Is Virtual Reality (VR) just a hi-tech toy for gamers? Doctors are willing to argue. Technologies that immerse a person in an artificially created world are used in many areas of medicine - from surgery to rehabilitation of patients after a stroke.
See the light
In 2016, neurosurgeons from the French University Hospital of Angers removed a brain tumor for the first time in the world using a virtual reality device. VR has already been used in such operations - for example, for visual simulation of the situation. But this time the virtual world has become a full-fledged surgical "tool".
For 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 giving credit to this man's courage. Due to a tumor, one of his eyes had already lost his sight by the time of the operation, so that the slightest mistake of the surgeons could leave the patient blind. However, it was this danger that prompted the doctors to take a non-standard solution.
To be sure, it was necessary to monitor the patient's condition as accurately as possible, so the doctors combined the two monitoring techniques. First, brain activity was recorded using the usual electroencephalography method using electrodes. Secondly, a special virtual environment was modeled for the operation: luminous objects appeared in the field of view from time to time, the patient followed them with a healthy eye. This helped to establish exactly which parts of the brain are being activated. The surgeons successfully removed the tumor without affecting these areas. Repeated examinations a few weeks later showed that the eyesight was not affected.
Doctors from Angers are confident that the VR control method during operations will develop along 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
The first steps towards the creation of a man-made "world" were made by classical painting. At the end of the 18th century, panorama paintings appeared, where many scenes, stretched out in a closing tape, literally surrounded the viewer, creating the feeling of a horizon ring. For panoramas, special rounded buildings were erected - it was in this that 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" made it possible to view photographs in volume. For this, a stereopair 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 person's eye sees only one shot, one image "overlaps" the other, creating a three-dimensional effect. "Virtual tourism" was especially popular: people could spend hours looking at pictures of forest paths and park alleys going deep into the depths.
Probably the most impressive "VR technology" of the mid-20th century is the Sensorama personal cinema. The device resembled modern slot machine simulators, but it involved all the user's senses at once. Three-dimensional images flashed on the screen, they were accompanied by stereo sound, the chair under the viewer vibrated. In addition to this, Sensorama generated smells and a breath of wind at the right time. However, the simulator was not very successful.
Modern virtual reality headsets, of course, do not compare with their analog "ancestors". These devices masterfully work with our senses. Spectacular 3D landscapes for sight, for hearing sound design with 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, which convey heat, vibration and tactile sensations. The development of modern devices that reproduce odors are underway. Most often, they mix several perfumed solutions in accordance with the set program and gradually evaporate the mixture at the right time.
Today, all this is in demand primarily in the entertainment industry. How many possibilities for interactive computer games! There are flight simulators and fights on carefully rendered virtual weapons. But remember that the artificial environment is capable of more than entertaining.
Physician is one of those professions where education not only plays a decisive role, but, in fact, never ends. Both the student and the specialist need huge amounts of information and constant practice. Virtual reality can do both.
Already, many medical universities around the world use virtual applications to familiar anatomical atlases. Students examine the volumetric images in full detail, enlarging the desired areas. In addition, 3D organs can be used to simulate the processes occurring in the human body - 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 images from several cameras were combined into a "circle" so that viewers could switch in search of the most comfortable vantage point. This technology cannot be called virtual reality in full, since in real VR the viewer usually interacts with objects. But panoramic footage could be the backbone of medical simulation apps that students can use to 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 in the treatment process even before the appearance of “volumetric” atlases and videos. In the 1990s, psychologists and psychiatrists drew attention to the nascent technology. A decade earlier, doctors had coined the concept of post-traumatic stress disorder (PTSD), a serious condition that sometimes occurs in those who are faced with a traumatic situation.
PTSD was originally known as the "Vietnam Syndrome" because in the late 1970s it was most commonly diagnosed in soldiers returning from the war in Southeast Asia. Later it turned out that this disorder also affects people who have experienced serious illness or domestic violence. 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 their life completely fell out of memory.
