Christina Spellman, MayDay Fund, Opening Welcome Speech (5mins)
Dave Thomas, NIDA, Skype Talk (10mins)
(alphabetically, by speaker)
Perspective Taking and Empathy in Virtual Reality
Jeremy Bailenson, Virtual Human Interaction Lab, Stanford University
Industry such as journalism, film, and even medicine are taking as a given that VR experiences generate empathy. Evangelists argue VR is unprecedented in its ability to produce empathy compared to traditional media. However, the data are more nuanced. I will review 15 years of research using VR to generate empathy and behavior change, and present a realistic view of results across many experiments. Moreover, I will present future opportunities, as well as areas for concern.
The Dolphin Swim Club – a healing Virtual Reality experience
Benno Brada, The Dolphin Swim Club, (Marijke Sjollema, Wim Veling, and Benno Brada)
The 360°VR project of the Dolphin Swim Club is, foremost, about sharing the joy, playful spirit and beauty of the dolphins. However from the beginning we were focussed on producing a so called: ‘dolphin assisted therapy’ as well, due to the remarkable results within healthcare of patients coming in contact with dolphins. Nowadays many patients swim as a treatment with dolphins in captivity. In case we succeed to develop an effective therapy with wild, free dolphins by VR, the ease of accessibility (in combination with animal welfare) makes it available to everyone, everywhere. Founder of the Dolphin Swim Club is Marijke Sjollema, an artist and storyteller. One very true and special story has been waiting a long time to be told in some form. Over two decades ago, in 1993 she encountered, by chance, a wild dolphin while snorkelling. She was forever enchanted. Since then, she makes regular trips to meet whales and dolphins around the world. In the beginning of 2015 she came into contact with 360° Virtual Reality, and knew she had found the perfect way to share the joy of meeting a wild dolphin. Her partner Benno Brada joined in, they rounded up a team of Europe’s best specialists, most likely thanks to the magic word: ‘dolphins’. In December 2015, in the crystal clear waters of the Red Sea – Egypt, the Dolphin Swim Club was fortunate enough to successfully film pods of 90+ resident spinner- and indo-pacific bottlenose dolphins. Early 2016 we came to an agreement with Professor Wim Veling of the University of Groningen (the Netherlands) to start an official research about the effects of such a VR-therapy. In Groningen they will do research on a therapy to treat patients with depression, psychoses and anxiety disorders. A short paper of this research is being presented at the 11th International Conference on Disability, Virtual Reality & Associated Technologies. Midway June 2016 the 15 minutes 360°VR healing experience became available in super high quality and with the original sounds of the wild, free dolphins in their natural habitat. End of June, the Norwegian Cancer Society has started to use our therapy in Oslo, swimming with wild dolphins for the use of patients between 13 – 19 years that will undergo bone marrow transplants, in order to provide an escape from life in an isolation room (5-6 weeks). They want to explore practical implications and whether the use of VR can help children and young adults to cope better with the adverse effects of their treatments. 3 health organisations, helping more than 14.000 patients in the Netherlands, have started working with the Dolphin Swim Club 360°VR dolphin therapy. They want to open up the world of multiple disabled patients, or provide an opportunity to reduce stress within all kinds of healthcare. A special department of one of these organisations is organising the healthcare for a special home for young autistic patients. Earlier in 2016 we had already agreed with Professor Skip Rizzo on a partnership to carry out research concerning autism. Now that our high quality VR therapies are ready we will shape our collaboration and we will exchange the first data from the pilot researches. Several private practises (physiotherapy, pelvic therapy) started pilot projects with the footage as well, focused on giving patients (children) a relaxing and positive experience during visits. Since May 2016 our 360°VR experience is shown in the first VR-Cinema’s in Europe. Based in Amsterdam, Berlin and Copenhagen. Now you can buy tickets for a VR Cinema instead of a dolphin show. In addition to this project we have made the first steps to develop a consumer version of waterproof VR-goggles for a total experience and treatment of severely paralyzed patients. We are at the point to get a substantial subvention in the Netherlands to develop waterproof VR-goggles for the consumer/healthcare market and we expect to get the green light before the end of August. The goal is to produce them using recycled ocean waste plastic and/or ghost fishing nets. For the love of dolphins, For the love of people.
