Posts Tagged VR

[WEB SITE] ‘After, I feel ecstatic and emotional’: could virtual reality replace therapy? – The Guardian

If you’ve got acrophobia, paranoia, fear of flying, PTSD, even depression, software could soon be the solution

Virtual reality is the great hope for many mental health professionals.

 Illustration: Leonard Beard for the Guardian

Leslie Channell admits he’s not a typical case for treatment. Channell, known to everybody as Chann, is a registered pilot who served 24 years in the army working on Apache helicopters. Chann also happens to be scared of heights. He doesn’t mind flying planes or sitting on the side of the Apache with the door open; he’s just terrified of going up two or three floors of a building or driving over a bridge.

Chann is nervous; his speech is fast. He says he’s sweating. We meet at a trendy startup in Oxford, where he is about to undergo virtual-reality therapy for his phobia (although the term “virtual-reality” therapy is controversial: some say the VR is just a tool for the therapy; others argue that the virtual reality is the therapy itself). Psychologists are now trialling VR for all kinds of conditions, from phobias to pain management to post-traumatic stress disorder (PTSD).

There are two other people in the room. Cognitive-behavioural therapist Polly Haselton sits behind a curved computer screen watching Chann, occasionally asking questions. Daniel Freeman, professor of clinical psychology at the University of Oxford and one of the world’s pioneers in this field, watches Chann’s every movement. Freeman explains there are three common fears of heights: that you will fall; that what you are standing on will give way; or that you will jump, which is known as “the call of the void”. Chann’s fear is of falling.

A view of the virtual-reality therapy programme that guides patients through their fear of heights.

 The virtual reality therapy programme that guides patients through their fear of heights

A view of the virtual-reality therapy programme that guides patients through their fear of heights.

Photographs: Nowican/Oxford VR

He straps on his virtual-reality headset (also known as a head-mounted display, or HMD). Inside the headset, he will find himself fully immersed in a three-dimensional world. Today, he is going to level four of a 10-storey building in New York to rescue a kitten stranded on a branch of an indoor tree.

Chann has to use a lever to push himself on to a small platform towards the cat. He is a stocky, tough-looking man in his late 50s. But he’s not looking tough any more. His voice is rising, and he’s shaking. He edges forward along the virtual branch. In real life, his feet also move gingerly – then come to a sudden stop. His breathing becomes louder and more staccato.

“You’re doing really well,” Haselton says.

“You don’t know how difficult this is,” Chann pants. “Come here, cat.” Then he stops. “Nah, can’t get it. Aaaagh. No! Gotta come back.”

He starts again, cautiously edging forward. “Yes. Yes. Yes! No, stop Chann. Yes! Yes!” His yeses are urgent, desperate. He makes a grab for the kitten, and returns it to virtual safety.

Task complete. He takes his headset off, talking even faster. “My anxiety levels were way high. Super high.”

“We’re talking nine out of 10, 10 out of 10?” Freeman asks calmly.

“Yeah. I really didn’t want to be there. I had to think I was in a room in Oxford. ‘You’re not here, it’s all OK, do it.’”

Chann is one of a dozen people currently testing this software. (Next month, the trial is being extended to 100 people.) Already, he says, it has made a difference to his life. “Yesterday, I went on a rollercoaster with my daughter. I had never gone on one before. Not the big ones, the smaller ones, but still…” He’s spent only around 20 minutes in the virtual world today, but he is exhausted. “I was worried about coming here, and I’ve done it, and I’m buzzing. Elated.” He pauses, trying to catch his breath. “But I know in my heart of hearts, if there was a real cat on level four, I would not be going out and getting it. Polly asked me, what if it was a little baby? That would change the dynamics.”

Freeman has been working with VR for 16 years. What he loves about this therapy is its simplicity. “There are very few conditions VR can’t help,” he says, “because, in the end, every mental health problem is about dealing with a problem in the real world, and VR can produce that troubling situation for you. It gives you a chance to coach people in other ways of responding. The people I see are anxious or depressed, or worried about people attacking them, and what they’ve done in their life is retreat from the world. With VR, you can get people to try stuff they haven’t done for years – go in lifts, to shopping malls, then they realise they can do it out in the real world.”

Acrophobia, or the fear of heights, is just the start, Freeman says. He has already developed VR programs that treat people with paranoia – for example, placing them in virtual libraries, lifts or on tube trains with strangers eyeballing them. In a Medical Research Council-funded study, he used VR with 30 patients to help them re-learn that they are safe around other people.

“The results were remarkable. From just 30 minutes in VR, there were large reductions in paranoia. Immediately afterwards, more than half the patients no longer had severe paranoia. Importantly, the benefits transferred to the real world. It wasn’t a definitive study. It was small and short-term, but the results do show great potential.” The program will initially be used in NHS mental health services with a staff member present, but Freeman believes that, ultimately, it could be available commercially.

Nearly two million people sought advice for mental health issues in 2015, according to the Health and Social Care Information Centre – up from 1.2 million in 2010. Meanwhile, the number of mental health nurses fell by nearly 15% from 45,384 in 2010 to 38,774 in July 2016, according to a written parliamentary answer from Philip Dunne, the health minister. The British Medical Association recently revealed that in 2016-17, 5,876 adult patients with mental health conditions were referred to another health trust for treatment, with some patients being sent 600 miles away to Scotland. Against this backdrop, virtual reality is the great hope for many mental health professionals. Some psychologists believe they are on the brink of a VR revolution. Then again, they were saying the same thing a quarter of a century ago.

