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Virtual Reality, Real Medicine: Treating Brain Injuries With VR
The controlled environment of virtual reality is proving ideal for diagnosing and treating traumatic brain injuries. Learn why the Department of Defense is funding trials.

For some people, virtual reality is anything but a game. For some traumatic brain injury patients, it’s a means to living a normal life.

Meet Dr. Denise Krch, a research scientist and one of the leaders in virtual reality (VR) applications for sufferers of traumatic brain injuries (TBI). Krch has won grants from the National Institute on Disability, Independent Living, and Rehabilitation Research and from the Department of Defense (DOD) for her promising research, and works with the DOD to help impaired soldiers.

Krch doesn’t ask a patient to strap on an Oculus Rift or an HTC Vive. In fact, her VR doesn’t use headsets at all. That surround experience is called immersive VR. What Krch uses is non-immersive. Her VR is shown on a computer monitor and is more like a video game in which a player uses a joystick and mouse to manage real-world situations.

For TBI sufferers, distractions and the need to juggle multiple tasks can make the typical workplace impossible to navigate. They find their thoughts batted around by each new interruption, and are unable to focus on one task for long. It’s frustrating and frightening. Krch’s VR applications don’t transport patients to far-off worlds; they put patients in the middle of an office, one that grows more distracting as they progress.

Krch is based in East Hanover, N.J., at a division of the Kessler Foundation, a nonprofit that assists people with physical disabilities, and she is affiliated with Rutgers University’s New Jersey Medical School, but she owes her interest in VR to a guest from the West. Seven years back, Albert “Skip” Rizzo, the director for medical virtual reality at the University of Southern California’s Institute for Creative Technologies, visited the Kessler Foundation to share his research in VR as a treatment Krch was impressed with the role VR can play in rehabilitation and rebuilding cognitive functions that are difficult to improve.

She was so impressed, in fact, that she began working with Sebastian Koenig, then a post doctorate student and researcher in Rizzo’s lab, on a new trial.

Krch’s work deals with the cognitive area called executive function, which includes our ability to organize, plan, and shift attention from one task to another or keep two things in mind at once. Impairments in this area are difficult to measure in neuropsychological assessments. The first challenge Krch and Koenig tried to solve was measuring executive function performance. They wanted to use VR to determine which patients were having trouble multitasking or switching attention in real world situations.

From left to right: Sebastian Koenig, Ph.D., CEO of Katana Simulations; Albert “Skip” Rizzo, Ph.D., director of medical virtual reality, Institute for Creative Technologies; Denise Krch, Ph.D., research scientist in the Traumatic Brain Injury Laboratory at Kessler Foundation Research Center; Nancy Chiaravalloti, Ph.D., director of the Neuropsychology and Neuroscience Laboratory and Traumatic Brain Injury Laboratory at Kessler Foundation Research Center

To do that, they created software that put the test subjects in a virtual environment where they were challenged to perform tasks while distracted or where they were forced to shift focus. The researchers ran their tests with a healthy control population and with patients they suspected of having impairments. Some of these patients had TBI, while others had multiple sclerosis (MS).

The VR environment put subjects in an office where they were seated at a desk and charged to pay attention to different messages coming through their computer. Some messages were spam, which they had to learn to ignore. Other emails required a response. Many included real estate offers, and the subjects had to decide whether to accept offers or decline them.

Besides making financial decisions, subjects had to keep watch on an office projector. That projector wasn’t visible from where they were seated, but was in a nearby conference room. Told that the projector’s light was on the fritz, they needed to turn and check on it frequently while managing their other tasks.

“We found that indeed our patient populations were actually seemingly intact or normal on our traditional neuropsych measures, but they were performing in the very impaired range when we looked at them using VR,” Krch says.

To understand why this video-game-like experience is called VR, it’s necessary to understand “presence”—the feeling of how much believability an immersive situation offers. For a test to be effective, patients need to feel like they’re in a believable scenario. Krch and Koenig’s simulation proved to be extremely believable, stressing out TBI patients in no time with competing stimuli. While creating actual physical spaces could test the same functions, that isn’t practical, and bringing patients into stores or similar real-world locations can lead to safety issues. Using VR better helps researchers control the experience: They can precisely monitor stimuli and responses while generating clinical data.

“In a virtual environment, you have complete control over whether the environment was fairly sterile and limited in distraction. As they were able to build to tolerating more distraction, you could add. So really that’s the biggest advantage of having a virtual environment,” Krch explains.

That trial successfully tested for a variety of impairments in attention and executive function. It showed impairments in the ability “to remember to remember,” called prospective memory, in turning to check the projector. Responding to emails tested selective attention where the subject chooses to focus on one thing and not another. Determining whether or not to accept the real estate offers tested problem solving. TBI and MS patients who didn’t show problems on standard neuropsych tests showed problems across the board when using VR.

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