Future of Healthcare: VR in Rehab

Let’s face it: technology is taking over the world. Smart phones, smart televisions, smart homes, robots that vacuum your house; it truly never ends. Healthcare is no exception and seems to be an area of interest for technology developers. According to the Future of Technology in Health Care document produced by the Canadian Medical Association (2018), Augmented Reality (AR) and Virtual Reality (VR) are both having increased application in surgery and medical training. In this publication, VR is also presented as a new tool that shows promise in the treatment of pain (CMA, 2018).

I had the chance to use VR in my role as the rehab physio during my posting in Ottawa. I consider myself as technology illiterate so it was shocking to me that I actually enjoy working with patients using this massive 6 degree of freedom platform. Here is a video that was produced by Courtney Bridgewater, the CAREN operator at The Ottawa Hospital Rehabilitation Centre, that describes well the technology:

https://video.wixstatic.com/video/f53b77_690acc06c63c4b49afe716c7f7ed4bab/1080p/mp4/file.mp4

During my time working in the VR lab, I was collaborating with Courtney, the operator, to change the environment in order to challenge patients who had sustained a concussion. Some of them were at a very fragile state while some of them were at the tail end of their rehab. My physiotherapy colleague Janet Holly, a certified pain specialist, was using the system mostly with her Chronic Regional Pain Syndrome (CRPS) patients. I had the privilege to observe a few of her patients and learn from her and was amazed at how much we could manipulate the virtual environment and directly affect the patient’s symptoms. According to Keefe et al (2012), ‘’ it may be practical to tailor VR environments on the basis of visual, auditory, tactile and even olfactory stimuli’’ and this is likely where the future of intervention for pain management lies. I have discussed in a previous post that pain was more than a biomedical experience and this is most likely why VR can be so powerful for this type of population: a safe environment to work on movement and creating positive changes in the brain. Neuroplasticity at is finest.

The military has now been using VR with the CAREN for almost 10 years. We initially used it with our amputee population like our US colleagues and it was an extremely valuable gait training tool. A few of our trained mental health provider use it to treat Post Taumatic Stress Disorder and have specifically used Eye Movement Desensitization and Reprocessing (EMDR) while on the platform. In recent years, we have developed a different approach to treating concussion and pain using VR. What was initially criticized as a an expensive toy is now being fully used with a variety of conditions. Here is a time table of how the CAREN system in Ottawa has been used by the Canadian Army Forces to date.

In the civilian rehab world, there is growing interest in research for more compact and affordable VR solution. A recent study by Jones, Moore and Choo (2019) used VR goggles with an app (Cool!) and proved a 33% decrease in pain in patient with persistent pain. Other areas of rehabilitation are also using varied VR platform to improve outcomes: in neuro, stroke and parkinson patients would be two other groups that are currently studied in the world of virtual reality. We are extremely lucky to see all of these progress happening in our time. I am looking forward to see new advances in the VR realm.

References

Cadadian Medical Association (2018) The Future of Health Technology: A Primer. Health Summit Backgrounder. Retrieved from: https://www.cma.ca/sites/default/files/pdf/health-advocacy/activity/2018-08-15-future-technology-health-care-e.pdf

Jones T, Moore T, Choo J. The impact of virtual reality on chronic pain. PLoS One. 2016;11(12):e0167523

Keefe, F. J., Huling, D. A., Coggins, M. J., Keefe, D. F., Zachary Rosenthal, M., Herr, N. R., & Hoffman, H. G. (2012). Virtual reality for persistent pain: a new direction for behavioral pain management. Pain, 153(11), 2163–2166.

For your perusing, a list of a few VR lab in Canada: https://www.pearltrees.com/anmala/vr-labs-canada/id27991204#l100