Robotic Playmates for Children with Autism

AHN has an interesting article discussing the potential use of therapeutic robots for children with autism. Robots could prove to be an economically sound solution to addressing the needs of people with autism. Though initial research demonstrates that robots can be engaging to children with autism, it remains to be seen how robotic therapy will be generalized to interactions with other human beings.

Hiatus

This blog is on temporary hiatus for a bit as I prepare for the MCAT. However, the world of virtual reality and therapy continues to hurtle forward with exciting new applications, and I would like to direct you to a few reports:

• At the University of Medicine and Dentistry of New Jersey, post-stroke patients manipulated a robot in virtual environments as part of rehabilitative physical therapy. The virtual reality group walked farther and faster than a group that only used the robot. Read more here.

• GestureTek, a company whose innovations have been utilized for previous virtual reality therapeutic applications, was on display this past weekend at the Consumer Electronics Show. Read more about their new 3-D depth tracking system here.

Virtual Reality Treadmills

One of the major rehabilitation challenges for older stroke victims is re-learning how to walk. A new system, designed by a former chiropractor and current University of Portsmouth Ph.D. student Wendy Powell, aims to change that with an innovative virtual reality system, used in conjunction with a treadmill.

As patients walk on a standard treadmill, moving images projected onto a screen in front of them attempt to trick their brains into thinking that they are walking at a slower rate than they are actually walking. This reduces fear of falling and gradually encourages them to walk faster, increasing endurance and speed. The system is expected to enhance speed, endurance, and strength among stroke victims. Clinical trials are being conducted with a research team from Canada's McGill University.

• University of Portsmouth Front Page News
  

Ditto!

Researchers from Australia have designed a new tool in the quest to bring pain relief to burn victims. The project, lead by Dr. Sam Bucolo, involves a hand-held circular device which engages children as they get their burn dressings changed. Previous work for burn victims has involved goggles, headsets, or other types of immersive virtual reality settings, but this device, Ditto, is designed specifically for small children, aged three to eight. Preliminary data indicate that Ditto can engage children in less than a minute and keep them preoccupied throughout a full bandage replacement, which typically takes around 20 minutes. The results also show that Ditto had more success reducing pain scores during treatment as opposed to traditional distraction tools, such as videos or computer games. Clinical trials are underway, and Ditto is expected to be released for commercial use within the year.

• ScienceAlert Article
  

Virtual Reality Loses A Hero

Dr. Randy Pausch, a talented, generous, and inspiring researcher and educator, passed away on Friday, July 25. The field lost a true hero whose contributions to virtual reality will live on in his imaginative projects, including computer programming teaching tool ALICE. You can read my tribute to him here.

More Information:
PC World
Wall Street Journal (written by Jeffrey Zaslow, co-author of "The Last Lecture," the novel form of Dr. Pausch's lecture)

VR + Students with Special Needs

The journal Topics in Language Disorders has a review by Sue Cobb of projects that utilize virtual reality to teach students with special needs. One of the most promising aspects of VR education is its capacity to teach skills that can be transferred to real-world situations. In the late 90s, researchers from the University of Nottingham and VIRART (Brown, Kerr, and Wilson, 1997) designed and tested virtual ski, driving, home, and supermarket environments. Since then, a variety of others have followed suit, examining the impact of virtual reality settings on everything from social skills to language learning to daily life skills. Cobb summarizes the results; while many studies found that students learned within the setting, and others found evidence that the skills were transferred, the studies have not followed students or interventions for long enough time periods to fully conceive the generalization ability of such programs. The article is a terrific summary of the progress that has been made thus far as well as future areas to examine more.

• Cobb, Sue V.G. Topics in Language Disorders. Virtual Reality: Exploring New Dimensions for Conversation, Language, and Learning. 27(3):211-225, July/September 2007.

VR in the News

This summer has been full of exciting new developments and reports from the intersection of virtual reality and therapy.

