How virtual reality is expanding healthcare

Doctors can help patients recover from a stroke while they are anywhere in the world, even in states or countries that are far away from each other, by using a combination of robotics and virtual reality devices.

It’s happening at the Georgia Institute of Technology, where Nick Housley leads the Sensorimotor Integration Lab. There, patients undergoing neurorehabilitation, including those recovering from stroke, are fitted with robotic devices called Motus, which are strapped to their arms and legs. The goal: to accelerate recovery and assist with rehabilitation exercises. Patients and practitioners using the system wear virtual reality headsets. The Motus device sends feedback to the physician, who can guide the patient through exercises designed to restore lost movements. “The headset tells you really important things, like how much force a person’s muscle can exert,” Housley says. “It can also tailor an intervention — for example, if someone has difficulty picking up a cup of coffee, you can guide them in real time.”
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Virtual reality is increasingly being used to educate healthcare providers, assist with pain management and to provide telemedicine around the world. Headsets are now relatively inexpensive, at $300 to $1,000 per device, and can extend a practitioner’s reach to anywhere on the planet. “The potential benefits of VR for clinicians are enormous, and only the limits of our imagination limit its possibilities,” said Dr. José Barral, chair of biomedical sciences at Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, California.

According to one study, virtual reality plays an important role in improving physician performance and should be used as a complementary educational tool. For example, laparoscopic surgery can be taught with VR and this type of training leads to higher accuracy. VR tools are “highly effective at transferring skills to the operating room,” the study authors write. They added that VR should be used to train doctors in skills such as suturing, ultrasound and nursing procedures.

According to the American Board of Internal Medicine, doctors are best trained through VR tools before attempting real interventions on patients. VR is an effective way to learn how to perform invasive hemodynamic monitoring and mechanical ventilation, the organization says.

Another study described VR as “a cornerstone of clinical training.” It provides benefits for learners and educators, the researchers noted, and provides cost-effective, repeatable and standardized clinical training on demand. “While VR is not a panacea, it is a powerful educational tool,” the authors said.

However, virtual reality is not yet a standard part of most doctors’ arsenal. VR headsets are still primitive and the image quality cannot compete with the real world. In addition, headsets suffer from non-intuitive user interfaces and can pose health risks such as dizziness, says Rema Padman, who studies VR as a professor of management science and health informatics at Heinz College at Carnegie Mellon University. “Particularly, the hardware limitations of headsets and associated software and tools pose a challenge to clinicians using VR in surgery,” said Padman. “Likewise, there are limitations in terms of long-term use for patients, especially those who are frail or frail, such as children and the elderly.”

Despite these drawbacks, virtual reality holds great promise. Here’s a look at how it’s being used to enhance telemedicine, surgery, and medical training.

telemedicine

When Housley works remotely with stroke survivors, he bridges the gap between himself and his patients using virtual reality. Most stroke patients treated by Georgia Institute of Technology clinicians have moderate to severe muscle weakness or paralysis known as hemiparesis. Conducting assessments and physical examinations requires physical interactions, such as manual muscle, reflex and sensory tests, which would be nearly impossible through traditional telemedicine. So instead, Housley uses a robotic exoskeleton and virtual environment to examine his patients. “This works because the patient wears a robotic exoskeleton on their paretic limb, and it contains sensors and actuators that allow me to digitize their movements and muscle actions,” he says. “This data is sent to me and allows me to act on it to personalize the exam.”

Another part of the Motus system is designed to help stroke survivors through virtual reality games. There are about 25 different types, ranging from simple tasks like adjusting a thermometer to moving an avatar in a virtual environment. These games make therapy fun, immersive and challenging.

The system performs just as well as face-to-face treatment, Housley says, with the added benefit of convenience. “I did my first assessment with someone in Australia and there was only a two-second delay,” he says. “It was just incredible to jump into the virtual environment and let the game interface work with them.”

Another benefit: patients have easy access to extra hours of therapy that they could not get from personal caregivers. Because they can use the technology at home, they don’t have to commute to a facility or worry about time-consuming medical appointments.

Using VR has led to faster patient outcomes, such as improvements in range of motion, pain reduction and greater adherence to treatment plans, Housley says. In virtual environments, patients can see their personalized stats in real time and track their progress, often resulting in much greater buy-in.

