Virtual Reality (VR) in Health Care

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Introduction

Virtual reality (VR) is a simulated experience that can create a new and artificial reality which eliminates the user from their actual surroundings. The use of headsets and headphones envelops the user in an illusion of an alternate world. Once associated only with games and films, it is now becoming a real game-changer in healthcare. VR has numerous applications in robotic surgery, medical education, pain management, healthcare devices, etc. which are slowly gaining popularity and are expected to be adopted by various healthcare organizations while being accepted by people. Some of the pioneering virtual solutions aimed at changing the face of healthcare are discussed below.

Pain Management

One of the first applications of VR was in using the technology as a clinical tool for pain management. Cognitive distraction methods have already been used by physicians to treat different types of pain for a long time now. Today, VR provides a new face to these distraction methods through various interactive games that are played in a simulated environment and loaded with interactive features [1].

Recently, doctors and researchers from Monash Children’s Hospital, and Royal Children’s Hospital in Australia conducted a clinical trial to assess the efficacy and safety of a virtual reality distraction for needle pain in their hospital emergency department (ED) and outpatient pathology. They found that in children aged 4-11 years undergoing intravenous cannulation or venipuncture, virtual reality was efficacious in decreasing pain while being safe [2].

Screenshot of the virtual reality aquatic environment. Depicted are fish, coral, and a central visual effect that appears when the child directs their gaze at fish (Source)

AppliedVR created a pain-specific application called Pain RelieVR to relieve pain and tested it through a VR goggles to identify pain from infections, back pain, and abdominal pain. The application teaches patients to cope with pain through breathing techniques and positive thinking [3].

Medical Education / Training

Implementation of VR solutions can simplify the whole process of medical education and subsequent training. With a little help from headset and a wide array of various sensors, it is possible to recreate a scenario that will put to the test the trainee’s skills in an engaging manner. It allows the trainees to practice complex, life-saving procedures in a risk-free environment, improve their skills, and get usability feedback during the process.

Presently, medical students learn on cadavers, which are difficult to get hold of and also, they do not react in the same way a live patient would. In VR however, one can view minute details of any part of the body and create training scenarios which replicate common surgical procedures [4].

Medical Realities, a technology enhanced healthcare company has developed a 360-degree video, which unlike traditional still surgery videos, provides a detailed perspective of the surgery to help medical students or surgeons stay better prepared when they step into the operation theatre for the first time [5].

Visualising the brain in VR (Source)

Researchers from KEMRI- Wellcome Trust Research Programme, Kenya, and University of Oxford, UK have collaboratively developed a low-cost VR training scenario, LIFE:VR for the Life Saving Instruction for Emergencies (LIFE) project, and tested it with healthcare workers in Kenya to establish the potential feasibility and acceptability of the low-cost VR for medical simulation training. The LIFE:VR was established through an informal partnership with VR Education, University of Oxford and HTC. A neonatal resuscitation module was developed based on ETAT+ training that is available through the Engage education platform and can be downloaded for free. HTC provided the LIFE project with VR equipment that comprises a HTC Vive™ VR headset, hand controllers and base stations to enable users in Kenya to test the module [6].

LIFE:VR for the Life Saving Instruction for Emergencies (LIFE) project (Source)

McMaster University, University of British Columbia, Simon Fraser University, Centre for Digital Media, Canada, and Dania Games, Denmark have collaboratively developed a VR-CPR prototype, VR-mannequin hybrid system for hands-on Cardiopulmonary Resuscitation (CPR) training using virtual reality (VR) technology. The VR-CPR prototype was designed to be generic, approachable, and easy to follow. CPR skills including chest compressions, rescue breathing, and automated external defibrillator (AED) are taught in VR (HTC VIVE) using Unity3D software, through focused instructions, demonstrations, and simulated interactive scenarios. A real mannequin is integrated in the VR space and overlaid with virtual 3D-human model for realistic haptic feedback and hands-on training. This innovative technology provides self-directed learning with no restrictions of time, place, or personnel, which are the main challenges in current traditional courses [7].

VR-CPR prototype – VR-mannequin hybrid system (Source)

Lucile Packard Children’s Hospital at Stanford built the Stanford Virtual Heart, which depicts congenital heart defects in 3D and exposes doctors to a more realistic version of a congenital heart defect that can ultimately help them better explain the condition to patients.

The Stanford Virtual Heart (Source)

Embodied Labs created a VR-powered product, We Are Alfred that is aimed at enabling caregivers to understand what it is like to live as a 74-year-old man with visual and hearing impairments. Each user gets to be an ‘Alfred’ for 7 minutes and experience life from the older patient’s perspective. This can bridge the gap between caregivers and elderly patients, and help provide better care to senior citizens [8].

