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Virtual Reality, Real Medicine: Treating Brain Injuries With VR

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Testing showed subjects had the biggest problem with interruptions. The biggest stressor in the experience was a phone ringing in the background. Hearing an unanswered phone ring over and over really derailed people’s thoughts. Krch and Koenig used their data to come up with rehabilitation programs that also use VR, and then to write a grant proposal to fund new software that can improve problems with divided attention (multitasking) and set shifting (switching between tasks). Funding by the National Institute of Disability, Independent Living, and Rehabilitation Research led to 3 years of development work with clinicians and TBI patients, and the recent start of randomized clinical trials. Testing involves eight treatments conducted over 4 weeks. The 15 subjects are being tested before and after treatments to monitor progress. Krch began the trial the week before this interview, so she didn’t yet have data.

In this testing, Krch and Koenig’s VR office software has gotten an upgrade. Now the subject works at a corporation that makes a toy animal called the Wonderkin. While there’s plenty of usual office chores, such as sitting at a desk and making decisions about emails coming in, the toy animals add a little fun. One treatment module is set in a laboratory where subjects have to check whether or not toys are broken. Toy horses, goats, and pigs jump around, while subjects make sure they aren’t breaking. The idea in this and other modules is to create a game-like treatment where patients have fun while improving attention skills. As subjects improve, the difficulty rises.

Since this is a clinical treatment and not an evaluation tool, a clinician works with each subject to keep him or her on course. If the subject starts to feel overwhelmed by distractions, the clinician starts the patient on something simpler and helps the person build up.

Krch has a second grant-funded trial going, also continuing work started in Skip Rizzo’s USC–ICT lab. Funded through multiple Department of Defense studies, this treatment seeks to improve balance.

“The DOD has tremendous interest in finding treatments that help rehabilitate individuals with traumatic brain injuries,” Krch says. “As a matter of fact, now having been DOD funded and involved within the DOD system and learning about the DOD system, they actually fund a wide range of things from cerebral palsy research to cancer research to things that seemingly you wouldn’t think the military would care about. But the military serves not just the people who are serving directly, but their families.”

With many soldiers coming back from combat with concussions and TBIs, the DOD has funded a good deal of research in the area, especially studies that use tech simulations. Rizzo is also developing military-funded treatments for veterans, using VR to treat post-traumatic stress disorder.

Krch’s randomized clinical trials on balance use VR software displayed on a large wall-mounted monitor. An infrared beam detects the subject’s body and the screen shows an avatar in a virtual environment. Testing with active duty personnel is done at Fort Belvoir Community Hospital in Fort Belvoir, Va. Krch’s VR balance treatments don’t currently use headsets, but that’s changing. Patients are more prone to fall when wearing a headset, and the immersive experience can lead to “simulator sickness,” which is becoming less of a problem as VR hardware improves. Krch’s team is adapting a VR program called the Fruit Toss to headsets. In it, fruits fly at the test subject, who has to either catch or kick them. Krch hopes to have it completed by the end of the year. Her team is currently collecting data and feedback on immersive VR tests, which they’ll use as pilot data for an immersive technology grant proposal.

“Our lives are full of distractions. You’ve got a kid in one hand and you’re closing the door. You’re helping a child with homework and you’re cooking, or you are on the phone with your health insurance company and you’re balancing your checkbook. The demands of our lives constantly require us to switch our attention a lot and to do more than one thing at a time,” Krch says. And that’s true in the office, as well: “Most job scenarios nowadays expect you to be able to multitask and to do it in the presence of many, many distractors.” With help from treatments like those Krch is creating, TBI patients are able to return to the workforce sooner and MS patients are able to stay at their jobs longer. That means a better social environment and better quality of life.

The virtual reality environment might still feel like a game, but the results of Krch’s work are a better payoff than any high score.

[This article appears in the September 2017 issue of Streaming Media Magazine as "Virtual Reality, Real Medical Carea."]

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