Posts Tagged Exposure Therapy
[Abstract] The influence of virtual reality on rehabilitation of upper limbs and gait after stroke: a systematic review – Full Text PDF
Stroke is the leading cause of functional disability in adults. Its neurovascular origin and injury location indicates the possible functional consequences. Virtual rehabilitation (VR) using patient’s motion control is a new technological tool for conventional rehabilitation, allowing patterns of movements in varied environments, involving the patient in therapy through the playful components offered by VR applications. The objective of this systematic review is to collect data regarding the influence promoted by VR in upper limb and hemiparetic gait. Full articles published between 2009 and 2015 in english were searched and selected in PubMed, Cochrane and Pedro databases. Eleven articles included (5 for VR and upper limbs; 4 for VR, gait and balance; and 2 for VR and neural mechanisms). The articles included demonstrate efficacy in VR treatment in hemiparetic patients in the variables analyzed.
POST WRITTEN BY Eran Orr. Eran Orr is the founder of XRHealth, the leader in extended reality and therapeutic applications.
Veterans returning home from war zones after serving in combat face a myriad of health concerns. Most of these concerns have to do with pain. A 2016 survey by the NIH found that 65.5% of U.S. military veterans said they have pain, and the pain is severe for 9.1% of the group surveyed. Whether it is reported in a vet’s back, neck, knees or shoulders, the pain usually persists. Chronic pain (pain that lasts for more than 12 weeks) affects many of the 20 million U.S. veterans.
And on too many occasions, it isn’t properly treated.
All of these difficult issues, including nonspecific physical complaints, such as fatigue, cognitive disturbances, memory or concentration problems, are tied together. Far too often, you’ll see these problems getting lumped into what’s known as post-traumatic stress disorder (PTSD). This is a serious psychological issue that garners its fair share of attention and sometimes unhelpful distortion from the news and entertainment media.
The question for far too many years has been: What can be done about it? How do we provide veterans with meaningful healthcare and rehabilitation that can help ease them back to their normal lives again? We’re learning that virtual reality (VR), delivered through technologically advanced headsets, can have an impact on the treatment of chronic pain and could become a powerful alternative to opioid interventions. Years ago, this was something that couldn’t have been imagined, but the same gear associated with video gaming and entertainment is indeed helping veterans with pain management, physical rehabilitation and the cognitive disorders associated with PTSD.
I am a cofounder and CEO of a company that in the last four years has sought to elevate the use of extended reality and therapeutic applications for healthcare. But it goes much deeper than that. As a military man in the Israeli Air Force, I toiled in the field of physical therapy with specific expertise in spinal cord damage prevention. I myself also experienced a long but successful injury rehabilitation process, which included VR as a means to heal. That experience convinced me that the use of virtual reality could change healthcare for the better.
What VR can provide and the reason it can be so effective for the patient is that it creates an immersive 360-degree world. Patients are guided through this virtual world with sophisticated software on virtual reality headsets, which provides a smooth and relaxing environment. The patient’s focus is redirected while being guided through a virtual world that provides a distraction from the pain or anxiety they are being treated for. Many patients get to the point where they are tricked into really believing they are in another reality.
A 2019 study with 120 participants looked at on-demand VR therapy compared to specialized “health and wellness” television programming for pain reduction in hospitalized patients. The results showed that VR was “significantly” better at reducing pain and was “most effective” as a remedy for severe pain. Today, VR is also being used as a vehicle for a treatment technique called exposure therapy. For example, one such program called Virtual Iraq immerses veterans from the Iraq war suffering from chronic PTSD in an environment that, according to Veterans Families United, produces “visuals of a war zone and … the other senses, sound, smell, touch that is experienced in a war zone.” The hope is that the everyday things that can trigger fear and panic become insignificant through virtual repetition and the reactions to the memory become disconnected from the memory itself.
An additional benefit of virtual reality is that when it is incorporated with artificial intelligence, it can be the basis of gaining comprehensive real-time data from the vet’s work with the headset. The data provides an opportunity for a therapist to adjust the program immediately if need be. The data can also be made available instantly to the patient and shared with other veterans. Despite recent advances, more attention and research will need to be applied to the treatment of veterans utilizing virtual reality. Market education is the toughest challenge right now. AR/VR platforms for therapeutic purposes are aimed at providing clinicians with an option to better manage their patients’ care via specialized extended reality technology solutions and data analysis. It is our job to educate the marketplace and continue to provide clinical evidence to the United States Food and Drug Administration (FDA) that the platform is worthy of designation as a medical device.
