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Lupine Publishers | Assessment of Neurobehavioral and Anti-Aging Effect of the Test Formulation in D-Galactose-Induced aging Dysfunction in Sprague Dawley Rats
Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Abstract
The
study aim was to evaluate the neurobehavioral effect of Consciousness Energy
Healing Treated test formulation using behavioral test in male Sprague Dawley
rats. The test formulation was divided into two parts, one was denoted as
control, while the other was treated with Biofield Energy by Mr. Mahendra Kumar
Trivedi (the Trivedi Effect®-Consciousness Energy Healing) and defined as the
Biofield Energy Treated sample. Besides, three group of animals were also
received Biofield Energy Treatment by Mr. Trivedi. In Y-maze test, number of
entries was significantly increased in the animals per se received Biofield Energy Treatment (-15
days) group (G6) by 176%, 47.53%, and 66.67% in the start arm, explored arm,
and novel arm, respectively as compared to the untreated test formulation group
(G4). Further, Biofield Treated animals per se +
Biofield Treated test formulation (-15 days) group (G8), showed 100% and 32.74%
increased the number of entries in start arm and novel arm, respectively
compared to the G4 group. Moreover, percent of alternation behaviour was
increased by 7.26% in the G8 as compared to the G4 group. In force swim test
(FST) showed the number of climbing was significantly increased by 13.58%,
24.69%, 32.1%, and 40.74% in the G5, G6, G7, and G8, respectively compared to
G4 group. Swimming time was significantly increased by 9.34% and 10.31% in the
G6 and G9, respectively compared to G4 group. Further, immobility time was
significantly decreased by 27.91%, 55.81%, 61.63%, and 11.63% in the G5, G6, G7,
and G9, respectively compared to the G4 group. The results of Morris water maze
(MWM) test data showed that the escape latency was significantly decreased by
12.06% (session 2), 13.04% (session 3), 14.88% (session 3), and 17.52% (session
3) in the G5, G7, G8, and G9 groups, respectively compared to the G4 group. The
resting time was significantly (p≤0.05) decreased by 16.26% (session 3) and
15.45% (session 3) in the G7 and G9, respectively compared to G4 group.
Besides, total distance travelled was significantly reduced by 27.23% and 23%
(in session 2) in the G5 and G9 groups, respectively compared to the G4 group.
The results showed significant reduction of disease progression and
disease-related symptoms in the preventive Treatment group per se and/or Biofield Energy Treated Test
formulation groups (viz. G6, G7, G8, and G9) comparatively with the disease
control group. Therefore, data suggest that Biofield Energy Treatment per se and Biofield Energy Treated test
formulation have significant cognition and memory enhencing activity and could
be utilized in various aging and neurobehavioral related disorders such as
stroke, dementia, multiple sclerosis, acute confusional states (delirium),
focal lesion syndromes, frontal lobe syndromes, etc.
Keywords: Biofield energy healing; The trivedi effect®;
Neurobehavioral; Force swim test; Spatial memory; Antiaging; Morris water maze;
Y-maze test; Antiaging
Abbreviations: FST: Forced Swim Test; NIH/NCCAM: National
Institute of Health/National Centre for Complementary and Alternative Medicine;
SD: Sprague Dawley; Na-CMC: Sodium Carboxymethyl Cellulose; MWM: Morris Water
Maze
Introduction
The behavioral test batteries are used to
assess the learning and memory. Learning is a process of gathering lots of
information about the outside world, and memory is the process of processing,
storing and reproducing this information in a suitable environment, where it is
required. Experts reported that by 2050 up to 15 million Americans and more
than 135 million people worldwide will suffer from different types of
neurodegenerative disorders which affect memory function like Alzheimer’s
disease [1]. Different behavioral test is used currently among them Y-maze,
force swim, and Morris water maze tests. Y-maze experiment is used to find the
capability of rodents in the recognition and memory ability and it provides a
fruitful information that reflects the animal’s ability to recognize and
remember the new environment [2]. Stress is the causation of most prevalent
psychiatric challenging disorders such as depression and anxiety [3]. The
rodent forced swim test (FST) is mainly used as a preclinical model for
depression [4,5]. There was a direct correlation between integration of aging
and cognitive behaviour. There is a numerous evidence suggesting that adults
have more trouble learning new information, exhibit less efficient reasoning
skills, are slower to respond on all types of cognitive tasks, and are more
susceptible to disruption from interfering information than younger adults [6].