Barbara Rothbaum’s office in Atlanta, Georgia, is closed due to the impending arrival of Hurricane Irma. In between electricity cuts, I manage to speak to her at her home. Rothbaum is a professor in psychiatry, a clinical psychologist at Emory University, and the founding mother of exposure therapy using virtual reality. “We published the very first study using VR to treat a psychological and psychiatric disorder back in 1995,” she tells me. Again, it was to treat acrophobia, and the results amazed Rothbaum. “Seven out of 10 people who got the virtual reality reported putting themselves in real-life height situations afterwards.” That was when they thought they were on to something big. “We used to say: ‘We’re on the cutting edge of the lunatic fringe.’ That was our line at the time.” She laughs.

After acrophobia, Rothbaum developed a VR program for fear of flying. This was even more effective, because traditional exposure therapy (paying for yourself and a therapist to travel on a plane) is time-consuming and expensive. “I can do all that in my 45- to 50-minute therapy session, with ultimate control. So if I know they’re not ready for turbulence, I can guarantee there won’t be turbulence.”

Rothbaum then went on to do pioneering work with Iraq and Afghanistan war veterans suffering from PTSD. Before VR, veterans were confined to imaginal therapy – basically, shutting your eyes and thinking yourself back to the original situation. But now Rothbaum could recreate it for them in a controlled environment. “With PTSD, especially in military folk, they are very avoidant emotionally. With VR, it’s harder to avoid, because it is such a potent stimulus.”

Early on in her VR career, a public-private partnership between Emory University and the Georgia Institute of Technology insisted Rothbaum and her colleagues form a corporation and patent their software. The result was a company, Virtually Better, that designs environments for fellow clinicians to use. “That is my conflict of interest,” Rothbaum says. Whoever she speaks to, she instantly declares it. Does it worry her that she is responsible for the research showing how effective her own VR products are? “It has done, over the years,” she says. “One of the ways I manage it is, I disclose, disclose, disclose.”

Rothbaum is not alone. VR therapy is a small, niche world. Read the scientific papers, and the same names crop up again and again. And most of these academics are now also running commercial companies. As traditional funds dry up for universities, people such as Rothbaum are increasingly reliant on business – often their own business – for support in their research.

As it happens, Rothbaum says, she lacked the cut-throat instincts to be a good businesswoman. “A criticism of Virtually Better was that it was run more like an academic department than a business. We knew how to write grants so we’d write small business grants and enjoy collaborating rather than competing. I thought it was an interesting way to do exposure therapy and wasn’t very mercenary about it.”

Has she ever used VR to treat her own fears? “No. My fear early on was that somebody was going to make a lot of money, and it wasn’t going to be us. Actually, that is probably still going to come true. But I’ve adapted to that; it’s all right.” She’s still not rich? “Oh no, not by a long shot, no.”

Despite research showing its efficacy, the VR therapy revolution did not take off in the 1990s or the noughties. This time around, though, it looks as if it might. Mel Slater, a professor of virtual environments, shows me why. We meet in the London HQ of Digital Catapult, a government initiative to promote the digital economy. Slater hands me the headset used in the virtual psychotherapy sessions he is developing. “The VR world burst open in 2013 when this Oculus Rift was released for a few hundred dollars, compared with the next credible headset of $50,000, and now all the big companies have gone into it.”

Slater talks quietly and, facially, has a touch of Woody Allen about him. Although primarily a computer scientist, he is now largely based in the psychology faculty at the University of Barcelona. Slater is one of the most-in-demand academics in the virtual world, with an endless list of titles, including professor of virtual environments at University College London, co-founder of the company Virtual Bodyworks, and immersive fellow at Digital Catapult. He also works with Daniel Freeman on treatments for persecutory delusions and acrophobia.

Like Rothbaum, Slater is one of the early 1990s pioneers. “Nobody told me virtual reality died, so I stayed with it.” He smiles.

And had it died? “No, but for a long time people said, ‘It’s not going anywhere because it’s too expensive.’ The equipment we used at UCL cost £1m. The equipment I have in Barcelona, when I set up there 10 years ago, was £100,000. Now I can do the same thing with £3,000.”

Slater says the human reaction still surprises him. “There is some level of the brain that doesn’t distinguish between reality and virtual reality. A typical example is, you see a precipice and you jump back and your heart starts racing. You react very fast because it’s the safe thing for the brain to do. All your autonomic system starts functioning, you get a very strong level of arousal, then you go, ‘I know it’s not real’. But it doesn’t matter, because you still can’t step forward near that precipice.”

Virtual reality therapy session

Simon Hattenstone explains his problems to Sigmund Freud…

Virtual reality therapy session

 …then analyses himself as Freud. Photographs: Event Lab, University of Barcelona, Spain

In some ways, he says, virtual reality beats reality because it enables you to experiment in ways you can’t, physically, in real life (for example, putting people in different bodies to experience what it is like to be a different gender or ethnicity) or in situations you would avoid.

“I was in one session where the guy had such a fear of public speaking that he told us about speaking at his daughter’s wedding, and we said, ‘How old is your daughter?’ and he said, ‘Three!’ So he spoke to a virtual audience. He said: ‘I can’t do this, I’m turning bright red, my voice is an octave higher.’ The psychologist later played it back to him and said: ‘Is your face red? No. Are you speaking an octave higher than normal? No.’ The psychologist did in one afternoon what would normally take 12 weeks.”

