Medicine in "full scope"

How Virtual Reality Saves People

Natalia Pelezneva, Naked Science

See the light

In 2016, neurosurgeons from the Angers University Hospital in France removed a brain tumor for the first time in the world using a virtual reality device. VR has been used in such operations before – for example, for visual modeling of the situation. But this time the virtual world has become a full-fledged surgical "tool".

To do this, doctors did not need to wear special virtual reality glasses in the operating room. The headset was put on by the patient: during the procedure he remained conscious. It is worth paying tribute to the courage of this man. Because of the tumor, one of his eyes had already lost sight by the time of the operation, so the slightest mistake by surgeons could leave the patient blind. However, it was this danger that prompted the doctors to make a non-standard solution. 

In order to act for sure, it was necessary to monitor the patient's condition as accurately as possible, so the doctors combined two monitoring methods. Firstly, brain activity was recorded by the usual method of electroencephalography using electrodes. Secondly, a special virtual environment was simulated for the operation: glowing objects appeared in the field of vision from time to time, the patient followed them with a healthy eye. This helped to determine exactly which areas of the brain are activated. Surgeons successfully removed the tumor without touching these areas. Repeated examinations a few weeks later showed that vision was not affected. 

Doctors from Angers are sure that the VR-control method during operations will develop together with the technique. But can virtual reality heal on its own? To answer this question, let's figure out how the world of illusions works and how to get there.

The Road to Virtuality

Classical painting also took the first steps towards creating a man-made "world". At the end of the XVIII century, panorama paintings appeared, where many scenes stretched into a closing ribbon literally surrounded the viewer, creating a feeling of a ring of the horizon. Special rounded buildings were built for panoramas – this is where the famous "Defense of Sevastopol" was located. 

The real prototype of modern glasses and virtual reality helmets appeared in the late 1830s. A device called a "stereoscope" allowed viewing photos in volume. To do this, a stereo pair was created – two slightly different photos of the same object (for example, taken from two points at a short distance from each other). If you arrange them so that each human eye sees only one picture, one image will "overlap" with another, creating a volume effect. "Virtual tourism" was especially popular: people could spend hours looking at pictures of forest paths and park alleys going somewhere deep. 

Probably the most impressive "VR technology" of the mid–twentieth century is the Sensorama personal cinema. The device resembled modern slot machine simulators, but involved all the senses of the user at once. Three-dimensional images flashed on the screen, they were accompanied by stereo sound, the chair vibrated under the viewer. In addition to this, Sensorama generated odors and a whiff of wind at the right moment. However, the simulator did not enjoy great success. 

Sensorama / ©sensoramalab

Modern virtual reality headsets, of course, cannot be compared with their analog "ancestors". These devices masterfully work with our senses. For vision – impressive 3D landscapes, for hearing – sound design using multi-channel speakers. In order for the viewer to interact with virtual objects as with real things, special gloves and whole VR suits are used, transmitting heat, vibration and tactile sensations. Modern devices reproducing odors are being developed. Most often, they mix several perfumed solutions in accordance with the program laid down and at the right moment gradually evaporate the mixture. 

Today, all this is in demand primarily in the entertainment industry. How many opportunities for interactive computer games! There are flight simulators and duels on carefully rendered virtual weapons. But let's remember that an artificial environment can not only entertain.

3D Anatomy

A doctor is one of those professions where education not only plays a crucial role, but never, in fact, ends. Both the student and the specialist need huge amounts of information and constant practice. Virtual reality can solve both problems. 

Already, many medical universities around the world use virtual applications to the usual anatomical atlases. Students view three-dimensional images in all details, enlarging the desired areas. And it is also possible to simulate the processes taking place in the human body on 3D organs - for example, to see how blood moves through the vessels. 

VR technologies will help future surgeons prepare for work in the operating room. Panoramic shooting is replacing video recordings of operations. In April 2016, doctors at the Royal London Hospital conducted a full-fledged panoramic broadcast of the operation for the first time in the world. The image from several cameras was combined into a "circle", so that viewers could switch in search of the most convenient point of view. This technology cannot be called virtual reality in full, since in real VR the viewer usually interacts with objects. But panoramic surveys can become the basis of medical simulation applications, on which students will hone their technique. In addition, this is an important step towards the development of distance learning for doctors anywhere in the world.

The cure for fear

Oddly enough, virtual reality began to be used directly during the treatment process even before the appearance of "three-dimensional" atlases and videos. In the 1990s, psychologists and psychiatrists drew attention to the emerging technology. A decade earlier, doctors had introduced the concept of post-traumatic stress disorder (PTSD) – a serious condition that sometimes occurs in those who are faced with a traumatic situation. 

Initially, PTSD became known as the "Vietnam syndrome" because in the late 1970s it was most often diagnosed in soldiers returning from the war in Southeast Asia. Later it turned out that people who have experienced serious illnesses or domestic violence also suffer from this disorder. The level of anxiety among the victims of PTSD was extremely high, they had frightening flashbacks every now and then, or, conversely, some period of life completely dropped out of memory. 

In the late 1990s, psychologist Barbara Rothbaum worked with Vietnam War veterans suffering from PTSD. Barbara and her colleagues created virtual models of places that are significant for one of the patients. The first model was a helicopter flying over Vietnam, the second was a small clearing in the jungle. These models complemented exposure therapy sessions, a method in which the patient begins to interact with frightening images gradually. Over time, the psyche adapts to them and the fear recedes. According to medical estimates, after therapy using virtual reality, the anxiety of the Rotbaum patient decreased by 34%. The veteran himself estimated the decline even stronger, up to 45%. 

Today, virtual reality allows you to cope with many mental disorders. It complements exposure therapy in the treatment of phobias: for example, those who are terrified of heights can "visit" the roof of a skyscraper, while knowing that in fact they are completely safe. 