Low Vision Treatment

IrisVision Global Inc. developed a wearable low vision aid, IrisVision, an easy-to-use product that helps the low vision patient regain their sight via VR experience. Dr. Frank Weblin, and his team at the University of California worked on it for providing patients with a way to magnify desired objects in the visual scene without losing consciousness of the overall environment around them. The user gets to choose the magnification they wish, along with things such as contrast, ambient level, and text options, and perform eye-hand coordinated activities with relative ease [8].

Relaxing Hospitalized Patients

VisitU, provides patients with a downloadable app and virtual glasses, which allow them to get in touch with their home and loved ones at any time, day or night [8].

Rehabilitation

It has been widely accepted that the earlier a stroke survivor starts rehabilitation, the better are the chances for regaining the functions they have lost. Clinicians in Schon clinic in Munich, have been using VR as a component of in-patient Parkinson Disease motor rehabilitation programs. The VR system comprises of a computer, a large monitor or projector, and an optical motion tracking camera. Approximately 54 square feet of free space iss allocated between optical camera and monitor for training patients. The clinicians have identified these systems to be of value especially for balance and fall prevention training when applied under the supervision of a physiotherapist [9].

Patients with Parkinson disease using VirtualRehab at Schon Clinic, Munich. (Source)

Researchers from Polytechnic University of Catalonia and Barcelonabeta Brain Research Center, Barcelona, Spain, have developed an up-to-date open-source, adaptive, multipurpose VR environment that can be used for various biomedical and healthcare applications whereas most previously implemented VR environments were tailored to a specific application or situation and not designed to facilitate adaptability to new settings. The utility of the developed VR environment has been validated via two test applications: an application in the context of motor rehabilitation following injury of the lower limbs, and another in the context of real-time functional magnetic resonance imaging neurofeedback, for regulating brain function in specific brain regions[10].

MindMaze’s neurorehabilitation solution, MindMotion™ uses virtual environment-based technology to enhance patients’ motivation and engagement towards their recovery. It allows patients to practice moving their fingers or lifting their arms in a fun fashion with the help of VR. Despite patients not carrying out the actual movement, it notably improves their engagement, motivation, and attention through audio-visual feedback, which could speed the recovery of traumatized nervous systems. Language and speech therapy can help improve the person’s communication abilities and social interactions. As of now, autism therapy involves in-person sessions with the doctor [8]. Floreo, a start-up, promotes virtual reality to help simplify the delivery of autism therapy so parents can support their children from home. Their product prompts social interactions with autistic kids by using mobile VR to spur virtual characters in a scene, thereby enabling children needing therapy to see a giraffe in a virtual safari park, for instance, instead of looking at toys on a table. Besides that, it even enables parents or doctors to tailor the virtual environments and choose the sensory complexity within them .

VR systems have been used as treatment tools to address the primary impairments of attention deficit hyperactivity disorder (ADHD), cerebral palsy disorder, and also control memory loss [11].

Physical Therapy

In physical therapy, VR has been shown to be effective in speeding up recovery. Allowing the patient to do the prescribed daily exercises in a virtual environment makes the activity more fun and keeps the patient focused . The researchers from The Jerzy Kukuczka Academy of Physical Education in Katowice, have conducted a test to assess the enjoyment and intensity of physical exercise while practicing physical activity in immersive virtual reality (IVR) using innovative training devices (omni-directional Omni treadmill and Icaros Pro flight simulator). The participant’s exercise intensity was assessed during 10-min sessions of active video games (AVGs) in IVR. It was found that the average enjoyment level during physical exercise was high and differed significantly in favor of physical activity on Omni treadmill. The majority of participants opined that the AVGs in virtual reality on the tested devices constitute a sufficiently useful form of physical activity to meet the needs of leisure time activities [12].

VR is being used for physical therap (Source)

Mental Health Therapy

VR can be used to treat not just physical conditions but also treat patients with mental health conditions ranging from post-traumatic stress disorder (PTSD) to schizophrenia. Exposure therapy is one of the standard procedures for treating anxiety disorders. It is easy for therapists to implement the VR exposure therapy and often more acceptable to patients than in vivo or imaginal exposure [13].

Lucile Packard Children’s Hospital at Stanford have developed a largest virtual reality program called the Childhood Anxiety Reduction through Innovation and Technology (CHARIOT) program that puts technologies such as VR into the hands of children undergoing surgeries and small procedures and helps remove some of the anxiety and stress. Children can immerse themselves in a game while they are undergoing specific parts of the procedure. All the child life specialists at the hospital are trained to use VR for IV placement, chest tube removals, dressing changes and other similar situations. VR can also temporarily reconnect patients suffering from dementia or hallucinations with reality by helping them distinguish between hallucinations and reality.

