Introduction: Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. We conducted a systematic review to determine the effect of digital technology distraction on pain and distress for children experiencing acutely painful conditions or medical procedures. Methods: We searched eight online databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, IEEE Xplore, Ei Compendex, Web of Science), grey literature sources, scanned reference lists, and contacted experts for quantitative studies where digital technologies were used as distraction for acutely painful conditions or procedures in children. Study selection was performed by two independent reviewers with consensus. One reviewer extracted relevant study data and another verified it for accuracy. Appraisal of risk of bias within studies and the certainty of the body of evidence were performed independently in duplicate, with the final appraisal determined by consensus. The primary outcomes of interest were child pain and distress. Results: Of 3247 unique records identified by the search, we included 106 studies (n = 7820) that reported on digital technology distractors (e.g., virtual reality; videogames) used during common procedures (e.g., venipuncture, minor dental procedures, burn treatments). We located no studies reporting on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (SMD -0.48, 95% CI -0.66 to -0.29, 46 RCTs, n = 3200), observer-reported pain (SMD -0.68, 95% CI -0.91 to -0.45, 17 RCTs, n = 1199), behavioural pain (SMD -0.57, 95% CI -0.94 to -0.19, 19 RCTs, n = 1173), self-reported distress (SMD -0.49, 95% CI -0.70 to -0.27, 19 RCTs, n = 1818), observer-reported distress (SMD -0.47, 95% CI -0.77 to -0.17, 10 RCTs, n = 826), and behavioural distress (SMD -0.35, 95% CI -0.59 to -0.12, 17 RCTs, n = 1264) compared to usual care. Few studies directly compared different distractors or provided subgroup data to inform applicability. Conclusion: Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over non-digital distractors is not established. Healthcare providers and parents should strongly consider using distractions as a pain-reduction strategy for children and teens during common painful procedures (e.g., needle pokes, dental fillings). Context, child preference, and availability should inform the choice of distractor.

Introduction: Intravenous insertion (IVI) is identified by children as extremely painful and the resultant distress can have lasting negative consequences. There is an urgent need to effectively manage such procedures. Our primary objective was to compare the pain and distress of IVI with the addition of humanoid robot-based distraction to standard care, versus standard care alone. Methods: This two-armed randomized controlled trial (RCT) was conducted from April 2017 to May 2018 at the Stollery Children's Hospital emergency department (ED). Children aged 6 to 11 years who required IVI were included. Exclusion criteria included hearing or visual impairments, neurocognitive delays, sensory impairment to pain, previous enrolment, and discretion of the ED clinical staff. Primary outcomes were measured using the Observational Scale of Behavioural Distress-Revised (OSBD-R) (distress) and the Faces Pain Scale-Revised (FPS-R) (pain). A total of 426 pediatric patients were screened and 340 were excluded. Results: We recruited 86 children, of which 55% (47/86) were male; 9% (7/82) were premature at birth; 82% (67/82) had a previous ED visit; 30% (25/82) required previous hospitalization; 78% (64/82) had previous IV placement and 96% (78/81) received topical anesthesia. The mean total OSBD-R score was 1.49 ± 2.36 (standard care) compared to 0.78 ± 1.32 (robot group) (p = 0.047). The median FPS-R during the IV procedure was 4 (IQR 2,6) in the standard care group alone, compared to 2 (IQR 0,4) with the addition of humanoid robot-based distraction (p = 0.10). Change in parental state anxiety pre-procedure versus post-procedure was not significantly different between groups (p = 0.49). Parental satisfaction with the IV start was 93% (39/42) in the robot arm compared to 74% (29/39) in the standard care arm (p = 0.03). Parents were also more satisfied with management of their child's pain in the robot group (95% very satisfied) compared with standard care (72% very satisfied) (p = 0.002). Conclusion: A statistically significant reduction in distress was observed with the addition of robot-based distraction to standard care. Humanoid robot-based distraction therapy reduces distress and to a lesser extent, pain, in children undergoing IVI in the ED. Further trials are required to confirm utility in other age groups and settings.

The goal of this paper is to present a new hybrid system based on the fusion of gaze data and Steady State Visual Evoked Potentials (SSVEP) not only to command a powered wheelchair, but also to account for users distraction levels (concentrated or distracted). For this purpose, a multi-layer perception neural network was set up in order to combine relevant gazing and blinking features from gaze sequence and brainwave features from occipital and parietal brain regions. The motivation behind this work is the shortages raised from the individual use of gaze-based and SSVEP-based wheelchair command techniques. The proposed framework is based on three main modules: a gaze module to select command and activate the flashing stimuli. An SSVEP module to validate the selected command. In parallel, a distraction level module estimates the intention of the user by mean of behavioral entropy and validates/inhibits the command accordingly. An experimental protocol was set up and the prototype was tested on five paraplegic subjects and compared with standard SSVEP and gaze-based systems. The results showed that the new framework performed better than conventional gaze-based and SSVEP-based systems. Navigation performance was assessed based on navigation time and obstacles collisions.

The purpose of this study was to analyze the DiViSA’s predictive validity in school-age children. To do so, two groups of school-age children were compared: one with low school achievement (N = 1,174), and one with typical development (N = 1,426). The obtained results show that: (1) in all grades, children with poor school performance exhibited lower levels of attention and task organization, greater hastiness, and made more commission errors; (2) the combination of variables that best differentiated between groups was not the same in all grades; (3) level of organization improved with age in the low-school-achievement group, and did not in the typical-development group; (4) the data regarding sensitivity (81% to 93%) and specificity (79% to 90%), for the first time computed for each grade separately, support the test’s predictive validity in the grades we evaluated. The discussion focuses on the DiViSA test’s usefulness in diagnosing attention problems. It is the first computerized test to include separate scores for: (a) how children complete the task (organization) and (2) the source of their errors (distraction or hastiness).

Background: Post event processing (PEP) in social anxiety disorder involves rumination about social events after the fact, and is thought to be a crucial feature of the maintenance of the disorder. Aims: The current experiment aimed to manipulate the use of PEP in individuals with social anxiety disorder. Method: Forty-one individuals with social anxiety disorder completed a videotaped speech. Anxiety ratings and degree of PEP were measured after the task as well as the day following the experiment. Results: Individuals in the distract group reported a greater decrease in anxiety from baseline to post-experimental task than those asked to focus. Individuals in the distract group also reported higher PEP about the task than those instructed to complete a focus task, which appeared to be partially accounted for by baseline differences in symptom severity and state anxiety. Degree of PEP was positively correlated with anxiety ratings, both after the experimental task as well as 24 hours later. Conclusions: These findings suggest that naturalistic PEP is problematic for individuals with social anxiety disorder, especially for those with more severe symptoms. A distraction task, even with breakthrough PEP, appears to have useful short-term effects on anxiety reduction as compared to focus instructions.