There’s a revolution taking place in the healthcare sector – one that stems from an unlikely source. While virtual reality (VR) often makes headlines for transforming the way we digest content – bringing movies, gaming and even pornography to life – its medical applications are less obvious. But VR is making huge strides in this space, holding the potential to vastly improve the lives of millions of people around the world.
Perhaps most exciting is just how many applications VR could have in the healthcare sector, from helping those with autism to improving pain management and cognitive rehabilitation. Dementia is a particularly interesting area for VR, largely due to the marked lack of progress in finding a cure for a condition that, according to the World Health Organisation, some 50 million people around the globe suffer from.
“Dementia is already one of the greatest health challenges we face and is predicted to affect more than 130 million people worldwide by 2050,” Tim Parry, a director at Alzheimer’s Research UK, told The New Economy. “Research and available funding for Alzheimer’s and other [forms of] dementia has long lagged behind other serious health conditions – it’s taken us too long to wake up to the seriousness of the condition and its impact medically, socially and economically.”
VR is already beginning to tackle this lack of research. In 2016, Deutsche Telekom and game company Glitchers, together with scientists from the University of East Anglia, University College London and Alzheimer’s UK, released Sea Hero Quest, which sees players make their way through various checkpoints, scoring them for their navigational skills. As the loss of navigation and orientation skills is one of the first signs of Alzheimer’s, scientists hope to gain a better understanding of when these abilities begin to falter by using data retrieved from the game.
Dementia is a particularly interesting area for VR, largely due to the marked lack of progress in finding a cure for the condition
Progress has been tremendous so far: having been downloaded around four million times, the mobile game has gathered data the equivalent of some 17,600 years of lab research, according to the company’s website. Using this information, scientists have been able to create a benchmark for spatial navigation across various factors, such as age and location. “Research holds real power for creating [the] more accurate diagnostics and effective treatments that those living with dementia and their families really need,” Parry told The New Economy.
With the introduction of VR to a new version of the game, released in 2017, scientists have been able to obtain greater volumes of even more accurate data. Through VR headsets, scientists have gained crucial insights into the head movements and direction of a subject’s gaze when they are navigating. Michael Hornberger, Professor of Applied Dementia Research at the University of East Anglia and one of the project’s collaborators, said: “With the tablet version, it’s quite difficult because people need to swipe to look around, while with a virtual reality headset, of course, it’s very quick to do this.”
people suffer from dementia globally
dementia patients cared for in Hogeweyk, The Netherlands
Sea Hero Quest VR enables scientists to understand how healthy people navigate in comparison with those that are at high risk of dementia, as well as those already affected. “The idea behind it is that the processes in the brain in Alzheimer’s disease particularly affect these navigation areas, and what we know from brain scans or other studies is that these changes occur up to 10 to 15 years before actual memory symptoms occur,” Hornberger explained. “So the potential is for you to test spatial navigation in diagnosing people much, much earlier.” Earlier diagnosis could also provide the key to creating preventative treatments – a development that could change the lives of millions worldwide.
There are other ways that VR can help, too: Alzheimer’s patients, for example, can often become disorientated and lost, placing them in harm’s way. Though it has not yet been explored, VR could train individuals to use landmarks and improve their navigation skills, which – coupled with medication – could help keep them safe. Through applications like Sea Hero Quest VR, scientists can assess those most at risk of Alzheimer’s and create better safeguarding measures for them.
The power of the past
A study published in the Journal of the American Medical Directors Association in 2015 indicates that reminiscence therapy – a treatment that uses audiovisual aids to help patients remember their past – can improve cognitive functions. Scott Gorman, Co-Founder and CTO of London-based start-up Virtue Health, told The New Economy: “Research shows that reminiscence therapy can [also] improve communication abilities, elevate mood and help to recall memories in people with dementia.”
