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VR application in medical facilities

Virtual Reality (VR) is essentially a way for humans to visually connect with, manipulate, and interact with computers. That enables users to immerse with synthetic computer-generated virtual environments similar to real-life activities and events and could be interpreted as an advanced human-computer interaction. 1 VR is gradually incorporating into our lives. At the time of writing Playstation has sold over 3 million headsets and they are clearly focusing on gaming and storytelling. But VR is being implemented in many other aspects, speeding manufacturing processes, changing the way we are trained in dangerous and expensive environments and how we are educated within schools and universities. It is not a big surprise, that it has carved its pathway into the healthcare system and its facilities. The global AR and VR in healthcare market generated $1.08 billion in 2018, and is estimated to grow over $11.14 billion by 2025. 18

VR will start having an impact in lots of place in the healthcare world...

At ward

Wards are the heart of hospitals. They are a commonplace for patients closely monitored by doctors, nurses and other healthcare practitioners. VR is an invaluable addendum which improves the recovery process and may substantially reduce the time of unwellness.  In almost every study that dealt with VR simulators, researchers have arrived at the same conclusion that both doctors and patients could benefit from this novel technology. 2

VR could be particularly useful at surgical wards. Physicians may develop a personalised treatment plan in accordance with particular patient anatomy and even practice the procedure beforehand on a simulator. That is especially important for younger, less experienced operators. Moreover, more and more surgical theatres implement VR systems which improve tools navigation and become a platform for global streaming. 3 Moreover, the presented simulation during a clinical discussion is a vivid and understandable explanation for patients. 4 Thanks to it an individual may easily understand the pre-procedural plan, acknowledge benefits and risks connected with a procedure and provide well-informed consent as a result.

VR technology has been firstly proposed as a tool for pain modulation in 1998.2 A simple system composed of a computer, head-mounted display system, game software and tracking system proved to provide analgesia without side effects and with little impact on the physical hospital environment. 5 Another type of analgesia delivery VR system is virtual reality hypnosis. Patients, who followed the path of virtual igloos, snowmen and penguins, reached the state of relaxation which is an effective addition to morphine for pain management. 6 Furthermore, the VR system demonstrated to increase analgesic efficacy for patients with a chronic pain lasting more than 3 months and thus provided a promising alternative treatment for long-lasting pain. 2,6

Every hospital admittance should be preceded by the introduction of a patient to local rules and laws. The task is especially hard for psychiatric wards, which are still surrounded by a significant societal stigma and deal with mentally unstable people. Incorporating VR for a virtual guided tour helped to both improve the level of understanding as well as reduce new patient's level of anxiety. 7

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At medical university

For many decades, the acquisition of technical skills under the supervision of senior Colleague has been the only way for junior doctors to receive training. However, sole observation is no longer enough for acquiring certain skills.2 VR is great for filling up this important gap in medical education.

The VR course provides not only a deeper insight into human anatomy and physiology8 but enables for hands-on experiences to teach procedure conduct and improve its performance metrics. Bronchoscopy 9, colonoscopy 10, spinal and brain surgeries 10 are just a few examples. The pivotal positive aspect is 100% patient safety, as the learning happens on the artificial subject without a patient participation. 4 Furthermore, senior supervision is no longer needed during the period of basic skill training and acquisition, since the VR simulations can provide a controlled virtual environment necessary to satisfy these requirements. 2 Moreover, whole performance can be recorded, compared and analysed, making objective data permanently available for trainees and their mentors. 2

For mechanical thrombectomy due to ischemic stroke, which is simply declotting a brain, prospective, randomised, and blinded clinical studies have demonstrated that trainees who acquired their skills to a level of proficiency on a simulator perform significantly better (40%–69% better) in vivo in comparison with their traditionally trained colleagues. 11 It is important, that the learning curve of a procedure is done in a safe environment and no patient is at risk. It provides patient with a well-trained team which directly improve clinical outcomes. Additionally, the VR simulation enables a proficient operator to practise novel, high-risk procedure. 11

It was suggested that the ideal educational delivery of the training interventions using the simulated setting should be composed of minimum 5 sessions for each task with a minimum duration of 20 minutes, independent of the simulation model. In each session, the novices perform training with basics tasks followed by more advanced tasks afterwards. 12

However, medical education is not restricted solely to healthcare professionals. The general public may profit from VR experience during gaining the skills needed for basic life support.4

At rehabilitation centre

Rehabilitation programs are offered to individuals with an impaired function to improve abilities in activities of daily living and increase social participation, for example among post stroke patients, patients with cerebral palsy, spinal cord injuries, Parkinson disease, ADHD, dyslexia, multiple sclerosis, ataxia, epilepsy. 1 A range of benefits was associated with VR interventions, including improvement in motor functions, greater community participation, and improved psychological and cognitive function. 1

Some patients, especially those living in the rural areas, may find the journey to a rehabilitation centre problematic. 11-month long study for patients with cerebral palsy who performed at-home rehabilitation session with a VR glove proved to be as effective as normal sessions. However, remote input of the data is not enough for the sustenance of adherence - humans must be heavily involved in remote monitoring to maintain benefits.  In-home telerehabilitation increases the accessibility of rehabilitation and has the potential to become inexpensive with large scale production. 13

A recent meta-analysis showed that VR rehabilitation programs focused on motor control, balance, gait, and strength are, overall, more effective than traditional rehabilitation programs. It can be caused by excitement, physical fidelity, and cognitive fidelity provided by the virtual environment. 14

