From entertainment to therapy – five ways Virtual Reality can change future healthcare

Virtual reality (VR) started as a technology most people associated with video games and entertainment, now it’s becoming a part of medical technology.

 

VR is revolutionizing healthcare in a number of areas: Calming children taking an MRI scan, providing pain management, rehabilitating after a stroke, training surgeons and treating phobias. With worldwide healthcare costs rising from 8.6% of global GDP in 2000 to almost 10% today1, and with an expected increase in global spending on health from 7.8 trillion USD in 2013 to more than 18 trillion USD by 20402, there is an urgent need for cost efficient treatments. Virtual reality could reduce the costs while improving health care.

MRI Scans
MRI scans are an increasingly important part of paediatric radiology but some of the procedures require children to stay still up to one hour, not easy for young children. A MRI scan can also be a claustrophobic and traumatic experience. Some children need a preprocedural sedation or general anaesthesia, which entails risks.

The British hospital physicist Jonathan Ashmore had his office next door to the MRI scanner. He noticed how scared many children were when taking their scans3 and how traumatic the procedure was. He created a virtual MRI experience which the children can use to prepare for their scan. Ashmore’s app “Virtual reality MRI” has been a big success and is used at several hospitals including King’s College hospital in London and the Royal Belfast hospital.

Pain management
Prescribing opioids can be difficult for practitioners – on one hand a large proportion of the population is suffering from chronic pain conditions, on the other hand the misuse and spread of opioids is rising. In the last years USA has faced a drug epidemic with more people dying from drug overdoses than car accidents and gun violence4. The majority of these deaths are caused by opioids. But USA isn’t the only country facing an increase in opioid related deaths. There is an urgent need for safe, non-addictive alternatives to the opioids used today. With studies showing up to 50% reduction in pain, VR may be the solution5.

Distractive video games for cancer patients receiving chemotherapy and augmentation of hypnosis for burn-victims are examples of successful usage areas for VR as treatment for more acute pain5. There is growing evidence to support the use of VR for more chronic conditions. The exact mechanisms behind how VR works as analgesia are still under investigation but are thought to be connected to its distractive effects. In partnership with Brennan Spiegel’s research team at Cedars-Sinai, the start-up company appliedVR have developed a VR library of interactive games and meditations, which function as pain-relief through distraction6. Karuna Labs, a software company, create VR applications that treat chronic pain using a different approach. Developed by clinicians from UCLA, Stanford, Penn Medicine and others, their software addresses neuropathic pain by targeting sensorimotor incongruences and pain-avoiding behaviour7.

 

Stroke rehabilitation
Activities that used to be easy to perform everyday often become difficult after a stroke.  Rehabilitation and physical therapy are important treatments to improve sensory and motoric functions as well as maintaining musculoskeletal strength. However, for many patients rehabilitation can be difficult to adhere to and everyday situations can be difficult to train in a hospital environment. The FDA-approved SaeboVR’s rehabilitation system focuses on activities of daily living, ADL’s, by letting patients practice real life activities in a simulated environment8 while still in hospital. Neurotech company MindMaze use 3D motion cameras in their MindMotion Pro programme to trace patients’ movements and map them on a 3D avatar9, making rehabilitation more enjoyable and increasing patient compliance. In the future, stroke patients could be using VR therapy from their homes, reducing the cost and the burden of visiting a medical facility for conventional therapy.

Training surgeons
Attending an operation as a medical student can be tough, with the crowded operating theatre, strict routines to keep objects sterile and long hours. Getting a good look at the procedure itself isn’t always easy – especially nowadays with increasingly smaller incisions and more use of robot techniques. Witnessing a surgery through VR goggles can make procedures more accessible. With faster internet, better smart phone quality and a VR headset that can be crafted from cardboard and a pair of lenses, more students can have access to more surgeries at a lower cost. In 2016 Shafi Ahmed,  a cancer surgeon at Barts Health NHS Trust, preformed the world’s first operation to be streamed live in a 360-degree video10. The surgery was recorded with a VR camera worn by Ahmed and anyone interested could see him perform the surgery live using a VR headset and smart phone. This offered a unique learning opportunity, letting the viewer experience the surgery through the eyes of the surgeon.