According to Hasher and Zacks [7], have
reported that older adults are less effective at inhibiting irrelevant
information than young adults. Based on the literature an importance of
essential vitamins and minerals on stress-related disorders authors newly
designed a proprietary test formulation consisting of zinc chloride, iron (II)
sulfate, copper chloride, magnesium gluconate hydrate, cholecalciferol (vitamin
D3), vitamin B6 (pyridoxine HCl), and vitamin B12 (cyanocobalamin), which would
be able to combat with stress-related disorders. Biofield Therapy has been
established to be an alternative medicine approach effectively used on various
properties of living organisms in a cost-effective manner [8]. Every living
system bearing kind of unique quality vital force, an élan vital, which gives
them special quality so called ‘life’ [9]. This ambiguous vital force defined
as the ‘Bioenergetics Field’. Many alternative therapies, medicines and
practices such as Tai Chi, natural products, chiropractic/osteopathic manipulation,
deep breathing, yoga, meditation, Qi Gong, special diets, massage, homeopathy,
guided imagery, progressive relaxation, acupuncture, acupressure, relaxation
techniques, hypnotherapy, movement therapy, healing touch, rolfing structural
integration, pilates, mindfulness, traditional Chinese herbs and medicines,
Ayurvedic medicine, naturopathy, aromatherapy, essential oils, cranial sacral,
and Reiki therapy are extensively used as a complementary and alternative
medicine (CAM) system. Although, a human has the ability to acquire the vital
force energy from the universe and can transmit it into a useful way that is
called Biofield Energy and the process is called as “Biofield Energy
Treatment/Healing”. Biofield (putative energy fields) or electromagnetic based
energy therapies used to promote health and healing that had been exclusively
reported by the National Institute of Health/National Center for Complementary
and Alternative Medicine (NIH/NCCAM) [10]. The Trivedi Effect® has been
published in numerous peer-reviewed science journals with significant outcomes
in many scientific fields such as cancer research [11,12], microbiology
[13-16], biotechnology [17,18], pharmaceutical science [19-22], agricultural
science [23-26], materials science [27-30], nutraceuticals [31,32], skin
health, human health and wellness. Depending on the importance of herbs and
various essential vitamins and minerals on cognitive disorders and aging, the
outstanding effects of Biofield Energy Healing in multiple-fields authors
hypothesized that the Biofield Energy Treated test formulation may able to
combat with cognitive and aging-related disorders rats model. Therefore,
authors performed this study to evaluate the effects of Biofield Energy Treated
and untreated test formulation through the measurement of different behaviour
parameters in male Sprague Dawley rats.
Materials and Methods
Chemicals and reagents
Cholecalciferol
(vitamin D3),
copper chloride, iron (II) sulfate, and sodium carboxymethyl cellulose (Na-CMC)
were procured from Sigma-Aldrich, USA. Zinc chloride, vitamin B6 (pyridoxine hydrochloride),
cyanocobalamin (vitamin B12), resveratrol, and magnesium (II) gluconate were purchased
from TCI, Japan. D (+) Galactose obtained from Amresco, LLC. All the other
chemicals used in this experiment were analytical grade procured from India.
Experimental animals
Randomly breed male Sprague Dawley (SD)
rats with body weight ranges between 240.48 to 428.27gm were used in this
experiment. The animals were purchased from M/s. National Institute of
Biologicals, India. Animals were randomly divided into nine groups based on
their body weights consist of ten animals of each group. They were kept
individually in sterilized polypropylene cages with stainless steel top grill
having provision for holding pellet feed and drinking water bottle fitted with
stainless steel sipper tube. The animals were maintained as per standard
protocol throughout the experiment.
