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The Potential for Virtual Reality to Improve Health Care

  • Virtual Reality Medical Center


The Potential for Virtual Reality Improve Health Care
The Potential for Virtual Reality to Improve Health Care©
presented by Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA
Copyright © 2006 by VRMC: The Virtual Reality Medical Center. No reproduction permitted
without the express written permission of VRMC: The Virtual Reality Medical Center. All rights
What is Virtual Reality (VR)?
VR is a medical tool.
VR is a tool in translational research.
VR is an enhancement for exposure therapy.
VR is an enhancement for distraction therapy.
VR is a tool for physical and cognitive rehabilitation.
VR is a resource for surgical planning and performance.
VR is a tool in prevention of physical and emotional illness.
VR is a diagnostic tool.
VR supports the development of sustainable and efficient healthcare
The Potential for Virtual Reality to Improve Health Care
…Improving the health of European citizens and increasing the
competitiveness of European health-related industries and businesses, while
addressing global health issues including emerging epidemics. Emphasis will
be put on translational research (translation of basic discoveries into clinical
applications), the development and validation of new therapies, methods for
health promotion and disease prevention, diagnostic tools and technologies,
as well as sustainable and efficient health care systems.
From the 7
Virtual Reality (VR) has the potential to support and integrate the guiding themes of the
European Commission’s 7
Framework while improving health and increasing the
competitiveness of European technology in the international economy.
Dr. Brenda K. Wiederhold, President of the Virtual Reality Medical Institute (VRMI), with
offices in Brussels, Belgium, and Executive Director of the Virtual Reality Medical Center, with
offices in San Diego, Palo Alto, and Los Angeles, California; is world renowned for her
leadership in the field of VR. Working with European experts in the field, Dr. Wiederhold brings
evidence to the European Commission on the integral role Virtual Reality (VR) must play to
improve the health of European citizens and increase the competitiveness of European health-
related industries and businesses.
Dr. Wiederhold is a licensed clinical psychologist in California and Switzerland, and has a
doctorate in Clinical Health Psychology as well as national certification in both biofeedback and
neurofeedback. She is a Clinical Instructor in the Department of Psychiatry at the University of
California, San Diego and is president of VRHealth, a woman-owned healthcare company. In
addition, she serves on the editorial board for several renowned publications, including
CyberPsychology & Behavior Journal, the International Journal of Virtual Reality, and
Emerging Communication, a book series by IOS Press. She also serves on the advisory board for
the International Child Art Foundation, and the advisory committee for the California Science
Center’s exhibit on scientific and cultural aspects of fear.
Dr. Wiederhold serves as Chief Executive Officer of the Interactive Media Institute (IMI) and
the Interactive Media Institute-Europe (IMI-E), non-profit organizations dedicated to furthering
the application of advanced technologies for patient care. Under IMI, she began the first VR and
behavioral healthcare symposium at the Medicine Meets Virtual Reality (MMVR) conference,
growing this into an independent International Conference, CyberTherapy, now in its 12
CyberTherapy brings together researchers, clinicians and funders to share and discuss the
growing field of CyberTherapy. This conference was originally a specialized symposium at the
Medicine Meets Virtual Reality Conference featuring presentations that dealt primarily with
conceptual matters and future possibilities. The symposium has continued to grow over the years
in both size and scientific evidence and is now an independent three-day conference. The 10th
annual CyberTherapy Conference, held in June 2005 in Basel Switzerland, highlighted the
largest program ever presented on controlled clinical trials of virtual reality and other cutting-
edge technologies in the areas of mental health, rehabilitation, disabilities, training, and
education. It involved representatives from 19 countries, reflecting its truly international
character. In 2006, the Conference attracted over 200 attendees to Gatineau, Canada.
Dr. Wiederhold is recognized as an international leader in the treatment of anxiety, panic and
phobias with virtual reality exposure and cognitive-behavioral therapy, and has completed over
5,000 virtual reality therapy sessions. In 2004 and 2005, Dr. Wiederhold was invited to address
the National Institutes of Health in Washington, D.C. as one of the world’s leading specialists in
the field of VR treatment for medical illness. In addition, she has shared her insights as an
invited speaker in Belgium, Canada, China, Croatia, Denmark, France, Germany, Israel, Italy,
Korea, Luxembourg, Slovenia, Spain, Sweden and Switzerland on the topic of technology in
Dr. Wiederhold currently has funded programs from the National Institute of Drug Abuse, NIH,
National Science Foundation, Office of Naval Research, Defense Advanced Research Projects
Agency, and Telemedicine and Advanced Technology Research Center in addition to serving as
an unpaid consultant on several current research projects in Europe and Korea.