VR creates a safe space to practise real-world scenarios and learn transferable skills without pressure or risk
In recent years, this type of therapy has been used on a grand scale in the form of dementia villages. One notable example is Hogeweyk in the Netherlands, a village designed to care for 152 dementia patients and help them remember their past through the use of life-sized props.
Naturally, the cost and accessibility of reminiscence therapy on such a grand scale makes it inaccessible to many, but this is where head-mounted displays – like those used in VR gaming – can step in. One app in particular, LookBack by Virtue, is leveraging VR in this way. With help from carers and family members, patients can select settings and scenes best suited to their past: they can choose to sit in a tearoom set in the 1950s or ride a steam train. In other words, LookBack brings reminiscence therapy to patients from the comfort of their own homes.
“We believe in the potential for immersive technology to provide a more affordable and flexible option for conducting reminiscence therapy,” Gorman told The New Economy. “An app like LookBack is not a panacea, but it can help improve quality of life and potentially reduce the need for certain medications.”
While there is a preconceived notion that the elderly and technology don’t mix well, the reality is not as black and white. “We found this mercifully as definitely not the case – that really people embrace it once they understand how it works and how easy it is to use,” Hornberger said. “We found that for all the people and dementia patients it’s fantastic because it’s so much more intuitive than using a keyboard or anything like this.”
Training for reality
Autism is another area in which VR has huge potential. Dr Nigel Newbutt, Senior Researcher in Digital Education at the University of the West of England, Bristol, believes this is due to the two simply being a natural fit: “VR is a form of technology, and we know that forms of technology appeal to people with autism because they are predictable, they’re controllable, they remove the need for face-to-face communication, and often they’re a one-on-one interaction.”
For this reason, Newbutt has been looking into the various ways VR can help those with autism, such as by enhancing their social communication skills and breaking down other barriers they may face. He said: “What the research does show quite well is that there is a lot of ecological validity – which is feeling natural in virtual spaces – so that ability to take what they learned in a virtual space into the real world is closely aligned.”
Equivalent years of lab research collected
Removing the need to decode facial expressions and handle the nuances of communicating with a real person allows people with autism to face one challenge at a time, instead of being bombarded by a variety of stimuli. Settings can also be modified to suit the individual, allowing users to improve at their own pace. “[For] someone with autism, trying to interact with a real-world scenario can get very overwhelming,” Newbutt explained. “What we’ve found is that those anxiety and stress levels are reduced in actual fact [when] using VR.” Newbutt believes there’s less pressure, too: “They can practise things, try things out; they can make mistakes without real-world consequences.”
One area that Newbutt has received multiple requests to help with is dating. “[You’re] going into a space you’ve maybe not been to before and having to socially interact with lots of loud noises,” he explained. With a VR app, these stimuli can be controlled and increased slowly. This, Newbutt said, can “help somebody transition into a real-world scenario like that more comfortably”.
Newbutt has also worked with the UK’s Department for Work and Pensions, developing virtual versions of job centres to improve access to employment opportunities for autistic groups. Other companies are exploring the world of autism through VR, too. Washington-based Floreo, for example, has been making strides to help with joint attention, which is the ability to take cues regarding what objects should be given attention in a social interaction.
There are numerous ways in which VR could help people with autism: it creates a safe space to practise real-world scenarios and learn transferable skills without pressure or risk. Naturally, research and development for every type of situation and corresponding platform will take time, as well as a series of scientific studies and controlled trials. Fortunately, this process has already begun, and the next step towards widespread adoption will be greater affordability. This could see the technology adopted in schools, clinics, centres and homes around the world.
A virtual future
Simulating real-world scenarios in VR is not limited to enhancing social communication skills: there are countless other situations and groups that could benefit from training exercises in the safe and controlled environment afforded by VR.
Dr Wendy Powell, Associate Professor at the Department of Cognitive Science and Artificial Intelligence at Tilburg University, put forward one example: “Someone who has recently had a stroke may not be safe to practise crossing roads, but we can create a road-crossing simulation, complete with various levels of traffic and other pedestrians, in order to practise safely until they are ready to try in the real world.”