In the meantime, wider adoption of this tech by more healthcare organization leaders would help position VR as a routine treatment option. There are many companies out there, such as AppliedVR and BehaVR, that are also working toward the same health-related, therapeutic goals, especially in pain management. As an industry, we understand and can demonstrate how VR/AR therapy supports rehabilitation services, cognitive assessment and training, and pain management. Conversations with healthcare leaders about how it works and its enormous potential will need to continue so they can see this tech in operation.
Perhaps the tipping point for the adoption of VR therapy platforms will occur once it becomes designated as a medical device. When it happens, I believe you could eventually see VR headsets in every hospital, every nursing home and every healthcare facility in the next couple of years. More than any other subset of the population, military personnel are familiar with VR as used as a digital training tool for war exercises and other training. This familiarity is an ideal rationale for continued strategic advances in VR healthcare therapy and the development of VR medical devices, incorporating hardware and software that can be widely used to provide a significant variety of post-deployment treatment for veterans.
Virtual reality (VR) is used in various areas in hospitals such as medical treatment, the education of medical staffs and the enhancement of the convenience and safety of those who visit hospitals.
According to the medical world on November 21, VR is touching various medical fields such as medical education through virtual surgery, virtual rehabilitation treatment and the like. Especially, the field of mental health medicine is garnering much attention and an exposure treatment method which treats various phobias and addictions by using VR is already in a clinical utilization stage.
An exposure therapy is a behavioral therapy that develops emotional tolerance in a deliberate and painful situation for patients suffering from psychological distress that occurs in certain situations. VR is receiving much attention from medical staffs in that it allows precise control over a situation that doctors want to expose patients to. The field to which VR is most actively applied is posttraumatic stress disorder (PTSD). VR is actively used to treat patients suffering from the avoidance and re-experiencing of traumatic situations such as war or traffic accidents and anxiety about such situations.
Gil Hospital of Gachon University will establish the ‘Virtual Reality Therapy Center’ in January of next year and treat PTSD and panic disorder patients in earnest. In the future, the hospital is planning to expand VR treatment areas to mild cognitive impairment or attention deficit hyperactivity disorder (ADHD). “In order to treat PTSD and panic disorder, patients and therapists must go to sites which trigger PTSD and panic disorder or be exposed to stimuli that spark off stress but it is practically or physically impossible,” said professor Cho Seong-jin, a professor of mental health medicine in Gil Hospital. “VR can enable patients to reach a treatment stage by repeatedly giving stimuli in accordance with patients’ conditions.”
Sejong Hospital recently launched a VR application to let patients take a tour of examination rooms, wards, the checkup center and surgery center before visiting the hospital in person. ‘Cancer Hospital VR’ App was released by Samsung Seoul Hospital. The application guides patients about the hospital’s major facilities. VR can help patients reduce their anxiety and stress by taking a look at places where they will be treated and their medical procedures. Bundang Hospital of Seoul National University came up with the results of the application of a VR video for child patients. That is to say, the hospital developed a VR video that allows children close to undergoing surgery to experience surgical procedures with “Pororo” Character popular among kids in a VR world. So the hospital could reduce children’s anxiety before anesthesia 40% in actual surgery.
Gangnam Severance Hospital which has operated a virtual reality clinic since 2005 is developing technology to manage mental health via VR in cooperation with Samsung Electronics. The hospital and the IT giant will jointly develop diagnostic kits and chairs to analyze psychological states with VR devices, a VR mental health program including psychological evaluation, education and training processes, and an artificial intelligence diagnosis system among others with the goal of commercializing them next year.
People with obsessive-compulsive disorder (OCD) struggle to overcome their repetitious urges due to an inability to learn what kinds of stimuli are actually safe, new research suggests.
OCD is a disorder where people feel compelled to repeatedly perform certain tasks or think particular thoughts. These insistent routines are called ‘rituals’, and scientists think the behaviours persist because those with OCD struggle to learn when situations aren’t threatening.
“Our study suggests that something is going wrong in the brains of people with OCD when they are learning what is safe, and this in turn affects how they perceive threats under updated circumstances,” says neuroscientist Annemieke Apergis-Schoute from the University of Cambridge in the UK.
Apergis-Schoute and her team conducted a learning experiment where they compared the brain activity and anxiety responses of OCD patients with measurements taken from people without the condition.
OCD is estimated to affect around 1 percent of the adult population in the US, with the disorder compelling people to do things like repeatedly wash their hands, or check that doors are locked and appliances are switched off.
“They’re not usually off-the-wall bizarre,” one of the team, Naomi Fineberg from the Hertfordshire Partnership University NHS Foundation Trust in the UK told New Scientist.
“The obsessions are the sorts of things that most people would understand as being rational but exaggerated – for example, the need to wash your hands after going to the toilet.”
While these rituals aren’t necessarily harmful in themselves, they stem from intrusive and unwanted feelings that are usually associated with anxiety, and can have a considerable impact on carrying out day-to-day activities.