Consciousness energy
healing strategies
The test formulation was divided into two
parts. One part of each ingredient was considered as control, where no Biofield
Energy Treatment was provided. Another part of each ingredient was received
Biofield Energy Treatment by Mr. Mahendra Kumar Trivedi (known as the Trivedi
Effect®) under laboratory conditions for ~3 minutes through the Healer’s unique
Energy Transmission process to the test formulation. The blessing/treatment was
given to the test items/animals by his physical presence without touching in
the laboratory of Dabur Research Foundation, near New Delhi, India. Besides,
three group of animals were also received Biofield Energy Treatment under
laboratory conditions for ~3 minutes. Similarly, the control samples were
subjected to “sham” healer under the same laboratory conditions for ~3 minutes.
The “sham” healer did not have any knowledge about the Biofield Energy
Treatment. After that, the Biofield Energy Treated samples were kept in the
similar sealed condition and used as per the study plan. The Biofield Energy
Treated animals were also be taken back to experimental room for further
proceedings.
Experimental procedure
Five days after acclimatization, animals
were randomized and grouped based on body weight. Dosing for group G7 and G8
was also initiated on day -15 till end of the experiment. However, G1 to G6 and
G9 animals were dosed from day 1 till the end of experiment. All the animals
except G1 received D-Galactose, daily (500mg/ kg; i.p.) from day 1 to the end
of the experiment. Body weight and clinical signs were taken daily throughout
the experimental period. Feed consumption was measured once in a week. At the end
of the experimental period, i.e., during 9th week, all the animals were
individually subjected to assessment of behavioral parameters such as Y-maze,
Morris water maze (MWM) test and Forced swim test (FST). All behavioral
parameters were recorded using suitable Software (Panlab, Smart 3.0) for all
the animals and analyzed.
Behavioral testing
Y-maze test: Impairment of spatial memory
was evaluated using a Y-maze test paradigm following chronic D-galactose
administration. The Y-maze consisted of three equal-dimension arms with an
angle of 120 °C. The arm closest to the experimenter was defined as the start
arm in which rat was placed at the start of each trial. During trial 1 (5
minutes), the entrance to the novel arm was closed, limiting the animal to exploration
of the start arm and the open arm. After an interval, animal was allowed to
explore all three arms by having the entrance to the novel arm open.
Exploratory behaviour was assessed for 5 minutes. After the last dose of
D-galactose and test item to the experimental animals, the Y-maze analysis was
performed on the next day to all experimental rats. Each rat was placed at the
centre of the apparatus and allowed to move freely through the maze for three 8
minutes sessions. The series of arm entries was observed and the following
parameters such as time spent in each arm and number of entries made into each
arm were calculated. Spontaneous alternation was defined as the successive
entry of the rat into the three arms in overlapping triplet sets.
Percentage alternation behaviour was
calculated using Equation (1):
= (Successive triplet sets / Total number of arm entries - 2) X
100------------- (1)
(Successive triplet set: Entries into three different arms consecutively)
Forced
swimming test (FST): The forced swim test was performed
with slight modification as described [33,34]. In brief, all the animals except
G1 were individually subjected to swim in a glass cylinder (40cm high, 18cm in
diameter) filled with water (25 °C) up to height of 34cm for 10 minutes. In
this cylinder, rats cannot touch the bottom or escape. For the first exposure,
rats were placed in the water for 15 minutes of forced swimming (training
session). Twenty-four hours later, rats were placed in the cylinder again for a
5-minute period (test session). In the test session rats were scored by an
observer blind to the effect of test substance exposure of the animal for
immobility time (floating with only small movements necessary to keep their
head above water), swimming time (pedalling or making circular movements), and
struggling time (climbing walls or diving attempts to escape). Water in the
tank was changed after each session.
Morris
water maze test: The test was performed as per with
slight modification [35]. Escape platform was sub-merged 1.0cm below the
surface of the pool water, which was maintained at 23±2 °C, and mixed with milk
powder to obscure the platform. The location of the platform remained in the
center of south west quadrant throughout the training period. Before the first
session, each animal was put on the platform for 15 seconds, and then was given
a 60 seconds free swim and then guided to the platform, where it remained for
another 20 seconds. Latencies to escape from the water maze (finding the
sub-merged escape platform), total distance travelled, and resting time of each
animal were collected and the average value of each trial for a session was
calculated.
