Archive for category Virtual Reality
Curiscope, a startup, aims to blend VR and AR. Their Virtuali-Tee allows users to take a peek inside their own chest cavities.
TAKE A LOOK AT YOURSELF
Most people feel confident that they know a fair amount about their own body, in terms of general health and what they look like from the outside. However, most of us haven’t taken a look inside—literally speaking. Ed Barton and his UK-based startup Curiscope is hoping to change that with a unique blend of virtual reality (VR) and augmented reality (AR). Using an anatomy VR app and the company’s Virtuali-Tee, a t-shirt, they are allowing people to see inside of their own chest cavities.
Barton explained to Wired: “We use a mix of VR and AR to see inside the anatomy…With positionally tracked AR, you can position VR experiences physically within your environment.”
Barton and Curiscope co-founder Ben Kidd have so far raised almost $1 million in seed funding from LocalGlobe, and they’ve already sold almost 3,000 of the Virtuali-Tees.
HIGH TECH T-SHIRT
Barton told Wired that, using positional tracking, “we have a blurring of physical and digital items, and an experience more tightly connected to reality.” He continued, “With the Virtuali-Tee, AR is your interface and VR is used to transport you somewhere else. The technologies should be merging.”
This technology works using a highly-stylized QR code printed onto the front of the t-shirt. When you scan the code with the corresponding app, you can explore throughout the chest cavity, including the heart and lungs.
AR technology hit the mainstream with the release of Pokémon Go, but its applications have shown that it can reach far beyond games. From smartphone usage to vehicle blueprint design, AR is quickly developing. The combination of both AR and VR could not only make the Virtuali-Tee device fully immersive, but also lead to a whole host of other technologies that combine AR and VR.
This t-shirt, specifically, could be a fantastic tool for the curious. It can be used for educational purposes, allowing anatomy and biology to be a fun experience that students can really wrap their minds around. Even outside of a formal educational setting, this device could allow us to better connect with our own biology. Virtuali-Tee could help people to better understand their own inner workings, and how the things we do every day—from what we eat to how we exercise—might affect our health.
[Mini Review] No distance between disabled people and rehabilitation engineer in high-tech era – Full Text PDF
Traditional face to face diagnosis and treatment model has existed for thousands of years between doctors and patients. But now high technologies have brought people great convenience in many fields. When the disabled people concerned, many technologies such as internet, remote sensing, signal processing, Virtual Reality and so on, are already playing an important role in rehabilitation engineering. This paper introduces these emergency new technologies associated with the disabled people and engineers in recent years, which can eliminate the psychological and space distance between disabled people and rehabilitation engineer in high-tech era.
The rehabilitation strategies are needed to optimize function and
reduce disability of disabled people. Many public plans are developed
in some countries . And now lots of specialized institutions for the
rehabilitation of disabled people have been established . The disabled
people is widely distributed , so many scholars are committed to
provide a rehabilitation approach to them . Remote rehabilitation
is a combination of rehabilitation medicine, computer technology,
internet technology, sensor technology, information processing
technology, etc., it is a new rehabilitation resources with a new concept
of rehabilitation, which can provide space for the further development
of rehabilitation engineering technology . Based on the realization
of cross-regional rehabilitation services, remote rehabilitation is
the integrated use of communication technology, remote sensing
technology, remote control technology. Remote rehabilitation allows
people to achieve rehabilitation cross the geographical area via the
information exchange. The value of remote rehabilitation is also
reflected in the fact that it can optimize the configuration of manpower
and materials. In fact, for individuals with disabilities, rehabilitation
affected by many factors such as their family, their mood, social
environment , especially today’s high technologies.
