the scan time and the entire procedure runs as smoothly as possible. These are all factors that also make physicians' lives easier.

Can you provide a quick progress report: How successful is the application?

Liszio: Even though the study has not been completed yet, we have already received tons of feedback from parents and children, as well as from our participating physicians in the clinical facilities. So far, the feedback has been very positive!

Could you envision a use of your technology in other fields as well?

Liszio: I truly believe that our concepts can be applied to other situations in hospitals – especially whenever a patient faces a potentially scary treatment or procedure. The app would have to be modified accordingly, but the underlying ideas can also be applied to other areas. We can also see where the app could be translated into other languages in the future. It is only available in German at the moment. Meanwhile, there are many different languages spoken in hospitals today. Needless to say, that's something we would like to accomplish, so children who speak other languages can also benefit from the app. But that involves additional costs of course.

Virtual reality and gamification are hot topics in many areas of life. What potential of these types of applications do you see in medical science?

Liszio: I see immense potential! The fear of certain medical exams and procedures often stems from past negative experiences or lack of knowledge. Oftentimes, it is actually a lack of knowledge about medical procedures that creates fear and truly worries people - not just children, but also adults - and makes things so uncomfortable for them. That's also why a key aspect for us with our Pingunauten Trainer is to impart information beforehand, so that we can show the patient what to expect and explain what happens during the treatment. The ease and the positive effects of games simply help defuse a tense medical situation.