Statistical analysis
The data were expressed as mean ±
standard error of mean (SEM) and subjected to statistical analysis using Sigma
Plot (Version 11.0) using one-way ANOVA. Student’s t-test was performed for
comparison of the individual treatment group with control. The p≤0.05 was
considered as statistically significant (n=10).
Results and Discussion
Behavioral testing
Y-maze
test: The Y-maze test for cognitive
function in laboratory animals is extensively used as a tool during the
development of pharmaceutical formulations to the treatment of
neurodegenerative diseases [36]. This behavioral test is used for the evaluation
of cognitive functions like memory and learning ability of short-term work and
is based on the natural instinct of rodents to explore unknown environments
[37]. The effect of the test formulation on cognitive function using Y-Maze
test in male Sprague Dawley rats is shown in Figure 1. Increased frequency of
number of entries in the arms was considered as improve locomotor activity and
increase percentage alternation was considered as an improved spatial memory
function. In this technique, parameter like number of entries was significantly
increased in the animals per se received
Biofield Energy Treatment (-15 days) group (G6) by 176%, 47.53%, and 66.67% in
the start arm, explored arm, and novel arm, respectively as compared to the
untreated test formulation group (G4). Moreover, number of entries was
significantly increased by 38.02% in the Biofield Energy Treated test
formulation (-15 days) group (G7) on explored arm compared to the G4 group.
Further, in the Biofield Energy Treated animals per se +
Biofield Energy Treated test formulation (-15 days) group (G8), showed 100% and
32.74% increased the number of entries in start arm and novel arm, respectively
compared to the G4 group. Further, number of entries was significantly elevated
by 76%, 38.02%, and 22.12% in start arm, explored arm, and novel arm,
respectively as compared to the G4 group. Other parameter like time spent was
increased by 17.58% in the Biofield Energy Treated test formulation group (G5)
on start arm compared to G4 Group. Moreover, G6 group an increased time spent
by 43.32% and 13.1% on explored arm and novel arm, respectively compared to the
G4 group. Time spent was increased by 14.64% in the G7 group on start arm only
compared to G4 group. Further, time spent was increased by 37.95% in the G9
group on explored arm as compared to the G4 group. The percent of alternation
behaviour was increased by 7.26% in the Biofield Energy Treated animals per se + Biofield Energy Treated test formulation
(-15 days) group (G8) as compared to the G4 group (Figure 1). Besides, in case
of spontaneous alternation, where rats made alternations when they sequentially
visited the three arms, without repeating any one arm [38]. The results
indicated more alternation task because they spent more time to elucidate which
was the last arm visited. Measurement of spontaneous alternation using a Y-maze
is a test also utilized for the evaluation of habituation and spatial working
memory [39]. Overall, Biofield Energy Treatment improved cognition function by
significantly increasing number of entries, time spent and % alternation
compared to the untreated test formulation group.
Forced
swimming test (FST)
The results of FST after administration
of the test formulation are shown in Figure 2. In this experiment, the number
of climbing was significantly increased by 13.58%, 24.69%, 32.1%, 40.74%, and
3.70% in the G5, G6, G7, G8, and G9, respectively compared to the untreated
test formulation control (G4) group. Additionally, the swimming time was
significantly increased by 4.67%, 9.34%, and 10.31% in the G5, G6, and G7,
respectively compared to the G4 group. Besides, the immobility time was
significantly decreased by 27.91%, 55.81%, 61.63%, 5.81%, and 11.63% in the G5,
G6, G7, G8, and G9, respectively compared to the G4 group (Figure 2). The FST
is another behavioral test battery normally used for rodent [40]. It is also
called as Porsolt swim test developed for rats. It is used for the screening of
antidepressant efficacy of new chemical entity and preventing depressive-like
states [33,41]. It is also considered as an important tool in both academic
research and drug discovery in industrial settings, where reliability and high
throughput screening of novel compounds are essential [42]. Overall, the
improvement of these parameters in the Biofield Energy Treated groups might be
due to The Trivedi Effect®-Consciousness Energy Healing Treatment.