Stuff.co.nz has an article following the rehabilitation of three patients at a Ryde, Australia hospital. It provides examples of how the Nintendo Wii offers an engaging and challenging platform for physical and emotional progress after debilitating injuries or illnesses. One of the patients, trained as a physiotherapist, designed a glove that allows less mobile people to access the handheld Wii remote.

VR and Burn Wounds: Hydrotank Research

Researchers from University of Washington's HITLab have published a new study on virtual reality pain control during the removal of burnt tissue in The Clinical Journal of Pain. In burn treatment, patients often experience extreme pain during the earliest treatment sessions, which are often held in hydrotherapy tanks. Although medications are used to reduce pain, analgesics are not always effective and can lead to other side effects. Based on a model in which attention is a requirement for pain, the VR treatment used in this study attempts to distract users with images and sounds that are engaging and positive.

In this experiment, 11 patients (ranging in age from 9 to 40 years of age) were studied during the painful bandage removal and wound cleansing sessions. For part of the treatment, they received no distraction and were asked to report the worst pain they felt, the amount of time they spent thinking about pain, and the unpleasantness of their experience. Two additional ratings that measured 'fun' and 'presence' in the virtual world were also administered. In another part of the treatment, the patients were immersed in a world filled with icy, cool images called SnowWorld. During this phase, the participants were given the same ratings scales as in the other phase. However, treatment sequence was randomized, so some patients received the control treatment first, then the VR treatment; others received it in the opposite order.

The study demonstrated that in the VR condition, participants spent less time thinking about the pain and experienced lower pain intensity and less unpleasantness. The virtual reality condition was rated, unsurprisingly, as more 'fun' than the control condition, which involved no distraction. Interestingly, patients with higher presence ratings - the extent to which they became cognitively involved in the virtual environment - experienced less pain. Pain was reduced from 'severe' to 'moderate' on average, but in the group of the six most engaged participants, ratings dropped from 'severe' to 'mild.'

The study authors point out one possible bias of the study: the nurses providing care knew which treatment the patients were receiving, control or VR, because of the headset. Therefore, there is a chance they could have unknowingly treated the VR patients more gently throughout the treatment.

However, this is the first controlled multi-subject study to demonstrate that virtual reality allows pain reduction for patients undergoing treatment within the hydrotank, which is extremely promising news for burn care. Past pain-reducing options have failed to prove sustainable for many patients undergoing wound treatments, and virtual reality could offer new hope for this group.

• Hoffman, H. (2008). Virtual Reality Pain Control During Burn Wound Debridement in the Hydrotank. Clinical Journal of Pain, 24(4), 299.

Case Study on VR Treatment for PTSD

Researchers at Emory University published an article on virtual reality exposure therapy for Iraq war veterans with PTSD in the most recent issue of the Journal of Traumatic Stress (view abstract here). Due to the extreme number of soldiers who experience events that put them at an increased risk for PTSD (92% of soldiers and Marines who served in Iraq report being attacked or ambushed; 70% report having seen dead or seriously wounded Americans) clinicians are trying to develop new technology to meet the mental health needs of returning veterans.

In this case study, a 29-year-old male veteran underwent four exposure therapy sessions using a VR headset system. The veteran is a combat engineer who served one year in Iraq and met the diagnostic criteria for PTSD. He reported having trouble focusing at work, driving, and sleeping. He also experienced hypervigilance - constantly being on alert - as well as mood swings and irritability.

The rationale behind exposure therapy (VR and non-VR) is based on Foa and Kozek's model of emotional processing, which posits that in order to overcome a fear, it must be activated and one must learn how to get used to it without an emotional response. Eventually, the fear can be extinguished as the patient learns to remember the traumatic incident in a non-threatening way.

During the four exposure therapy sessions, the therapist paired traditional therapeutic techniques such as breathing and treatment information with exposure in the VR environment. The system allowed the therapist to manipulate different variables that included visual, auditory, and olfactory components. As the sessions went on, the therapist increased the intensity of the stimuli to add stress. The patient completed pre-therapy and post-therapy assessments.