Rehabilitation engineers can hear the voice of distant people through
the microphone and touch the distant people via embedded artificial
sensors into skin to get the signal such as the surface temperature,
moisture distribution of disabled people . Rehabilitation engineers
can also operate medical and rehabilitation equipment by the remote
control system . With the aid of a remote rehabilitation system,
information interaction between rehabilitation engineers and disabled
people can be more flexible, efficient and convenient . In addition,
other technologies, such as wearable technology , gait analysis
technology , synchronous audio-visual technology  and so
on have been already implicated in the field of remote rehabilitation
engineering. In the following paper, several important high technologies
for remote rehabilitation will be systematically analyzed via contacting
the traditional rehabilitation engineering. […]
Virtual Reality Enhanced Robotic Systems for Disability Rehabilitation
The study of technology and its implications in the medical field has become an increasingly crucial area of research. By integrating technological innovations into clinical practices, patients can receive improved diagnoses and treatments, as well as faster and safer recoveries.
Virtual Reality Enhanced Robotic Systems for Disability Rehabilitation is an authoritative reference source for the latest scholarly research on the use of computer-assisted rehabilitation methods for disabled patients. Highlighting the application of robots, sensors, and virtual environments, this book is ideally designed for graduate students, engineers, technicians, and company administrators interested in the incorporation of auto-training methods in patient recovery.
[ARTICLE] Neurologic Music Therapy to Facilitate Recovery from Complications of Neurologic Diseases – Full Text
Neurologic music therapy (NMT) has fostered recovery from complications in patients suffering from a wide variety of neurologic diseases. Combining music and virtual reality with standard rehabilitation therapies can improve patient compliance and make therapy more enjoyable. Listening to music can reduce epileptiform discharges and enhances brain plasticity. Music produces variations in brain anatomy between musicians and non-musicians. Music therapy is an inexpensive intervention to help post-stroke patients to recover faster and more efficiently if applied soon after the event. There is evidence that incorporating music into a rehabilitation program fosters recovery of hand function, dexterity, spatial movement, cognitive function, mood, coordination, stride length and memory. Learning words as lyrics, melodic intonation therapy and singing can help the aphasic patient to recover faster. NMT therapists are valuable members of the rehabilitation team. NMT has been approved by the World Rehabilitation Federation as an effective evidence based method of treatment.
Incorporating music into routine rehabilitation programs not only fosters initial recovery but also contributes to improvement and enduring benefit after stopping the treatment. Disabilities stem from different neurologic disorders, work-related injuries and trauma such as motor vehicle accidents and sport injuries. Disabilities can have devastating physical, emotional and financial effects on the lives of patients and their families. It is important to identify and incorporate strategies that supplement traditional rehabilitation therapy in order to optimize the recovery of function and quality of life. NMT, by facilitating the patients’ recovery, contributes to positive patient outcomes. The following reviews the evidence base highlighting the importance of adding music to more standard forms of rehabilitation therapy. It references the neurobiological foundation of NMT, its history and applications. Evidence in support of its use to facilitate recovery from a wide range of complications related to specific neurological diagnoses will be discussed.[…]
[BLOG POST] Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home – Evidently Cochrane
In this blog, neuropsychologist Marta Bieńkiewicz explores the potential of virtual reality to help people with Parkinson’s disease, and after stroke, and looks at the evidence from Cochrane reviews.
By 2020 it is estimated that there will be 120 million active users of Virtual Reality (VR) via mobile headsets; nearly a fifth of whom will be using it for healthcare solutions (ABI report, 2015). The hype about VR is currently reaching fever pitch, thanks mostly to the increased accessibility of it for the average Joe (via solutions such as smartphones add-ons spectacles). All over the globe VR setups are being tested and investigated as a novel means of enabling more fun and efficient physical exercise as part of rehabilitation. But is all the money that goes into research and development for this technology justifiable? Could it be better spent – for example on training more therapists or providing activity groups for patients?
In an attempt to answer this question, let’s walk through some facts to get a better picture as to what VR is and what it might hold for people with stroke and Parkinson’s disease (PD).