I have seen headlines suggesting that VR can cure depression. Surely that is an exaggeration? “Cure, I don’t know,” Slater says. “But we published a study last year where we reduced the level of depression among a cohort of people through a VR intervention not that dissimilar from what I’m going to show you today. Part of having depression is that you are overly self-critical and cannot give compassionate thoughts to yourself. So in the VR, you see a crying child. Beforehand, the therapist has given you a structure of things you should say to other people in order to give them compassion. So you say these things to the child who starts looking at you and stops crying. Then, in the next phase, you are that child, so you then see and hear your previous self giving you the compassionate speech. When we gave this to a group of moderately depressed people three times, the level of depression decreased.”

I put on my headset and sit in front of a screen. The program I’m trying, called VReflect-Me, is still being developed for people with anxiety issues and depression. It is based on the notion that, when advising friends, we are often kinder and more objective than when analysing ourselves.

First of all, an avatar is created of me. Then I embody that avatar. I am in a therapy session with a psychiatrist (in this case, Sigmund Freud) and I tell him my problems. In the next stage, I embody Freud. When my head moves, Freud’s head moves; when my hands move, his move; and when I’m ready, I advise myself in the form of Freud. (Slater says that Freud is a useful avatar, because you tend to adopt characteristics of your avatar; so, if he is wise, you become more wise.)

I tell Freud I have paranoid tendencies; generally, I think I’m incredibly boring with nothing to say and hate formal social situations (not the pub), because I fear my stupidity will be exposed. More specifically, I tell Freud, I have just read comments on social media about an interview I just wrote saying that I gave my subject an easy ride. I am full of self-loathing, and feel useless at my job.

Now I switch roles, and am Freud advising me. The first time I do it, I’m too self-conscious. Slater gently suggests that I was not fully immersed. I ask if I can do it again. This time, I go for it. It might not be the way Freud would have responded, but I listen to my problems and then tear into myself – rightly or wrongly, I make a good case for not being boring, stupid and a rubbish journalist. I verbalise everything and dismiss it as solipsistic nonsense. I then return to my own avatar. “Good points. Well made,” I say to Freud. And I mean it.

When I take off my headset and leave the virtual world, my breathing is fast and shallow – not unlike Chann’s after he’d been to the heights. I feel both ecstatic and emotional. Tearful, almost. Even if it doesn’t last, it’s been a useful exercise. I might say this kind of stuff to myself in my head, but it feels different when you say it out loud.

Slater is pleased with me. “Wow! You did amazing. You said, ‘You, you, you!’ which is great.” What he means is, I successfully got out of my head and into Freud’s. It strikes me as a powerful tool for therapists. There is no way I would have said what I said, as Freud, if I was simply talking to a real person.

But I can’t help thinking I’m a relatively safe case. What if I were more vulnerable? What, for example, if I suffered from the acrophobic’s call of the void, did the VR program, convinced myself I’d overcome my phobia, went to the nearest high-rise and jumped?

Dr Kate Anthony, an expert on the use of technology in therapy and a fellow of the British Association for Counselling & Psychotherapy, stresses that technology is there to be used alongside therapy, rather than instead of. “VR is a good opportunity for helping psychotherapists,” she says, “but we’re not at a stage yet where virtual reality is going to be able to replicate a human therapist.”

It’s all very well, she adds, having software to encourage you to talk and tackle your fears, but that will take you only so far. “The VR therapist can’t respond in any meaningful way, and without that meaningful response, I don’t think the client is going to progress.”

Once VR treatments have been proven to be effective, she says, she would like to see them available on prescription. What about making them commercially available? No, she says, it’s too risky. “If we’re talking about paranoia, for example, any of these situations can trigger the client. The trouble with something like that is it could bring up all sorts of issues. I would want to see it closely managed.”

Dr Michael Madary, a philosopher and technology ethicist, and his colleague Thomas Metzinger, have drawn up a code of conduct for the use of VR, some of which addresses its use in therapy. He thinks VR can have a positive impact, but that therapists must not blind themselves to the dangers. One particularly sensitive issue, Madary says, is data. Participants in studies know their data is confidential, but that could be very different if commercial companies invest in VR therapy purely for profit. “With motion tracking, particularly facial tracking, users are going to reveal a lot about themselves – about their mental state, about how they react to various stimuli – and that data can be collected and then used as a powerful bargaining tool.”

He envisages a scenario where there is an advertisement flashed, or product placed, in the virtual world and the content creators collect the response of users to that ad based on the faces they make. “You can imagine seeing your avatar in a new jacket, for example. There will be a lot of powerful techniques that emerge in marketing, with widespread use of motion capture.”

Mel Slater accepts that virtual reality can be abused. But anything can, he says. “You can use a bread knife to cut bread or to stab someone, so any tool can be misused deliberately. This is why I think the applications in clinical psychology have to be led by people such as Daniel, who know the risks.”

Back in Oxford, Daniel Freeman is not so sure the programs need his presence to be effective. He is talking about his company Nowican, and anticipating the launch of its first product – Nowican Do Heights, the acrophobia program being trialled by Chann.

He hopes that the NHS and individual psychologists will invest in it, but believes its prime use will be for individuals seeking help. “We’re putting a virtual coach in there so you don’t need a therapist, and we’re also looking at better techniques than simple exposure.”

Is he in danger of doing himself out of a job? “No. We’re not saying it has to replace the therapist. Some people will want to talk to a therapist, and sometimes the complexity means you need a therapist. But the issue is, there aren’t enough therapists.” Freeman is hoping that, before long, we will be able to download this as an app on our smartphones.

In a world of diminishing NHS resources, Freeman regards it as a no-brainer: “I see people who have been waiting 20 years and not had a chance of seeing a therapist. The idea that we can give so many people the chance to access what the best therapists should be doing – that is really exciting.”