Although the sessions had increasing intensity, the patient's ratings on a PTSD symptoms inventory decreased as the sessions continued. By the end of the treatment, the subject's overall ratings had decreased by 56%. He initially fit the definition of "extreme" symptoms, but by the end of treatment, fell into the "mild/moderate" range of PTSD. The patient reported that he could concentrate more at work, had improved communication with his wife, and socialized more often. While this is an extremely new therapy with little empirical data, this study offers a promising vision for virtual reality researchers as well as a technical system and protocol for therapy.

• Gerardi, M., Rothbaum, B.O., Ressler, K., Heekin, M., Rizzo, A. (2008). Virtual Reality Exposure Therapy Using a Virtual Iraq: Case Report. Journal of Traumatic Stress, 21, 209-213.
  

Virtual Reality News April 2008

• Hunter Hoffman and David Patterson's SnowWorld, which I've written about before, is currently being used at Loyola University Hospital in Maywood, IL for burn victims. More than just a distracting media presentation, SnowWorld is an immersive VR video game that relies on the user to complete problem-solving tasks in the game, reducing their pain levels as evidenced by self-reports and MRI scans

• In stroke rehabilitation, researchers in Israel are using VR to enhance both diagnosis and therapeutic treatment selection for patients. Currently, the team of computer scientists and health professionals have designed a system that can differentiate between types of injuries - traumatic brain injuries vs. cerebrovascular accidents. Next, they will program the computers to generate models of patient recovery in order to select the best treatment for each specific patient. While diagnosis is an area that doctors can already do without the help of technology, projecting treatment outcomes with consistent accuracy is not something doctors can currently do with high consistency and accuracy. The VR is also used in patient therapy to demonstrate healthy movements of limbs without physical movement. The patient sees their limbs on a screen performing movements without pain, which can activate mirror neurons, which are frontal lobe neurons that fire when performing a task or seeing it performed. By seeing a natural movement, not experiencing pain, and having the typical motion pathway activated in your brain, pain is reduced and the patient's motility increased.

• London researchers recently used a VR headset to study paranoia in the general population, as subjects were transported via a virtual London Underground on a 4-minute ride. About 1 in 3 participants experienced paranoid thoughts about one or more of the neutral passengers populating the subway. People who experienced day-to-day thoughts of paranoia were more likely to experience it in the virtual underground. The next steps are to design a protocol that allows diagnosis and therapeutic sessions utilizing the technology. Read more here.
  

Citation:

Freeman D, Pugh K, Antley A, Slater M, Bebbington P, Gittins M, Dunn G, Kuipers E, Fowler D and Garety P (2008) Virtual reality study of paranoid thinking in the general population.
British Journal of Psychiatry, 192, 258-263.

VR Grocery Shopping

Today, researchers from the University of Pittsburgh will present a poster on the correlation they found between conventional clinical measures of balance and measures of balance while subjects were immersed in a virtual grocery store environment. They will present their ideas on how VR environments can be used for therapeutic purposes for people with balance disorders. Specifically, a grocery store was chosen because of the need to simultaneously walk through different aisles while looking at various height levels of products.

Read the full abstract at NIH NIDCD Abstracts

Videos of PTSD Exposure Therapy

The Health Blog recently posted a thorough and clear explanation of how PTSD exposure therapy works, complete with video!

It also brings up an important problem that needs to be addressed before VR therapy becomes more prevalent. The article focuses on war veterans, and the studies have a high dropout rate exists because the realistic therapy is so difficult to endure. Maybe this is why (coupled with the fact it's relatively new) it's so hard to find hard numbers on VR. If you know of any, as always, please shoot me an e-mail or comment. Thanks!

