Clinicians can help patients recover from strokes while they’re anywhere in the world—even states or countries far away from each other—by using a combination of robotics and virtual-reality devices.
It’s happening at Georgia Institute of Technology, where Nick Housley runs the Sensorimotor Integration Lab. The robotic Motus devices are used to attach robots to the arms and legs of patients who are undergoing neurorehabilitation. This is done to help with rehabilitation and speed up recovery. Virtual reality headsets are worn by both patients and professionals who use the system. Motus devices send feedback to the clinician who can direct the patient through exercises that help them recover their lost movement. “The headset tells you really critical things, like how much force someone’s muscle can put out,” Housley says. “It can also tailor an intervention—for example, if someone has difficulty picking up a cup of coffee, you can guide them in real time.”
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It is becoming more common to use virtual reality for training health care professionals, pain management assistance and telemedicine around the world. Headsets are relatively inexpensive now, at $300 to $1,000 per device, and can expand a practitioner’s reach to anywhere on the planet. “The potential advantages of VR for clinicians are tremendous, and only the limits of our imagination restrict the possibilities,” says Dr. José Barral, chair of biomedical science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, Calif.
According to one study, virtual reality plays an important role in improving doctors’ performance and should be used as a complementary education tool. Virtual reality can also be used to teach laparoscopic surgery. This type of training results in higher precision. VR tools are “very effective in transferring skills to the operating room,” the study authors write. The study authors also suggested that virtual reality should be used for training doctors in techniques such as ultrasound and suturing.
According to the American Board of Internal Medicine, it’s best for medical residents to be trained via VR tools before attempting real-life interventions on patients. According to the American Board of Internal Medicine, VR can be used to teach how to do invasive hemodynamic monitoring or mechanical ventilation.
Another study described VR as “a cornerstone of clinical training.” It offers benefits for learners and educators, the researchers noted, and delivers cost-effective, repeatable, and standardized clinical training on demand. “Though VR is not a panacea, it is a powerful educational tool,” the authors said.
However, virtual reality isn’t yet a standard part of most physicians’ arsenals. VR headsets are still crude, and image quality can’t compete with the real world. In addition, headsets suffer from nonintuitive user interfaces and can pose health risks like dizziness, says Rema Padman, who studies VR as a professor of management science and health care informatics at Carnegie Mellon University’s Heinz College. “In particular, the hardware limitations of headsets and accompanying software and tools pose challenges for clinicians using VR in surgery,” Padman says. “Similarly, there are limitations in terms of prolonged use for patients, especially those who are vulnerable or frail, such as children and the elderly.”
Virtual reality has many advantages, despite these limitations. Here’s a look at how it’s being used to improve telemedicine, surgery, and medical training.
Telemedicine
Housley uses virtual reality to bridge the gap between him and stroke victims when he works remotely. The majority of stroke victims being treated at Georgia Institute of Technology have mild to moderate paralysis or muscle weakness. Conducting evaluations and physical exams requires physical interactions—such as manual muscle, reflex, and sensory testing—which would be nearly impossible via traditional telemedicine. Housley instead uses a virtual environment and robotic exoskeleton to evaluate his patients. “This works because the patient is wearing a robotic exoskeleton on their paretic limb, and it houses sensors and actuators that allow me to digitize their movements and muscle actions,” he says. “This data gets transmitted to me and allows me to act upon it to personalize the exam.”
The Motus system also includes a virtual reality component that is intended to assist stroke victims. You can adjust a thermometer or move an avatar within a virtual world. There are 25 types. This makes therapy immersive and fun.
Housley claims that the system is as effective as in-person therapy, and has added benefits such as convenience. “I did my first assessment with someone in Australia, and there was only a two-second lag,” he says. “It was just incredible to jump into the virtual environment and make the gaming interface work with them.”
Another benefit: patients have easy access to additional hours of therapy that they couldn’t receive from in-person providers. Because they can use the technology at home, they don’t have to commute to a facility or worry about squeezing in time-consuming medical appointments.
Housley states that VR can help patients achieve faster outcomes. This includes improved range of motion and pain relief, as well as better adherence to their treatment plans. Patients can view their individual statistics, track their progress and have a virtual environment that allows them to monitor their health. Virtual environments often result in greater support.
