An overview of Virtual Reality (VR) for clinical rehabilitation settings

Author: Dr Daniel Harvie, The Hopkins Centre

“Virtual reality is replacing the real world with an artificial one, this can include swapping your real body for a digital avatar so that you can interact with the digital environment and digital objects using your virtual body.”

The way we see ourselves (our bodies) shapes our feelings and perception, directs the way we interact with the world. For example, after an ongoing pain problem, people often feel that their body is weak and fragile, which can increase pain and decrease activity levels. Virtual Reality (VR) allows people to become anything and anyone.  Such experiences can have profound impacts on how we see ourselves.  At The Hopkins Centre, we are trialling several projects aimed to test a novel VR approach, to help people regain confidence in their bodies.

The following overview on Virtual Reality (VR) is accompanied by a series of six (6) videos. Read each section and click on the hyperlinks at the end to view the individual videos and accessible transcripts, or visit The Hopkins Centre YouTube Channel, and select the HabITec Playlist for access to the entire VR Series. Download the accessible Virtual Reality Video Series Transcript.

What is virtual reality (VR)?

Virtual reality (VR) is replacing the real world with an artificial one.  This can include swapping your real body for a digital avatar so that you can interact with the digital environment and digital objects using your virtual body.

Virtual reality depends on two main components. The first is physical equipment or hardware, which includes a head-mounted display and hand controllers. Importantly, these hardware elements are fitted with motion tracking technology that synchronizes your real-world movement to virtual movement ­– and it’s this that makes it feel like you’re really there, and add to that immersive quality of virtual reality.

Some systems can also include additional components like pucks – and these can be really strapped to anything, for example they can be strapped to your feet to enable your feet or the movement of your feet to be transferred to the feet of the avatar.

The second component the second component of virtual reality, of course is the software. The software might run on the head-mounted display itself, for example using Oculus Quest, which is fully self-contained and wireless, so the software runs on the head mounted display itself – or the software might run on a high-end computer, through cables connected to a headset like the Oculus Rift.

View the video: What is Virtual Reality

Accessible video transcript: What is Virtual Reality

Managing hygiene with virtual reality

One of the most important things you need to consider with virtual reality, particularly in this era of COVID, is to think about how you’re going to manage hygiene.

The first thing is to consult your in-house infection control officer to ensure you have the right procedures for your setting.

The second the second recommendation is to replace the fabric components on the virtual reality headsets with non-porous alternatives, and this will make cleaning much easier. There are a few ways you can go about this. One of the main areas where you will need to manage hygiene is the professional interface, for example replacing the fabric interface with a silicone cover, so it fits on like a glove. Silicone covers are readily available for purchase on eBay and other places online.

Another approach is to replace the facial interface with a vinyl alternative, and you can get these replacement interfaces which snap in and snap out, so that’s an easy and thorough way to sort out that problem.

There is fabric in the headstrap on most headsets that can also be replaced. Many headsets, such as Oculus, come with an alternate plastic headstrap as an option, which is easy to adjust and certainly easier to clean.

It is also recommended to disinfect the equipment between each and every use.  Hospital grade disinfectant wipes are ideal for this purpose.  Be sure to wipe down all the surfaces on both the hand controls and their headsets themselves.

It is important to screen users for communicable diseases and perhaps also to screen them for immunocompromise.  These might be two groups of people that you decide not to use virtual reality with, just purely because of that risk, and it is important to assess this base on current health advice for your area.

The final recommendation is to consider using disposable facial coverings, that go over the ears, and look a bit like you’re going to a masked ball, but I would stress that these should be used in addition to other hygiene practices and not as an alternative.

View the video: Managing hygiene with virtual reality

Accessible video transcript: Managing hygiene with virtual reality

Purchasing the right virtual reality equipment

Let’s talk about purchasing equipment.

You should first check that there’s software suitable for your purposes before you spend money on equipment – and it might be the software that you want to run that dictates the headset that you need to purchase.

If all you want to do is have people visit a relaxing environment, then perhaps a cheaper headset will work for you, perhaps even one that involves a mobile phone being inserted into a shell.

Some software may only run on a computer-based system, which will require you to spend several thousand dollars on the computer itself and up to $1,000 on the head-mounted display.

If a high-end wireless device suits your needs, and these days that often will be the case, then you may only need to spend around $500 to $600 per device.

However, remember with any of these devices you will also need to consider the cost of any software that you might need to purchase and that may involve a subscription (not only a one-off cost), in addition to the cost of hygiene accessories and replacement components, and the cost of any other accessories like pucks.

If you simply want to use off-the-shelf games, rather than specialised health applications, you may wish to start simply by Googling the best virtual reality headsets for 2021 or 2022 – and you’ll get the most updated comparisons of features and prices.

View the video: Purchasing the right VR equipment

Accessible video transcript: Purchasing the right VR equipment

 

Is virtual reality right for your setting?

