Feeling blue? Or in pain? Don a VR headset: VR as a therapeutic tool

Software developers and medics around the world are working to prove that Virtual Reality (VR) powers stretch far beyond gaming and entertainment and have the potential to aid thousands suffering from cancer, anxiety, personality disorders, physical or psychological traumas.

VR can save no lives directly. But it can add quality to the day-to-day routine of patients, by offering immersive experiences to improve pain and stress management. To what extent can VR headsets replace painkillers and anti-depressants? What does the pharmaceutical industry have to say about that?  Companies targeting the healthcare niche in the VR market are still not able or willing to provide concrete answers. And current lack of regulations in the sector makes VR’s medical future even more uncertain. However, its hospital deployment is now underway, even though it is at an experimental stage.  Volunteer patients are already benefiting from the engaging, three-dimensional nature of virtual reality, whose relaxing effect is a substitute for meditation, according to some.

VR is making progress in healthcare

“Different patients experience VR differently. But it is already obvious that it has a positive effect on many”, says Diane Jooris, CEO and co-founder of Belgian start-up OnComfort which offers variety of VR tools for the healthcare sector. The company partners with twenty hospitals in Belgium and France and is doing clinical researches with healthcare institutions in Asia.

Children and elderly people appear to be easily mesmerised by VR’s soothing powers, while teenagers aged 14 to 18 are the greatest sceptics. “They are tech-savvy, hard to please and always demand more”, the expert explained.

Scepticism within the healthcare sector also thwarts VR’s progress. Jooris adds: 

“Some doctors still see VR headsets as glamorous futuristic gadgets that don’t belong in hospital wards. A change in mentality is needed but it will take time. How will we achieve it? By literally living in hospitals, talking to staff, engaging them in debates, and so on.”

According to Jooris, it takes between one and four years for the full impact of VR on a patient to be revealed. But volunteers are already providing positive feedback. Recently a breast-cancer patient shared her experiences on how the virtual undersea environment of one of OnComfort’s products – Aqua – helped her go through a painful procedure without having to rely on drugs. Aqua’s components include progressive muscular relaxation, deep breathing training and clinical hypnosis.  According to its creators, the product aims at bringing natural relaxation and modified perception of painful stimuli and anxiety-triggering environments.

Different condition, different headset

Of the therapeutic applications for VR, chronic pain is the hardest condition to deal with ( the effect only lasts as long as the patient wears the headset), and anxiety treatment offers best results thanks to the distraction effect. According to Jooris, no universal therapeutic tool is possible because no two medical conditions are the same. For instance, simplistic 3D images are required for dementia sufferers whose fading memory struggles anyway with the complexity of the real world, while advanced and engaging virtual worlds must be created to distract cancer patients from the painful procedures they have to endure. VR for young children is a whole different story where a fairy-tale, cartoon-like approach is vital.

Various experiments and pilots taking place around the world validate Jooris’ conclusions. Medical VR is believed to be at its strongest when faced with procedural pain and phobias but not as efficient in alleviating long-term physical pain.   The pleasant distraction it renders is enjoyed by children subjected to painful medical procedures, patients whose severe injuries require urgent medical intervention, cancer-sufferers undergoing chemotherapy. However, its effect on chronic pain is still unclear, as scientists believe more experiments are to be conducted before categorical conclusions are reached.  

Packard’s Children’s hospital in the USA is among the first in the world to deploy VR therapy to fight the anxiety and pain in its young patients. Parents’ testimonies published on the hospital’s website tell about screams of terror turning into exclamations of amazement once little patient is immersed into the wondrous world of VR. Virtual miracles work on adults too. Would you wear a VR headset while having your wisdom tooth extracted? A study led by the University of Plymouth in the UK revealed an interesting fact - a virtual walk through the streets of a real-life town had a soothing effect on dental patients, while a stroll through a virtual settlement did nothing to ease the pain and tension caused by the routine intervention.  This has led scientists to conclude that the mere distracting effect of VR is not sufficient, and immersive reality needs to feel familiar in order to provide comfort.