The virtual reality (VR) environment
My first exposure to VR was during my PhD days. My future husband (as it turned out 5 years later) was doing his doctorate on the non-clinical applications of what was, at the time, a technology in its infancy. In the simplest of definitions, VR is a computer designed environment that can be displayed in a headset glasses or a cave (special room) to create a feeling of full immersion that you are somewhere else; completely detached from the real world yet fully engaged with the virtual world. The high immersion display might trick you into thinking you are on a tennis court playing a game at Wimbledon for example. The low immersion VR environments comprise computer displays – usually tablets or regular screens. In this case you can still enjoy a game or follow on-screen instructions, but your brain keeps check of its whereabouts.
So, the main concept behind VR-based rehabilitation games is twofold. Firstly, they provide a clear, visual means of prompting users’ movements (i.e. in the example of picking up an apple, the user might be guided toward it). Secondly, they increase the personal motivation of the user. The higher the engagement with the environment and varied scenarios, the higher the enjoyment and willingness to repeat the same exercise all over again (Lewis & Rosie, 2012). A Cochrane review (French et al. 2016) reported that repetitive training may improve walking distance and is probably effective for improving upper limb rehabilitation. For a fantastic example of how this field is moving forward see the KATA project based at John Hopkins University which uses a combination of VR (Pixar like!) display with robotic-assisted therapy for stroke.
The reality of stroke and Parkinson’s disease
Stroke and Parkinson’s disease are two different neurological conditions. The first one happens suddenly and changes mobility overnight, which may mean changing from being a fully active person to being limited in one’s independence. The second is characterised by gradual and sneaky progression of compromised mobility. Either condition may make everyday life increasingly a real struggle. When it is not easy to get dressed, the idea of doing physical exercise seems totally unattainable. People find themselves not being able to do the tasks they previously took for granted – preparing a sandwich, driving a car, or simply going out of the house, and now add to it catching up with the modern technology.
Exercise may help
If you are a sufferer, these two aspects might discourage you from reading on – exercise and VR sounds too hard to even bother! But here is the thing. While guidelines on how to improve mobility in neurological conditions are scarce, the ones that are there (Keus et al., 2014)suggest that the power of exercise might help. Studies suggests that intense exercise in Parkinson’s may slow down the progression of the disease due to neuroprotective benefits (Alberts et al., 2016, Corcos et al., 2013) and help maintain independence (van Nimwegen, 2011). After stroke, physiotherapy is usually started straight away or during the hospitalisation period. In fact, many research teams are convinced that the time window for the real functional recovery of lost limb power (i.e. regaining the previous dexterity) is quite short and is limited to 6 months post accident or shorter (Cortes et al., 2017). This is the window of opportunity for brain reorganisation, after which improvement is maybe not impossible, but certainly more challenging.
Depending on patients’ needs, exercise should target general mobility, dexterity, walking, or specific daily activities. There are exercise-based interventions in particular that were reported to show improvement in people with Parkinson’s Disease: such as tandem or automated stationary cycling (Ridgiel et al., 2015) and pole-striding (Bombieri et al., 2017; Krishnamurthi et al., 2017), and for stroke: physical rehabilitation (Pollock et al., 2014) or robot-assisted interventions (Mehrholz et al., 2015, 2017). In both conditions, it is thought to be important to start as soon as possible and introduce exercise regime as a regular part of daily life.
For people with PD or after stroke who are keen to become more fit and actively steer their rehabilitation, VR could be their new best friend.
Does virtual reality offer real life benefits?
The Cochrane review of VR (Dockx et al., 2016) and gaming for Parkinson’s, with a focus on walking and balance, provides us with evidence that VR based training may lead to better improvements for stride length, but overall may have similar effects on walking parameters and balance as conventional therapy, while the effect on quality of life is uncertain. The upper limb interventions were not included.