  • Watch the Guardian’s latest VR experience The Party, filmed from the perspective of a 16-year-old girl with autism, on our new Guardian VR app. You can download it from the Apple App Store and the Google Play Store, or watch it as a 360 video, along with other Guardian VR experiences, at

via ‘After, I feel ecstatic and emotional’: could virtual reality replace therapy? | Technology | The Guardian


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[WEB SITE] Virtual Reality Tech Tackles Post-Stroke Effects No Worse Than Physiotherapy.

Travel journalists watch a virtual reality presentation given by United Airlines as part of their new international business class dubbed United Polaris in New York, U.S. June 2, 2016

Virtual reality (VR) training is no less effective than conventional physiotherapy during post-stroke rehabilitation, a new report in Neurology magazine states.

German researchers led by Iris Brunner from Bergen University in Norway tested two methodologies as a total of 120 patients underwent post-stroke rehabilitation, comprising a minimum of 16 60-minute sessions over four weeks. The patients with an equal degree of paresis were divided into two groups, 60 in each, to perform either traditional training, or one involving use of VR technologies.

​The study provides sufficient evidence that for patients with upper extremity motor impairment, VR training and physiotherapy contributed equally to upper extremity function improvement, which was estimated at about 21 percent promptly after the training sessions. However, the former also allows doctors to adjust by hand the intensity of the VR training depending on the severity of paresis. Three months after the rehabilitation program, patients could boast of having boosted their motor functions by a staggering 30 percent.

“The results found that additional upper extremity VR training was not superior but equally as effective as additional conventional training (CT) in the subacute phase following a stroke,” the Neurology abstract reads.
VR technologies have long been used for purposes other than entertainment. For instance, VR glasses imitating social interactions are being employed to help cure such medical conditions as paranoia, depression and have even helped eradicate the fear of death in some cases.

via Virtual Reality Tech Tackles Post-Stroke Effects No Worse Than Physiotherapy – Sputnik International

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[WEB SITE] O&P’s Virtual Present and Future.


Virtual reality is a potentially important tool in patient rehabilitation and training, as well as prosthetic design.

O&P News, December 2017

Despite technological advances in prosthetics, a major problem within the O&P profession remains that a large percentage of amputees still abandon or reject their prosthesis due to lack or training or knowledge of their device, according to Ashley D. Knight, PhD.

A biomedical engineer research associate at the Center for Assistive, Rehabilitation and Robotics Technologies at the University of South Florida, Knight told O&P Newsthat untrained amputees will adjust their bodies in awkward or compensatory motions rather than reposition a joint position while performing a task with a prosthetic device. This causes misuse and improper function, which has been shown to lead to significant injuries.


However, according to Knight, one possible way to address this is by incorporating virtual reality into rehabilitation and prosthesis training.

“A successful training and rehabilitation program would allow amputees to improve their ability to perform with optimal motion and use all prosthetic control capabilities,” Knight said. “Using virtual reality for training and rehabilitation could allow for a successful controlled, individualized, progressive regime, while providing expertise care to patients both in a clinic and at home.”

Jeff Erenstone, CPO, founder and CEO of Create O&P, uses modification software in virtual reality to make digital plaster models.

Jeff Erenstone, CPO, founder and CEO of Create O&P, uses modification software in virtual reality to make digital plaster models.
Source: Gary Ziele/Create O&P.

Advanced stick figures

According to Knight, whose dissertation, “The Development of a Platform Interface with the Use of Virtual Reality to Enhance,” investigated the use of virtual reality in prosthetic training, the advantage of using virtual reality in O&P is that it allows for instant visual feedback, expertise training and motivational, immersive applications.

Knight’s dissertation, which was published in 2017 by ProQuest LLC, described the development of a “stick figure” model of the user’s motion in real-time and a character avatar animating certain motions that the patient can follow while performing rehabilitative and training tasks. Among the five participants who were unilateral transradial amputees using their own prosthetic devices, all showed improved positing, movement symmetry, joint range of motion, motivation and overall improved performance after using the virtual reality program.

“Virtual reality could allow patients to be immersed into a virtual environment while provided real-time visual feedback of their instantaneous motion, alongside an individualized predictive optimal goal motion to follow,” Knight said.

Virtually ‘endless’ advantages

Michael Wininger, PhD

Michael Wininger

According to Michael Wininger, PhD, an assistant professor of prosthetics and orthotics at the University of Hartford department of rehabilitation sciences, the potential advantages of virtual reality are endless.

“In virtual reality, you can create any setting, any environment and customize it to the patient,” he told O&P News. “You can have it be really sensitive to their specific needs, and the program can run anytime, day or night. You don’t have to feed it, and you don’t have to pay it. It’s always ready to be turned on, and it doesn’t have bad days.

Virtual reality, as well as augmented reality, has become more popular in teaching and clinical settings in the last 15 years, Wininger said. He added that researchers have found that rehabilitation and training with virtual reality can result in improved outcomes for patients compared to the current training and rehabilitation paradigm.

This has been recognized in the past with regard to stroke rehabilitation. However, it has more recently been implemented in O&P settings, he said.


“If you have someone who has a stroke and they can’t use their affected limb well and you present them with a conventional clinical test, it’s up to the clinician to get as much as they can from the patient,” he said. “However, with virtual reality, the clinician can encourage the patient to engage with the virtual environment — they want to grab a ball or score a point, and it becomes more satisfying. People are inherently interested in playing games and getting the high score.”