VR has been praised for having a positive effect on phobias too. In July 2018, a report published by the NHS revealed how VR headset could help people overcome their fear of heights (acrophobia). The disruptive technology was used to “lift” patients to various virtual heights – from skyscrapers’ rooftops to mountaintops. During VR session people were advised by professional psychologist on how to deal with heights in a more positive manner. 51 participants with proven acrophobia were subjected to the innovative treatment. Results revealed that after four weeks of VR therapy their levels of fear were reduced. The same amount of time showed no change in patients who were treated in a more conservative way excluding VR.

According to the NHS report: “No adverse effects of the intervention were reported on VR patients”. However, study failed to answer whether the improvement in patients will have a long-lasting effect or what will happen once participants in the VR experiment decide to put their fears to test in a real-life environment. It is also unclear if a sample of 100 people could be considered representative as acrophobia is a common mental health issue which, according to various reports, affects one in five adults. And VR’s therapeutic effects are yet to be assessed against those of cognitive behavioural therapy. However, the researchers at the University of Oxford, University of Barcelona and Virtual Bodyworks in Barcelona, Spain who conducted the survey conclude: "Psychological therapy delivered automatically by a [virtual reality] coach can produce large clinical benefits. Evidence-based [virtual reality] treatments have the potential to greatly increase treatment provision for mental health disorders."

Meanwhile, the NHS itself is testing a VR therapy on another group of mental health patients – dementia sufferers. The ongoing experiment due to be completed in the coming months is based on showing participants VR images from their youth such as seaside resorts, street celebrations to stimulate memory and improve bonding with family and caregivers. The trial aims to find if the technology has broader scale future.

Deploying medical VR on a broader scale is something that the UAE’s Ministry of Health and Prevention plans to do. In the summer of 2018, it announced its intentions to use VR for physiotherapy for stroke sufferers, patients with balance disorder and children with development disorders. Specialists believe that VR will open the door to remote rehabilitation and patients recovering in the comfort of their home. But until similar initiatives get underway, VR’s impact on chronic pain will be regarded as uncharted territory as there are relatively few research projects.

One of the few studies that has been published (in December 2016 by Ted Jones, Todd Moore and James Choo) focuses on the impact of a brief virtual reality session on the experience of chronic pain. The authors suggest that that

“VR is more effective for chronic pain disorders that more intimately involve the central nervous system such as complex regional pain syndrome (chronic pain condition that may result in extreme sensitivity and pain to the hands and elbows or knees and legs, in particular, without an obvious cause that would explain the degree of pain) or fibromyalgia (long-term condition that causes pain all over the body) while being less effective for more mechanically-based pain disorders such as low back pain or arthritic conditions.”

The study also points out that future researches on the subject must find out how age and gender affect the way chronic pain patients respond to VR treatment. Another more recent study was conducted by the University of Seville, University of Malaga, Pablo de Olavide University and University of Osuna, Spain, on over 400 patients with multiple sclerosis. It showed that VR treatment impact on gait impairment and chronic pain was positive but no different to that of conventional treatment.  

Experiments, research and pilots will continue to define VR’s most promising healthcare applications. At present hospitals, surgeries and dental practices appear to be best equipped to accommodate the disruptive technology. VR also shows potential in paediatrics and psychotherapy practices, especially when it comes to dealing with phobias and mental impairments. These are the likeliest places where its future commercial deployment is expected to commence. However, VR headsets are already available to end-users in the market. Many believe that in the near future,  once their efficiency is finally defined, they could become a “must have” item for people experiencing health problems, just as they are to gamers now. The table at the end of this article identifies a number of companies developing healthcare solutions based on VR.