Morris
water maze test: Many water mazes have been
developed so far, but the ‘the water maze’ was developed by Richard Morris to
assess spatial or place learning and defined as Morris water maze (MWM) [43].
For the assessment of spatial learning and memory Morris water maze test is
widely used as a behavioral test [44,45]. The MWM is an important and dominant
method has become more widely used than its predecessors such as radial-arm
maze, passive avoidance, T-mazes and their variations, etc. [46]. The impact of
the test formulation on activeness and spatial memory using Morris water maze
test is shown in Figure 3. The escape latency was significantly reduced by
12.06% in session 2, in the G5 group compared to the G4 group. Moreover, escape
latency was decrease by 6.33% and 13.04% in session 1 and 3, respectively in
the G7 group compared to the G4 group. G8 group showed 14.88% reduction of
escape latency in session 3 and G9 group showed 17.52% in session 3 compared to
the G4 group. Thus, reduction of escape latency indicated that the rats learned
the location of the platform during the experimental days. The parameters
traveled distance and resting time were recorded additionally to avoid
interpretation of confounding changes of behavior [47]. Resting time was
reduced by 2.31% and 15.45% in session 2 and 3, respectively in the Biofield
Energy Treatment per se to animals plus
untreated test formulation (Group 9) compared to the untreated test formulation
group (G4). Further, the resting time was reduced by 16.26% in the Biofield
Energy Treated test formulation (-15 days) group (G7) on session 3 compared to
the G4 group.
Besides,
total distance was significantly reduced by 27.23% and 23% in session 2 in the
Biofield Energy Treated test formulation group (G5) and G9, respectively
compared to the G4 group. Moreover, in session 3, total distance travel was
reduced by 13.76% in the Biofield Energy Treated animals per se + Biofield Energy Treated test formulation
(-15 days) group (G8) compared to the G4 group. In this research plan, four
groups were considered as preventive maintenance groups. These groups were G6
(Biofield Energy Treatment per se to
animals at -15 days), G7 (Biofield Energy Treated test formulation from day
-15), G8 (Biofield Energy Treatment per se to
animals along with Biofield Treated test formulation from day -15), and G9
(Biofield Treatment per se at -15
days to animals with untreated test formulation). The results showed the
significant slowdown of the disease progression, disease related all other
symptoms/complications and also reduced the chances of disease susceptibility
in these groups. Specifically, group G6 (preventive Biofield Energy Treatment
group per se at -15 days) showed the best results as a
prophylactic/preventive treatment group compared to the other groups. Based on
the overall data, it suggests that the Biofield Energy Healing Therapy was found
to be most effective and benefited in order to prevent and protect from the
occurrence of any type of diseases in rat model. It indicated that this therapy
can act as a preventive maintenance therapy to prevent the occurrence of the
disease, slow down the disease progression and disease related complications of
the existing aliments that will ultimately improve the overall health and
quality of life in human.
Conclusion
The
result of Y-maze data suggested that number of entries was significantly elevated
by 176% (in start arm), 47.53% (in explored arm), and 66.67% (novel arm) in the
animals per se received Biofield Energy Treatment (-15
days) group (G6) compared to the untreated test formulation group (G4). The
number of entries was also increased by 100% (in start arm) in the Biofield
Treated animals per se + Biofield Treated test
formulation (-15 days) group (G8) compared to the G4 group. Additionally,
percent of alternation behaviour was increased by 7.26% in the G8 as compared
to the G4 group. The results of force swim test showed that climbing frequency
was increased by 24.69%, 32.1%, and 40.74% in the G6, G7, and G8, respectively
compared to G4 group. Parameter like immobility time was significantly
decreased by 27.91%, 55.81%, and 61.63% in the G5, G6, and G7, respectively
compared to the G4 group. Besides, the results of the Morris water maze (MWM)
data showed that escape latency was significantly decreased by 12.06% (session
2), 13.04% (session 3), 14.88% (session 3), and 17.52% (session 3) in the G5,
G7, G8, G9 groups, respectively compared to the G4 group. Biofield Energy
Healing Treatment (the Trivedi Effect®) per se showed
best results with respect to different efficacy and biomarker parameters in the
preventive maintenance group, G6 as compared to the other preventive
maintenance groups (G7, G8, and G9) in rat model study. It also helped to slow
down the disease progression and disease related complications of the overall
animal’s health. These data suggested that Biofield Energy Treatment per se and/or Biofield Energy Treated Test
formulation in combination would be the best treatment strategies in order to
prevent and protect from the occurrence of any type of diseases.