An amputee performs a rehabilitative training task on the Computer Assisted Rehabilitation Environment system at the Center for Assistive Rehabilitation and Robotics Technology Lab at the University of South Florida, with the optimal model shown on the right as the character avatar and the real-time model shown on the left as the white stick figure.
Source: Ashley D. Knight/Center for Assistive Rehabilitation and Robotics Technology Lab, University of South Florida.


Using virtual reality, patients can see themselves in a brand-new space, with the room transformed around them into something exotic or engaging, Wininger said. Such immersive environments can in turn help the patient become more interested in training. According to Wininger, if clinicians can convince patients to complete a task when they are inside the clinic or when they are in a virtual training environment, they are more likely to be able to accomplish that same task once they have left the clinic or that training environment.

“The old adage is, ‘If you don’t use it, you lose it,’” Wininger said. “It’s about developing skills in a setting that they can translate into actual activities in their daily living. If they don’t practice it, then they are never going to use it in the real world.”


Virtual reality can also make rehabilitation more accessible for patients.

As an example, Wininger pointed to the Nintendo video game Pokémon Go, which uses augmented reality to allow players to “catch” monsters that appear to populate the real world. According to Wininger, the game shows that children, teens and young adults are open to such virtual or augmented experiences, and could be more willing to use similar technologies in rehabilitation and prosthetic training.

“Kids know this stuff and they want this stuff,” he said. “It also makes it more accessible because they can just bring it home. You don’t have to schlep all this equipment to the clinic on a snowy day. You can just turn on your virtual reality system and do it at home — and they should, because research shows that regular exposure to your training program improves your outcomes. Doing it multiple times a week is not effective, but multiple times a day will improve outcomes.”

Clinicians and their young patients stand to gain tremendously if they can find a way to incorporate virtual gaming into their prosthetic rehabilitation program, Wininger added, as it could boost participation.


“Suddenly you have people who could not play games, playing games,” he said. “It could make an inroad for them.”

Virtual design, digital fabrication

In June 2017, 3-D printer supplier Create O&P, announced the development of a new software platform that uses virtual reality and 3-D printing to allow clinicians to design, print and test fit a prosthesis in less than 3 hours.

Clinicians who use the system are able to scan a patient and upload the image to a smartphone. Then, using a virtual reality headset, they can modify a digital mold by hand in the virtual world, the company said. The clinician can design a test socket around the digital mold and send it to a 3-D printer for fabrication.

Jeff Erenstone

According to Jeff Erenstone, CPO, founder and CEO of Create O&P, the company uses the Google Daydream, a virtual reality headset that interfaces with the user’s smartphone. The headset can cost as little as $60. Unlike other virtual reality systems that require large amounts of computing power, the Daydream uses a smartphone, which has the additional benefit of increasing mobility, Erenstone said.

“It’s used for the modifications on the amputee’s limb, making digital plaster models,” he said. “Usually in O&P, you would take a cast, make a plaster model from that, modify the shape to get the right clinical set to make the socket and get the right prosthetic leg or arms. In our office, we are doing, from start to finish, check sockets in 3 hours consistently, and that involves 15 minutes on a computer, the printer prints it in about 2.5 hours, and then there is 10 minutes of post processing. Aside from that 15 minutes on the computer, it’s a completely hands-free process, so no technician is running around to get that done.”

According to Erenstone, that represents a huge gain in man-power efficiency, both in terms of the practitioner and the technician. The technician can then focus on more complex things “instead of just pouring plaster,” he added.

However, even with its advantages, the transition to virtual reality can be awkward for technicians who are used to working with solid objects. For that reason, Erenstone, who is also the owner and head clinician of Mountain Orthotics and Prosthetics, said his companies use touch screens along with the virtual reality technology, to simulate a certain degree of “pushback.”


“It’s weird — you don’t get the haptic feedback,” he said. “That’s why we’ve been using the touch screen technology, so you can feel your fingers pushing back on something. Meanwhile, with virtual reality, you are sort of just waving your hands in the air. Adding haptic feedback would be huge, so you could actually push back against something.”

According to Erenstone, the hardest part of convincing clinicians and technicians to use the software is the idea of no longer working with one’s hands and performing the physical manipulation of a plaster model.

“So, we’ve been working on intuitive ways to transfer the skillset they already have and have them be able to, without a big paradigm shift, use this digital technology,” he added.

Current limits

Despite its promise, virtual reality, as the technology currently stands, is not without drawbacks.

According to Erenstone, the lack of a haptic response is one of them.

“There is still kind of a software lag, where it’s not as efficient as we need to be yet, but that is just the virtual reality aspect of it,” Erenstone said. “However, in 6 months that issue may be resolved, based on the way technology moves. In the past, you would need an $800 virtual reality system and need to plug it into something with serious computing power to access these systems. Now, it can be cellphone based, and browser based and now they are writing programs that can build on that.”

According to Knight, there is limited knowledge of virtual reality currently in O&P, which could result in insufficient training.

“There are a limited number of specialists and expertise in the field, especially when considering upperextremity prostheses, resulting in amputees not having sufficient training with their device,” Knight said.

Another issue with the current state of virtual reality technology is that it is not known exactly how to design and interface with the program with the highest efficiency. According to Wininger, the best virtual reality systems available today still require supervision by humans, even as it adapts to the patient’s needs.

“The problem is that the intelligence for these software packages is not where we need it to be yet, so it still requires a lot of management,” Wininger said. “And if you present something to a patient that is suboptimal, they may get discouraged and throw it away and decide not to use it. That way, you have lost on your investment, and virtual reality is currently not cheap.”