Surgical Planning

VR can help surgeons work out surgeries beforehand and experience possible outcomes without actually having to deal with them in reality. Such trials can help to make the whole operation more precise and controlled. ImmersiveTouch, is engaged in creating simulation-based surgical exploration and training, through a series of simulators with a digitally replicated environment. With this innovative VR platform, surgeons can access an immersive 3D operating experience that allows them to see and take part in the entire surgical procedure. In addition, doctors can upload VR patient scans for case reviews or detailed surgery planning. The ImmersiveView Surgical Planning (IVSP™) platform converts medical imaging data into high-fidelity 3D VR models for visualization, and provides a full range of tools for surgeons to plan their surgeries in advance and use intra-operatively [14].

ImmersiveView Surgical Planning (IVSP™) platform (Source)

Robotic Surgery

VR technology plays a major role in robotic surgery by reducing the time and risk associated with surgery complications. The surgeons and researchers from Medical College of Wisconsin, USA have reviewed the current literature pertaining to the use of virtual reality (VR) simulation in the acquisition of robotic surgical skills. Four commercially available simulators such as the da Vinci Skills simulator, the Mimic dVTrainer, the Robotic Surgical Simulator (RoSS), and Sim- Surgery Educational Platform have been demonstrated to be capable of assessing robotic skill. The researchers have found that the literature demonstrates that VR simulators are appropriate tools for measuring robotic surgical skills. It has been demonstrated that basic robotic surgical skills on the actual da Vinci System have improved after training on VR simulators [15].

The RoSSTM Robotic Surgery Simulator (Source)

The da Vinci surgical simulator (dVSS) (Source)

Robotic urologists from Changhai Hospital, Shanghai, China have investigated the application of virtual reality training in vesicourethral anastomosis during robot-assisted radical prostatectomy (RARP). The effectiveness of the virtual training was evaluated and it has been observed that the time of anastomosis was shortened, the economy of motion improved, and instrument collisions decreased after training. VR helped the surgeons to become quickly familiar with robotic system operation which enabled them to operate with high efficiency [16].

Patient Education

Feasibility to view the inside of the human body is useful not only for doctors, but also for patients, who can be walked through their surgical plan by virtually stepping into a 360° VR-constructed patient-specific anatomy. This results in enhanced understanding of the treatment, and consequently higher patient satisfaction .Researchers at Virginia Commonwealth University School of Medicine, have developed a three-dimensional (3D) model of an abdominal aortic aneurysm (AAA) for patients diagnosed with the same. The standardized 3D model of the AAA was generated from a computed tomography scan and uploaded onto a 3D image-hosting website. Patients with the AAA who participated in the study viewed the digital 3D AAA image in VR headset mobile device and found VR to be an engaging learning tool helping them in understanding their health status [17]

Front-view of the digital 3D model with the aorta and arteries (red ), kidneys ( yellow), spleen (blue), and skeleton ( gray) (Source)

Disease Awareness

AbbVie, created a VR experience to raise awareness amongst medical professionals of the daily struggles of patients suffering from Parkinson’s disease. The experience was demonstrated at an industry trade show where people could put on a headset and experience first-hand as a Parkinson’s patient navigating a virtual supermarket, encountering awkward moments when coming into contact with other people.

he AbbVie Parkinson’s experience (Source)

HEALTHCARE COMPANIES CREATING BREAKTHROUGH INNOVATIONS

Karuna Labs

Karuna Labs employees immersive virtual reality in treating chronic pain. Its Virtual Embodiment Training™ platform uses evidence-based approaches to chronic pain treatment focusing on function and improved quality of life. It takes a multi-modal approach to pain management and rehabilitation. It contains modules for upper limb, lower limb, cervical and lumbar spine. Its software minimises the threat response that causes pain and fixes the brain incongruities by means of motion and visual-based experiences. The product educates chronic pain victims in understanding how pain works at various levels of the brain, rehabilitates them and eventually allows them to live a normal, less painful life again.