In the late 1990s, psychologist Barbara Rothbaum worked with Vietnam War veterans with PTSD. Barbara and her colleagues have created virtual models of places that are meaningful to 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 the exposure therapy sessions, a method in which the patient begins to interact with fearful images gradually. Over time, the psyche adapts to them and the fear recedes. According to doctors, after therapy using virtual reality, patient Rothbaum's anxiety decreased by 34%. The veteran himself estimated the decline even more, 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 have a panic fear of heights can “visit” the roof of a skyscraper, while knowing that they are in fact completely safe.
VR also helps people suffering from paranoia and similar disorders. A recent study by scientists at Oxford University showed that rehearsing scary 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 a subway car. The people were divided into two groups: in the first, the participants used habitual defensive techniques during the "communication", in the second they refused them. Training in a VR environment helped: 20% of participants in the first group felt a significant decrease in anxiety and more than 50% in the second.
Illusion against pain
Virtual reality techniques facilitate not only mental but also physical condition. For example, in the burn department of Loyola University Hospital in Illinois, VR has been used alongside pain relievers for several years. During painful procedures, patients play the SnowWorld simulator. This is a virtual snowball fight set against 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 less perceived during play.
Another simulator, Virtual Meditative Walk, helps you manage chronic pain. The session looks like this: the patient walks slowly on the treadmill, observing the gradually changing landscape around. The virtual walk complements the so-called “mindfulness meditation”, during which a person completely concentrates on his state of affairs at the moment, not thinking about the past or the future.
The patient's physical condition and reactions are constantly monitored by monitors. They measure indicators that indicate stress levels, such as body temperature and heart rate. 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.
Back to life
Virtual reality technologies can not only heal, 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, helping to regain lost freedom of movement.
In 2015, this technique was successfully tested at the Val d'Hebron Hospital in Barcelona. One of the participants in the study was Gloria Bou Ferreiro, who had a stroke immediately after giving birth. The woman was practically paralyzed: the body did not obey her, she could hardly speak. For several months, Gloria participated in a rehabilitation program, which also 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 has mastered many levels of the game, including a virtual analogue of bowling. “The rehabilitation program turned out to be truly motivating. I could perfect my hand movements, without realizing it, in an absolutely natural way,”says the woman. Self-study at home after returning from hospital is extremely important for those who have had a stroke. Now that the program has proven its effectiveness, they plan to use it throughout Europe.
make yourself at home
Nobody likes to lie in the hospital - you can't argue with that. But even a hospital room can be made less dull by turning to virtual reality.
Developers from the Netherlands have created VisitU 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 captures everything that happens at home or in the classroom and transmits the image to a VR headset. A familiar environment literally surrounds the child and allows you to forget about the procedures and analyzes at least for a while.
Software and hardware are evolving rapidly, and VR techniques are featured prominently in most “technology of the future” reviews. Are the prospects really so exciting and cloudless? Of course, there are certain barriers to virtual reality.
One of the main technical problems is the "motion sickness effect", which occurs if a VR headset is connected to a not very powerful computer. When the device "slows down" and plays less than 90 frames per second, seemingly imperceptible "gaps" appear in the image and the user begins to feel mild nausea.
Manufacturers of headsets 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 dropped 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 associated with the physical condition of patients. VR technologies are still very young, which means that their impact is not well understood. But already now, 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's in store for VR medicine?
Technologies are becoming more accessible and more diverse, so in the near future virtual reality will gain popularity from year to year. According to the forecasts of the research company MarketsandMarkets, the market for virtual reality technologies may grow to almost $ 34 billion by 2022 (in 2015, the capacity of this market was $ 1.37 billion).
The growing popularity of the technology in general will affect its use in medicine. New methods of using virtual reality in treatment and rehabilitation will appear. Surely, new technical solutions will not be long in coming: the effect of presence will become even more tangible.
Why are new ways of using virtual reality in medicine developing all over the world? It's not just about its analgesic and sedative 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 realizes the responsibility for their own health and sees that their possibilities are much wider than it might seem. We must not forget that most of the medical virtual reality programs are games. The game captivates, gives new sensations, dilutes the hospital routine.
Like any medical technology, virtual reality is about to be rigorously tested. It is necessary to check what effect it has on patients in the long term, how persistent its effect will be. This research can significantly limit the use of VR, or, on the contrary, help new developments. There is no doubt about one thing: real discoveries await us in the virtual world.