Surgery

Complex surgeries can strain even the most experienced clinicians, but virtual reality provides a way to practice before the actual procedure.

Earlier this year, Cleveland Clinic developed a way for neurosurgeons to refine surgical techniques using VR. A patient requiring surgery will undergo MRI brain scans, which will be sent to a company that converts them into 3D images that are transferred to a VR platform. There, the doctor can plan the surgery and practice for the procedure. “By giving doctors real-life experience…the results will improve every time,” said Pieter VanIperen, the founder of PWV Consultants who helped create VR platforms for medical training.

In addition to planning and practicing, virtual reality can help surgeons in the operating room. The robotics startup Vicarious Surgical aims to help clinicians complete very fine dissections and sutures to increase their access to the abdominal cavity. The system combines human-like mechanical arms with VR technology. The goal is “to make the surgeon feel like they’re being transported into the abdomen,” says Dr. Barry Greene, chief medical officer at Vicarious Surgical.

Medical training

Clouds of smoke at the scene of a subway bombing. First responders arrive and have minutes to figure out how best to classify victims. But this isn’t real life: the scene is set in virtual reality and the first responders are medical students wearing headsets. It is a system designed by the Ohio State University College of Medicine to teach doctors and first responders how to help in emergency situations.

“What’s important [during the training] is to find the patients who would immediately benefit from medical care,” said Dr Nicholas Kman, a professor of emergency medicine at the university who helps conduct the VR training sessions. “The previous training was via PowerPoint. But with virtual reality, it’s much easier to learn these skills when you see the patients in front of you and feel a heartbeat” while the headset controllers vibrate.

The college is one of a growing number of medical schools incorporating virtual reality into their education. VR can grab students’ attention in ways traditional media like books or computer screens can’t, says Dr. Daniel Katz, the vice chair of education for the Mount Sinai Department of Anesthesiology, Pain and Perioperative Medicine in New York City. “For example, imagine the difference between clicking through a fire safety PowerPoint presentation compared to an operating room on fire, and it’s up to you to manage the situation,” he says.

Ohio state fourth-year students studying emergency medicine use VR rigs to learn how to care for a heart attack patient. This simulation begins in a hospital emergency room when a virtual patient arrives on a stretcher, struggling with crushing chest pain and shortness of breath.

Using headphones, the students quickly assess the patient’s condition. In the simulation, an avatar or virtual representation of the student is standing by next to the stretcher, with a tablet computer used to order tests and treatments. While the students are triaging the patient, he or she goes into cardiac arrest, which the students must resolve with epinephrine. “Having them manage that patient teaches them what steps to take in real life,” Kman says. “It’s pretty cool.”

The adage “see one, do one, learn one” has been the foundation of surgical training for more than a century, Dr. Soheila Borhani, a researcher at the University of Illinois at Chicago who studies virtual reality in medicine. Medical students and residents first observe a procedure done for them by an instructor, then perform it once on their own and finally teach it to one of their peers. “Today it is possible to practice a given procedure as many times as needed through the use of VR platforms that not only allow for repetitive risk-free trials and errors, but also facilitate 3D understanding of complex anatomical structures,” says Borhani.

The only medium that comes close to the level of immersion of VR is a high-fidelity simulation with actors, which is too expensive for most scenarios, Katz says. Such a simulation would typically cost thousands of dollars and take weeks of planning. So instead Ohio State uses the consumer-grade Oculus Quest 2 virtual reality headset and can arrange training sessions in about half an hour. “Learning can take place at your leisure in most cases,” Katz says.

The biggest challenge for VR in medical education is the lack of a comprehensive platform and standardization for educational activities, Katz says. There is no “app store” for medical education, which means that each module must be purchased from different suppliers.

There are also hardware challenges, Katz notes. For example, hand-tracking technology that can accurately mimic hand movements is still lagging behind headset development, although it’s improving rapidly.

Future hardware advancements are likely to make VR rigs an increasingly large part of the medical toolkit, said Douglas Danforth, an associate professor of obstetrics and gynecology at the Ohio State University College of Medicine who works with virtual reality. “As processing power improves, VR simulations will become more realistic and eventually become nearly indistinguishable from interacting with real patients,” Danforth says.

This post How virtual reality is expanding healthcare

was original published at “https://time.com/6155085/virtual-reality-health-care/”