On the contrary, the Cochrane review of VR in stroke focused interventions (Laver et al., 2015) was primarily focused on upper limb function and found that VR based interventions may lead to greater improvements in both function and daily task performance compared to conventional therapy. Global mobility and grip strength remained on level par. It is not clear how long-lasting those effects are, nor which characteristics are the most meaningful for patients’ recovery. The number of studies examined was small and information insufficient to look into other dimensions such as quality of life or cognitive functions.
So what does this all mean? The interventions using VR were overall found to be probably similar to the conventional therapies, with the potential added value in the form of accurate feedback and the ability to stimulate users by creating personalised, motivational and fun interventions (Dockx et al., 2016, Laver et al., 2015). If more evidence is found to confirm those findings, it would mean VR can be potentially be as good as a supervised therapy, which is great news. Why? Because it means you can bring it home.
Why Occupational Therapists can sleep well at night (for now…)
Let’s make it clear, this is not an overnight take-over of conventional therapy. VR and gaming solutions have the potential to provide a similar level of care to traditional exercise-based therapy, without having to replace it. At least for the next decades, think of it as a potential complementary therapy subsidised by the NHS or private insurance: part of a medical treatment that would encourage patients to do meaningful exercise in between the supervised physiotherapy sessions. Conversely, VR-based exercise units in hospitals could train patients in daily tasks, emulating their home environment. Beyond that, the technology is simply not mature enough to match that of a human eye and brain in terms of assessment and choice of best treatment. However, with Artificial Intelligence looming on the distant horizon, this is not beyond the realms of possibility…some day.
Tread carefully though when it comes to any products or apps that are advertised as a rehabilitation tool on the consumer market. In order for it to be a relevant training tool it needs to be paired with sensors (attached to your body or embedded in a special clothing) in order to provide feedback.
Looking to the future: Extended Reality
The future however, might lie in a newly born sister of VR, namely Extended Reality (ER). This technology is also based on wearable headsets (such as Hololens) but allows the user to be immersed in the virtual reality while seeing the physical environment.
The idea is that the juxtaposed feedback information is relevant and not interruptive for your current activity (e.g. walking a dog). It is also a safer mode of exercise as it does not require being detached from one’s surroundings despite a high level of immersion in the virtual environment/of immersion. At least four labs so far have been investigating this idea for stroke and Parkinson’s (Technical University of Munich, University of Rochester, University of Connecticut and Northeastern University). Along with ER developments, the level of immersion and therefore enjoyment can be increased with the sound spatialisation and touch sensation (i.e. Ultrahaptics). One could easily imagine that ER opens new horizons for combining a very accurate feedback tool with, for example, robotic therapy.
Hopefully the next years will bring answers to questions such as the level of transferability of VR/ER training into real life skills. Further research is necessary to inform tailored technology-based exercise regimes and to clarify whether or not rehabilitation with limited supervision is a feasible model.
The take home message
While certainly the technological development in the current era is both exciting and a little daunting, it brings solutions that were not previously available at such affordable cost. VR essentially offers a therapy that is likely to become almost as good as conventional therapy from within the comforts of your own home. VR and gaming can be fun, can provide excitement of immersion and prevent boredom while also achieving exercise goals for task-specific rehabilitation. While current solutions are not yet up to the ‘buy now’ level, this area should definitely make your watchlist.
References may be found here.
Marta Bieńkiewicz has nothing to disclose.
Virtual Reality for Physical and Motor Rehabilitation
While virtual reality (VR) has influenced fields as varied as gaming, archaeology, and the visual arts, some of its most promising applications come from the health sector. Particularly encouraging are the many uses of VR in supporting the recovery of motor skills following accident or illness.
Virtual Reality for Physical and Motor Rehabilitation reviews two decades of progress and anticipates advances to come. It offers current research on the capacity of VR to evaluate, address, and reduce motor skill limitations, and the use of VR to support motor and sensorimotor function, from the most basic to the most sophisticated skill levels. Expert scientists and clinicians explain how the brain organizes motor behavior, relate therapeutic objectives to client goals, and differentiate among VR platforms in engaging the production of movement and balance. On the practical side, contributors demonstrate that VR complements existing therapies across various conditions such as neurodegenerative diseases, traumatic brain injury, and stroke. Included among the topics:
- Neuroplasticity and virtual reality.
