Augmented Reality to Reduce Pain During Botulinum Toxin Injections in Cerebral-palsied Children

Objective: To evaluate the effect of the use of a module with augmented reality (Mini-Docs) on pain during botulinum toxin injections in children with cerebral palsy aged from 3 to 8 years

Method: Randomized controlled trial comparing a group of children receiving the module with augmented reality of the Mini-Docs and drug pain management (nitrous oxide and medications), with a group of children receiving the usual care of pain management that combines drug pain management (nitrous oxide and medications) and distraction techniques. The device with the augmented reality module allows the child to add virtual content to the real images of the care. The pain will be assessed for each child 10 minutes after the injections, using a self-assessment scale (the Faces Pain Scale - Revised) or a heteroevaluation scale (the Face Legs Activity Cry Consolability scale given by the nurse). The study will be conducted in two centers of physical medicine and pediatric rehabilitation of the French Red Cross (Paris and Lyon).

Expected Results:

• Decreasing children's pain during botulinum toxin injections
• Decreasing anxiety in children and parents during injections
• Increasing coping skills in children
• Facilitating of the achievement of the therapeutic goal during injections

Inclusion criteria

• Cerebral-palsied children, whose diagnosis of cerebral palsy was confirmed by a neurologist reported in the medical record
• Aged 3 to 8 years (until the day before 9 years old)
• With a functional level of Gross Motor Function Classification System (GMFCS) I, II, III or IV
• Treated by TB injection (child with or without a history of TB injections)
• With a sufficient level oral expression to respond to questionnaires and to interact with the nurse for the use of augmented reality device
• Obtaining written parental consent and oral approval by the child

Exclusion criteria

• Impossibility to assess pain during the session by the FLACC scale or FPS-R scale
• Visual disturbances excluding to use of the augmented reality device
• Severe cognitive impairment making it possible to answer questionnaires
• Child of functional level child GMFCS V
• Child with a specific request for distraction (eg if the child demands to watch a cartoon). This in order not to interfere with the coping strategies used by the child.
• Refusal on the part of the parents to sign consent, and refusal on the part of child to use the tablet
• Child not benefiting from social security coverage