Virtual Embodiment Training™ (Source)

ImmersiveTouch

ImmersiveTouch provides virtual reality training and surgical simulation to the healthcare industry through multiple platforms. ImmersiveView™ VR, is a product that is compact and easily transportable. Loading patient-specific data on ImmersiveView is simple and efficient, making it a versatile choice in both planned procedures and acute trauma cases. It converts CT, CBCT, 3D angiography and MRI scans into a ‘digital twin’ of the patient and gives a completely unique and unobstructed view in virtual reality. Viewing is no longer limited to certain angles and doctors can easily view the target anatomy, clearly and accurately, just as it exists in reality. Doctors handle the scan as if it were a physical object in the palm of their hand, observing from every angle to get the very best understanding of the situation. It is ideal for viewing critical scan information in all areas of the hospital: Radiology labs, Operating Rooms, Emergency Rooms, and doctors’ offices.

ImmersiveView™ VR is also a useful tool for Patient Education and Engagement as patients can better understand their condition. Physicians have the opportunity to actively consult withthe patients through proposed interventions and determine the best therapeutic choice. It can be used to reduce patient anxiety, reinforce patient understanding, and increase informed consent for medical plans of action. It is FDA-cleared and CE certified and uses patient specific data to simulate surgeries.

Other platforms such as ImmersiveSim™ and ImmersiveTouch3™ provide the most realistic replication of surgery available today. Medical professionals can plan and rehearse the surgeries in VR environment that accurately replicates the surgical anatomy, environment, tools, and sensations with advanced haptic feedback. Both platforms are FDA-cleared and CE certified and use patient specific data for simulating the surgeries.

ImmersiveSim provides users with a fully immersive experience. Compatible with Oculus Rift,HTC Vive, and Windows Mixed Reality systems, users put on a VR headset and are transported right into the middle of an operating room. While in simulation, the robotic stylus replicates the sensation of using various surgical tools, and use of VR hand controllers replicate the user’s hand motions 1:1. It is mounted on a mobile, compact cart with a computer monitor for collaborative viewing, making it a smart and portable option for use in hospitals [14].

ImmersiveTouch Surgical Training (Source)

Virtually Better (VBI)

Virtually Better (VBI) is founded with the goal of creating virtual reality environments for use in the treatment of anxiety disorders such as fear of public speaking, fear of flying, fear of heights and post-traumatic stress disorder (PTSD). In an attempt to use VR in various treatments and therapies, it has developed the “exposure therapy”. Here, the patient is exposed to an anxiety-causing stimulus in a controlled environment, which facilitates faster recovery of the patients.

Medical Realities

Medical Realities is one of the companies pioneering the use of VR to deliver high-quality surgical training. They film real life surgery in 4K 360° video from multiple angles which is then combined with Computer-generated imagery (CGI) of the anatomy being operated upon to provide an immersive & interactive training experience.

Medical Realities uses VR to train surgeons (Source)

Osso VR

Osso VR uses VR to provide the platform, content and tools to bridge the surgical training gap. It has developed a simulated surgery system which allows users to use their hands. Its objective is to improve patient outcomes, increase the adoption of higher-value medical technologies and democratize access to surgical education around the globe. Osso VR has been working with many of the world’s top orthopedic hospitals and device companies [19].

Osso VR platform (Source)

Firsthand Technology

Firsthand Technology has created smart virtual environments that are powered by biosensors to transform people from health consumers to health producers. It has played a major role in pioneering VR as a digital therapeutic for pain and rehab, mental health, and for promoting healthy lifestyles. It is representing a possible synergy between gaming and healthcare, uses VR to promote positive health effects, such as fitness, good hygiene, etc. [20].

A clinical trial of Firsthand’s VR pain relief software on pancreatic cancer patients in post-surgery recovery at Providence Cancer Center in Portland, Oregon. The outcomes showed significant improvements over Providence’s historic standard-of-care: 30% less Pain, 20% less opioids, significantly lower care costs [20].

Firsthand’s VR platform (Source)

INTERESTING PATENTS

Some recent patent applications presented below could be an indicator of things to come in the future.

WO2019071166 from VRHealth deals with continuous clinical evaluation and care adjustment using virtual reality for performing a variety of assessments on cognitive or physical performances. Desired care may be obtained hrough virtual environments and adjustments to patient care.

KR20190027696 from M2S CO LTD. deals with a device and method of providing a medical service using virtual reality for alleviating the psychological pain of a patient through a character growing or changing according to a process in an examination. The method comprises generating and storing a character in a virtual reality environment and changing the character according to a therapeutic action or a clinical indicator of the patient.

US2019156690 from Medical Realities deals with a virtual reality system for surgical training that provides an improved graphical user interface and that can effectively present a number of different types of content within a virtual reality environment.

