Medical VR, or how one could make medicine engaging

Victoria Yaskevich
February 7, 2020

This article is written by Elinext’s Healthcare IT Consultant, Victoria Yaskevich, who carefully collected the most exciting medical VR use-cases to provide you with a clear insight into this promising MedTech trend.
Enjoy your reading.

For hundreds of years, medical students have been tortured cadavers to learn more about the internals of the human body. Nowadays a new trend came – virtual reality apps for medical training and education. Just put on a headset with the relevant program – and your teacher will guide you through a lesson on a virtual human subject.

It was April 2016 when the first operation using VR camera was performed. Shafi Ahmed, a cancer surgeon, held it at the Royal London hospital. Saying that it was a huge step in surgery is saying nothing. Everyone could participate in the operation in real-time through the Medical Realities website and the VR in OR-app. No matter whether you are a promising medical student, an interested journalist or a worried relative, you could still follow through two 360-degree cameras on how the surgeon removes a cancerous tissue from the bowel of the patient.

Medical education, surgery, rehabilitation program, psychiatry, and psychology – these are some of the areas to benefit from medical VR. As a doctor, you could assist in the operating room (OR) without ever lifting a scalpel or prepare for complex surgeries efficiently. As a medical student, you could study the human body more closely and get ready for real-life operations.

However, patients would benefit the most. Virtual reality could help them tackle chronic pain, fight with fears and phobias, distract from pain of childbirth and vaccination. One could not only go through the rehabilitation process faster and easier but also escape from the hospital environment into a virtual wonderland or a peaceful place.

And perhaps the most successful application of VR so far is a stress release and pain reduction for patients suffering from chronic pain. For example, there is a  VR game called Farmoo. It is intended to help teen cancer patients get distracted during chemotherapy and focus more on the activities inside the game, rather than the treatment itself.

Researchers at the University of Washington showed that a 40-year-old patient with burns on over 19% of his body benefited greatly from the combination of hydrotherapy and VR usage. They even developed a Pixar-like app with a relaxing snow scene together with Firsthand Technology to help him alleviate the pain felt during wound care.

Medical VR entirely breaks the conventional belief that technology makes healthcare less human, less empathetic and less caring. I tried to gather some evidence of that (hey, grumpy pessimists!). Feel free to supplement my list if I missed anything!

1) Teaching empathy to medical students

No matter how virtuoso you are in an operating theatre, one of the most challenging parts of being a doctor is mastering a patient-doctor communication.

Delivering tough news about the death of a patient or about his cancer diagnosis requires enormous strength of mind and empathy as well as an appropriate practice: lots of practice. That is where VR comes into play. Researchers from Medical Cyberworlds Inc. and the University of Michigan made an experiment where medical students were armed with Mpathic-VR technology to talk with emotive, computer-based virtual humans who can see, hear and react to them in real-time. The virtual humans used a full range of behaviors expected of two people talking to each other. Applying this technique in future curriculums, medical students practiced difficult conversations before going out and experiencing them in real life.

2) Helping physicians experience life as an elderly

How does it feel to be old? How does it feel not to be able to lift your hand, lose your sharp eyesight, or recover from a heart attack?

Embodied Labs created “We Are Alfred” with the help of VR to show young medical students what ageing means. Everyone can be the hypothetical Alfred for 7 minutes, and experience how it feels to live like a 74-year-old man with audio-visual dysfunctions.

The ultimate goal is to mitigate the disconnection between young doctors and elderly patients due to their huge age difference. Fostering empathy is much easier when physicians can feel themselves in patients’ shoes.

3) Making dying patients’ last wishes come true

Greg always wanted to go to Africa, see the Northern Lights, and experience scuba-diving, but his sudden disease gave it all up for lost. To help Greg and other palliative care patients, David Parker, an IT consultant from Toronto, uses the power of virtual reality. He lets bedridden patients get out of their beds virtually and travel around the world, crossing items off their bucket list. As a result,  Bridgepoint Health and Mount Sinai Hospital in Toronto has already introduced VR headsets in their palliative care programmers. Some patients “traveled” more than once and keep going back for the experience. 