According to Wininger, the most significant issue with virtual reality is that developers still do not yet know exactly how to design or harness virtual reality for maximum efficacy.


“Therefore, there are less opportunities to improve our game there,” he said. “I would say that, in 10 years, the statisticians will have caught up to software designers to address this issue, but we’re not there yet.”

Future, fun and games

According to Wininger, the true driver of virtual reality technology is currently the gaming market, due to its deep pockets and active development scene. However, he foresees O&P “catching up to gaming” in the coming years.

“In the short-term, we will eventually see a situation in which innovations in virtual reality that come out in the gaming world will soon after become available for use in O&P,” Wininger said. “After that, anything that the gaming folks come up with, we in O&P can then use, and then we can work in lockstep with them. We’re almost there now.”

In rare instances, Wininger said O&P could develop technologies that could eventually be appropriated by the gaming industry.

“Prosthetics is all about controlling one thing with something else,” he said. “I can see some applications where gamers may be interested in taking prosthetic systems and even using them in a game.”

According to Knight, the future of virtual reality in O&P should include small-scale, adaptable options for rehabilitation practitioners. She added that widespread at-home use could successfully provide effective training and rehabilitative care to patients.

Virtual reality technology also has the potential to affect the future of the developing world, according to Erenstone. The continued development of mobile-based virtual reality will help residents and researchers in developing countries to more easily take advantage of the technology, he added.

“In the United States, we can buy a laptop with a touchscreen, but in the developing world, that is a specialty device and another piece of hardware they have to buy,” he said. “Meanwhile, everyone has a cellphone. I’ve been to Haiti, Nepal and India, and everyone has a cellphone, partly because they don’t have the infrastructure for landlines. We would be using the technology that they already have.” – by Jason Laday

Disclosures: Erenstone reports employment with Create O&P and Mountain Orthotics and Prosthetics. Knight and Wininger report no relevant financial disclosures

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via O&P’s Virtual Present and Future


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[WEB SITE] VR could trick stroke victims’ brains toward recovery.

Could virtual reality help stroke survivors regain motor function?

That’s a question Sook-Lei Liew is looking to answer.

Liew, an assistant professor at the University of Southern California and an affiliate of the Stevens Neuroimaging and Informatics Institute at the Keck School of Medicine, was inspired by research from Mel Slater and Jeremy Bailenson on embodiment in VR. If someone’s given a child’s body in VR, for example, they might start exhibiting more childlike behavior.

She wondered if giving stroke survivors with motor impairments a virtual avatar that moves properly could help promote brain plasticity (or the ability to change) and recovery. Maybe it would eventually lead to them to moving an impaired limb again.


USC researcher Sook-Lei Liew and her partners are testing to see whether virtual reality could help with stroke rehab. Nate Jense

“So, kind of like tricking the brain through visual input,” said Liew, who is also director of the Neural Plasticity and Neurorehabilitation Laboratory. “There’s a lot of emerging evidence from neuroscience and psychology that was showing that you can really identify [with the avatar], and it changes your behavior based on the avatar you’re given in VR.”

Virtual reality is a computer-generated simulation of a 3D environment. Using a VR headset with lenses that feed images to the eyes, a person can be virtually transported to another location, or interact with a setting in a seemingly realistic way. It’s commonly been used in gaming, but it’s being tested in other environments, too — like rehab.

Implementing VR in health care and patient treatment isn’t new. It’s been used to help people overcome phobias and anxiety disorders. But the application is starting to take off now that the technology is more developed and commercially available. Some medical schools are looking to train students with virtual simulations, and it’s even helping midwives learn how to deliver babies.

Liew’s research team has been working on a study for about two years called REINVENT, an acronym for Rehabilitation Environment using the Integration of Neuromuscular-based Virtual Enhancements for Neural Training. The researchers also collaborated with the USC Institute for Creative Technologies to develop the prototype.

The process works by using a brain-computer interface, which takes a signal from the brain and uses it to control another device: a computer, a robot or, in REINVENT’s case, an avatar in VR.

Next, researchers read electrical signatures of brain activity from the surface of the scalp using electroencephalography, or EEG, for short. The team also uses electromyography, which studies the electrical activity of the muscles. That can tell them whether somebody’s moving or if they’re trying to move.

Those signals are then fed into a program on a laptop. The program has thresholds so that when specific signals in the brain or muscle activity that correspond to an attempt to move are detected, they drive the movement of a virtual arm. The resulting visual feedback through a VR headset could help strengthen neural pathways from the damaged motor cortex to the impaired arm or limb.

While the researchers could theoretically extend this process to a patient’s lower limbs, Liew said it can be dangerous for someone with a motor impairment in the lower extremities to try to move with VR, so seated studies are much safer.

The research group recently finished testing the prototype using an Oculus DK2 with 22 healthy older adults, who provided a sample of what the brain and muscle signals look like when they move. They’re now starting to test with stroke patients in a controlled lab setting, aiming to work with 10 in the short term and hundreds in the long term, in both clinical and home environments.

The team also found that giving people neurofeedback of the virtual arm moving in a VR headset was more effective than simply showing it on a screen.

“Their brain activity in the motor regions that we’re trying to target is higher, and they’re able to control the brain-computer interface a little bit better and faster,” Liew said. “It makes the case that there is an added benefit from doing this in virtual reality, which is one of the first things we wanted to know.”

An unclear future

Because VR is still a relatively new technology, there are many unanswered questions on the best ways to use it in the medical profession.