At outpatient clinic

Current VR systems aim to engage patients. Studies have indicated that VR provides the possibility of creating real 3D environments capable of eliciting realistic perceptions and reactions in the patient. The observer may closely monitor and record the performance of the proposed task, allowing the gradual follow-up, and thus making further treatment highly personalised and developed accordingly.1

Most psychological problem and therapy happens in an out-patient clinic settings. Some treatment for people dealing with fears are based on direct confrontation with a triggering stimuli, namely exposure therapy2. The randomised trial for social anxiety, based on self-reported outcomes registered six months following the treatment, has shown that VR exposure is superior to the standard, real-life exposure. 15

Care homes

The rapid increase in the numbers of old people in society and the corresponding strain on medical resources will result in greater importance being placed on home and nursery home health care. 16 Older adults are particularly prone to falls, which substantially decrease their mobility and quality of life. Therefore it is crucial to implement balance training programs to prevent this debilitating complication. VR simulators are as effective as traditional methods. 17 Dementia is also being tackled using ‘reminiscence therapy’ traditionally this is done using video and pictures allowing patients to use distant memories to help them today. VR has the ability to further this by taking people space which has a deeper effect.

Today

VR is being used in many different medical and health environments. At Rescape we are researching and innovating in lots of different new applications. For example, we have been working closely with hospices not only helping patients reduce pain and anxiety, but also allowing them to confront and discuss important and difficult end-of-life resolutions. We have been taking patients that are confined to bed to see and be at their loved one's weddings. VR is set to revolutionise healthcare, in many discovered and undiscovered ways, the question is how and where will you incorporate it into your day to day work. We’d love to discuss how we can start this journey.

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References:
  1. Massetti, T. et al. The Clinical Utility of Virtual Reality in Neurorehabilitation: A Systematic Review. J. Cent. Nerv. Syst. Dis. 10, 1179573518813541 (2018).
  2. Li, L. et al. Application of virtual reality technology in clinical medicine. Am. J. Transl. Res. 9, 3867–3880 (2017).
  3. Khor, W. S. et al. Augmented and virtual reality in surgery-the digital surgical environment: applications, limitations and legal pitfalls. Ann Transl Med 4, 454 (2016).
  4. Hu, H.-Z. et al. Application and Prospect of Mixed Reality Technology in Medical Field. Curr Med Sci 39, 1–6 (2019).
  5. Das, D. A., Grimmer, K. A., Sparnon, A. L., McRae, S. E. & Thomas, B. H. The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: A randomized controlled trial [ISRCTN87413556]. BMC Pediatr. 5, 1 (2005).
  6. Konstantatos, A. H., Angliss, M., Costello, V., Cleland, H. & Stafrace, S. Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes. Burns 35, 491–499 (2009).
  7. Lau, W.-C., Choi, K.-S. & Chung, W.-Y. A virtual psychiatric ward for orienting patients admitted for the first time. Cyberpsychol. Behav. Soc. Netw. 13, 637–648 (2010).
  8. Weyhe, D., Uslar, V., Weyhe, F., Kaluschke, M. & Zachmann, G. Immersive Anatomy Atlas-Empirical Study Investigating the Usability of a Virtual Reality Environment as a Learning Tool for Anatomy. Front Surg 5, 73 (2018).
  9. Gopal, M. et al. Bronchoscopy Simulation Training as a Tool in Medical School Education. Ann. Thorac. Surg. 106, 280–286 (2018).
  10. Bernardo, A. Virtual Reality and Simulation in Neurosurgical Training. World Neurosurg. 106, 1015–1029 (2017).
  11. Liebig, T. et al. Metric-Based Virtual Reality Simulation: A Paradigm Shift in Training for Mechanical Thrombectomy in Acute Stroke. Stroke 49, e239–e242 (2018).
  12. Guedes, H. G. et al. Virtual reality simulator versus box-trainer to teach minimally invasive procedures: A meta-analysis. Int. J. Surg. 61, 60–68 (2019).
  13. Golomb, M. R. et al. Eleven Months of home virtual reality telerehabilitation - Lessons learned. in 2009 Virtual Rehabilitation International Conference 23–28 (IEEE, 2009).
  14. Howard, M. C. A meta-analysis and systematic literature review of virtual reality rehabilitation programs. Comput. Human Behav. 70, 317–327 (2017).
  15. Bouchard, S. et al. Virtual reality compared with exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial. Br. J. Psychiatry 210, 276–283 (2017).
  16. Gourlay, D., Lun, K. C. & Liya, G. Virtual reality and telemedicine for home health care. Comput. Graph. 24, 695–699 (2000).
  17. Yeşilyaprak, S. S., Yıldırım, M. Ş., Tomruk, M., Ertekin, Ö. & Algun, Z. C. Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey. Physiother. Theory Pract. 32, 191–201 (2016).
  18. Bhavya Banga BIS Research Inc.2019
    Global Augmented Reality (AR) and Virtual Reality (VR) Market in Healthcare Market to Reach $11.14 Billion by 2025
Kevin Moss

Written by Kevin Moss

As Product Development Director Kevin is obsessed with making all aspects of Rescape’s products and content simple, intuitive and beautiful. Kevin has over 20 years of digital experience managing multi-disciplinary teams. He has been at the forefront of technology working in digital product development, content creation (gaming and video) and innovation marketing. Recently as Creative Innovation Director within Dentsu Aegis he helped clients evaluate the impact of new technologies including projects for VR, AR and voice. He co-founded a digital agency which he sold to WPP and has worked in multiple startups. He has worked with bluechip clients including PlayStation, Lego, Sony, BBC, Honda, Channel 4 - from devising a Bafta-nominated digital drama to designing PlayStation Online.