October 25, 2019
VR in healthcare: treating patients in virtual and real worlds
Virtual reality is changing the world. With entertainment as the primary application, VR’s main goal is to take you anywhere and let you do anything—play in snow fights, navigate a submarine, milk a cow, or even perform an alien surgery.
The ability to create the feeling of being present in a virtual world has attracted other industries, such as education, tourism, media, sales, and healthcare. There might be a bit of skepticism over introducing an element that is typically thought of as providing entertainment into healthcare. However, there are numerous benefits to VR in this setting.
According to a ResearchAndMarkets report, virtual reality applications in the US market will surpass $5 billion by 2024. The same report also mentions that healthcare is predicted to be one of the main industries that will increase its use of virtual reality. So, in the near future, healthcare software development services will increasingly include the provision of AR and VR solutions.
While the majority of patient-facing approaches don’t include VR in healthcare for now, it brings in the potential for entering a value-based care era with improved health outcomes and reduced costs. This can be especially true for patients with chronic and mental health conditions. Here’s how.
They say time heals, and that can be true. Our brains can help us overcome traumatic experiences, blurring the memory, or even changing it.
As improbable as it sounds, believing in something can help us to survive soul-crushing life events. Virtual reality accelerates the brain’s capability to transport you to fantasy lands and helps people recover faster or overcome their long-term phobias, fears, and anxieties.
Recently, there has been a lot of academic support to the idea that VR significantly reduces pain. One of the ways it does this is by providing the patient with a distraction. The use of VR can distract the patient from their current condition or a procedure they are undergoing, thus decreasing their perception of the pain. Therefore, using virtual reality in healthcare could potentially redefine the clinical approach to chronic pain management.
We all feel different types of pain from time to time, but, in most cases, it subsides quite easily and doesn’t require much attention. Chronic pains are different because they rarely give the sufferer any relief. According to a report by the Centers for Disease Control and Prevention, approximately 50 million US adults are living with chronic pain.
The healthcare system was designed to achieve results within short-term care cycles and move on, so chronic pain management and discomfort relief aren’t among its top priorities. Accordingly, addictive painkillers, such as opioids, have become the standard treatment for chronic pain.
But this isn’t an optimal solution. As opioid abuse claims about 130 lives every day, providers are eager to find effective, non-addictive alternatives.
Thankfully, value-based care has put an emphasis on each patient’s outcome, prioritizing a higher quality of life, and using virtual reality in healthcare has the potential to provide that.
Psychological therapy choices, such as cognitive behavioral therapy and mindfulness, can also be effective, but they require more activity from the patient’s side. Since chronic pain may entail mood changes, fatigue, and sleep disturbances, it can be challenging to motivate patients to perform exercises or be open about their current emotions.
VR technology allows for the possibility of overcoming that challenge by taking the proactive role during the session. It also creates an immersive environment that allows patients an effective distraction from the pain.
A 2019 study at Cedars-Sinai Medical Center found that VR significantly reduces pain in hospital patients and that the more severe the pain, the more effective VR is.
In the study, 61 patients were asked to use a VR headset for ten-minute sessions three times per day. Patients could use the headset more often if they desired and if their care team agreed. During waking hours, the patients were asked to rate their pain on a 0-10 scale every three to four hours.
The results showed that the patients who used VR reported significantly lower numbers on the pain scale than their counterparts in the study who were not given access to VR. The study also showed that the patients who had reported the highest level of pain at the beginning reported the greatest amount of decrease in pain.
Up to 70% of amputees experience phantom limb pain, or PLP. The reasons PLP occurs are not yet defined, but one of the most popular theories states that the brain struggles to process a sudden lack of input from the lost neural cords.
The syndrome feels like growing tension in toes, fingers, or muscles of a missing limb when the brain tries to reach out to this part of the body. This pain can last for days and may not even subside under strong painkillers like codeine and morphine.
For amputees, VR submerges the patient into an alternate reality via goggles and sensors to capture limb motions. In this reality, the patient is able to control both the existing and missing limbs and perform different exercises, such as pushing buttons, grabbing things, and moving objects around. With the regained ability to control the non-existing body part in the virtual world, the patient’s brain can release the tension and reduce the pain in the real world.