Dr. Wiederhold is currently completing her ninth book and has over 100 publications. Her
current project, a collaboration with Dr. Giuseppe Riva of Milan, Italy, and Spanish researchers
Rosa Banos and Cristina Botella, on their important work with the application of VR in the
treatment of eating disorders and obesity, will help to form the basis for a European network
for translational research on healthcare applications of VR technology.
What is Virtual Reality?
Virtual Reality (VR) is generally defined as a three-dimensional computer-generated world that
can be explored interactively through a variety of computer peripheral devices. VR systems are
configured to display the computer-generated world, or virtual environment, so that the image
changes continuously depending upon the orientation and gaze of the user. In this way, the user
may “walk” through a virtual building to explore different rooms, turn his head to “look around”
a virtual airplane cabin and out the window, or navigate in a virtual outdoor environment of
streets, buildings, fields and people. Because of this level of interactivity, the user begins to feel
as though he is a part of the virtual world, actually experiencing it first hand. This is what is
referred to as “immersion” or “presence.” This makes VR much different from the non-
interactive, passive action of watching a movie or video, and is much more immersive than
playing a videogame (Wiederhold, 2004).
A VR system usually includes four major elements:
A computer of at least 500 MHz with an advanced graphics card,
A software program with the virtual environment,
A tracking device that tells the computer where the user is looking based on head or body
movement, and
An image display system such as a large high-resolution digital display or a head-
mounted display (HMD). HMDs project the computer image to the user through an
optical system which is worn as either a helmet or as a pair of glasses. The displays
include small monitors and stereo earphones to provide both visual and auditory stimuli.
VR was initially developed for use by the military and entertainment industries, but has now
found applicability in the medical and scientific fields. A wave of VR applications in medicine
started in 1993, with VR displays being used to treat mental health disorders. Initially, VR
cognitive behavioral therapy (CBT) was successfully employed to treat specific phobias, such as
fear of heights. This application made intuitive sense, and it was a fortunate first choice, since
most clinics still have above a 90% success rate today.
Virtual Reality is a medical tool.
Virtual reality is quickly finding wide acceptance in the medical community as researchers and
clinicians become aware of its potential benefits. In the United States, significant public dollars
have been invested in the research and development of VR technologies, especially by the
military which views VR as a promising tool for both training and physical and psychosocial
rehabilitation. "Recent advances in computer processor speed and graphics make it possible for
even desk-top computers to create highly realistic environments," said Dr. Walter J. Greeenleaf
at a conference hosted by the U.S. National Institute on Drug Abuse to highlight VR
technologies in medicine. "The practical applications are far reaching. Today, using VR,
architects design office buildings; NASA controls robots at remote locations, and physicians plan
and practice difficult operations. Several pioneer research groups have already demonstrated
improved clinical performance using VR imaging, planning and control techniques (Pueschel,
Revolutionary health care applications have been studied for surgical procedures (e.g., remote
surgery), medical therapy, preventive medicine, visualization of databases, skill enhancement
and rehabilitation, and medical education and training (Vincelli, 1999). VR has also been shown
to be highly effective as a psychotherapeutic tool. It is often used to distract patients during
painful medical procedures (Sander, 2002. Perry, 1981. Hoffman, 2000a. Hoffman, 2000b.
Hoffman, 2001a, Hoffman, 2001b. Hoffman, 2004. Thomas, 2003. Tse, 2003. Regera, 2004)
or to provide graded exposure during treatment for a wider range of anxiety disorders
Wiederhold & Wiederhold, 2002) including posttraumatic stress disorder (Hodges, 1999). VR
can provide a blend of both distraction and experiential therapies that teach patients these
techniques within a structured, safe environment.
The rapid advancement of technology combined with decreasing costs has propelled the VR field
forward. Cutting edge VR systems have been designed to run on desktop and laptop personal
computers, lowering costs to between € 6,275 and € 12,550 for a complete system. Real
digitized images can now be introduced into virtual worlds, making it possible to replicate actual
places, such as classrooms and family living rooms, in VR, increasing the potential to treat more
mental health disorders including fear of public speaking, social phobia, and Attention-
deficit/Hyperactive Disorder. By importing photographs of classmates, co-workers or family
members into the virtual world, therapists can practice social skills with patients in the safety of
a virtual environment before attempting interaction in the real world.
A wide field-of-view fiber optic image delivery system has made it possible to give people the
illusion of being inside a virtual world while undergoing an fMRI brain scan. Researchers are
beginning to combine VR with fMRI brain scans to the study of neural correlates of
psychological disorders and to study the impact of therapy on patterns of brain activity. VR is an
innovative technology that has a number of valuable healthcare applications worth exploring.
VR is a tool in translational research.