“For the most part, nobody knows how to make great VR experiences, for business or consumer,” Gartner analyst Brian Blau said. “Over time, those issues will get resolved. But for the medical industry, they have the extra added bonus of having even more types of physical behaviors that they have to either mimic or want to measure.”

And while the possibilities for VR in health care are exciting, Liew is careful not to get ahead of herself.

“We think that VR is a promising medium, but we’re moving ahead cautiously,” she said. “A lot of the work that we’re trying to do is to test assumptions, because there’s a lot of excitement about VR, but there’s not that much that’s scientifically known.”

Only time — and plenty of research — will tell.

Tech Enabled: CNET chronicles tech’s role in providing new kinds of accessibility.

The Smartest Stuff: Innovators are thinking up new ways to make you, and the things around you, smarter.

via VR could trick stroke victims’ brains toward –

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[WEB SITE] Virtual Reality As Effective As Standard Training for Post-Stroke Rehabilitation.

Improvements were similar in subgroup analysis of mild to moderate vs severe upper extremity paresis.

Improvements were similar in subgroup analysis of mild to moderate vs severe upper extremity paresis

HealthDay News — Virtual reality (VR) training is as effective as conventional training for upper extremity rehabilitation after stroke, according to a study published online in Neurology.

Iris Brunner, PhD, from the University of Bergen in Norway, and colleagues randomized 120 patients with upper extremity motor impairment within 12 weeks after stroke to receive VR or CT as an adjunct to standard rehabilitation. Participants underwent at least 16 60-minute training sessions over a 4-week period.

The researchers found that there were no between-group differences for any of the outcome measures. Improvement of upper extremity motor function assessed with the Action Research Arm Test was similar between the groups at the post-intervention (=.714) and follow-up (=.777) assessments.

Improvements were seen in patients from both groups from baseline to the post-intervention assessment and from baseline to follow-up. Improvements were similar in subgroup analysis of mild to moderate vs severe upper extremity paresis.

“Additional upper extremity VR training was not superior but equally as effective as additional CT in the subacute phase after stroke. VR may constitute a motivating training alternative as a supplement to standard rehabilitation,” concluded the authors.


Brunner I, Skouen JS, Hofstad H, et al. Virtual reality training for upper extremity in subacute stroke (VIRTUES): a multicenter RCT [published online November 15, 2017]. Neurology. doi:10.1212/WNL.0000000000004744

via Virtual Reality As Effective As Standard Training for Post-Stroke Rehabilitation

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[Abstract] Virtual reality for stroke rehabilitation. – Cochrane Review



Virtual reality and interactive video gaming have emerged as recent treatment approaches in stroke rehabilitation with commercial gaming consoles in particular, being rapidly adopted in clinical settings. This is an update of a Cochrane Review published first in 2011 and then again in 2015.


Primary objective: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on upper limb function and activity.Secondary objectives: to determine the efficacy of virtual reality compared with an alternative intervention or no intervention on: gait and balance, global motor function, cognitive function, activity limitation, participation restriction, quality of life, and adverse events.


We searched the Cochrane Stroke Group Trials Register (April 2017), CENTRAL, MEDLINE, Embase, and seven additional databases. We also searched trials registries and reference lists.


Randomised and quasi-randomised trials of virtual reality (“an advanced form of human-computer interface that allows the user to ‘interact’ with and become ‘immersed’ in a computer-generated environment in a naturalistic fashion”) in adults after stroke. The primary outcome of interest was upper limb function and activity. Secondary outcomes included gait and balance and global motor function.


Two review authors independently selected trials based on pre-defined inclusion criteria, extracted data, and assessed risk of bias. A third review author moderated disagreements when required. The review authors contacted investigators to obtain missing information.


We included 72 trials that involved 2470 participants. This review includes 35 new studies in addition to the studies included in the previous version of this review. Study sample sizes were generally small and interventions varied in terms of both the goals of treatment and the virtual reality devices used. The risk of bias present in many studies was unclear due to poor reporting. Thus, while there are a large number of randomised controlled trials, the evidence remains mostly low quality when rated using the GRADE system. Control groups usually received no intervention or therapy based on a standard-care approach.


results were not statistically significant for upper limb function (standardised mean difference (SMD) 0.07, 95% confidence intervals (CI) -0.05 to 0.20, 22 studies, 1038 participants, low-quality evidence) when comparing virtual reality to conventional therapy. However, when virtual reality was used in addition to usual care (providing a higher dose of therapy for those in the intervention group) there was a statistically significant difference between groups (SMD 0.49, 0.21 to 0.77, 10 studies, 210 participants, low-quality evidence).


when compared to conventional therapy approaches there were no statistically significant effects for gait speed or balance. Results were statistically significant for the activities of daily living (ADL) outcome (SMD 0.25, 95% CI 0.06 to 0.43, 10 studies, 466 participants, moderate-quality evidence); however, we were unable to pool results for cognitive function, participation restriction, or quality of life. Twenty-three studies reported that they monitored for adverse events; across these studies there were few adverse events and those reported were relatively mild.


We found evidence that the use of virtual reality and interactive video gaming was not more beneficial than conventional therapy approaches in improving upper limb function. Virtual reality may be beneficial in improving upper limb function and activities of daily living function when used as an adjunct to usual care (to increase overall therapy time). There was insufficient evidence to reach conclusions about the effect of virtual reality and interactive video gaming on gait speed, balance, participation, or quality of life. This review found that time since onset of stroke, severity of impairment, and the type of device (commercial or customised) were not strong influencers of outcome. There was a trend suggesting that higher dose (more than 15 hours of total intervention) was preferable as were customised virtual reality programs; however, these findings were not statistically significant.


via Virtual reality for stroke rehabilitation. – PubMed – NCBI

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[WEB SITE] Beyond VR Games – VR Techs Applied to Medical Treatment such Psychotherapy, Mock Surgery

The field to which VR is most actively applied is posttraumatic stress disorder (PTSD).