More than one clinician has called me up and said I bought this great virtual reality set up. Now what do I do with it? Thus, before rushing out to purchase such sophisticated equipment, raising your awareness is important.

The first thing you might like to think about, is what is it that you want to do exactly and is there good evidence or good rationale for doing that thing.  For example, you might have heard that virtual reality is effective in stroke rehabilitation, but what exactly is it effective for?

Balance training, upper limb rehabilitation training, treating hemineglect or training speech impairments? It could be anything, so be clear on exactly what it is that you want to do.

Secondly, you need to think about whether you might need specialised programs or software and to work out whether that software is publicly available. Can you actually get the software that you’re hoping to use?

Next, you might want to think about whether you can safely and effectively use that system, given the space constraints that you have, time constraints and other barriers.

Next, you want to make sure you get enough feedback from clients and colleagues to make sure that people in your setting are going to engage with virtual reality. 

Are they actually interested in using it? Or is it going to be wasted if you go out and buy this equipment?

And finally, are there people in your area, in your clinical area, either nationally or even internationally who are already using virtual reality, and can you get in touch with them to try to find out what they’re doing exactly? What are some of the barriers and pitfalls? So that you can get off on the right foot.

So, the take home here is to know in advance exactly what you want to achieve and how.

View the video: Is virtual reality right for your setting?

Accessible video transcript: Is VR right for your setting?

Examples of virtual reality in health settings

We’re really only just discovering all of the ways that virtual reality could be useful.  Here I want to give you five (5) examples, including three (3) examples from The Hopkins Center, of how VR could be used in health and rehabilitation, and I hope that these might inspire you to think of ways that VR could be used in your area.

The first example is the use of virtual reality for medical anxiety and procedural pain, and this is perhaps where virtual reality has been most used to date. Virtual reality is a powerful distracter, so whether you use a game or a guided meditation, the effect is likely to be one that significantly reduces pain and anxiety.

Another example is the use of virtual reality in neurorehabilitation, for example upper limb rehabilitation where a patient can use VR to alternate between use of their right and left hand, forcing them to use a hand that perhaps they are otherwise neglecting or perhaps is weak.

Now to some things that we’re working on at the Hopkins Center and the first is something called Virtual Reality Body Image Training. There’s something that happens when you swap your real body for a digital body or an avatar, and that is when you tend to take on some of the perceptions and behaviours that are unique to the character that you’re embodying.

So, for example, if you become the Incredible Hulk in virtual reality, then you will tend to genuinely feel strong. And we’re seeing if we can leverage that effect to help people who feel weak and vulnerable, because perhaps they’ve had an injury and long term pain, and we’re trying to help them regain that physical confidence.

Something else we’re working on, in our project led by Associate Professor Heidi Zeeman, is we’re seeing whether we can map or assess people’s spatial attention, which is something that can be lost after a stroke. So, for example, we can ask people to try to find the upright sic (6) in a map that’s full of sideways sixes and nines, and we can measure the time that it takes them to find that six in different locations, in order to assess their spatial attention.

Another Hopkins project is one led by Professor Michael Coppieters based around a virtual walking simulator.  It’s based on a similar idea to Mirror Therapy for phantom limb pain, in that it creates the illusion that a missing or paralysed body part is still moving and intact – and something about this and what it does to the brain has been shown to reduce pain.

So that’s five examples of how virtual reality is or could be used in health and rehabilitation and I hope that inspires something for you in considering how you might use virtual reality in your setting.

View the video: Five examples of virtual reality in health settings

Accessible video transcript: Five examples of VR in health

Changing perceptions of pain with Virtual Reality

BEEEHIVE: Brain and Enriched Environments Lab

Musculoskeletal Health and Persistent Pain

“We’re really only just discovering all of the ways that virtual reality could be  useful in health and rehabilitation.”

Research Participation

At The Hopkins Center we are passionate about research that makes a difference for people with disabilities.

You might have been asked to consider participating in research and this can be a really valuable way to help answer important research questions and to develop better ways of doing things.

When weighing up whether or not to participate in research, there are some things you should consider.

Firstly, taking part in research is your decision 100% of the time and before agreeing to participate you have the right to understand as much as you want to about the research process and to ask any questions you might have. Like, how much time will it take? What is required of me? What are the risks? And what are other potential benefits both to you and to others.

Before agreeing, you should feel you can make an informed decision, feel confident you can ask questions or withdraw at any time and feel empowered as an important part of the research process.

For more information about informed research participation visit The Hopkins Centre website.

Participating in Research: View the Animation

Accessible video transcript: Participating in Research

This animation is proudly produced by the supporting ethical inclusion of people with acquired disability in research project collaboration between The Hopkins Center and The Australasian Human Research Ethics Consultancy Services (AHRECS)

 

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