- Vision and perception in virtual reality.
- Sensorimotor recalibration in virtual environments.
- Rehabilitative applications using VR for residual impairments following stroke.
- VR reveals mechanisms of balance and locomotor impairments.
- Applications of VR technologies for childhood disabilities.
A resource of great immediate and future utility, Virtual Reality for Physical and Motor Rehabilitation distills a dynamic field to aid the work of neuropsychologists, rehabilitation specialists (including physical, speech, vocational, and occupational therapists), and neurologists.
Rohan O’Reilly is a movement therapist in Newcastle, New South Wales, who has been using alternative therapies involving virtual reality devices to help his clients with rehabilitation.
“It really came back to the point of listening to people’s stories who had had large-scale traumas, and their experiences of what they went through, from their initial accident through to therapy,” Mr O’Reilly said.
“For most of them it was really [boring] and quite uncomfortable and not inspiring.
“So we thought ‘We need to make this feel better’.
“Lucky for us we’re living in a time where there’s an amazing new array of technologies that are not widely known about.
“Virtual reality would be the one that’s hot at the moment, and essentially that is a game changer. It’s phenomenal what can be done with that as a platform for putting people in a state where they want to play.”
Making therapy fun
Mr O’Reilly said virtual reality helped clients to exercise their bodies in non-traditional ways.
“It’s about emotions,” he said.
“If your rehabilitation just tended to be based around the fact that you had to pick up an inanimate object, which you had no real emotional connection to, repetitively … for most people, they would think ‘OK, I can do this for a little while’, but they’re quickly going to run out of steam.
“If you put someone in virtual reality with everything that reminds them of the things that they love to do, they’re essentially just going to give themselves therapy.
“We’re just simply creating an environment where they can explore their own capabilities.”
Client notices big improvements in health
Almost four years ago, Angus McConnell had an accident that changed his life.
He was riding his bicycle down a hill in Newcastle when a car turned across him.
“I hit the windscreen, bumped off down the road, and ended up with a spinal cord injury — a C7 complete quadriplegic,” Mr McConnell said.
“It hits you on and off, and still does.”
Mr McConnell went through traditional hospital rehabilitation, but was looking for other options to continue his treatment.
“As your journey goes along, you want to work out whether you’re going to ignore the parts of the body that aren’t working, or you’re going to make them move,” he said.
Mr McConnell said he had noticed big improvements in his health after the alternative therapy.
“Originally we started on building up the muscles and hopefully a nerve signal that’s coming through,” he said.
“I can feel further down into my body, with electrodes on parts of my body where the nerves come close to the skin.
“I’m standing up now with the help of electrodes, and that’s something I hadn’t thought possible two-and-a-half years ago.”
Academic says VR effective, but people should be cautious
Associate Professor Coralie English, a stroke researcher at the University of Newcastle, said people should approach alternative therapies with a degree of cautiousness.
“There is a reasonable amount of evidence for the effectiveness of virtual reality training for people after stroke,” she said.
“This sort of therapy is useful for people who’ve already got some movement. There’s certainly no evidence to suggest that if you can’t move at all, trying to move within these environments is going to result in any recovery of function.
“It needs to ensure that the person is practising what they need to practice, and that it’s based on a thorough assessment by a qualified health professional.”
[Abstract] Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and compliance of a virtual reality system.
Background: New technologies, such as telerehabilitation and gaming devices offer the possibility for patients to train at home. This opens the challenge of safety for the patient as he is called to exercise neither with a therapist on the patients’ side nor with a therapist linked remotely to supervise the sessions.