One of the ways of treating OCD is called exposure therapy, where people with the condition are made to confront the source of their anxiety – such as touching a dirty object – in an attempt to control their response.
But exposure therapy doesn’t work for every patient, and even in people who do learn to control their anxiety response, the effectiveness can be limited.
To find out why exposure therapy might only have limited success in treating OCD, the researchers recruited 78 people for a learning experiment – 43 of the volunteers had OCD, and 35 acted as a control group.
Each of the participants were asked to lie in a functional magnetic resonance imaging (fMRI) scanner, which measured their brain activity while they were shown one of two faces – a red face or a green face.
In the first experiment, the participants would receive a mild electric shock when shown the green face, but wouldn’t be shocked when viewing the red.
Sensors that measured tiny amounts of sweat produced by the participants showed that the group learned to associate anxiety with the green face (as a result of the electric shocks that came with it), but not with the red face.
But then the researchers swapped the green and red faces around, so that it was the red face that now came with an electric shock.
While the control group successfully learned the new associations – green is now safe, red is bad – the participants with OCD were less able to register that the green face no longer posed a threat.
Measurements of the participants’ brain activity when they were shown the now safe green face indicated that the OCD patients had less activity in the ventromedial prefrontal cortex – which is associated with processing safety signals in the brain, and decision making in relation to perceived risks.
According to the researchers, this could explain why people with OCD have difficulty overcoming their rituals, because their brains may find it significantly harder to unlearn negative associations, even when treatment such as exposure therapy attempts to directly counter them.
“This needs to be taken into consideration when we’re developing future therapies to tackle the disorder,” Apergis-Schoute explains in a press release.
“Current exposure therapies may help the patient take control over their compulsions, but our work suggests that they might never learn that their compulsions are unnecessary and they may return in times of stress.”
It’s worth pointing out that the researchers are drawing their conclusions from a very small sample of participants, so larger studies involving more patients affected by OCD will be needed to confirm the findings.
But if the results can be replicated, it could help explain some of the limitations of exposure therapy, and improve the delivery of the treatment in the future.
“The bit of their brain that should be telling them it’s safe isn’t working,” Fineberg explained to Clare Wilson at New Scientist.
“Now we can say to them this is why [exposure therapy is] taking so long and we should stick with it.”
The findings are reported in PNAS.
[ARTICLE] A Virtual Reality Exposure Therapy Application for Iraq War Military Personnel with Post Traumatic Stress Disorder: From Training to Toy to Treatment – Full Text PDF
Post Traumatic Stress Disorder is reported to be caused by traumatic events that are outside the range of usual human experiences including (but not limited to) military combat, violent personal assault, being kidnapped or taken hostage and terrorist attacks. Initial data suggests that 1 out of 6 Iraq War veterans are exhibiting symptoms of depression, anxiety and PTSD. Virtual Reality (VR) exposure treatment has been used in previous treatments of PTSD patients with reports of positive outcomes. The aim of the current paper is to specify the rationale, design and development of a Virtual Iraq PTSD VR application that has been created from the virtual assets that were initially developed for a combat tactical training simulation, which then served as the inspiration for the X-Box game entitled Full Spectrum Warrior.
In 1997, researchers at Georgia Tech released the first version of the Virtual Vietnam VR scenario for use as a graduated exposure therapy treatment for Post Traumatic Stress Disorder (PTSD) with Vietnam veterans. This occurred over 20 years following the end of the Vietnam War. During that interval, in spite of valiant efforts to develop and apply traditional psychotherapeutic approaches to PTSD, the progression of the disorder in some veterans severely impaired their functional abilities and quality of life, as well as that of their family members and friends. The tragic nature of this disorder also had significant ramifications for the U.S. Veteranes Administration healthcare delivery system often leading to designations of lifelong service connected disability status. In mid-2004, the first systematic study of mental health problems due to the Iraq conflict revealed that ?@The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent)T (Hoge et al., 2004). With this history in mind, the USC Institute for Creative Technologies (ICT) has initiated a project that is creating an immersive virtual environment system for the treatment of Iraq War veterans diagnosed with combat-related PTSD. This project has now been funded as part of a larger multi-year effort by the U.S. Office of Naval Research that brings together the technical, clinical and creative forces of ICT, Virtually Better, Inc. and the Virtual Reality Medical Center. The VR treatment environment is based on a cost effective approach to recycling virtual graphic assets that were initially built for a combat tactical simulation scenario entitled Full Spectrum Command, which later inspired the creation of the commercially successful X-Box game, Full Spectrum Warrior. This paper will present the vision, rationale, technical specifications, clinical interface design, and development status of the Full Spectrum PTSD treatment system that is currently in progress at the ICT.