4) Tackling depression and pain in hospitalized patients

If you’ve ever been hospitalized or visited someone in a hospital, you might know that lying in a room for days or weeks, often in pain and distress, can be physically demanding, emotionally draining, and socially isolating. In many ways, a hospital room can be more like a bio-psycho-social jail than an uplifting healing environment. So virtual reality might be a great tool to escape the scary hospital environment without physically going anywhere or to mitigate chronic pain without painkillers.

In 2017, Dr. Brennan M. Spiegel and his research team at the Cedars-Sinai Medical Center have made an experiment and concluded that VR could go beyond the entertainment industry and step into healthcare! They enrolled 100 patients suffering from gastrointestinal, cardiac, neurological and post-surgical pain.  Fifty patients received virtual reality therapy consisting of watching calming video content such as helicopter rides over scenic portions of Iceland, or imagery of swimming in the ocean with whales. Those patients reported a 24 percent drop in pain scores after using the virtual reality goggles.

Another 50 patients viewed a standard, two-dimensional nature video, depicting relaxing scenes with a calming music audio track, on a close-proximity screen. Although those patients also experienced a reduction in pain, the decrease of 13.2 percent was less dramatic.

Spiegel says that not only the hospital experience can be improved with medical VR, but the costs of care may also be cut. By reducing stress and pain, the length of the patient’s stay in the ward or the amount of resources utilized can both be decreased.

However, not everyone is willing to try it out, especially when it comes to older patients. In their first study, published in JMIR Mental Health, Spiegel and the team found that the average age of patients willing to try VR was 49.7 years old, whereas those unwilling to try it was 60.2 years old on average. This is consistent with the known “digital divide” between generations, which describes the difference in comfort and familiarity of using digital technologies.

5) Making children feel like they’re at home

The experience of being in a hospital is even more stressful and mentally burdening for children who miss their parents, their friends, their toys, their favorite blanket and, in general, their home.

Thus, a Dutch company made their stay at hospitals less stressful. Through a smartphone and virtual glasses, VisitU makes live contact with a 360-degree camera at the patient’s home, school or special occasions such as a birthday celebration or a football game. Though hospitalized, young patients can relax and still enjoy their lives.

6) Making vaccination more tolerable

No one likes to get vaccinated. Especially children. The American Academy of Pediatrics even found that one of the reasons parents delay vaccinating their children is due to the concerns of discomfort!

Doctors, in their turn, invent various strategies to help patients get through the process. They tell them to look at specific spots, tell stories or jokes. But there is an even more efficient way to make needles and vaccination more tolerable. In a study of 244 children at Sansum Clinic locations in Santa Barbara and Lompoc, California, roughly half of the children were given VR goggles to view ocean scenes while getting their seasonal flu vaccine. Parents reported that their sons and daughters experienced 48% less pain and 52% less fear due to that! The clinicians mentioned even higher numbers – 75% less pain and 71% less fear.

Apart from the ocean shore, children could be immersed in the virtual world of a lively cartoon where they can feel like superheroes building a shield against monsters by getting the “Fire Fruit” – the vaccine shot in reality.

7) Mitigating fear and traumas

Are you afraid of giant tarantulas crawling on your back? Or do you have a fear of heights, so you can’t look down when you’re standing on a balcony? Virtual reality offers a new way to get rid of your fears and phobias.

The immersive environment not only recreates the fearful situation but also offers a safe place to get over the fears: patients are under the control of physicians and can get out of the simulation at any time.

The Spanish and American behavioral health technology company Psious offers this unique VR treatment for psychological conditions such as fear of flying, needles, various animals, public speaking, general anxiety or agoraphobia. Virtually Better, the pioneering VR company founded in 1996, also offers therapy for people suffering from anxiety disorders, specific phobias or post-traumatic stress syndrome.

A research team at the University of Southern California developed a project called Bravemind – another VR exposure therapy for soldiers that gradually immerse them into the virtual environment similar to the one where they got traumatized and help them overcome the feelings associated with traumas.