Aim: To study the safety, usability and patient acceptance of an autonomous telerehabilitation system for balance and gait (the REWIRE platform) in the patients home.
Design: Cohort study.
Setting: Community, in the stroke patients’ home.
Population: 15 participants with first-ever stroke, with a mild to moderate residual deficit of the lower extremities.
Method: Autonomous rehabilitation based on virtual rehabilitation was provided at the participants’ home for twelve weeks. The primary outcome was compliance (the ratio between days of actual and scheduled training), analysed with the two-tailed Wilcoxon Mann- Whitney test. Furthermore safety is defined by adverse events. The secondary endpoint was the acceptance of the system measured with the Technology Acceptance Model. Additionally, the cumulative duration of weekly training was analysed.
Results: During the study there were no adverse events related to the therapy. Patients performed on average 71% (range 39 to 92%) of the scheduled sessions. The Technology Acceptance Model Questionnaire showed excellent values for stroke patients after the training. The average training duration per week was 99 ±53min.
Conclusion: Autonomous telerehabilitation for balance and gait training with the REWIRE-system is safe, feasible and can help to intensive rehabilitative therapy at home.
Clinical Rehabilitation Impact: Telerehabilitation enables safe training in home environment and supports of the standard rehabilitation therapy.
Advances in technology over the last decade have led to a swift rise in the volume of research surrounding transcranial magnetic stimulation (TMS) and its therapeutic effects. A team from the Würzburg University Hospital in Germany has just published a new study demonstrating how TMS, in conjunction with a virtual reality experience, can help alleviate anxiety disorders and essentially help people “unlearn” fears.
Transcranial magnetic stimulation works by directing a targeted magnetic field toward specific areas in the brain. Depending on the frequencies delivered this can either stimulate or inhibit the brain activity of the targeted area. Initially conceived as a research tool allowing scientists to understand exactly what roles certain areas of the brain play, TMS has more recently been explored as a potential new tool for treating an assortment of problems.
TMS devices have already been approved to treat migraines and some major depressive disorders, but other research is looking into its uses as a learning aid and a way to help visually-impaired people navigate the world.
This new study looks at how the technology could improve a patient’s response when used in conjunction with a more traditional treatment method. Anxiety disorders are incredibly debilitating for many, from social phobias to more specific problems such as a fear of heights. Classically, the treatment for people with these disorders has been a type of cognitive behavioral therapy where one is exposed to the source of their anxiety under the supervision of a psychologist.
The team at the Würzburg University Hospital decided to examine whether this kind of classic therapy could be improved using TMS. Previous studies have shown that by targeting the frontal lobe with magnetic stimulation an anxiety response can be reduced, but the new research looks at how this could be incorporated into a specific treatment method for a targeted anxiety.
Thirty-nine subjects with an active fear of heights were split into two groups, including a control group which received fake TMS. The groups received 20 minutes of either real or fake TMS directed at the ventral medial prefrontal cortex, followed by virtual reality exposure to a dizzying height. After two sessions the group treated with the TMS prior to VR exposure exhibited reduced anxiety and avoidance symptoms compared to the control group that didn’t receive the TMS.
“The findings demonstrate that all participants benefit considerably from the therapy in virtual reality and the positive effects of the intervention are still clearly visible even after three months,” explains Professor Martin J. Herrmann, one of the researchers working on the study.
The researchers suggest that adding TMS and VR to an already well-proven treatment process increases the overall efficacy and essentially helps the brain “unlearn” its anxiety responses. The next phase for the study is to look at other forms of anxiety and see if the process is equally effective.
And the next fear that is being tackled? Arachnophobia.
The research was published in the journal Brain Stimulation.
Source: Würzburg University Hospital
The controlled environment of virtual reality is proving ideal for diagnosing and treating traumatic brain injuries. Learn why the Department of Defense is funding trials.
For some people, virtual reality is anything but a game. For some traumatic brain injury patients, it’s a means to living a normal life.