VRMC has demonstrated through its research that virtual reality systems provide valuable tools
for the scientist to assure that his translational research is reliable, valid and replicable. VR
environments allow for the repeated and systematic presentation of material to patients in a
manner that is predictable, controllable, and reliable. VR can also simulate many situations that
may otherwise be difficult to control for or simulate in real life, such as a fire emergency,
resulting in ecologically valid and dynamic assessment and training. While controlling outside
disruptions, VR can systematically introduce distractions. VR can be manipulated in ways that
the real world cannot.
Patients who are experiencing VR can also be instrumented with non-invasive devices that
accurately and objectively measure performance and physiological responses. VRMC has
pioneered the use of sensors that record heart rate, heart rate variability (including very low
frequency, low frequency, and high frequency spectral analyses), skin conductance, skin
temperature, and respiration.. Easy-to-use protocols for placing sensors on individuals who enter
virtual worlds have been developed and all sensors are interfaced to PCs so that data can be
easily displayed in real time and collected for later analysis. This is done so that a patient’s
physiological reactions to the treatment can be objectified and compared with that same patient’s
self-reported subjective responses. Participants are often monitored throughout their VR
immersion. Five-minute samples are taken prior to VR immersion, at the beginning of
immersion, in the middle of immersion, at the end of immersion, and after immersion in VR is
terminated in order to measure psychophysiological changes the patient may experience
throughout the VR experience.
VR enhances exposure therapy.
VRMC researchers have demonstrated over the past decade that using VR to treat patients with
psychological problems is one of the most promising practical uses of VR technology. For
example, VR exposure therapy is proving valuable for treating clinical anxiety disorders. In
exposure therapy, a patient uses relaxation skills to manage reactions towards feared situations.
VR technology has allowed clinicians to treat patients more effectively and efficiently without
concerns of excessive cost, loss of confidentiality, and limited safety that may arise with real-
world exposure.
Prior to VR technology, exposure therapy was dependent upon the patient’s ability to imagine a
feared stimulus, a barrier to many who lack the necessary visualization skills. VRMC’s virtual
environments have allowed outreach to a group of individuals who were too overwhelmed with
the thought of being “stuck” on a real freeway or on a 30-minute airplane flight to even attempt
treatment. The prospect of VR exposure, which can be terminated with the mere removal of a
head-mounted device, is far less frightening for many than the real-life alternatives. As they
exercise control over their own treatment, patients increase their level of self-efficacy, ultimately
gaining control over their own lives.
VRMC’s first use of virtual reality was with fear of flying patients and progressed to other
phobias and PTSD in motor vehicle accident survivors. The need is high considering that 32
per cent of mental health dollars are spent on anxiety treatment while 33 per cent of people with
insomnia, chest or abdominal pain actually have an anxiety disorder (Pueschel, 2004).
Treatments such as cognitive behavioral therapy (CBT) teach patients to change their thought
processes and then their behaviors. Prior to VR, therapists had to actually take their patients on a
plane or get them to sit and visualize the experience that caused their anxiety in order to help
them. VR made CBT more effective because it was no longer dependent on a patient’s
imaginary abilities and provided a structured environment, was less time-consuming, less
expensive and safer. Our research has shown that VR does not require exact digital replicas of
real world environments in order to elicit anxiety in patients. A more cartoonish VR world may
force the patient to more actively engage his or her brain in order to “fill in gaps”. (This active
participation has been found to be necessary for therapeutic efficacy). Physiological monitoring
during exposure through virtual reality informs therapists where the reaction starts so that they
can help their patients control their anxiety more effectively.
Although traditional cognitive-behavioral treatments for specific phobias are successful for those
who seek and complete treatment, the vast majority of phobics never seek treatment. VR allows
clinicians to treat a larger proportion of phobics, and there is evidence that phobics find the
thought of VR therapy less repugnant than in vivo therapy. Among other disorders, European
researchers have shown VR exposure therapy to be effective in treating fear of heights, fear of
spiders, fear of flying, claustrophobia, eating disorders, panic disorder and agoraphobia (Vincelli,
Riva, and Wiederhold, 2002) and posttraumatic stress disorder (Garcia-Palacios, Hoffman,
Carlin, Furness, & Botella-Arbona, 2002).
, a VR project funded by the 6
Framework in recognition of the great potential of
VR in the health arena, began work on the development of an intelligent multi-sensor wearable
system for the treatment of phobias and situational anxiety. The system aims to incorporate
emotional intelligence - via a biosensors fusion system able to sense the underlying phobic’s
states - and a virtual environment that, based on the machine's intelligent decisions, will virtually
expose patients in situations that help them overcome their phobias. In addition, it plans to
communicate with a healthcare professional's site to provide decision support concerning the
patient's therapy. The INTREPID project has been limited in scope but may provide a platform
on which to expand to wider applications and advanced economic opportunity of the technology.
VRMC has made significant contributions to the application of VR-enhanced exposure therapy
in the treatment of Post Traumatic Stress Disorder (PTSD), especially in returning soldiers.
