Straight Out of Star Trek: The Biomedical Boon of Virtual Reality

By Brandon Levy

Wednesday, March 7, 2018

Once confined to the realms of science fiction, virtual reality (VR) has crossed over into the real world in a wide array of fields, including scientific research and clinical medicine. In the IRP, several researchers are utilizing the cutting-edge technology in their efforts to improve human health.

Susan Persky, Ph.D., for instance, runs the Immersive Virtual Environment Test Unit, where she uses VR to simulate how genetic information might affect doctor-patient interactions and influence patients’ emotions, beliefs, and decisions. She has also put the technology to use studying the food choices of overweight and obese individuals by presenting them with a simulated buffet. Meanwhile, John Ostuni, Ph.D., explores how VR might help doctors diagnose or treat patients, such as by providing access to physical therapy without going to the hospital. And Victor Cid, M.S., creates virtual reality scenarios for the Disaster Information Management Research Center that can train emergency personnel how to more effectively respond to major crises.

On Friday, February 23, they joined several NIH colleagues for a Reddit “Ask Me Anything” (AMA) to answer questions from the public about how virtual reality might change the way medicine and research are practiced and ultimately make people’s lives better. Read on for some of the most interesting exchanges that took place or check out the full AMA on Reddit.

Question (Q): “What type of research, from your experience, is best facilitated using immersive or augmented technology? What challenges over real-world research are cheaper/easier/faster within the use of these immersive/augmented technologies?”

John Ostuni, Ph.D., Staff Scientist

“Many people consider VR as a simulator for reality. But it is also important to think about VR as a simulator for non-reality. In VR you can create an experience limited only by your creativity. What’s interesting about this is that your body/brain only know about reality and will react to any non-reality situation with a response based in reality. For this reason, you can fool your brain with illusions, such as the illusion of being somewhere else, the illusion of owning another body and the illusion of being a participant in an experience that isn’t real. You can ask so many interesting questions when you realize this. For example, how will someone react if they were in a body of a different race, gender, or age? How will someone react to an experience of shooting someone? How will someone react to seeing someone suffering? And the most important question: how will these experiences change them? Because these types of VR experiences do change people.

“As far as challenges are concerned, VR has a big advantage for any research involving non-real environments (as mentioned above), but also for research involving environments that could be dangerous to the subject. NIH is extremely concerned about the safety of their research subjects so controlled, safe, simulated environments may open up new research opportunities.”

Q: “During the Olympics, a commercial has been running in which VR is used during rehab for a young woman with a prosthetic leg. Is this technology currently being used as therapeutic intervention?”

Patti Brennan, R.N., Ph.D., Director of the National Library of Medicine

“I, too, was really excited about the Olympics ad showing the woman learning to use a prosthetic leg but instead of seeing herself in a physical therapy department, she was walking on a beach. So as I understand Head Mounted Devices (HMD), the advantage is that one blocks out all ‘real world stimuli’ and can have rich visual experiences — like walking on the beach — but it is really impossible to see through an HMD and actually detect parts of one’s own body. Sometimes animations can be mapped to an actual limb, so as the participant moves the limb they get the visual cues — there are some new devices that don’t require advanced tracking, and I see great promise with the VIVE and other ‘through the glass’ Augmented reality devices.

“I am completely unaware of any VR experience stimuli where one could actually feel water lapping over one’s feet -- sounds pretty cool to me, though!”

Q: “‘Cognitive training’ has been something of a hot topic recently, both in terms of improving cognitive function in healthy persons and restoring function in cognitively compromised persons. Where does VR fit into this picture? Are you aware of any groups conducting cognitive training trials in VR environments?”

Patti Brennan

“There’s a lot of interest in using VR for patients with mild cognitive impairment and other dementias. There is some evidence that exposure to VR stimuli can improve executive function (being able to do tasks that follow a natural ordering) among elders. There is also some interest in creating neuropsychological testing using Virtual Reality exposures. That said, most of the effects seem to occur when VR approaches are combined with some type of in-person or interpersonal care.”

Q: “Can you expand on the use of VR in TBI-related recovery? What specific advantages is VR posited to have over (for example) a multimodal, engaging, computerized task?”

John Ostuni

“Part of TBI-related recovery is re-training and VR excels at that. One of the main reasons is that people do not learn skills simply by watching. Movement is an integral part and VR allows you to move appropriately while you are learning.

“Another feature of VR is that not only can you create realistic learning experiences, but these experiences have no penalties for failure. If water spills or items drop you can just start over. Also, since VR will be able to create realistic environments, they will create useful measures for TBI assessment. In fact, this could be done remotely without having to go the doctors. Lastly, it will be interesting to see how lost memories associated with TBI are affected by putting the subject into past experiences.”

Q: “How could researchers use VR to encourage healthy behavior in the public or in patients?”

Susan Persky, Ph.D., Associate Investigator

“This is an area with a lot of active research. In our lab, we’ve explored how VR education related to health risks can increase motivation to improve dietary and physical activity behavior. We’ve also developed a VR-based buffet as an outcome measure, but have an eye toward potential deployment as a tool to help parents practice making health choices for their children. Some of this research is available here: https://www.ncbi.nlm.nih.gov/pubmed/29277518
https://www.ncbi.nlm.nih.gov/pubmed/26850762.

