The Five Ways of Clinical Virtual Reality – Dr Keith Grimes & VR Doctors

 

Hello world!

I’m back from a digital detox and ready to rejoin the world of Social Media again. This first blog post is a transcript of the second episode of Curistica, which I posted today. There will be more blogging, tweeting, and podcasting ahead, but for now I’m dropping the same content three ways. Do let me know if that works for you!


Welcome to episode two of Curistica – adventures in digital health!

My name is Dr Keith Grimes, I’m a GP, Geek, Gamer, and your host for this podcast which looks at the fascinating world of Digital Health. If you’re wondering what Digital Health is, you might want to listen to Episode one, but if you’re as time-pressured and excitable as me, let’s re-up the definition. Paul Sonnier, curator of the Digital Health group on LinkedIN, defines Digtial Health as:

“…the convergence of the digital and genomic revolutions with health, healthcare, living, and society”

That’s a broad and interesting view, particularly as it includes genomics. Why genomics? Simply put, DNA is a digital molecule – instead of the base-2 of computers, life is written in the base-4 of Adenosine, Guanine, Thymine and Cytosine.

My more practical, applied definition of Digital Health is taking the  existing technologies I use in everyday life, and not leaving them at the door when I get to work. Technologies such as smart phones, voice interfaces, machine learning and chat-bots, and virtual and augmented reality.

Today, I’ll be talking Virtual Reality, or VR. VR is the use of computer technology to create a simulated environment and placing the user into the experience, allowing them to interact with it (You know, you’ve probably seen it already. Headsets and headphones on, people gazing around them open mouthed and grabbing at objects that aren’t there)

I’ve been excited by the potential of VR since I first experienced it in the early 1990’s. As you’ll hear in this podcast, many people were, but it’s taken the best part of 25 years to practically realise this vision

The talk you’re about to hear is one that I’ve given to Digital Health:London, and Health XL in San Diego. In it I describe the five ways of clinical VR ;The five main categories which I think VR can be used in healthcare.

I developed this idea from my exploration of the field, and through discussion with members of my facebook group ‘VR Doctors’. If you want to know more and perhaps join the community, I’d be delighted to see you online.

I’ll be giving the links to VR Doctors, as well as many of the people and companies I mention on this podcast, in the shownotes.

Without further delay, lets get going with episode 2 of Curistica – Adventures in Digital Health. Lets hear about the five ways of clinical VR.


25 years ago I fell in love with Virtual Reality.

I wasn’t the only one.

I have a book from the time, written by Howard Rheingold, and the cover quotes give a good idea about the state of the hype. Douglas Adams – Author of Hitch Hikers Guide to the Galaxy said:

“There are those who think that ‘VR’ may be the most important development since man first chipped flint, and there are those who don’t know what it is yet”

If you look at the back, we have Arthur C Clarke – Author of 2001, creator of HAL, and the mind behind geostationary comms satellite:

“VR won’t merely replace. TV, it will eat it alive”

I felt the same, and I wasn’t the only one. Many people believed this hype, and there was an explosion of ideas about how VR could change the world – entertainment, industry, the arts, education and medicine.

There was a huge interest, but it turns out that VR was writing cheques it couldn’t cash. It was actually kind of awful. So, shortly after being seduced by the idea of VR…the reality broke my heart.

But the revolutionary IDEA of VR remained, and people continued to work on it over the intervening quarter century. And here we are, 25 years later. In a world has changed beyond recognition.We have the internet, smart phones,  processors thousands of times faster, and powered by those changes, VR has come back, and its come back in a big way.

When delivered correctly, with modern technology, VR does an astonishing job of immersing the user in an alternative reality. It is this immersion that gives VR some of the remarkable applications in patient care.

The Five Ways of Clinical Virtual Reality
The Five Ways of Clinical Virtual Reality

I believe there are FIVE main ways in which VR can be applied to patient care. We’ll start with the first, and how I got into using VR with my patients. VR can make existing treatment more comfortable or effective

I’m a geek and a gamer. So I have all the gadgets, nice and early, but I’m also a General Practitioner, and so I have patients who see me about all kinds of things. I’d like to introduce you to one

In the middle of 2016, I met someone I’ll call Eve. Eve needed help with managing pain. She had a large wound that required frequent, painful dressings. She was really struggling with the dressing changes, but she was also a new mother, and breast feeding, so taking pain relief was difficult. We both felt stuck as to what to do.

I was, however, aware of the research, some of which showed how VR can be an effective way of reducing pain and distress during dressing changes. I had my Samsung mobile phone, and Gear VR. I also had a patient with pain during dressing changes.

So…we just….did it

Over the following week I was amazed by the transformation. She went from a lady anxious and distressed by her care to one who was laughing through the procedure. On one occasion, she was so engrossed we had to tell her that we’d finished. The nurse was delighted too, because she got her job done more quickly

I’ve since used VR with many other patients in my own practice for wound care, joint injections, blood tests.

