Recent developments in immersive virtual reality (VR) are defining new directions in healthcare. The raise of commercial, affordable VR equipment, the recent market boost and the media coverage of new Metaverse initiatives, and the shared VR environment-developing engines (e.g. Unity) determine a current landscape with new opportunities. One advantageous feature is the evolving integration of VR into the larger internet of things network. It allows the synchronization of VR with other technologies such as wearables, biomedical sensors, smartphone apps and advanced motion capture systems. In health, these new possibilities translate into the adoption of VR for (cognitive and motor) rehabilitation treatments, self-management, programs of prevention and wellness, enhanced interventions, long-term care and community and remote care. Below, some more concrete examples of these new directions are described.
- Ghost avatars are virtual characters created by multisensory cues (mainly visual, but can also be auditory, tactile) that provide feedback for behavioral performance. One easy way to imagine Ghost avatars is thinking on the traditional video game Mario Kart ghost race, in which you compete against a ‘ghost driver’; i.e. a reflection of your best previous performance. The idea can be translated into rehabilitation strategies for setting real-time feedback and to promoting motivation; for instance, in gait training sessions you can see in VR your best previous walking performance and the patient may have such performance as a target to improve at every new treatment session.
- VR as medium for brain-computer interfaces. VR is growingly being used as a training platform for human technology interaction. For example, to train patients utilizing new prosthetics, robotic limbs or exosqueletons. Thus, the patient can have interactive goal-oriented tasks in VR, based on the tasks expected to be accomplished with the new medical device or technology. For instance, if it is a new leg prosthetics for amputee patients, the patient can train locomotion in a lab controlled VR environment, before using the prosthetics at home or outdoors.
- Digital twin. The concept is relatively recent. Although it is more commonly associated with remote control of industrial apparatuses (e.g. digital twins of wind turbines), new applications show the potential of integrating the concept in healthcare. The working principle lies in the measuring of physiological and biomedical parameters of a person, for example, the digital twin of a patient can be set by the measurement and categorization of vital signs. It can contribute to self-care practices and for tele-medicine. Alarms can be set to announce when any of the measured variables fall out of the normality values, which may translate into certain action; e.g. medication, a (medical) consultation.
- VR for distraction. There has been studies investigating the role of VR to calm pain, alleviate stress and anxiety, or to facilitate medical procedures such as blood tests and flu shots. For instance in children, VR can be used as a distraction method to facilitate vaccination. The child can have the VR headset on, and a signal can indicate the clinician when there is a key moment of the VR scenery that demands the attention of the child, so maintaining her/him busy and concentrated in the VR task. The vaccination, blood test or shots can take place right when the signal appears on, so that the child is not fully aware of it, thus avoiding potential accompanying difficulties.
- Virtual hospital tours. These can be used to prepare patients for complicated medical procedures. It can be, for instance, a VR scenery that immerses and prepares the patient on what to expect during the visit to the hospital. Including the hospital rooms that the patient will enter, the hospital staff that will be encountered, and a simulation of the medical procedure itself.
- Physiological embodiment & Biofeedback based techniques. VR embodiment refers to experiencing ownership over (parts of) our body in a VR environment; e.g. a look-alike avatar, a virtual hand. However, new research points towards embodiment of physiological functions such as breathing and heart rate (e.g. the embreathment illusion). The method translates into care opportunities for implementation of game-like biofeedback techniques. For instance, the patient can navigate through a VR scenery by using longer, deep breathing with larger inspiratory and expiratory cycles. Successful VR navigation can be set according to pre-defined parameters that determine the necessary levels of respiratory parameters. This method can be useful for treating patients with respiratory conditions; e.g. asthma, chronic obstructive pulmonary disease.
- Wearables 2.0, active sensors and haptic devices. ‘Wearable skin’, or skin-integrated wireless haptic interfaces, enhances immersion and presence in VR. New developments in wearables and its integration to VR brings new levels of immersion making users feel like they can reach out, grasp and touch objects in the virtual world. Such wearable skin can come in the form of a thin, elastomeric layer that sits on the skin. The functional layer may contain common polymers and actuators. In healthcare, this will bring new possibilities, for instance, in the rehabilitation of upper limbs movements and in the treatment of sensorimotor deficits usually present among persons with neurological conditions.
- Integral rehabilitation facilities for exergaming. Exergaming is crossing new frontiers thanks to the synchronization of VR with assistive training equipment. For instance, with ergonomic bicycles, kayak simulators, omnidirectional treadmill, boxing gloves. It makes VR exergaming more engaging and allows for multiuser experience. For example, competitive VR cycling races. Also, the emergence of omnidirectional treadmills greatly improves the possibilities for rehabilitation of balance and gait; for instance, among patients with Parkinson’s disease, multiple sclerosis and cerebral palsy.
- Objective cognitive assessment. In recent years, there has been a lot of development in the translation of traditional pen-and-paper cognitive tests into VR-based multitasking scenarios, and in the creation of new VR environments, that enable simulation of naturalistic cognitive challenges that result engaging and allows for a controlled experimental environment with ecological validity. Among the targeted cognitive functions that can be assessed and trained via VR-cognitive interaction platforms, are verbal memory, processing speed, attention, working memory, space orientation and navigation, and planning skills. It can be attained, for instance, by using simulated home (e.g. a kitchen) or social (e.g. a supermarket) environments.
The aforementioned list set emerging themes that establish new care opportunities, and define novel research and innovative directions for scientific groups, clinical organizations and enterprises working with healthcare applications of VR.
Note: this blog piece has been completed in the context of a VR in healthcare mapping exercise that the author is working on together with the Centre of Expertise for Innovative Care and Technology (EIZT – Dutch abbreviation) from Zuyd University of Applied Sciences.
About the author
Desiderio Cano Porras is a Postdoctoral Researcher at the Brightlands Institute for Smart Society (BISS), Maastricht University, The Netherlands.