Surgery
Complex procedures can make even experienced surgeons nervous. However, virtual reality makes it possible to experience the actual procedure in real time.
Cleveland Clinic has created an innovative way that allows neurosurgeons using VR to improve their surgical skills. A patient coming in for surgery will have to undergo MRI brain scannings. These scans are transmitted to a company, who transforms them into 3D graphics that can be uploaded to a VR platform. This allows the doctor to practice and plan the procedure before it occurs. “Giving physicians real-life experience … will improve outcomes every time,” says Pieter VanIperen, the founder of PWV Consultants who helped create VR platforms for medical training.
The virtual reality tool can be used to aid surgeons during surgery, beyond planning and practice. Vicarious Surgical is a robotics startup that aims at helping clinicians to perform very precise dissections. It also provides sutures for expanding their access into the abdomen. It combines VR technology with human-like robotic arms. Its goal is “to make the surgeon feel as though they’re transported into the abdomen,” says Dr. Barry Greene, Vicarious Surgical’s chief medical officer.
Medical training
At the scene of a bombing in a subway station, smoke rises. It takes first responders minutes to determine how to best triage the victims. But this isn’t real life: the scene is happening in virtual reality, and the first responders are medical students wearing headsets. It’s a system designed by the Ohio State University College of Medicine to help teach physicians and first responders how to assist in emergencies.
“What’s important [during the training] is to find the patients who would benefit from medical care immediately,” says Dr. Nicholas Kman, a professor of emergency medicine at the college who helps run the VR training sessions. “The previous training was via PowerPoint. But with virtual reality, it’s much easier to learn these skills when seeing the patients in front of you and feeling a pulse” as the headset’s controllers vibrate.
Virtual reality is becoming a more popular training tool for medical students. VR can grab students’ attention in a way that traditional media like books or computer screens cannot, says Dr. Daniel Katz, the vice chair of education for the Mount Sinai Department of Anesthesiology, Pain and Perioperative Medicine in New York City. “For example, imagine the difference in clicking through a PowerPoint presentation on fire safety as compared to being placed in an operating room that’s on fire, and it’s up to you to manage the situation,” he says.
Students in fourth year at Ohio State are learning how to treat a person suffering from a heart attack. When a simulation takes place in an emergency room, a virtual patient on a wheelchair arrives with severe chest pains and shortness or breath.
Wearing headsets, the students quickly assess the patient’s condition. A virtual student avatar is placed beside the gurney and holds a tablet computer to order treatment or tests. The student must triage the patient while they are administering epinephrine to the heart. “By getting them to manage that patient, they’re learning what steps to take in real life,” Kman says. “It’s pretty cool.”
The adage “see one, do one, teach one” has been the basis of surgical training for over a century, points out Dr. Soheila Borhani, a researcher at University of Illinois at Chicago who studies virtual reality in medicine. First, medical students and residents observe the procedure being performed before they can perform the task on their own. Then, they then have to teach their fellows how it works. “Today, it’s possible to practice a certain procedure as many times as needed through the use of VR platforms that not only enable repeated risk-free trials and errors, but also facilitate 3D understanding of complex anatomical structures,” Borhani says.
The only medium that comes close to VR’s level of immersion is a high-fidelity simulation using actors, which is too expensive for most scenarios, Katz says. This simulation could cost hundreds of thousands and take weeks to plan. Ohio State instead uses Oculus Quest 2. This headset is consumer-grade and allows for training sessions to be organized in under 30 minutes. “Learning can occur at your convenience in most instances,” Katz says.
Katz states that the biggest obstacle to VR education in medicine is the absence of an integrated platform or standardization. There is no “app store” for medical education, which means that each module must be purchased from different vendors.
Katz also notes that hardware issues exist. For example, hand-tracking technology that can precisely mimic hand motions still lags behind headset development, though it’s improving rapidly.
VR rigs will become a more common part of medical tools in the future, according to Douglas Danforth (an associate professor of obstetrics at Ohio State University College of Medicine) who studies virtual reality. “As processing power improves, VR simulations will become more realistic, eventually being nearly indistinguishable from interacting with real patients,” Danforth says.
