Clinicians can help patients recover from strokes while they’re anywhere in the world—even states or countries far away from each other—by using a combination of robotics and virtual-reality devices.
It’s happening at Georgia Institute of Technology, where Nick Housley runs the Sensorimotor Integration Lab. There, patients undergoing neurorehabilitation, including those recovering from a stroke, are outfitted with robotic devices called Motus, which are strapped to their arms and legs. The goal: to speed up recovery and assist with rehabilitation exercises. Patients and practitioners using the system wear virtual reality headsets. The Motus device sends feedback to the clinician, who can guide the patient through exercises designed to recover movements they have lost. “The headset tells you really critical things, like how much force someone’s muscle can put out,” Housley says. “It can also tailor an intervention—for example, if someone has difficulty picking up a cup of coffee, you can guide them in real time.”
Virtual reality is increasingly being used to train health care providers, assist with pain management and provide telemedicine across the globe. Headsets are relatively inexpensive now, at $300 to $1,000 per device, and can expand a practitioner’s reach to anywhere on the planet. “The potential advantages of VR for clinicians are tremendous, and only the limits of our imagination restrict the possibilities,” says Dr. José Barral, chair of biomedical science at the Kaiser Permanente Bernard J. Tyson School of Medicine in Pasadena, Calif.
According to one study, virtual reality plays an important role in improving doctors’ performance and should be used as a complementary education tool. Laparoscopic surgery, for example, can be taught using VR, and this type of training leads to higher accuracy. VR tools are “very effective in transferring skills to the operating room,” the study authors write. They added that VR should be used to train doctors in skills such as suturing, ultrasound, and nursing procedures.
According to the American Board of Internal Medicine, it’s best for medical residents to be trained via VR tools before attempting real-life interventions on patients. VR is an effective way to learn how to perform invasive hemodynamic monitoring and mechanical ventilation, the organization says.
Another study described VR as “a cornerstone of clinical training.” It offers benefits for learners and educators, the researchers noted, and delivers cost-effective, repeatable, and standardized clinical training on demand. “Though VR is not a panacea, it is a powerful educational tool,” the authors said.
However, virtual reality isn’t yet a standard part of most physicians’ arsenals. VR headsets are still crude, and image quality can’t compete with the real world. In addition, headsets suffer from nonintuitive user interfaces and can pose health risks like dizziness, says Rema Padman, who studies VR as a professor of management science and health care informatics at Carnegie Mellon University’s Heinz College. “In particular, the hardware limitations of headsets and accompanying software and tools pose challenges for clinicians using VR in surgery,” Padman says. “Similarly, there are limitations in terms of prolonged use for patients, especially those who are vulnerable or frail, such as children and the elderly.”
When Housley works remotely with stroke survivors, he bridges the distance between himself and his patients by using virtual reality. Most of the stroke patients being treated by Georgia Institute of Technology clinicians have moderate to severe muscle weakness or paralysis known as hemiparesis. Conducting evaluations and physical exams requires physical interactions—such as manual muscle, reflex, and sensory testing—which would be nearly impossible via traditional telemedicine. So instead, Housley uses a robotic exoskeleton and virtual environment to examine his patients. “This works because the patient is wearing a robotic exoskeleton on their paretic limb, and it houses sensors and actuators that allow me to digitize their movements and muscle actions,” he says. “This data gets transmitted to me and allows me to act upon it to personalize the exam.”
Another part of the Motus system is designed to help stroke survivors through virtual reality games. There are about 25 different types, ranging from simple tasks like adjusting a thermometer to moving an avatar in a virtual environment. These games make therapy fun, immersive, and challenging.
The system performs as well as in-person treatment, Housley says, with the added benefit of convenience. “I did my first assessment with someone in Australia, and there was only a two-second lag,” he says. “It was just incredible to jump into the virtual environment and make the gaming interface work with them.”
Another benefit: patients have easy access to additional hours of therapy that they couldn’t receive from in-person providers. Because they can use the technology at home, they don’t have to commute to a facility or worry about squeezing in time-consuming medical appointments.
Using VR has resulted in more accelerated patient outcomes, such as improvements in range of motion, pain reduction and greater adherence to treatment plans, Housley says. In virtual environments, patients can see their personalized statistics in real time and track their progress, and as a result they frequently have much greater buy-in.