Therefore, the Biofield Energy Treatment might act as a preventive maintenance
therapy in order to maintain good health, or full restoration of health or
improve the overall health and quality of life in human. This therapy might
also reduce the severity of any type of acute/chronic disease (auto-immune
related and inflammatory disorders) progression rate and can be used in both
before and after the manifestation of any disease symptoms in healthy,
unhealthy, and ill peoples. Therefore, it is assumed that the Biofield Energy
Treated test formulation could be more useful in various aging and
neurobehavioral-related disorders such as stroke, occlusion, hemorrhagic,
transient ischemic attack (TIA), arterialvenial malformation (AVM),
phenylketonia (PKU), encephalitis, amnesiac syndrome, psuedopsychiatric
syndromes, visual agnosia, prosopagnosia, ideomotor apraxia, constructional
apraxia, etc. Besides, it can also be utilized in organ transplants (kidney,
liver, and heart transplants), various autoimmune disorders Fatigue Syndrome
and Vasculitis, as well as inflammatory disorders such as such as Lupus,
Addison Disease, Celiac Disease (gluten-sensitive enteropathy),
Dermatomyositis, Graves’ Disease, Hashimoto Thyroiditis, Rheumatoid Arthritis,
Multiple Sclerosis, Myasthenia Gravis, Pernicious Anemia, Sjogren Syndrome,
Scleroderma, Aplastic Anemia, Reactive Arthritis, Fibromyalgia, Disease,
Psoriasis, Chronic Asthma, Systemic Lupus Erythematosus, Vitiligo, Type 1
Diabetes, Alzheimer’s Disease, Alopecia Areata, Crohn’s, Ulcerative Colitis,
Irritable Bowel Syndrome, Atherosclerosis, Dermatitis, Diverticulitis,
Hepatitis, inflammatory diseases, antiinflammatory, anti-arthritic,
anti-osteoporosis, anti-apoptotic, antistress, wound healing, anti-cancer,
anti-aging, activities.
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Friday 5 February 2021
Lupine Publishers | Indications and Therapeutic Potential of Virtual Reality in Pediatric Dentistry
Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Abstract
In the age of technology, Virtual Reality
(VR) has stormed into many aspects of our lives, the medical field is no
exception. According to Global Industry Analysts, the VR market in medicine is
expected to grow to $2,2 billion by 2027. This technology hold promises in
revolutionizing the healthcare industry. Its applications are ranging from
training medical professionals (with possibilities for students to better
assess medical notions or to treat virtual patients during their pre-clinical
course) to diagnosing and treating various conditions. The user is immerged
into a tri-dimensional multi-sensory ambiance and his focus is solely on the
scenario. It’s an immensely powerful tool for probing the relationship between
emotion and audio/visual perception. As imaginative and inquisitive as children
are, the immersive quality of VR is most likely to amaze them. Their attraction
for new technologies combined with their ease to escape to a specific scenario
through movies or videogames can make the VR experience, and therefore the
medical or dental procedure, more pleasant for them. This article summarizes
the therapeutic potential of VR in pediatric dentistry through its anxiolytic
and analgesic effects.
Keywords: Virtual reality; Analgesia; Anxiolytic;
Distraction; Dental; Children
Introduction
The coronavirus pandemic and its social
restrictions have helped boost our interest in Virtual Reality (VR) when it
comes to entertainment and business, fields for which it was originally
designed for. Its applications also expand to the healthcare field [1],
especially in pediatric dentistry [2].