Meet Dr. Denise Krch, a research scientist and one of the leaders in virtual reality (VR) applications for sufferers of traumatic brain injuries (TBI). Krch has won grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and from the Department of Defense (DOD) for her promising research, and works with the DOD to help impaired soldiers.
Krch doesn’t ask a patient to strap on an Oculus Rift or an HTC Vive. In fact, her VR doesn’t use headsets at all. That surround experience is called immersive VR. What Krch uses is non-immersive. Her VR is shown on a computer monitor and is more like a video game in which a player uses a joystick and mouse to manage real-world situations.
For TBI sufferers, distractions and the need to juggle multiple tasks can make the typical workplace impossible to navigate. They find their thoughts batted around by each new interruption, and are unable to focus on one task for long. It’s frustrating and frightening. Krch’s VR applications don’t transport patients to far-off worlds; they put patients in the middle of an office, one that grows more distracting as they progress.
Krch is based in East Hanover, N.J., at a division of the Kessler Foundation, a nonprofit that assists people with physical disabilities, and she is affiliated with Rutgers University’s New Jersey Medical School, but she owes her interest in VR to a guest from the West. Seven years back, Albert “Skip” Rizzo, the director for medical virtual reality at the University of Southern California’s Institute for Creative Technologies, visited the Kessler Foundation to share his research in VR as a treatment Krch was impressed with the role VR can play in rehabilitation and rebuilding cognitive functions that are difficult to improve.
She was so impressed, in fact, that she began working with Sebastian Koenig, then a post doctorate student and researcher in Rizzo’s lab, on a new trial.
Krch’s work deals with the cognitive area called executive function, which includes our ability to organize, plan, and shift attention from one task to another or keep two things in mind at once. Impairments in this area are difficult to measure in neuropsychological assessments. The first challenge Krch and Koenig tried to solve was measuring executive function performance. They wanted to use VR to determine which patients were having trouble multitasking or switching attention in real world situations.
To do that, they created software that put the test subjects in a virtual environment where they were challenged to perform tasks while distracted or where they were forced to shift focus. The researchers ran their tests with a healthy control population and with patients they suspected of having impairments. Some of these patients had TBI, while others had multiple sclerosis (MS).
The VR environment put subjects in an office where they were seated at a desk and charged to pay attention to different messages coming through their computer. Some messages were spam, which they had to learn to ignore. Other emails required a response. Many included real estate offers, and the subjects had to decide whether to accept offers or decline them.
Besides making financial decisions, subjects had to keep watch on an office projector. That projector wasn’t visible from where they were seated, but was in a nearby conference room. Told that the projector’s light was on the fritz, they needed to turn and check on it frequently while managing their other tasks.
“We found that indeed our patient populations were actually seemingly intact or normal on our traditional neuropsych measures, but they were performing in the very impaired range when we looked at them using VR,” Krch says.
To understand why this video-game-like experience is called VR, it’s necessary to understand “presence”—the feeling of how much believability an immersive situation offers. For a test to be effective, patients need to feel like they’re in a believable scenario. Krch and Koenig’s simulation proved to be extremely believable, stressing out TBI patients in no time with competing stimuli. While creating actual physical spaces could test the same functions, that isn’t practical, and bringing patients into stores or similar real-world locations can lead to safety issues. Using VR better helps researchers control the experience: They can precisely monitor stimuli and responses while generating clinical data.
“In a virtual environment, you have complete control over whether the environment was fairly sterile and limited in distraction. As they were able to build to tolerating more distraction, you could add. So really that’s the biggest advantage of having a virtual environment,” Krch explains.
That trial successfully tested for a variety of impairments in attention and executive function. It showed impairments in the ability “to remember to remember,” called prospective memory, in turning to check the projector. Responding to emails tested selective attention where the subject chooses to focus on one thing and not another. Determining whether or not to accept the real estate offers tested problem solving. TBI and MS patients who didn’t show problems on standard neuropsych tests showed problems across the board when using VR.