Dr. Randy Pausch and the Last Lecture

Innovative virtual reality pioneer Dr. Randy Pausch of Carnegie Mellon University gave a talk on realizing your childhood dreams and enabling others to realize their dreams this past Tuesday night to a packed CMU auditorium. Pausch has terminal pancreatic cancer, and the lecture was his last. Pausch has done tremendous things for virtual reality, computer programming, and education and collaborated with institutions far and wide and groups such as Disney Imagineering and Electronic Arts. His ALICE, his program that makes learning to program simple, interactive, and fun, is being used to teach computer programming all over the world. You can read more about his Stage3 Research group, which strives to bring virtual reality to the next level, here.

Below is one of the first parts of his lecture; the complete speech is available in sections on YouTube and from CMU. The talk was powerful; captivating, enlightening, honest, and funny. In the end, Pausch reveals that one of the 'head fakes' of the lecture is that it was for his three children: though they weren't present, they are all under the age of five, and now they will be able to see their father's life lessons throughout their own lives, even if he won't be around to impart them in person. Moving, heartwrenching, and just plain good entertainment: all in a day's work for the co-founder of CMU's Entertainment Technology Center.



Read articles about Dr. Pausch and his Last Lecture in the Wall Street Journal and Pittsburgh Post-Gazette. You can also read about it at MetaFilter.

VR in Pediatric Physical Therapy

The Myrtle Beach Sun News reports on the emerging role of virtual reality in pediatric rehabilitation and physical therapy. One particularly popular technology allows the patient to see themselves projected into the virtual world. In this way, children in wheelchairs can visualize themselves doing everything from scoring goals on the soccer pitch to snowboarding down a snowy slope. The article also highlights the work of Pennsyvlania company VTree, Inc. Their actions back up their mission statement of helping to provide affordable technological solutions to physically and developmentally challenged people, such as employing developmentally delayed workers, taking input from parents, therapists, and teachers of students with special needs, and partnering with corporate sponsors to provide quality, yet affordable products to populations with special needs.

More on VR + CP

The idea of using virtual reality as therapy for kids with cerebral palsy isn't new. Psychologists like Dr. Denise Reid of the University of Toronto have been testing VR systems on CP patients since the early 2000s. Read abstracts here and here (subscription required for full articles). Though the sample population was small, increases were found for playfulness, upper-extremity mobility, and self-efficacy.

Helping Kids with CP Balance

CBS ran a story on VR therapy that allows children with cerebral palsy to move better by visualizing themselves in athletic environments. The system, Irex (made by Gesturetek), projects physical therapy patients onto a green-screen, participating in a variety of physical activities like skiing, soccer, and snowboarding. Each of the games or activities is designed to test a specific part or parts of the body. One group of patients who benefit from this type of therapy are children with cerebral palsy. Using this type of therapy, they can participate in engaging contact sports, which motivates them to complete their exercises, which translates to better balance and coordination.

Walter Reed Gait Laboratory

At the Walter Reed Gait Laboratory, US military personnel can get help improving their stride as they recover from debilitating amputations. A patient's movements are recorded and tracked as points of light on a LED display.

The patient and rehab team, including physician, prosthetist, and physical therapists, can then use the data from the computer program to determine the best prosthetic fit for the patient. The data can be compared to the gaits of non-amputees or even the patient's own non-amputee side stride.

VR for Social Anxiety Disorder

People with Social Anxiety Disorder (SAD) may benefit from virtual reality exposure therapy (VRET). Illumenta, a US-based company, hopes to re-condition people who atuomatically associate typical social interactions with fear and anxiety. Illumenta is partnered with Virtually Better, another US company that utilizes VR therapy.

Oklahoma gets VR therapy

KOTV.com has a piece featuring software developed by another PTSD lab at the University of Southern California, currently being used to help Oklahoma veterans.

Newsweek Video: VR and PTSD

Newsweek has joined the growing number of media outlets suggesting the benefits of VR in therapy for veterans with PTSD. Check out the article and video here.