Integrative Virtual Reality Therapy produces Lasting Benefits for a Young Woman suffering from Chronic Pain and Depression Post-cancer surgery: A Case Study
Greg Burdea, Rutgers, (G. House, G. Burdea, K. Polistico, N. Grampurohit, D. Roll, F. Damiani, J. Hundal, and D. Demesmain)
Background: Depression and chronic pain following breast cancer surgery can lead to life-long psychological and physical disabilities. With younger patients especially, it is important to have rehabilitation training methods that can produce long lasting benefits. The case study presented here was part of a study to evaluate the effectiveness of experimental BrightArm Duo Rehabilitation System in treating the effects of chronic upper body pain following breast cancer surgery.
Method: The subject was a 22-year old woman with post-surgical chronic pain for 9 years. The pain was localized in the right upper arm and was burning and stabbing in nature. Prior to the experimental therapy she carried her right arm in a sling. This prolonged pain resulted in severe depression, cognitive impairments, social withdrawal (self-isolation) and employment difficulties. The subject trained on the BrightArm Duo rehabilitation table by interacting with custom 3D games while her upper extremity gravity loading was modulated. BrightArm Duo measured bimanual hand position and grasp strength in real time. The study followed an A1-B-A2-A3 protocol with motor, cognitive and emotive standardized assessments done pre-training (A1), post-training (A2) and at 8-week follow-up (A3). Training (B) consisted of 16 sessions, with two sessions/week for 8 weeks, with sessions gradually increasing in length, game difficulty and gravity loading.
Results: The subject performed a total of 20,130 active arm repetitions and a total of 7,020 power grasps while playing a total of 412 games lasting a total of 567 minutes. There was a marked reduction in shoulder and arm pain of 4.4 points (on a 10-point Numerical Pain Rating Scale) over the course of the study. Depression severity was reduced by 16 points on the Beck Depression Inventory – Second Edition (from severe to moderate), the subject returned to full time employment and to driving. All standardized metrics for range of motion, strength, function, attention, and memory improved post-training (A2). All gains were maintained at follow up (A3) compared to (A1) despite the subject not receiving VR therapy after A2.
Conclusions: Initial findings demonstrate a meaningful reduction in chronic pain and physical and psychological improvement for a young female subject and suggest a need for controlled studies in young breast cancer survivors with pain and depression associated to post-surgical treatment of breast cancer.
On the precipice of a paradigm shift: using virtual experiences to alleviate suffering in the actual world.
JoAnn Difede, Weill Cornell Medicine, Cornell University
Dr. Difede will discuss contrasting therapeutic approaches, exposure and distraction, used to address psychological pain. While in VR exposure therapy, patients are immersed in virtual worlds configured to simulate the narrative and sensory experience of their trauma, in VR pain interventions, immersive environments are used to distract from the pain of injury and painful medical procedures. Dr. Difede will discuss results of research with immersive in environments used in exposure therapy for the treatment of PTSD following terrorism and combat as well as work developing VR environments and interventions for the amelioration of pain associated with burn injury.
Virtual Reality and Pain Management
Jeff Gold, Children’s Hospital Los Angeles (CHLA)
The clinical application of immersive virtual reality (VR) offers a promising modality as a means to manage procedural, acute, recurrent and chronic pain, especially with the advent of new affordable technological advances, i.e., GearVR. This translational, state-of-the-art lecture will examine 1) potential neurobiological mechanisms for pain attenuation, 2) real time (fMRI) basic brain science with novel therapeutic strategies (i.e., VR), 3) current state–of-the-science virtual reality based interventions, and 4) other forms of videogame and immersive VR technology for children and adults. This lecture will improve our understanding of VR as a non-pharmacologic form of analgesia by exerting an array of emotional affective, emotion-based cognitive and attentional processes on the body’s intricate pain modulation system. The presenter will discuss the current literature on immersive VR distraction as an approach to control procedural pain, burn wound care pain, pain associated with physical therapy, and lastly for chronic pain in children and adults. Studies will include VR-interventions for procedural pain including blood draw and cast removal, experimental laboratory pain studies testing the effectiveness of VR technology-assisted distraction for children exposed to cold pressor stimulation, and 2) thermal pain stimulator studies under real time fMRI. The presenters will discuss a variety of variables that may moderate analgesia such as age, gender, a sense of VR presence, and technology. Neuroboiological mechanisms of VR analgesia will be discussed in terms of complex attention diversion and cognitive distractions. Data will be presented demonstrating the use of GearVR in pediatric clinical environments like phlebotomy and orthopedics, and fMRI to examine the effects of VR during experimental thermal pain with adolescents. This translational research provides basic brain science that helps explain and improve therapeutic strategies such as VR and cognitive therapies. The present findings from these clinical studies may illuminate mechanisms underlying the effectiveness of VR distraction for children and adults lending support to future clinical applications. The presenters will explore limitations to VR for pain management and discuss methodologies for future scientific exploration.