Use of virtual reality in
pediatric dentistry
VR is a computer technology that creates
an artificial 3-dimensional simulated environment through audio and visual
immersion. It consists of a head mounted display and a pair of goggles that are
connected to either a computer or a cell phone. The headset has sensors that
track user’s head movements, creating the illusion of moving around in the
virtual space [3]. The VR scenario needs to be adapted to the context of dental
treatment, with calm and anxiolytic scenarios, avoiding any agitation,
hyperstimulation, or head movements during the procedures. However, the child
is much more than a simple passive recipient of VR: he becomes an active
collaborator of his treatment through the choice of the virtual reality
environment. While in VR, he can interact with virtual characters controlled by
computer algorithms called embodied agents. The first-person view in VR creates
the illusion of being surrounded by the virtual environment and sharing the
same physical space with the embodied agent [3]. In addition, VR can create
realistic simulations by allowing users to interact with the virtual
environment using naturalistic movement, similar to how they would navigate the
physical world. Research with children has shown that the brain can respond to
VR stimuli as if it were real [3]. Anxiety is often linked to pain and VR was
found effective, not only on anxiety, but also in pain relieve.
When it comes to pediatric dentistry, as
the patient’s attention is focused on the VR scenario, the visual and audio
stimuli that usually trigger anxiety are shunted. The reduction in fear in
pediatric needle procedure is significant while using VR compared with standard
methods of behavioral management or distraction [4]. Two recent meta-analysis,
published in 2019 and 2020, have investigated the physiological response in
children who received virtual reality devices during dental procedures. The
first one concluded that children with VR have a significant lower heart rate
during local dental anesthesia (MD, -3.78; 95% CI, -6.73, -0.83; p=0.01). This
result is based on 352 participants across 6 studies. However, there was no
significant change for the oxygen saturation level [5]. Unlike the first
meta-analysis, the second shows no significant improvement linked to VR use
during the administration of local anesthetic and the placement of the surgical
site. They concluded, however, that VR audiovisual distraction may reduce pain
perception and improve child behavior during decay removal and restoration
placement [6]. VR is also indicated for cognitive and behavioral therapies
based on progressive exposition to different stimuli such as the dental
anesthesia needle. Psychological preparation for a surgical intervention by
virtual visit of the operating room is possible and allows a reduction in
preoperative anxiety scores [7]. The main objective and interest of VR, in
these cases, is the cognitive reprogramming of anxious children. Furthermore,
there is growing interest in nonpharmacological techniques for anxiety and pain
management. Patients who are intolerant to pharmalogical conscious sedations
such as inhalation with nitrous oxide and oxygen or who cannot benefit from an
administration of benzodiazepines (midazolam) may also be treated under virtual
reality. However, given the nature of the procedure, the contraindications to
the use of virtual reality mainly refers to certain psychopathological contexts
(claustrophobia), a history of post-operative nausea and vomiting, growth
retardation or young age leading to an unsuitability of the virtual reality
mask. Another contraindication to the use of virtual reality is susceptibility
to motion sickness.
Medical hypnosis in
pediatric dentistry
One of the main non-pharmacological
distraction therapies used in pediatric dentistry is medical hypnosis [8]. In
children, clinical hypnotherapy techniques including hypoalgesia have relieved
acute pain associated with local anesthesia and therefore help allay fear or
increase patient cooperation [9]. According to the American Psychological
Association, medical hypnosis induces a “state of modified consciousness
involving focused attention and reduced peripheral awareness characterized by
an enhanced capacity for response to suggestion”. Milton Erickson developed a
permissive, accommodating, and indirect approach, often called Covert or
Conversational Hypnosis. This technique is particularly interesting for
children, who have a natural talent for playing and who find it easy to enter
into an imaginary world. Three fundamental conditions remain essential in
hypnosis: patient‘s motivation, patient’s cooperation, and patient’s confidence
in the therapist [10]. One study demonstrated that hypnosis was effective in
reducing preoperative anxiety in the group of children receiving local dental
anesthesia [11]. The mean modified Yale Preoperative Anxiety Score was 50%
lower in the Hypnosis group than in the Non-Hypnosis group at the time of anesthesia
[11]. There were less crying and decreased pulse rate [11]. Hypnosis also
modified the pain tolerance threshold, as shown by the Visual Analogue Scale
(VAS) scores, with 86% of children from the Hypnosis group compared to 40% from
the Non-Hypnosis group having a VAS score under 3 [11]. Another study found
that children under hypnosis exhibited significantly less resistance to
administration of local anesthesia (P<0.05) and there also was a significant
difference in pulse rate, attributable to the hypnotic condition (P=.000), but
not in oxygen saturation level [9].