So I started to talk about it, sharing what I’d found online and at presentations. Through this, I was introduced to Mr Sunil Bhudia, a cardiothoracic surgeon based in London, and he had an idea. Because of the nature of his work, his patients almost always require a stay in intensive care after their operations. Patients who visit ICU have a high rate of POST OPERATIVE DELIRIUM – a period of cognitive impairment that can lengthen their stay and delay recovery

Studies have shown that taking a patient to ICU before their operation can reduce post operative delirium, but this is simply impractical for all patients. Sunil asked me whether VR could replace this?

We think it can.

We believe that by allowing patients to experience the journey in immersive 360 before their operation, finding out more about the equipment and surroundings we can reduce anxiety, reduce Post operative delirium, and maybe even reduce the Post Traumatic Stress Disorder that some experience after their stay. We’ve worked together using Gear VR, 360 cameras, and we’re developing an app with a company called Medical Realities which we’re taking to a small scale study later this year, with support from Digital Health.London.

Psychological Resilience through VR Exposure as a Novel Therapy in ICU Delirium -We’re calling it PREVENT ICU DELIRIUM. This is VR AS A NOVEL THERAPEUTIC MODALITY.

The more you use VR, the more you find out about how it could be used. For example, did you know that VR CAN BE USED TO IMPROVE DIAGNOSTICS?

In 2015 two surgeons from Florida, Dr Redmond Burke & Dr Juan Carlos Muniz, used Google Cardboard, their smartphone, and a freely downloadable app to visualise the damaged heart of a baby in their care to pre-plan an operation.

Closer to my home, in Bournemouth, I visited a company called VitaeVR use VR to simulate a trip to the grocery store. Why, when you could use VR to go anywhere, would you go to the supermarket? It turns out the replicating real world tasks is potentially very sensitive way of detecting the early changes present in dementia. Could VR help identify changes much earlier than other methods?

VR ALSO APPEARS TO BE EXCELLENT FOR EDUCATION AND TRAINING.

Some of you will know about Mr Shafi Ahmed, an innovative and energetic surgeon based at Barts in London. On April 14th 2016, I watched him broadcast the world’s first live 360 stream of an operation to people around the globe.

His aim? To radically transform and democratise surgical training by delivering world class education to low-cost smartphones and cardboard headsets, helping meet the demand of the estimated 5 BILLION people who have limited access to safe surgical treatment.

With VR you don’t just have the opportunity to step into the shoes of a world renowned surgeon like Shafi – you get to take the place of the patient themselves and see healthcare from their eyes.

Nick Peres, a PhD student based in Torbay Hospital, has been using 360 cameras and cheap headsets to help teach the humanistic aspects of care provision, so often neglected in the rush to develop technical skills. As a result, Doctors and Nurses often transform how they treat patients once they see what it’s like on the receiving end.

And it’s this ability for VR to deliver empathy, leads to its fifth and final use:

VR CAN BREAK DOWN BARRIERS, AND ALLOW US TO EXPERIENCE NEW PERSPECTIVES.

Again, this needn’t be something fantastical. It can be something simple, and personal.VR Doctors member Alex Smale, at Tribemix, has been developing a VR experience which can be used in care homes to allow older people with memory impairment to digitally reminisce.This reduces agitation and brings calm into their troubled and confusing world.

Dr Brennan Spiegel, Professor of Medicine & Public Health at UCLA, talks about using VR to help patients escape the BioPsychoSocial Jail cell of their illness, taking them out of the hospital and to the beach, or canyons, or lakesides.

All using cell phones and headsets.

Back in Eastbourne, where I work, I’m now looking at how we might use VR to help at the end of our lives, in my local hospice. In the coming year we’ll explore what value there might be in seeing the street we grew up on one more time, or our home, or favourite park, or places that we always promised to visit?

VR has many applications in patient care.

I’ve illustrated just a small number today, some of which are being built, some which are already out there. Unlike the early 90s, the technology is already good enough, and its only getting better.

I’ve clearly fallen in love with VR again. I hope I’ve given you enough reason to suspend your judgement and give it a try as well.


There you have it. The five ways of clinical VR. Do you agree with my categories? Have I missed any? Are there too many? I’d love to hear from you about this, especially if you are using VR or Augmented reality in healthcare, or if you’re someone who has been using VR for your own health and wellness. Share your story! My invitation to you to join VR Doctors is still open. The link is in the shownotes, or you can simply type ‘VR Doctors’ into the Facebook searchbox and join.

You can also get in touch via twitter: I’m @keithgrimes , or you can visit my website: www.drgrimes.co.uk

Over the coming episodes I’ll be speaking to a whole host of incredible personalities from the world of Digital Health and bringing their stories to you. If you’d like to join me, please subscribe to the podcast. If you’ve enjoyed it, then you can show your support by rating me and sharing the show with friends and colleagues.

With that, it’s goodbye for now. I’ll see you next time, for episode three of Curistica – Adventures in Digital Health.


SHOWNOTES

 

360 video in Healthcare – Nick Peres & PatientVR.co.uk

Digital technology is radically transforming how we deliver healthcare. Join me, Dr Keith Grimes – Geek, Gamer, and General Practitioner, as I share the stories of the people I’ve met as I explore this incredible and vibrant new discipline in Medicine.

This first episode features Nick Peres, founder of PatientVR.co.uk. Nick is using 360 video and low-cost headsets to deliver radically new perspectives for healthcare workers learning their trade, by putting them in the shoes of their patients.