How Virtual Reality Technology Will Revolutionize Healthcare
Walter Greenleaf, Virtual Human Interaction Lab, Stanford University
Although entertainment, social connection and gaming will drive the initial adoption of VR technology, the deepest and most significant market for VR will be in clinical care, health, and wellness. We know from years of clinical research that VR can address and ameliorate the most difficult problems in healthcare – ranging from mood disorders such as anxiety and depression, to Post Traumatic Stress Disorder, Addictions, Autism, Cognitive Aging, Neuro and Physical Rehabilitation. The list of clinical interventions made possible by VR is long. VR technology also facilitates clinical assessments and medical training, as well as providing for improved surgical skill training and procedure planning. Personal health and wellness can be improved by using VR to engender better nutrition, promote healthy lifestyles, and to reduce stress and anxiety. As the cost of healthcare rises, VR technology can serve as an effective telemedicine platform to reduce costs of care delivery, and improve clinical efficiency. This talk will provide an overview of how VR technology will impact medicine, clinical care, and personal health and wellness, and how it will help to facilitate the shift of medicine to direct personal care.
Chronic Pain and the Modulation of Self in Immersive Virtual Reality
Diane Gromala, Simon Fraser University, (Diane Gromala, Chris Shaw, Meehae Song)
Many specialists who treat those who suffer from chronic pain have long observed the ways in which mind and body become altered (Gatchen, Peng, Peters, Fuchs & Turk, 2007). Indeed, in pain medicine, the distinction between the two becomes unsustainable. A patient’s sense of self is affected on many levels, including changes in body image and body schema (Gallagher, 1995). In the technological development of immersive virtual reality (VR), the simultaneous experience of a “virtual” environment and the “real” environment often lead to new or confounded perceptual experiences. In our studies of the way in which the sense of proprioception is disrupted, for instance, it is clear that a user’s body schema (and sometimes body image) can also be altered. Depending on the length of exposure, this can effect subtle changes in a user’s sense of self (Gromala, 1996). This paper explores some of the ways we understand this occurs by demonstrating the results of our work in pain and VR over the past decade. Unlike most research in pain and VR, ours does not simply seek to “distract” users from pain, but to arm them with a learned capacity to modulate it. One example is the Meditation Chamber, a VR system combined with biofeedback. Developed for those who suffer from chronic pain, it enables users to learn how to meditate and thereby to bring into conscious awareness certain aspects of their autonomic system and interoceptive senses (Shaw, Gromala & Seay, 2007). In doing so, they learn to exert some form of control or agency in their experience of unrelenting pain. Meditation, of course, does not require technology. However, VR offers several advantages or affordances. First, novice meditators learn to change visuals, sound and kinesthetic experiences as their physiological states continuously change in real-time. Though it is impossible to scientifically measure meditative states per se, a number of physiological measures, combined with first-person accounts, appear to be and have been accepted as reliable indicators. Second, in VR, confounded perceptual experiences result from, for example, “flying” in VR while simultaneously feeling the pull of gravity. Studies in proprioception articulate how this occurs. Most users quickly become accustomed or habituated to the confluence of disparate stimuli. Surprisingly, we have shown this disorientation and accommodation may alter a user’s body schema in the short term, and in some cases, longer terms. In the context of addressing chronic pain, we have also demonstrated that the initial disorientation enhances a novice meditator’s ability to self-modulate their experience of pain.