A recent Cochrane systematic review
attempted to answer the question: What is the effectiveness of hypnosis (with
or without sedation) for behavior management of children who are receiving
dental care in order to allow successful completion of treatment? Although
there are many case reports indicating the benefits of hypnosis in pediatric
dentistry, only 3 met the inclusion criteria and the authors concluded that
further controlled trials were necessary to suggest the beneficial effects of
hypnosis [12]. Given well‐known
developmental and inter-individual variations in suggestibility, researchers
may want to confine studies to limited age ranges or to include sufficient
numbers of children from various age groups to allow analyses of adequate
statistical power within age categories. Besides, the main difficulties for
comparing medical hypnosis between clinical studies correspond mainly to the
inherent heterogeneity of the hypnosis speech. The variability of the hypnosis
speech between practitioners makes it hard to compare them.
Medical hypnosis through
virtual reality
Several recent software offering a
multisensory immersion in sync with a hypnosis suggestion speech allow a more
standardized hypnosis therapy. It combines the benefits of the visual
distraction through VR with synopsis scripts based on cardiac coherence and
suggestion. It often includes musical constructions that have been clinically
proven to affect the patient’s heart rate through relaxation, associating the
ambient sounds with music therapy compositions.Hypnogram© is one that software
that are easy and clinically ready-to-use and don’t require hypnosis skills for
the practitioner. The patient can choose between different VR scenarios, voice
and music atmosphere. It’s a class 1 medical device, proven effective as a
natural anxiolytic. It can be used as replacement of premedication with a
long-lasting non-pharmacological anxiolytic effect. In association with local
or regional anesthetic adjunct, or during the induction for general anesthesia,
it provides analgesia with reduced side effects. Post-operative hypoalgesia can
reduce pain and opioid use with a faster recovery. When it comes to pediatric
dentistry, our pilot clinical study provides preliminary evidence of the
feasibility of using immersive, interactive VR to distract pediatric dental
patients and increase cooperation and of children during dental procedures. 12
patients were included, and the main inclusion criteria corresponded to an age
comprised between 9 and 13 years old, without any neurological or psychiatric
disease, in absence of previous post-operative vomiting or nausea. Our
preliminary results show a better tolerance and global experience of dental
procedure in a large range of procedures from oral surgery to endodontics or
conservative care.
Long clinical sessions (lasting more than 1 hour) were also carried out under
virtual reality, as part of complex rehabilitations of dental developmental
anomalies, such as Amelogenesis Imperfecta or Molar Incisor Hypomineralisation,
with a good level of cooperation from the patient. When used in conjunction
with local anesthesia, VR procedure decreases anxiety and reduces pain and the
need for sedatives and side effects, with perioperative anxiety score 45% lower
and a satisfaction rate of 8/10. The next step in our clinical research is a
prospective controlled clinical study aiming to compare this VR device with the
nitrous oxide pharmacological sedation in the context of anxious children
undergoing conventional dental treatment. Our main experimental objective is to
investigate the effectiveness of VR on anxiety and pain, as well as to compare
it with the standard option of care for anxious children corresponding to inhalation
conscious sedation with nitrous oxide and oxygen. Success and prognosis factors
such as child’s temperament will be discussed as they may influence
suggestibility in children and overall efficacy of VR procedure.
Conclusion
Recent mass production of immersive VR
goggles has increased their availability and affordability, and there is
growing interest in non-pharmacological techniques for pain management, making
VR analgesia a promising direction for future clinical research. Associating
with medical hypnosis scenario, it combines the benefits of both distraction
through VR and hypnosis. Children can discover the dental office in a playful
and fun way.
https://lupinepublishers.com/psychology-behavioral-science-journal/fulltext/indications-and-therapeutic-potential-of-virtual-reality-in-pediatric-dentistry.ID.000192.php
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