Regulation and side effects

Asked by Innovation Observatory whether VR headsets are likely to become medical devices in the future, the UK’s Medical and Healthcare Products Regulatory Agency provided the following answer: “We have already seen devices that utilise aspects of Virtual Reality as a component part particularly in mental health treatment”.  More information on the agency’s guidance on apps as medical devices is available here.

VR is still in its early days and its impact on human body and mind is yet to be thoroughly assessed. However, various sources point out that immersive reality and pharmaceutical products may have a thing in common – side effects. Reports (see for example here and here) mention risks of dizziness, disorientation, eye strain, nausea and even seizures if too much time (more than 35 min) is spent with VR glasses on. Whether it can lead to addiction is a question that is yet to be addressed. At present gamers, not patients, may be exposing themselves to significant health risks as binge gaming can go way beyond therapeutic time limits. The world record for continuous hours of VR gameplay is currently 36 hours; healthcare VR products never exceed sessions of 35 minutes, and patients are under constant medical observation.

Still, VR software and hardware developers are working to reduce potential harm to patients caused by so-called motion-to photon latency (the delay between the movement of VR helmet wearer and its representation on screen). The higher the resolution, the more computing power is needed for the headset to process it, and the more severely the delay is felt.  Also, VR headsets create the 3-dimensional illusion by showing different images to each eye, but are still not capable of generating consistent “focus cues”, which causes discomfort in user. These are considered the main causes for dizziness and nausea.

Recent press reports reveal that South Korean technology company LG is partnering with Sogang University to deliver an AI solution that could reduce the motion-to-photon latency and motion blur. First tests have shown that the innovation can reduce the unwanted effect to one-fifth of its current levels. It is achieved by employing a deep learning algorithm that produces high resolution images from low resolution ones without deploying external memory devices.

Meanwhile Sony has adopted a different approach for tackling the issue that some refer to as cyber sickness. The company filed a patent application for a bionic sensor VR headset that can detect any unhealthy reaction to the immersive virtual experiences. The patent does not deal with motion-to-photon delay but rather monitors heart rates and eye movement to alert the user at the first signs of nausea. Once a potential risk has been detected the headset could be programmed to disable VR content or alert those around the VR headset user.

Canadian company Lemnis Technologies is also addressing nausea-evoking latency. It has come up with a way of adjusting the VR headset in accordance with the specifics of the human eye, thus allowing users more control over the virtual reality environment. Its platform called Verifocal tracks the user’s eyes to enable natural accommodation response (accommodation is the process by which the eye changes optical power to maintain a clear focus on an object as its distance varies).

Minimising motion-to-photon latency and other technical limitations is one of the primary tasks the industry is being faced with as it will not only help make VR experiences more realistic but will also reduce the effect of cyber sickness on VR users.

VR is a promising new technology whose future in healthcare will be decided by the adoption of the right regulatory rules, careful risk assessment and constant dialogue involving developers, manufacturers, doctors and patients. Despite all the roadblocks, the medical world is already learning to see through VR glasses.  What will happen next is a matter of trials and investments, but most of all, putting patients first.

Other therapeutic VR companies

Company Application Details

Floreo

Autism

Supplementary method of teaching social and communication skills for individuals with Autism Spectrum Disorder (ASD)

Farmoo Cancer care Pain distraction experience to teenage cancer patients
Psious Phobias Phobia patients can face their fears in the world of VR under the control of specialists
Virtually Better Anxiety, depression, phobias Exposure therapy for patients with personality disorders and specific fears
Firsthand Technology Pain relief VR pain relief application for hospital use
VirZOOM Stimulation of physical activity Offers active motion control
Mindmaze Brain injuries Uses VR to retrain the brain in stroke sufferers
Deep Meditation Offers a relaxing VR underwater exploration
Zen Zone Meditation, relaxation Offers relaxing VR experience with music
Vivid Vision Lazy eye Users play VR games on the computer at home or under clinician supervision that are designed to treat amblyopia, strabismus, convergence insufficiency, and stereo depth deficiency
BehaVR Multiple Consultancy developing healthcare VR solutions
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