In a 2018 research of amputees experiencing PLP, participants rated their pain before undergoing an hour of virtual reality treatment. The treatment always started with 20 minutes of playing the most active game first. Then the participant was free to choose what games to play with the rest of the time.
The subjects reported a substantial decline in pain immediately following the VR sessions. Additionally, participants reported lower numbers on the pain scale before starting each subsequent session, showing a progressive decrease of PLP.
Multiple virtual reality games recently introduced controller support, so we can expect further evolution of motion capture technology in the next couple of years. Healthcare can certainly benefit from this, especially when it comes to physical and cognitive rehabilitation from brain injuries and traumas, such as stroke.
Sadly, not all patients who have suffered a stroke can regain full-body control. The rehabilitation process is complex; it requires a lot of engagement, motivation, and dedication from the patient’s side. A lot of post-stroke patients need to work with physical, occupational, and/or speech therapists every day, but this might not be enough. Many patients become bedridden for an extended period of time or suffer hemiparesis, which can further complicate the situation.
VR and motion capture sensors can facilitate recovery, as they allow patients to exercise for as long as they need to in an immersive environment, sometimes while lying in bed. Therefore, this can increase their chances of regaining use over paretic limbs.
A 2019 study conducted in South Korea showed that the use of VR, along with computerized cognitive training, is beneficial to patients with acute stage stroke. The researchers compared this group to another group that used computerized cognitive training without VR. They found that the group that used VR as part of their rehabilitation showed significant improvement over their peers in cognitive function and daily living performance.
The participants wore virtual reality training display devices and were asked to play a fishing game. The number of fish to catch could be changed based on the user’s accuracy of hand and finger movements. The therapy also included a picture matching game, which required the users to flip over cards and find their matches. Combined, the tasks were meant to improve upper extremity function, attention, and memory.
Surprisingly, only thirty minutes, five times a week of training, was enough to induce significant changes in the amount of cognitive function and performance of daily tasks.
VR allows physicians to assess a patient’s cognitive rehabilitation levels and determine if there are improvements being made. Virtual tools can be used to evaluate whether the patient is ready to return home and regain their previous quality of life.
After a stroke or other brain trauma, some patients struggle to handle such trivial tasks as shopping, eating out, going for a walk, or making plans. Virtual environments help physicians simulate these routine activities, gradually increasing the complexity level to increase the chances that patients will successfully return to their ordinary lives.
Having fears is a normal part of life. For most of us, our fears do not get in the way of our normal daily activities. However, for those who suffer from phobias, their fears can take over their lives. In these cases, undergoing supervised exposure therapy can be helpful.
VR takes exposure therapy to a whole new level, allowing therapists to personalize the phobia treatment process and make it as gradual as needed for each patient. At some point, a patient gets accustomed to situations pertaining to their phobia and gets to the point where they can better cope with their fear.
This approach also works with people suffering from post-traumatic stress disorder, or PTSD, such as soldiers or victims of assault. These patients can develop a variety of symptoms, including insomnia, nightmares, irritability, and panic attacks. Symptoms can appear years after the event, and patients can struggle to maintain a normal life.
VVR brings hope to help PTSD patients recover from their anxiety by allowing them to reenact the traumatizing experience as many times as needed. Eventually, many patients will be able to overcome the stress disorder. Kevin Tergliafera, a soldier who underwent VR sessions, comments on the therapy: “The layers, they just peel back, and they just get you to your core. At first, you don’t want to, but you break down and do it, and it’s absolutely amazing.”
With the opioid crisis in the spotlight, non-medication therapies are gaining momentum and attracting more effort, especially in the psychologic realm. As technology spurs forward, virtual reality in healthcare becomes a worthy alternative to addictive painkillers.
The accelerating quality and affordability of virtual reality devices and supporting motion trackers can expand access to immersive therapies for the patients who need them. Hopefully, with these developments, we can anticipate more effective post-stroke rehabilitation, phobia treatment, chronic pain management, and PTSD recovery.
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