The field to which VR is most actively applied is posttraumatic stress disorder (PTSD).

Seoul, Korea – 22 November 2017 – 9:45am –Choi Mun-hee

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.


via Beyond VR Games: VR Techs Applied to Medical Treatment such Psychotherapy, Mock Surgery | BusinessKorea

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[WEB SITE] How VR Helps Seniors and People With Disabilities Improve Their Health and Happiness

Credit to: NPR

With seniors over the age of 65 making up 617 million people worldwide and 15% of all people (over a billion) being disabled, health and happiness is an important concept that affects everyone.

News flash — we’re all human, everyone ages, many people are already disabled or will become disabled at some point in their life, and most people want to feel happy and healthy in their lives.

Not Enough Exercise

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Exercising for at least 30 minutes a day is linked to better physical and emotional health. With a third of adults aged 50 and up and 47% of people with disabilities ages 18 to 64 not getting enough exercise, there has to be something to get them moving and enjoying life to the fullest.

Seniors and people with disabilities are sometimes limited to what exercises they can do. Adaptive equipment like a wheelchair, walker, or cane are supposed to improve mobility but can become a hindrance to exercise for many. People with physical limitations may not even be able to stand, walk, or leave their bed due to medical reasons.

Credit to: CBS

So what’s the solution? How do we get seniors and people who are disabled more access to activity and increase their wellbeing? The answer is virtual reality. VR allows anyone to put on a headset, pick a game that’s standing or sitting, and enjoy the combined benefits of physical and mental activity.

VR Cardio

Getting cardio doesn’t have to mean going for a run or jog anymore, you can still get a workout and reap all the heart-healthy benefits from playing a VR game.

Credit to: Rec Room via Against Gravity

Rec Room is best played with a group of people because you’ll be playing games like paintball. The game won’t be too intense, you’re free to sit or stand while playing, and it will feel like the exercise equivalent to walking.

Credit to: Music Inside: A VR Rhythm Game via Reality Reflection

There’s also a faster paced drumming VR game called Music Inside: A VR Rhythm Game that can be played standing or sitting as you use your upper body to hit the drum to the beat and your core and lower body to stabilize.

There are many more VR games on the VR Fitness Insider game page that will get your heart pumping. Take a look!

VR Strength Training

Having strong muscles can help improve balance, strength, can reduce bone fractures, and can even improve independence during activities over time.

Fruit Ninja is a great standing game that has you using the VR controllers as a machete to slice and dice fruit. You’ll be using your upper body to reach and slice fruit, your mid-body to reach towards different directions, and your lower body to position your body and to move frequently. This VR game is rated by the VR Health Institute as being an equal workout compared to using an elliptical.

Please note: If you have a strong upper body or lower body and want a challenge you can always add hand weights or ankle weights to boost the difficulty level. Please consult a trainer or doctor before adding weights to your exercise plan.

VR Flexibility for Mind and Body

Exercising your body while also using your mind can help promote happiness, lower stress, improve memory, and flexible thinking skills.

Everyone experiences stress, so playing games like Wise Mind is a great way for everyone to unwind from a long day or start the day off with a clear and calm mind. Wise Mind has you practicing Tai Chi, balancing stones, and gives you mindfulness and meditation exercises to choose from. Tai Chi is great for a low impact and low-stress exercise that can be done seated or standing. Balancing stones is great for hand-eye coordination practice as well as promoting patience and understanding with yourself and others. While the meditation and mindfulness activities will keep your mind clear and resilient.

Stretching muscles helps to prevent muscle atrophy, improve range of motion and flexibility, reduces injuries, and increases pain relief.

VR apps like Yoga Joint VR Experience are great for getting a slow to advanced paced stretch while also building muscle strength and tone. Yoga involves you using your own strength to hold poses using your own body weight. Many yoga poses can be modified to suit needs based on injuries and physical limitations. Some yoga stretches can even be modified while sitting in a chair or wheelchair.

VR Helps Everyone Get Healthy

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Getting exercise, stretching, and being mindful using VR will improve your physical health but it will also make you feel happier overall. Getting VR headsets and games in the hands of the people who will benefit from using it the most is essential. Helping the disabled and the elderly gain access to VR helps them break through old limitations that used to hold them back.

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Using VR to exercise and experience new ideas, environments, and people drastically improves the quality of people’s lives. So let’s do something about it — tell your neighbors, friends, coworkers, and family members about the physical and mental health benefits of VR.

Source: How VR Helps Seniors and People With Disabilities Improve Their Health and Happiness – VR Fitness Insider

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[WEB SITE] New Anatomy VR App Lets You Look Inside Your Own Body


Curiscope, a startup, aims to blend VR and AR. Their Virtuali-Tee allows users to take a peek inside their own chest cavities.


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.


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.

Source: New Anatomy VR App Lets You Look Inside Your Own Body

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[BLOG POST] Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home – Evidently Cochrane

Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home


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., 2016Corcos 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., 2017Krishnamurthi et al., 2017), and for stroke: physical rehabilitation (Pollock et al., 2014) or robot-assisted interventions (Mehrholz et al., 20152017). 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., 2016Laver 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 MunichUniversity of RochesterUniversity 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.

Source: Virtual reality for people with stroke or Parkinson’s disease: bringing therapy home – Evidently Cochrane

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