Complex surgeries can tax even the most experienced clinicians, but virtual reality offers a way to practice before the actual procedure.
Earlier this year, Cleveland Clinic developed a way for neurosurgeons to finesse surgical techniques using VR. A patient scheduled for surgery will undergo MRI brain scans, which are sent to a company that transforms them into 3D images that are transferred to a VR platform. There, the doctor can plan and practice the surgery before the procedure. “Giving physicians real-life experience … will improve outcomes every time,” says Pieter VanIperen, the founder of PWV Consultants who helped create VR platforms for medical training.
Beyond planning and practicing, virtual reality can help surgeons in the operating room. The robotics startup Vicarious Surgical aims to assist clinicians in completing very fine dissections and sutures to expand their access to the abdominal cavity. The system combines human-like mechanical arms with VR technology. Its goal is “to make the surgeon feel as though they’re transported into the abdomen,” says Dr. Barry Greene, Vicarious Surgical’s chief medical officer.
Smoke billows at the site of a subway bombing. First responders arrive and have minutes to figure out how best to triage victims. But this isn’t real life: the scene is happening in virtual reality, and the first responders are medical students wearing headsets. It’s a system designed by the Ohio State University College of Medicine to help teach physicians and first responders how to assist in emergencies.
“What’s important [during the training] is to find the patients who would benefit from medical care immediately,” says Dr. Nicholas Kman, a professor of emergency medicine at the college who helps run the VR training sessions. “The previous training was via PowerPoint. But with virtual reality, it’s much easier to learn these skills when seeing the patients in front of you and feeling a pulse” as the headset’s controllers vibrate.
The college is one of a growing number of medical schools incorporating virtual reality into their training. VR can grab students’ attention in a way that traditional media like books or computer screens cannot, says Dr. Daniel Katz, the vice chair of education for the Mount Sinai Department of Anesthesiology, Pain and Perioperative Medicine in New York City. “For example, imagine the difference in clicking through a PowerPoint presentation on fire safety as compared to being placed in an operating room that’s on fire, and it’s up to you to manage the situation,” he says.
Fourth-year students at Ohio State who are studying emergency medicine don VR rigs to learn how to take care of a patient having a heart attack. This simulation begins inside a hospital emergency room when a virtual patient arrives on a gurney, struggling with crushing chest pain and shortness of breath.
Wearing headsets, the students quickly assess the patient’s condition. In the simulation, an avatar or virtual representation of the student is poised beside the gurney, holding a tablet computer used to order tests and treatments. While the students are triaging the patient, he or she goes into cardiac arrest, which the students must manage with epinephrine. “By getting them to manage that patient, they’re learning what steps to take in real life,” Kman says. “It’s pretty cool.”
The adage “see one, do one, teach one” has been the basis of surgical training for over a century, points out Dr. Soheila Borhani, a researcher at University of Illinois at Chicago who studies virtual reality in medicine. Medical students and residents first observe a procedure done in front of them by an instructor, then perform it once on their own and eventually teach it to one of their peers. “Today, it’s possible to practice a certain procedure as many times as needed through the use of VR platforms that not only enable repeated risk-free trials and errors, but also facilitate 3D understanding of complex anatomical structures,” Borhani says.
The only medium that comes close to VR’s level of immersion is a high-fidelity simulation using actors, which is too expensive for most scenarios, Katz says. Such a simulation would typically cost thousands of dollars and require weeks of planning. So instead, Ohio State uses the consumer-grade Oculus Quest 2 virtual reality headset, and can arrange training sessions within about half an hour. “Learning can occur at your convenience in most instances,” Katz says.
The biggest challenge facing VR in medical education is the lack of a comprehensive platform and standardization for educational activities, Katz says. There is no “app store” for medical education, which means that each module must be purchased from different vendors.
There are also hardware challenges, Katz notes. For example, hand-tracking technology that can precisely mimic hand motions still lags behind headset development, though it’s improving rapidly.
Future hardware advances are likely to make VR rigs a growing part of the medical tool kit, says Douglas Danforth, an associate professor of obstetrics and gynecology at the Ohio State University College of Medicine who works with virtual reality. “As processing power improves, VR simulations will become more realistic, eventually being nearly indistinguishable from interacting with real patients,” Danforth says.
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Contributor: Sascha Brodsky