©VR-STORE

VR also helps people suffering from paranoia and similar disorders. A recent study by Oxford University scientists has shown that rehearsing frightening situations in a virtual environment significantly reduces fear in reality. During the experiment, 30 people with acute delusions of persecution "communicated" with virtual interlocutors in several simulated situations – in an elevator or subway car. The people were divided into two groups: in the first, the participants used the usual defensive techniques when "communicating", in the second they abandoned them. Training in the VR environment helped: 20% of participants in the first group and more than 50% in the second felt a significant decrease in anxiety.

Illusion against Pain

Virtual reality methods facilitate not only mental, but also physical condition. For example, in the burn department of Loyola University Hospital in Illinois, VR has been used for several years along with painkillers. During painful procedures, patients play SnowWorld simulator.  This is a virtual snowball game against the background of a semi-fantastic winter landscape with frozen rivers, snowmen and penguins. The player needs to concentrate on completing tasks, so he is involuntarily distracted from physical sensations. MRI studies have confirmed that pain is actually perceived weaker during the game. 

©themedicportal

Another simulator, Virtual Meditative Walk, helps to cope with chronic pain syndrome. The session looks like this: the patient walks slowly on a treadmill, watching the gradually changing landscape around. The virtual walk complements the so-called "mindfulness meditation", during which a person completely focuses on his state at the moment, without thinking about the past or the future. 

The patient's physical condition and reactions are constantly monitored by monitors. They measure indicators indicating the level of stress – for example, body temperature and pulse. At the beginning of the "walk", the virtual mountains around are shrouded in fog, but as the patient concentrates and calms down, the fog dissipates. This allows patients to concentrate more easily and, as a result, pay less attention to pain.

Return to life

Virtual reality technologies are not only able to treat, they are able to restore many functions of the body after a serious illness. The main direction of such developments is rehabilitation after a stroke. VR is becoming an important part of physical therapy, it helps to regain the lost freedom of movement. 

In 2015, this technique was successfully tested at the Val d'ebron Hospital in Barcelona. One of the participants in the study was Gloria Bow Ferreiro, who survived a stroke immediately after giving birth. The woman was practically paralyzed: her body did not obey her, she could barely speak. For several months, Gloria participated in a rehabilitation program, which included a newly developed VR game. 

The patient had to interact with objects on the screen by moving her palms with sensors attached to them. At first, the task seemed impossible, but over time Gloria mastered many levels of the game, including a virtual analogue of bowling. "The rehabilitation program turned out to be really motivating. I could improve my hand movements without realizing it, in an absolutely natural way," the woman says. Self-study at home after returning from the hospital is extremely important for those who have suffered a stroke. Now that the program has proven its effectiveness, it is planned to be used throughout Europe.  

Make yourself at home

Nobody likes to lie in the hospital – you can't argue with that. But even a hospital ward can be made not so dull if you turn to virtual reality. 

Developers from the Netherlands have created the VisitU program for children who spend a lot of time in the hospital and miss home, parents and friends. For the application to work, you need a panoramic camera, it takes everything that happens at home or in a school classroom and transmits the image to a VR headset. The familiar environment literally surrounds the child and allows you to forget about procedures and tests at least for a while. 

Virtual obstacles

Programs and equipment are developing rapidly, and VR techniques consistently appear in most reviews of "technologies of the future". Are the prospects really so exciting and cloudless? Of course, there are certain obstacles in the way of virtual reality. 

One of the main technical problems is the "motion sickness effect", it occurs if the VR headset is connected to a not too powerful computer. When the device "slows down" and reproduces less than 90 frames per second, seemingly imperceptible "gaps" appear in the image and the user begins to feel a slight nausea. 

Manufacturers of helmets and virtual reality glasses have been struggling with this effect for a long time. In October 2016, the developers of one of the most popular Oculus Rift headsets proposed a new solution to the problem. If the computer does not have enough power, the technology of "asynchronous filling of missed frames" is connected. The software analyzes the frames adjacent to the "gap" and synthesizes a new intermediate frame based on them. This method will reduce the power requirements of computers and make virtual reality more accessible. 

A number of problems are also associated with the physical condition of patients. VR technologies are still very "young", which means that their impact has not been sufficiently studied. But already many doctors insist that immersion in virtual reality can be dangerous for people with epilepsy and other diagnoses. This does not mean that the use of VR in medicine will have to be abandoned – rather, we are waiting for new research into the possibilities of virtual reality.

What awaits VR medicine?

Technologies are becoming more accessible and more diverse, so in the near future virtual reality will gain popularity year by year. According to the forecasts of the research company MarketsandMarkets, by 2022 the market for virtual reality technologies could grow to almost $ 34 billion (in 2015, the capacity of this market was $ 1.37 billion). 

The growing popularity of the technology as a whole will affect its use in medicine. There will be new methods of using virtual reality in treatment and rehabilitation. For sure, new technical solutions will not take long to wait: the effect of presence will become even more noticeable. 

Why are new ways of using virtual reality in medicine being developed all over the world? It's not just its analgesic and soothing properties. Virtual reality involves the patient in the treatment process, makes him feel not an object of medical manipulation, but an ally of the doctor. Performing tasks in VR, a person is aware of the responsibility for his own health and sees that his capabilities are much wider than it may seem. We must not forget that most of the virtual reality medical programs are games. The game is fascinating, gives new sensations, dilutes the hospital routine. 

Like any medical technology, virtual reality will be thoroughly tested. It is necessary to check what effect it has on patients in the long term, how persistent its effect will be. These studies may significantly limit the use of VR, and may, on the contrary, help new developments. There is no doubt about one thing: real discoveries are waiting for us in the virtual world.

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