Testing showed subjects had the biggest problem with interruptions. The biggest stressor in the experience was a phone ringing in the background. Hearing an unanswered phone ring over and over really derailed people’s thoughts. Krch and Koenig used their data to come up with rehabilitation programs that also use VR, and then to write a grant proposal to fund new software that can improve problems with divided attention (multitasking) and set shifting (switching between tasks). Funding by the National Institute of Disability, Independent Living, and Rehabilitation Research led to 3 years of development work with clinicians and TBI patients, and the recent start of randomized clinical trials. Testing involves eight treatments conducted over 4 weeks. The 15 subjects are being tested before and after treatments to monitor progress. Krch began the trial the week before this interview, so she didn’t yet have data.
In this testing, Krch and Koenig’s VR office software has gotten an upgrade. Now the subject works at a corporation that makes a toy animal called the Wonderkin. While there’s plenty of usual office chores, such as sitting at a desk and making decisions about emails coming in, the toy animals add a little fun. One treatment module is set in a laboratory where subjects have to check whether or not toys are broken. Toy horses, goats, and pigs jump around, while subjects make sure they aren’t breaking. The idea in this and other modules is to create a game-like treatment where patients have fun while improving attention skills. As subjects improve, the difficulty rises.
Since this is a clinical treatment and not an evaluation tool, a clinician works with each subject to keep him or her on course. If the subject starts to feel overwhelmed by distractions, the clinician starts the patient on something simpler and helps the person build up.
Krch has a second grant-funded trial going, also continuing work started in Skip Rizzo’s USC–ICT lab. Funded through multiple Department of Defense studies, this treatment seeks to improve balance.
“The DOD has tremendous interest in finding treatments that help rehabilitate individuals with traumatic brain injuries,” Krch says. “As a matter of fact, now having been DOD funded and involved within the DOD system and learning about the DOD system, they actually fund a wide range of things from cerebral palsy research to cancer research to things that seemingly you wouldn’t think the military would care about. But the military serves not just the people who are serving directly, but their families.”
With many soldiers coming back from combat with concussions and TBIs, the DOD has funded a good deal of research in the area, especially studies that use tech simulations. Rizzo is also developing military-funded treatments for veterans, using VR to treat post-traumatic stress disorder.
Krch’s randomized clinical trials on balance use VR software displayed on a large wall-mounted monitor. An infrared beam detects the subject’s body and the screen shows an avatar in a virtual environment. Testing with active duty personnel is done at Fort Belvoir Community Hospital in Fort Belvoir, Va. Krch’s VR balance treatments don’t currently use headsets, but that’s changing. Patients are more prone to fall when wearing a headset, and the immersive experience can lead to “simulator sickness,” which is becoming less of a problem as VR hardware improves. Krch’s team is adapting a VR program called the Fruit Toss to headsets. In it, fruits fly at the test subject, who has to either catch or kick them. Krch hopes to have it completed by the end of the year. Her team is currently collecting data and feedback on immersive VR tests, which they’ll use as pilot data for an immersive technology grant proposal.
“Our lives are full of distractions. You’ve got a kid in one hand and you’re closing the door. You’re helping a child with homework and you’re cooking, or you are on the phone with your health insurance company and you’re balancing your checkbook. The demands of our lives constantly require us to switch our attention a lot and to do more than one thing at a time,” Krch says. And that’s true in the office, as well: “Most job scenarios nowadays expect you to be able to multitask and to do it in the presence of many, many distractors.” With help from treatments like those Krch is creating, TBI patients are able to return to the workforce sooner and MS patients are able to stay at their jobs longer. That means a better social environment and better quality of life.
The virtual reality environment might still feel like a game, but the results of Krch’s work are a better payoff than any high score.
[This article appears in the September 2017 issue of Streaming Media Magazine as “Virtual Reality, Real Medical Carea.”]