Quantitative and qualitative testing of over 400 users demonstrate the usefulness of this approach in training those who suffer from chronic pain to learn to modulate their experience of pain. The current extension of this project compares culturally distinct practices of meditation in order to understand if they can affect body schemas and body images of chronic pain sufferers in different ways.
VR as a non-pharmacologic analgesic for severe burn patients during painful medical procedures
Hunter Hoffman, HIT lab, University Of Washington
Acute pain during medical procedures is a problem at hospitals across the world, for a range of different pain populations. Severe burns are one of the most painful injuries in medicine. During hospitalization, patients undergo frequent (often daily) scrubbing of their severe burn wounds, to keep the wounds clean, prevent infection and so doctors and nurses can monitor healing progress. In addition, skin stretching physical/occupational therapy exercises help maintain skin elasticity, and maximize limb range of motion after healing. Hospitals rely largely if not solely on pharmacologic analgesia, but even powerful analgesics are often not enough to control the pain of severe burn patients during wound debridement. Psychological factors (e.g., anxiety) can amplify patients’ subjective experience of pain, and psychological treatments can help reduce how much pain patients experience during wound care. Immersive virtual reality is showing promise as a non-pharmacologic analgesic for acute procedural pain that can be used in addition to traditional pain medications. Compared to standard of care, during adjunctive immersive virtual reality, burn patients report 25-50% reductions in pain intensity, time spent thinking about pain, pain unpleasantness, and patients in VR even report having fun during burn wound care. This talk will summarize a few of the key findings from clinical research and fMRI brain scan studies by Hoffman, Patterson, Sharar, Carrougher, Richards and colleagues at the University of Washington, Walter Meyer at Shriners Hospitals for Children in Galveston, Chris Maani at Brooke Army Medical Center Institutes of Surgical Research in San Antonio, exploring our interdisciplinary team’s research on virtual reality pain distraction during the past 15-20 years.
What’s in a Game? The use of serious games in healthcare
Pam Kato, Coventry University
Dr. Kato is an internationally recognized expert on serious games and Professor of Serious Games at Coventry University in the UK where she is working with her team at the Serious Games Institute (SGI) to set the highest standards for serious games research and to promote processes for developing and distributing effective and engaging serious games. She will give a brief overview and discussion of serious games, simulations and simulations in healthcare. Then she will present two key examples of games for health, Re-Mission, a game for young people with cancer and Plan+It Commander, a game for young children with Attention Deficit Hyperactivity Disorder. She will focus on issues faced when evaluating games for health in randomized controlled trials.
What can seeing Virtual Humans in Pain Tell Us About Ourselves?
Ben Lok, University of Florida
Understanding how health care providers perceive others in pain is critical to making better pain management decisions. Many studies have established that health care providers use patient demographics in their judgments around pain management care. But addressing this issue has been very challenging due to being able to measure a health care provider’s biases. The challenge was how can we provide health care providers with standardized stimuli to evaluate decision making? In this talk, we will explore how presenting and interacting with a diverse group of virtual humans expressing pain can help identify the variables used in the health care providers judgment decisions. The decisions around the level of perceived pain of the virtual humans are input into a previously developed model of decision making. We will explore the impact of the virtual humans age, gender, ethnicity and race, and socio-economic status on how doctors, dentists, and other health care providers perceived the virtual human’s pain and communicated with the virtual humans. This talk will hopefully motivate the audience to explore using virtual reality and virtual human technology to study how pain is perceived as to reduce health disparities and increase the quality of patient care among those with chronic pain.
Reducing the Psychological Pain of PTSD with Virtual Reality Exposure Therapy
Skip Rizzo, University of Southern California Institute for Creative Technologies
The experience of pain is universal and can come from many sources. In its most common form, pain is the natural accompaniment to physical injury/illness and can also be a byproduct of the treatment of such trauma or disease process. The concept of pain can also be generalized to include the psychological pain embodied as symptoms of mental health conditions including anxiety, fear, and depression. When viewed in this wider context, it would not be a stretch to say that psychological care practitioners and researchers spend their much of their careers primarily focused on the reduction of human pain and suffering. This presentation will focus on the use of virtual reality as a tool for the treatment of anxiety disorders and PTSD by delivering trauma-focused prolonged exposure (PE) therapy. PE is considered to be an evidence-based cognitive-behavioral approach that helps a patient to confront and process difficult emotional memories, in imagination, within a safe, supportive clinical environment leading to the reduction of PTSD symptoms (e.g., avoidance, hyperarousal, sleep disturbances, cognitive/affective alterations). VR exposure therapy (VRET) is a method for delivering PE where the patient is gradually immersed within VR simulations of feared or trauma-relevant contexts and over the last 20 years has generated the largest scientific literature of any clinical VR application. At least four meta-analyses have been published endorsing the clinical efficacy of VRET for treating anxiety disorders and a positive literature has emerged reporting similar findings with PTSD. Research and development of VR simulations for treating PTSD due to combat exposure and military sexual trauma will be presented along with a discussion of plans to broaden the availability of this VR treatment option in the civilian population.