In her previous post, Powell led VR training and research at the University of Portsmouth’s School of Creative Technologies. Her team found success in increasing the pace at which a patient can walk by presenting their pace as slower in the virtual world than it is in reality. Studies show that a subject’s speed on a motorised self-paced treadmill accelerates naturally, without the anxiety that usually comes with encouraging patients to adopt a faster pace. This technique also found that the patient’s speed increased without aggravating pain.
Indeed, pain management is another area that could benefit from VR technology. Powell explained that VR works first as a means of distraction; by immersing one’s senses in a completely new environment, the focus is taken away from pain. “This is particularly helpful in the management of acute pain, or painful procedures,” she said. There’s also mounting evidence from brain imaging studies that VR has a direct effect on the brain’s pain centres. “Since pain often has a psychological as well as a physical component – for example, anticipating a pain tends to make it hurt more – using VR to reduce pain can break the pain-tension-pain cycle and may have [benefits] for chronic pain,” Powell added.
The team at Portsmouth also looked into using VR to manage phantom limb pain in amputees, as pain can be relieved if the brain believes the amputated limb is still present. In a study conducted by Aalborg University, residual limbs were given electrical impulses, which made the patient feel as if the limb they lost was still present. The patients then played VR games that involved carrying out the same task with, for example, both hands, such as holding an object and twisting it into different shapes. In the virtual world, the amputated limb is present again, reducing the sensory conflict that causes phantom pain.
VR can also make other types of therapy more fun and engaging, thereby helping patients to realise full recovery. Using VR for brain injuries and cognitive rehabilitation is another promising application. Relearning everyday tasks can be extremely repetitive, boring and frustrating but, according to Powell, “research shows that introducing cognitive training tasks into VR allows patients to engage with them in a variety of ways and with customised increasing levels of complexity, which can speed up recovery and regain better cognitive function”.
When considering these examples, what becomes clear is just how much potential VR holds for the healthcare industry. It can ease pain, help those whose memories have failed them, provide an invaluable training ground, and make therapy more engaging, and therefore more effective. We’re still just scratching the surface of what VR has to offer. With head-mounted displays becoming more affordable with each passing year, the technology won’t just be limited to the wealthy or certain institutions – it can be rolled out to the masses and change lives across the globe. VR is set to revolutionise healthcare as we know it, making the benefits of a virtual world a reality.
VR therapy games
As DEEP’s players drift through the game’s peaceful underwater setting, the custom controller monitors the speed and depth of their breathing. The game then feeds the player a variety of visual cues to prompt them to slow their breathing and relax. DEEP can be used to alleviate stress, anxiety and mild depression.
Many PTSD sufferers naturally develop avoidance tendencies, meaning they are unable or unwilling to imagine their traumatic experience. This limits their ability to process the distressing emotions that are symptomatic of PTSD. Bravemind immerses the player in an environment representative of their experience, controlling the stimuli to decondition the patient.
Glossophobia, or the fear of public speaking, is believed to affect up to 75 percent of the population. Limelight by Virtual Neuroscience Lab places its users on a stage in front of a virtual crowd, to whom they can practise a speech or presentation. The size and mood of the audience can be adjusted.
Exposure therapy is a style of cognitive behavioural therapy that immerses the patient in the source of their anxiety. Cityscapes, an app designed by Samsung, helps users overcome their fear of heights by placing them hundreds of feet above the ground. With three outdoor settings – a lift, a skywalk and a skyscraper – and a heart rate monitor, users can gauge their progress and control their phobia.
Designed specifically for children with autism, Floreo uses VR to teach social and communication skills in a fun and engaging way. The app currently features seven games – a further three are in development – that teach the player essential skills such as how to cross the road safely, interact with a police officer and develop their nonverbal communication skills.