8) Giving birth easier and with less pain

Erin Martucci didn’t expect to be among the first women to experience virtual reality during childbirth, she just wanted to deliver her baby without anesthesia or any drugs for labor pain. However, when the doctor Ralph Anderson gave her AppliedVR and virtually immersed her into a sunny beach with pleasing ocean waves and a calm voice coaching her breath, she completely lost the sense of time and only heard the phrase “You are ready to push”. Then Dr. Anderson took the device off her head.

In such a way, Anderson helped more than 40 mothers to give birth to their kids.  Unfortunately, so far, VR cannot “fight” the pain completely. However, the virtual universe distracts mothers a lot and acts like a good drug-reducing option.

9) Watching operations as if you hold a scalpel

Have you ever wondered what is going on in an operating theatre? Not just for fun but for an educational purpose. As I’ve mentioned, in April 2016 Shafi Ahmed performed an operation using a virtual reality camera at the Royal London hospital. And such experience opened new horizons for medical education and training of surgeons. Today, only a few students can peek over the shoulder of a surgeon during an operation. By using VR, surgeons can stream operations globally and allow medical students to actually be there in the OR using their VR goggles.

10) Speeding up recovery after a stroke

For patients who survived a stroke or traumatic brain injury, time is paramount. The earlier they start rehabilitation, the better chances they will successfully regain lost functions.

MindMotionPro by Mindmaze, allows patients to “practice” in lifting their arms or moving their fingers with the help of virtual reality. Although they might not do actual physical movements, the app enhances attention, motivation, and engagement with visual and auditory feedback. The mental effort and belief help traumatized nervous systems to recover much faster than lying helplessly in bed.

“VR Pharmacy”

As we know, VR is just a platform. What really matters are the visualizations themselves; i.e. their content, duration, and quality. And these visualizations should fit different patients’ tastes. Somebody likes to relax on a beach, others prefer to play games, some are annoyed by real-life footage, some – by dynamic environments. Thus, it would be great to have a sort of a “VR Pharmacy”evidence-based, well-characterized visualizations that clinicians can pull off the shelf and “prescribe” to individual patients. It would also help to have a formal way to match patient knowledge, attitudes, beliefs, and preferences with specific off-the-shelf visualizations. Then VR therapy could really flourish.

For sure, nothing is as easy as pie. Sometimes patients get dizzy after using VR devices. Sometimes they are just reluctant to give the technology a try. If one just gives goggles to patients, nothing changes. But if doctors become coaches, if they show benefits on their example, then VR would reduce pain, anxiety, phobias, PTSD and many other psychological disorders more efficiently.

Is VR for everyone?

Not exactly. For instance, Spiegel and his team have excluded patients who could not take decisions on their own (for example those with dementia), or who were placed in contact isolation, or who had head wounds or bandages that interfere with the VR headset.

VR may also cause motion sickness in some users. So, Spiegel excluded patients with a history of motion sickness and vertigo, and anyone experiencing active nausea or vomiting. Patients with a history of seizures or epilepsy were also excluded to limit the theoretical risk of initiating seizures with VR (Samsung Gear user manual cites a 0.025% risk from pediatric data).

Also, many patients are just reluctant to use VR. And they are not only “old-fashioned” seniors.

The very first patient I approached for our study was a 45-year-old woman who, a month before, developed a “cold” she couldn’t treat. It turned out she didn’t have a cold at all; she had metastatic lung cancer without ever having smoked a day in her life. She had a young child and a supportive family at her bedside. We approached her with a set of goggles, explained how the VR technology might help with pain management, and described how the experience might offer a temporary “escape” from the hospital. She looked at us, silently and unblinkingly, as if we were dropped into her room from another planet. She politely turned down the VR, but I could see in her eyes that our request was simply out of place. She died days later”.

What I’d like to say is that there are tremendous hope and hype around VR, but VR cannot cure cancer and should be recognized for what it is – a tool that, in some cases, could help relieve distress and anxiety together with other treatments. Yes, it is “transforming” healthcare. It really does. However, we should be careful to recognize its limitations while also acknowledging its benefits.

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