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Treatment, training and therapy: VR in healthcare


For many, virtual reality conjures images of gaming and entertainment, but it’s also making waves in healthcare.

Sergeant Jon Warren is standing in an Iraqi street market when a car suddenly explodes about one hundred feet ahead of him, and panic ensues. Later, he sits in an armoured vehicle on a long desert road while distant enemies bombard him with gunfire.

His experience is entirely virtual, of course – Warren is in fact sitting safely inside the University of Southern California, using a Virtual Reality (VR) headset. He is repeatedly re-living the moment in 2010 when, during his tour of Iraq with the US army, his squad was hit by a roadside bomb which left him seriously injured and psychologically traumatised. VR exposure treatment, which aims to reduce the fear of traumatic memories by allowing patients to re-live them again and again, is now widely used in the US to treat soldiers with post-traumatic stress disorder (PTSD), said Albert ‘Skip’ Rizzo, the award-winning clinical psychologist who pioneered the treatment several years ago.

Rizzo’s method is just one of many expanding uses of VR in healthcare, with doctors and developers predicting that in coming years the technology will be used to treat Alzheimer’s, to ease fear of spiders, to train surgeons, and much more. A widely-discussed Goldman Sachs report on VR published last year forecast healthcare as the second most significant beneficiary of the coming VR revolution (behind gaming), predicting that medical VR will be worth $5.1bn (£4.3bn) by 2025.

From its Silicon Valley roots, medical VR is moving over to the UK. But proponents of the practice complain of a shortage of funding, with the major clinical trials that are required before VR is rolled out into the mainstream proving perilously expensive. Doctors are also forced to battle a snobbery toward VR from certain medical quarters, with the treatment still regarded by some as a gimmick promoted by easily-excited Silicon Valley nerds. So, who is right?

Treatment tool

VR treatment simply acts as a tool to deliver the already well-established PTSD treatment of ‘prolonged exposure’, believes Rizzo.

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“Avoidance is one of the cardinal symptoms of PTSD,” he said, “we ask people in therapy to just pull up their traumatic memories in their imagination, but that’s a tall order. VR makes it much easier.”

While Rizzo’s therapy is now used widely across the US Armed Forces, and was recently adopted on eight Canadian military sites, the UK government has thus far refused to play ball, with the Ministry of Defence insisting VR is not yet a recognised treatment.

Professor Daniel Freeman’s experience in the UK has been far more positive. Freeman, based at Oxford University’s Department of Psychiatry, focuses on using VR to treat severe paranoia, and said the new technology has proven effective.

“In just a single session the benefits were marked,” he said, “the paranoia had greatly reduced and the individuals were much less distressed in real-world situations.”

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Paranoia patients afraid of close contact with others – say, on an underground train or in a lift – can use the VR headset to gradually neutralise their fears, by approaching virtual passengers within the safe confines of a therapist’s office. VR even has the potential to outperform traditional talking therapy, believes Freeman.

Funding hurdles

There are certain funding hurdles that must be addressed, of course. Before winning larger sums from the National Health Service, said Freeman, the treatment must prove itself in rigorous clinical trials – and clinical trials are expensive. But he is optimistic, with the UK’s government-backed Medical Research Council having recently approved a £750,000 grant for a VR trial beginning in June.

“So far, funding has been at low levels,” Freeman said, “but now research funders are appreciating the potential that VR could have to be transformative.”

And while treatments like his still generally rely upon philanthropic, government, or academic funding, private backers – including the commercial Oxford Sciences Innovation – are beginning to show an interest.

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Indeed, private backers for medical VR are not so hard to find, said Isabel Van De Kerre, founder and CEO of the London-based VR startup Immersive Rehab – you just have to look hard enough.

“There is definitely interest from private investors,” she said, “but it’s key to find the right ones”.

Private backers must be “open to new technology”, she said, and fundamentally they must accept having to wait longer for a revenue return in healthcare than in an area like FinTech, which may seem like a “safer bet” for many.

Immersive Rehab, created by De Kerre in 2016 after a serious work accident left her partially immobilised for several years, also shows VR is not just a tool for treating mental health, but physical disability as well. The treatment aims to help those suffering from mobility conditions like Multiple Sclerosis by “untapping the brain’s potential to retrain itself”. A patient learning to pick up a block, for instance, may struggle due to their muscle weakness. They quickly become frustrated and disengaged. VR allows the patient to pick up a virtual block instead, requiring no muscle strength but still forcing their brain to register their action. Users also remain much more likely to persevere, she explained, with VR boosting engagement in many rehab patients from one minute up to ten.

Enjoyment

Part of De Kerre’s aim is to make physical rehab “fun and exciting”, and there is much to learn here from the gaming industry, she believes, which has been the financial driving force behind most of VR’s technological innovation. Indeed, a close entwinement with the gaming industry is a common theme raised by many medical VR proponents. Skip Rizzo describes medical VR as an “unintended positive impact” of technology initially designed for gamers, and Professor Freeman agrees that developers are learning from gaming to make medical VR more exciting.

It is not just patients who are benefitting, either. Last year, Dr Shafi Ahmed from the Royal London Hospital won plaudits for performing the world’s first VR-broadcast operation. Armed with a headset, Dr Ahmed removed a tumour from a cancer patient while thousands around the globe watched from his visual perspective. His operations have now been viewed by 55,000 people across 140 countries.

While live broadcasting of surgery has existed for years, said Dr Ahmed, VR gives observers – particularly medical students – a wholly immersive experience: they can survey the patient’s body up-and-down, or look at the anesthesiologist. And all medical students need is a smartphone, internet access, and a cheap VR headset. Ahmed’s innovation will help democratise medical training, he believes, with students across the world able to observe the same operations without costly travel or study expenses.

The exact future direction of medical VR in the UK is not wholly clear: will it continue to rely mostly on philanthropy and government funding, or will private investors step in? Will government departments like the Ministry of Defence relinquish their rather quaint aversion to a treatment they say has not been sufficiently tested?

It is apparent, however, that medical VR cannot easily be ignored, and these treatments will, one way or another, find their way into UK hospitals in coming years. And perhaps, if proponents are to be believed, a hospital that looks increasingly like a high-energy gaming arcade would not be such a bad thing.

This article first appeared on edition 14 of Tech City News’ popular print magazine – The Virtual Reality Issue. Buy your copy here.



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