VR in healthcare: treating patients in virtual and real worlds

13.03.2018
9 min.
title

Everything you can imagine is real.

Pablo Picasso

Virtual reality takes over the world. With entertainment as the primary application, VR’s main goal is to take you anywhere and let you do anything—play snow fights, navigate a submarine, milk a cow or even perform an alien surgery.

The ability to create a feeling of presence played well with other industries, such as education, tourism, media, sales, and healthcare. There might be a bit of skepticism over introducing such a gamifying element as VR into healthcare, but a recent Grand View Research forecast blows it away. According to the report, the global market for AR and VR in healthcare is expected to reach $5.1 billion by 2025 with 29.1% CAGR. So in the nearest future healthcare software development services will increasingly include the provision of AR and VR solutions.

The same report by Grand View Research defines a couple of major VR applications in healthcare, including diagnostics, medical education simulation and a cluster of patient-facing approaches: pain distraction, exposure therapy, and rehabilitation.

While the cluster of patient-facing approaches doesn’t make the primary application for VR in healthcare for now, it brings in the huge potential for entering value-based care era with improved health outcomes and reduced costs, especially for patients with chronic and mental health conditions. Here’s how.

VR vs. pain, fear, and discomfort

They say time heals, and it is true. The thing is that our brains help us overcome traumatic experiences blurring the memory or even changing it.

As improbable as it sounds, believing in something really hard can help to survive soul-crushing life events. Virtual reality just accelerates the brain’s capability to transport you to the fantasy lands and uses it to help people recover faster or overcome their long-term phobias, fears, and anxieties.

Pain management

An array of studies proves that VR helps to relieve pain in both adults and children. The appeasing effect can be achieved by stimulating the brain’s somatosensory and insular cortex, which compose our pain modulation system. VR exerts emotion-based cognitive and attentional processes within these brain parts and reduces pain.

This effect allows people to withstand painful sensations, such as invasive medical procedures, dressing changes, and even phantom pains.

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 and cancer pains are different because they can’t pass completely. According to a report by National Institutes of Health, more than 25 million US adults are experiencing chronic pains on a daily basis.

Well, the healthcare system was designed to achieve results within short-term care cycles and move on, while chronic pain and discomfort relief weren’t among its top priorities. Accordingly, addictive painkillers such as opioids became the standard treatment for chronic pains.

But this isn’t an optimal solution. As opioids claim about 115 lives every day, providers are eager to find effective non-addictive alternatives.

Thankfully, value-based care has put the emphasis on each patient’s outcomes, prioritizing higher life quality. VR has everything to become the top pick.

The other 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 pains may entail mood changes, fatigue, and sleep disturbances, it can be challenging to draw patients into performing exercises or being open about their current emotions.

The VR technology allows overcoming the challenge taking the proactive role during the session and creating an immersive environment that allows patients to distract from the pain more effectively.

Virtual reality pain management
Image source: https://painresource.com/science-progress/virtual-reality-pain-management/

A recent study held by a team of pain psychologists has shown a 60% reduction in chronic pain during a VR session and a 33% reduction at the end of the session.

Here’s how the study was held.

30 patients were treated with 5-minute VR sessions. They traveled a fantasy world with ambient music, trees, snow scenes, caves, and flames, interacting with the world’s habitants—playful otters. Patients could look forward and around them, throw orbs to hit surroundings, and toss fish to feed the otters. No violence implied, no score kept. All patients enjoyed the experience, and some of them even asked to continue the simulation after 5 minutes.

Phantom pain treatment

If a patient suffers a disease or an accident that results in limb amputation, they can occasionally 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.

Research held at Aalborg University shows the ability of VR to help patients with PLP via the virtual mirror therapy.

The therapy allows submerging the patient into a virtual 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.
 

Physical and cognitive rehabilitation

In 2017, multiple virtual reality games introduced controller support, so we can expect further evolution of the motion capture technology in the next couple of years. Healthcare can definitely benefit from it, especially when it comes to physical and cognitive rehabilitation from brain injuries and traumas, such as stroke.

Sadly, not all patients who 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. All post-stroke patients need to work with physical, occupational, and speech therapists once a day, but this might not be enough. Many patients become bedridden for a long time or suffer hemiparesis, which doesn’t make the situation much easier.

VR and motion capture sensors can facilitate recovery as they allow patients to exercise as long as they need in an immersive environment when lying in the bed, and thus increasing their chances to regain use over paretic limbs.

Virtual reality goggles for stroke victims
Image source: https://www.bloomberg.com/news/articles/2015-05-04/mindmaze-s-virtual-reality-goggles-for-stroke-victims

According to recent research by Pompeu Fabra University in Spain, patients can get back to using their weakened limbs after going through a hemiparetic stroke. The researchers took 20 participants and offered them to control a virtual limb in a game-like environment with a Microsoft Kinect sensor to capture their performance.

The movement of a virtual limb was gradually enhanced, showing the increasing results in speed and accuracy to convince patients in their progress. The visual change made patients more confident about their recovery process and improved their rehabilitation.

Surprisingly, only ten minutes of enhancement was enough to induce significant changes in the amount of spontaneous use of the affected limb

Pompeu Fabra University Logo

More than that, VR allows physicians to assess a patient’s cognitive rehabilitation levels and improve them. Virtual tools can be used to evaluate whether the patient is ready to return home and regain their life quality.

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 to simulate these routine activities, gradually increasing the complexity level to make sure that patients will successfully return to their ordinary lives.

Exposure therapy

We all have our own monsters, some of them being completely understandable, such as height, darkness, and clowns (thank you, Stephen King), and some beyond irrational, like butterflies, dolphins, and even the sun. When this fear grows into a phobia, patients might have to undergo the exposure therapy, meeting their monsters with the help of a therapist.

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 a particular patient. At some point, a patient gets accustomed to the situation and gets to the point where they can 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. Sometimes, the symptoms can appear years after the event, and patients will struggle to maintain a normal life.

VR applications
Image source: https://medium.com/@myeagermind/the-growth-and-impact-of-virtual-reality-in-the-coming-years-5c62d11ad1d6

VR brings hope to help PTSD patients recover from their anxiety by allowing to reenact the traumatizing experience as many times as needed. Eventually, patients will be able to overcome the stress disorder. Jimmy Castellanos, one of the soldiers that underwent VR sessions, comments on the therapy: “You go over the story over and over again. I got so bored with my own story that it no longer elicited a reaction.”

On the verge of clinical VR

With the opioid crisis in the spotlight, non-medication therapies gain momentum and attract more effort, especially in the psychologic realm. As technology spurs forward, VR in healthcare becomes a worthy alternative to addictive painkillers.

The accelerating quality and affordability of virtual reality devices and supporting motion trackers will expand the access to immersive therapies for the patients who need them. Hopefully, we can anticipate more effective post-stroke rehabilitation, phobias treatment, chronic pain management, and PTSD recovery.