VR also offers an alternative to the old approach “see one, do one, teach one”. Through VR it is possible to actually practice surgery without the risk of harming a patient. Neurosurgeon Ali Alaraj has developed VR simulators for neurosurgical training in cooperation with Chicago based ImmersiveTouch11. Using VR to simulate a patient’s individual anatomy, surgeons can test different techniques before the surgery itself, while receiving haptic feedback depending on what structure they touch with the scalpel in the simulator. The technology of individual simulation of a patient’s anatomy isn’t available in hospitals yet but other simulators are already in use. Osso VR, a training platform for hospital staff of different skill levels is incorporated in several US medical school programmes, including Harvard Medical School, Colombia University and The David Geffen School of Medicine at UCLA12. Enabling better surgical training in a cost-efficient and harm-free way, VR already has a given place in surgical training.

Treating Phobias
One in four people will suffer from a mental disorder at some point in their life, which makes mental disorders one of the leading causes of disability worldwide13. Psychological treatment is the first option for many mental disorders. But it can be expensive and both human and economical resources are often lacking. Furthermore, for many conditions the best therapy is learning and coaching in real-world situations – something that few clinics can offer.

Researchers at Oxford University think they can have a solution to this problem14. Using automated treatment delivered through VR they have offered counselling for fear of heights – acrophobia. In the VR program, participants are asked to solve different tasks at simulated heights, while being guided by a virtual coach. Patients in their first trial reported an average reduction of 68 percent in their fear of heights after the therapy, better scores than face-to-face therapy has today14. Apart from phobias, VR could be used in treatment of other mental conditions. Start-up company Limbix for example, aims to treat depression, anxiety, pain, trauma and addiction using VR, in partnership with Harvard and Stanford15. Automatic VR coaching could make therapy accessible for more patients, while being more cost-effective than conventional therapy.

In areas ranging from pain management to treatment of phobias, VR is succeeding where conventional therapies have failed. By providing safe, affordable training environments for both surgeons and stroke patients, VR offers a unique addition to medical technology as we know it. While many usage areas still require more studies and technology needs to improve before usage on a broader scale, it seems like Virtual Reality is here to stay.

References:

  1. Thinking Holistically About Healthcare Costs And Long-Term Value, October 2018, https://www.forbes.com/sites/intuitivesurgical/2018/10/30/thinking-holistically-about-healthcare-costs-and-long-term-value/#5c814a12757b (Last Accessed: November 2018)
  2. National spending on health by source for 184 countries between 2013 and 2040, June 2016, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30167-2/fulltext (Last accessed: November 2018)
  3. MRI scans are horrible for kids – so I created a virtual reality app to help, September 2018, https://www.theguardian.com/society/2018/sep/13/mri-scan-children-virtual-reality-app (Last Accessed: November 2018)
  4. US drug overdose deaths rose to record 72,000 last year, data reveals, August 2018, https://www.theguardian.com/us-news/2018/aug/16/us-drug-overdose-deaths-opioids-fentanyl-cdc (Last Accessed: November 2018)
  5. Virtual Reality and Medical Inpatients: A Systematic Review of Randomized, Controlled Trials, February 2017, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373791/ (Last Accessed: November 2018)
  6. Escape The Scary and Painful in Healthcare: The AppliedVR Review, September 2017, https://medicalfuturist.com/escape-scary-painful-healthcare-appliedvr-review (Last Accessed: November 2018)
  7. Karuna VR http://karunavr.com/ (Last Accessed: November 2018)
  8. Benefits of Virtual Reality for Stroke Rehabilitation, July 2017, https://www.saebo.com/benefits-virtual-reality-stroke-rehabilitation/ (Last Accessed: November 2018)
  9. Virtual Reality Therapy Designed to Help Stroke Patients Recover, August 2017, https://www.rdmag.com/article/2017/08/virtual-reality-therapy-designed-help-stroke-patients-recover (Last Accessed: November 2018)
  10. Watch the world’s first surgery streamed in virtual reality live from London, April 2016, https://www.telegraph.co.uk/technology/2016/04/14/watch-the-worlds-first-surgery-streamed-in-virtual-reality-live/ (Last Accessed: November 2018)
  11. Virtual Reality is the Future of Surgical Training, October 2017, https://chicagohealthonline.com/virtual-reality-surgical-training/ (Last Accessed: November 2018)
  12. Osso VR makes introduction into medical school, June 2017, https://www.aiin.healthcare/topics/connected-care/osso-vr-makes-introduction-medical-school (Last Accessed: November 2018)
  13. Mental disorders affect one in four people, October 2001, http://www.who.int/whr/2001/media_centre/press_release/en/ (Last Accessed: November 2018)
  14. Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial, July 2018, https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30226-8 (Last Accessed: November 2018)
  15. How virtual reality is being used to treat mental health issues, July 2018, https://www.ft.com/content/1a9a4cac-83cb-11e8-96dd-fa565ec55929 (Last Accessed: November 2018)