“Beyond that, other researchers such as those at the VHIL at Stanford (https://vhil.stanford.edu/) have developed situations where watching our avatars exercise or eat healthy foods have encouraged those behaviors in research participants. A really interesting new study shows that eating virtual donuts may help people feel satiated and reduce real donut eating afterward. This work is all still in the research phase, but certainly some companies are entering the space too with VR physical activity platforms. I’m less familiar with the evidence base there, but if people (or the technology) can get us past the sweaty VR displays, I could definitely see these being motivating. There are also several products related to relaxation, biofeedback, and meditation. Relaxation in particular seems like a promising area for VR technology.”

Q: “In what ways can VR be used to improve the way doctors talk to their patients about genetics and family histories rife with certain harmful genetic conditions?”

Susan Persky

“VR may be useful for training physicians on how to navigate these types of sensitive interactions. There are several researchers and companies working on this (just for example: http://www.ufverg.com/). VR-based training scenarios could also feed information back to the learner and allow them to experience their own communication approach from the perspective of their patients. These approaches are in their early days, as is the artificial intelligence and other technologies they will need to be based on, however, and their benefits for interpersonal training are beginning to be demonstrated.”

Q: “Do you see a future where VR can be combined with telemedicine? Give the doctor the experience of being in the room with you?”

Victor Cid, M.S., Senior Computer Scientist

“Yes, I can. It will be some time until VR will be as good as a face-to-face meeting with your doctor, but for many purposes VR can provide enough tools for a doctor to do his/her job. VR can provide the same experience provided by today’s telemedicine platforms (video, audio, haptics…) and also provide the doctor and the patient with additional information/visualization tools that can enhance the remote interactions. Doctors can today collaborate doing surgery remotely via VR, for example (although the patient is not in VR). For instance, take a look around 13 minutes into this video: https://exponential.singularityu.org/medicine/an-avatar-in-your-o-r-redefining-human-interaction-in-surgery-with-shafi-ahmed/.”

Q: “Common is the phase ‘from bench to bedside’ in genetics and genomics. With the portability and ease of access to VR, do you expect a rapid influx of the technology into the homes of those who may benefit from it? The tech is rather pricey, however, so how does the field expect to overcome this?”

Jeremy Swan, B.A., Biovisualization Specialist

“Yes, just as the smartphone has become more common than personal computers in the home, the prices of VR and portable VR solutions are dropping rapidly as processors become more efficient and smaller and the economies of scale help to drastically reduce costs. Five years ago, a head mounted display would cost around $20,000. Now a comparable VR headset (Vive) is available for around $600 or $400 for the Oculus Rift, which have both reduced prices significantly since they were initially offered. Also, once a headset is in a household for the purpose of gaming, it could also be used for therapeutic purposes. The ability to convert a smartphone to a VR headset with an inexpensive viewer is another way to offer accessibility.

“While there is a great deal of promise for the benefits of VR, (and augmented reality) such as overlaying medical data on top of a patient during a medical procedure via a heads up display, there may also be negative side effects of using VR which also need to be studied.”

Q: “How accessible might this technology be for people living in remote parts of low-income countries?”

John Ostuni

“In many ways VR can be considered the great equalizer. For example, students can put on a VR headset and find themselves in a classroom with a highly skilled educator. The same educator that a non-rural, high-income student would experience. They can go on realistic field trips and have experiences that normally would not be available to them. Unfortunately, VR is dependent on network access and I am concerned that this will limit the usefulness of VR for low-income, rural areas.”

Q: “When will I start to see VR as a part of my health and medical care?”

Patti Brennan

“VR could be a part of it today! Distraction scenarios are quite helpful in helping patients better tolerate chemotherapy or handle treatments of severe burns. And we shouldn’t overlook the enjoyment of game playing as a part of work-life balance!

“It’s important to think about VR as a process of devising a scenario, creating or capturing relevant images, planning the pathway through then presenting the entire packet to the participant. There is health and medical care value in all of these steps, so it is likely that you will have VR in the background of some health care experiences even though you can’t see them or experience them – for example, in our vizHOME project (www.vizHOME.org) we used LIDAR to create full-scale 3D replicas of ordinary households and then could explore them in a CAVE or through a Head Mounted Device (HMD). We also figured out how to improve post-hospital home care planning by using the full-scale model to identify health assets and hazards in the home, marking them up, then inserting the manipulable 3D model into the patient’s record as a document and home care planning tool (https://healthit.ahrq.gov/ahrq-funded-projects/virtualized-homes-tools-better-discharge-planning). Check it out!”

From field trips and classrooms to doctor’s visits and donuts, VR’s near-infinite flexibility lends itself to a plethora of simulations and potential uses. Like any new gadget, price and access will be an issue for a time, but as the technology improves and spreads, those obstacles will slowly be surmounted. Soon, large numbers of researchers, clinicians, and average Joes could be taking advantage of VR to expand our scientific knowledge, help patients, and safely traverse environments that could once only be reached in our imaginations.

If you’d like to learn more about how scientists use virtual reality in their research, sign up for NIH’s Virtual and Augmented Reality Scientific Interest Group (VARIG) email list.

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