CHALLENGES

There are three major hurdles that hold VR back from being applied on a full-fledged scale [21].

i) Lack of quality content

Lack of content is a barrier for the adoption of VR in health care sector. It is especially critical, since patient outcomes are dependent on how good the content is. The key challenge faced by health care now is producing quality VR applications for varied platforms and needs .

ii) Expensive and uncomfortable hardware

The majority of health care institutions are reluctant to invest in first-generation headsets such as the Oculus Rift and HTC Vive in spite of the fall in their prices, owing to their numerous limitations in terms of animation, sound rendering, field of view, motion tracking, display quality, etc. Mobile headsets such as Samsung Gear VR and Google Cardboard give mobility but don’t offer the eminence users expect. Another important aspect that is to be addressed by hardware producers is hygiene which is critical in health care.

iii) Training

People usually have little or no exposure to VR devices and content leading to its long adaptation period. Educating people to use headsets will remain a challenge until they become a mainstream technology. Other obstacles hovering around health care include legal issues, regulations, lack of funding etc.

SUCCESSFUL START-UPS

VRHealth, an Israeli healthtech company headquartered in Boston, develops several products designed for cognitive rehabilitation, pain management, stress relief, and motor related disorders. A first-of-its-kind healthcare technology company, VRHealth helps clinicians in better management of patient-care through specialized VR technology solutions and data analysis. The user data is collected and examined through artificial intelligence (AI) and cloud-computing algorithms to deliver real-time advanced data analytics, thus eliminating the need to go to the hospital to be evaluated. It can be done remotely and the patient’s profile can be made available to the physician prior tothe patient’s visit for diagnosis or treatment [22].

VRHealth technology (Source)

FundamentalVR, a London based start-up, recently launched its new software platform, Fundamental Surgery that combines a cutting-edge VR experience with haptic sensors so that it gives users physical feedback simulating the feel of performing an operation. The platform provides health care professionals low-cost access to reliable surgical simulations with precise measurement and performance insight. It requires a VR headset and two haptic arm devices, and the software can run it on PCs or laptops. The users can get different physical feedback, such as what bone or skin feels like. The system can also switch up the surgeries so that the user can treat the conditions such as unexpected bleeding. Currently the system focuses on orthopedic area but in future it may move into areas such as laparoscopic, general surgery, cardiovascular, and otolaryngology [23].

Fundamental Surgery system (Source)

RealView Imaging, an Israeli start-up company, is pioneering the field of interactive live holography, creating a new dimension for medical imaging applications. The company’s proprietary Digital Light Shaping™ technology provides physicians with a unique natural user experience, creating the only accurate, three-dimensional holograms within hands’ reach. The 3-D holograms are created on proprietary hardware, wherein images appear as if floating in air and they can be manipulated at will by using hands. The holograms don’t require the viewer to wear any eyewear unlike the 3-D images viewed through other products [24].

RealView Imaging – Interactive Medical Holography (Source)

Vivid Vision, a San Francisco-based start-up, helps people improve their vision by having patients play VR games on computers, at home or under clinical supervision. Vivid Vision is a class I medical device, and is FDA-cleared and CE certified. It is a computer-based application with data tracking and analysis tools. The device is intended to identify strabismus, to assess binocular vision (use of both eyes to see), to treat suppression and amblyopia, and to treat problems of vergence [25].

Vivid Vision for Amblyopia (Source)

Psious, a Spanish behavioral healthtech start-up company that offers a Psious Toolsuite solution to people who suffer from anxiety-related disorders has created its own unique content of relaxation exercises which help patients suffering from depression and other mental illnesses. It applies virtual reality through VR goggles and a biofeedback sensor. Through a smartphone and VR goggles, patients can easily be transferred into a parallel reality which mental health professionals can use in their clinical practice [26].

Psious Toolsuite solution (Source)

CONCLUSION

Despite challenges, VR is poised to thrive and transform the way patients and doctors experience and practice health care. As VR has multitude of applications in healthcare ranging from life-saving techniques to training doctors, it is expected to be a far-reaching technology in the next 10 years with its applications and opportunities in the 3D/4D technology market.

While there are opportunities for companies to create lightweight, portable, user-friendly and affordable VR device hardware, for realizing these goals, skilled 3D artists, VR programmers, experienced designers and other specialists are required to create engaging content that will live up to the users’ expectations.

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Disclaimer:

This document has been created for educational and instructional purposes only
Copyrighted materials used have been specifically acknowledged
We claim the right of fair use as ascertained by the author

Author

Mr. Anil Vadnala

Anil Vadnala earned his Master of Engineering in Biomedical Electronics, and Bachelor of Technology in Biomedical Engineering. He has vast experience in medical technologies such as implants, surgical instruments, medical recorders, diagnostic and imaging devices, operation theatre equipment, surgical robotics, and other medical devices. Currently, he works for SciTech Patent Art as a Group leader.

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