Making VR a Mature technology
Howard Rose, DeepStream VR
After over a decade of foundational research and hundreds of published studies showing VR can deliver effective pain relief, why isn’t VR available in every clinic today, and what will it take to make it so? Clearly costs and technology have been major barriers to dissemination up until recently. But since VR is now generally affordable for widespread adoption, the biggest barriers ahead for the VR pain community have more to do with economics, politics, and social acceptance than the limitations of technology. Howard Rose and DeepStream VR are dedicated to advancing VR pain relief from research into medical practice. Howard will share his perspective on what will be required to make VR a mature technology for healthcare, and practical suggestions for the VR research community to achieve our common goal – make VR pain relief effective, practical and widely available.
Top 10 Lessons Learned using Virtual Reality in Hospitalized Patients
Brennan Spiegel, Director, Health Services Research, Cedars-Sinai Health System
If you’ve ever been hospitalized or visited someone in the hospital, then you know that patients can experience anxiety, uncertainty and boredom exacerbated by a radical change in living environment and loss of customary rights and privileges. Sitting in a hospital room for days or weeks, often in pain and distress, can be physically demanding, emotionally draining, and socially isolating. In many ways, the hospital room can become more like a biopsychosocial jail cell than an uplifting healing environment. Our VR research team at Cedars-Sinai Medical Center has been trying to address this problem by using VR to “transport” patients away from the four walls of their hospital room and into novel, positive, and emotionally enriching environments. Over the past year we have studied over 150 diverse patients using a range of VR visualizations. We published our initial experiences in a peer-reviewed study and are now beginning a large, randomized controlled trial testing the impact of VR on pain management, narcotic usage, length of stay, and satisfaction with care among hospitalized patients. In this talk, I will discuss the “Top 10 Lessons Learned” from our experiences using VR in hospitalized patients. Some of the lessons are not surprising, but others are striking and unexpected. We continue to learn from each and every patient who uses VR at Cedars-Sinai; this talk will share those experiences in an effort to help others seeking to employ VR for managing pain, anxiety, and distress.
Novel Embodiment for Complex Regional Pain Syndrome (CRPS)
Andrea Stevenson Won, Cornell University (Andrea Won & Brenda Golianu)
A number of difficult-to-treat chronic pain disorders, including Complex Regional Pain Syndrome (CRPS), and phantom limb pain (PLP), have been linked to mis-mapping of the motor and somatosensory cortices. One method of addressing such disorders is to provide visual information to counter these pathological states. Initial efforts using Mirror Visual Feedback for PLP and CRPS used an actual mirror to allow patients to see the movements of their uninjured limb. However, virtual reality is a more flexible modality; allowing participants to make more complex movements across the midline, address bilateral injuries, and create novel interventions such as changing the relationship between patients’ tracked movements, and how those movements are rendered in their avatars’ movements. While studies using virtual reality to provide novel visual feedback have shown promising results, the expense and logistical difficulties of programming and deploying virtual environments capable of tracking patient limb movement have hampered their adoption. However, with the advent of consumer virtual reality headsets, the hardware is now within reach for many more institutions and holds the potential for use in the home environment. We describe a prototype for providing novel visual feedback in a virtual environment using consumer virtual reality hardware. By deploying this prototype to multiple clinical sites, we aim to validate novel applications of visual feedback in virtual reality. In addition, we aim to test the feasibility of gathering movement data from patients experiencing at-home virtual reality therapy. This presentation will describe this system as well as the initial pilot study data that informed its design.