Virtual Reality Emerging, Helping Patients and Providers

Ingrid Hein

September 29, 2016

Orthopedic surgeon Justin Barad, MD, donned a headset and held a virtual reality controller while an avatar coached him through the assembly of a titanium nail. "The documentation for this procedure is over 80 pages," Dr Barad explained as he created the virtual nail. "And there are over 60 components to know."

The founder of Osso VR Technology, a surgical simulation company, was demonstrating a training tool for the surgical repair of a tibia fracture at the Health 2.0 Annual Fall Conference 2016 in Santa Clara, California.

After he assembled the nail, it was time to put it into the tibia — "the fun part," Dr Barad noted. Using the controller, he hammered the nail while the virtual instructor watched. When he realized he might have been overenthusiastic with the hammer, he joked, "You can see how advanced our physics are," evoking laughter from the audience.

Dr Barad was one of several presenters at the conference making the point that virtual reality is no longer just for gamers. Technologies that simulate reality are now being used in surgical education and to help patients manage stress and anxiety.

Devices for hip and knee replacements are becoming increasingly complicated, and surgeons are graduating without sufficient training, Dr Barad told Medscape Medical News.

"If you look at the general surgery literature, it identifies 121 critical procedures that a graduate should know," he explained. But if you look at the procedures graduates performed over the past year, the literature shows that "a large number performed no surgeries, many performed five, and some performed one or two."

It puts them in the shoes of a surgeon.

"There's an increased learning curve for medical devices," Dr Barad said. "I've done surgeries where I just sat at the computer reading the instructional manual out loud — a little like putting together IKEA furniture — because we don't currently have a training option like this."

"Virtual reality is a better way," Dr Barad said. "I think this will change orthopedics and medicine, and it will make patients safer. Better surgeons have better outcomes."

Gaps in the learning process were also addressed by Jean-Vincent Trives, founder and chief executive officer of SAS Revinax.

He explained that, normally, residents are stuck behind or beside a surgeon when they observe a procedure. As he showed a 360° video of a heart valve replacement surgery, he described how the virtual reality experience can immerse residents in the operating room and provide a more advantageous viewpoint.

"It puts them in the shoes of a surgeon," said Trives. One of the cameras films from the surgeon's point of view, but viewers are not limited to that. They can look all around the room — up, down, behind — and see all the action.

For procedures with two surgeons, viewers can switch between views. And the audio commentary can be turned off, so professors can use the technology with their own commentary.

Virtual reality is also making waves in the field of mental health. "Technology has given us the huge potential to impact mental health and behavioral health," said session moderator Arshya Vahabzadeh, MD, from Brain Power LLC.

Mental Health Improvements

Dr Vahabzadeh showed a video that demonstrated the technology his company uses to help autistic children learn social cues. An autistic child wearing Google Glass was able to identify the facial expressions of his mother in the program, which prompted him to look her in the eyes. The system assessed his gaze and corrected it when he did not look at her directly.

In the video, his mother sobbed when he looked directly at her, explaining that it was the first time this had happened.

Virtual reality has also been used to help people with combat-related PTSD and to reduce symptoms of chronic pain, as reported by Medscape Medical News.

And use of the technology in the operating room is now being explored. During surgical procedures, patients are being outfitted with AppliedVR headsets to alleviate stress and take attention away from pain.

"It's so immersive that it takes away the anxiety of the surgery," said Josh Sackman, president of AppliedVR. "We're using this to distract patients, to place them outside the operating room, so they don't need sedation," he told Medscape Medical News.

Hospitals are looking for ways to reduce opioid use, improve patient outcomes, shorten hospital stays, and manage pain and stress. The AppliedVR device arrives equipped with hardware, content, and know-how, eliminating the need for expertise in the hospital.

We're looking at having virtual reality available during dialysis, chemotherapy, IUD replacement, and other situations where it could be helpful to the patient.

"Whenever you go into fragmented spaces for software and for content, you have to deal with different companies with different hardware and maintenance plans," Sackman explained. But AppliedVR validates the technology and content to make sure it fits into hospital workflow, taking into account concerns like infection control and specific patient needs.

"We're a single point of entry that deals with device setup, training, protocols, and content," he said.

The company's main products have been developed in partnership with Cedars-Sinai Medical Center, a large nonprofit academic medical center in Los Angeles with 886 licensed beds and 2100 physicians.

Together, they have provided virtual reality games to patients to distract them from preoperative anxiety and, for patients needing distraction, relaxation, or stress management, they have provided peaceful scenic virtual environments.

"We're looking at having virtual reality available during dialysis, chemotherapy, IUD replacement, and other situations where it could be helpful to the patient," Sackman reported. He said his company hopes to become the "Netflix of hospital VR content."

"We're creating some content in partnership with doctors and doing some internal development. We're also actively looking to partner and to license VR content," he added.

Dr Barad is founder and chief executive officer of Osso VR. Mr Trives is founder and chief executive officer of SAS Revinax. Mr Vahabzadeh is director of digital health at Brain Power LLC. Mr Sackman is cofounder and president of AppliedVR.

Health 2.0 Annual Fall Conference 2016. Presented September 27, 2016.


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