By approaching stressors in a controlled environment and discussing their feelings both before
and after exposure, the afflicted can begin to work toward a place of increased peace and
stability. Before VR technologies, doctors and therapists were forced to find more creative
options for use in their sessions. This could mean using photographs or even just memories that
the patient had refused to revisit. Now, virtual reality scenarios created using the latest in video
game software can literally recreate scenes of battle.
In addition to presenting three-dimensional visual worlds through a head-mounted display,
augmented VR can introduce a variety of other stimuli to enhance VR immersion including
sound, vibration, currents of air, and olfactory stimuli. The government of the United States,
through grants to the VRMC from its Office of Naval Research and the Telemedicine and
Advanced Technology Research Center (TATRC), has invested significant resources to study the
promising protocols involving VR therapy for military troops in both the U.S. and Poland,
especially those returning from Afghanistan and Iraq. The governments of Canada, Australia,
the United Kingdom, France, Denmark, Poland, Sweden and Rwanda have expressed interest in
working with the Virtual Reality Medical Center to adapt PTSD products to their own
VRMC, with the support of its European colleagues, is pioneering research in the United States
on the application of VR-enhanced exposure therapy to eating disorders and obesity. Eating
disorders are complex, chronic illnesses often resistant to most traditional therapies. The most
common eating disorders - anorexia nervosa, bulimia nervosa, and binge eating disorder - are on
the rise worldwide. All socioeconomic, ethnic and cultural groups are at risk. More than ninety
percent of those with eating disorders are women. Further, the number of American women
affected by these illnesses has doubled to at least five million in the past three decades.
It is estimated that six in 10,000 European women suffer from anorexia and 8.5 in 10,000 from
bulimia, and this number is rising. Treatment for eating disorders varies widely across Europe.
According to the European Medical Association, large urban areas have three times the number
of sufferers per population size as people living in rural areas. That number is likely to be grossly
underestimated, as in many areas in Europe, the problem is not recognized.
Obesity (defined as a Body Mass Index of >
30) is rising at an alarming rate throughout Europe.
It forms a pan-European epidemic that presents a major barrier to the prevention of chronic non-
communicable diseases. At least 135 million EU citizens are affected and perhaps another 70
million in those countries seeking to join the EU. In many countries, significantly more than half
the adult population is overweight and up to 30% of adults are clinically obese (International
Obesity Task Force, 2002). As of 2000, the number of obese adults worldwide had increased to
over 300 million (International Association for the Study of Obesity, 2003). Obesity increases
the risk of many serious and fatal medical conditions, including heart disease, high blood
pressure, diabetes, and cancer. Among people diagnosed with Type 2 (non-insulin-dependent)
diabetes, 46% have a Body Mass Index of greater than 30 (the healthy range is between 18.5 and
24.9). In addition, 41.9% of men and 37.8% of women who are obese also suffer from
hypertension. Obese individuals have a 50%-100% increased risk of death from all causes when
compared with normal-weight individuals. According to Peter Kopelman of the Royal London
School of Medicine, life expectancy of a moderately obese person could be shortened by two to
five years.
Over the past five years, virtual reality environments have been successfully used to treat several
different types of eating disorders. At least five controlled clinical studies have shown that
virtual reality can significantly improve the positive effect of cognitive behavioral therapy in the
treatment of obesity, binge-eating disorder, anorexia, bulimia, and body dysmorphic disorder
(Riva, 2006). Virtual realty therapy has been most successful when used as an adjunct to both
in-patient and outpatient treatment programs. The original studies (Health Talk@Mac, 2004)
using virtual environments have typically included rooms and scenes where the activities of
eating and food preparation help to address patients’ feelings or conflicts about nutrition. Other
virtual scenes involving body image take advantage of a “virtual scale” and social scenes where
patients compare their body and their perceived body image to external cues. The patient’s
actual body dimensions are scanned using a digital camera and introduced as an avatar into the
virtual world. By comparing the perceived image to the body’s actual image, the underlying
body dysmorphic conflict or mismatch can be presented to the patient in a way that is both
beneficial and therapeutic.
Dr. Giuseppe Riva, a research professor of psychology in Milan, Italy has pioneered the use of
VR with clients who have distorted ideas about their own body shape. His analysis of published
data suggests that VR can help to address two key features of
eating disorders and obesity that are not always adequately
addressed by existing approaches: body experience
disturbances and self-efficacy. His interventions are based on
Integrated Experiential Therapy (IET), a relatively short-term,
patient-oriented approach that focuses on individual discovery.
Like Cognitive Behavioral Therapy, IET uses a combination
of cognitive and behavioral procedures to help the patient
identify and change maintaining mechanisms. IET focuses on
the negative emotions related to the body and on supporting
the empowerment process. Dr Riva conducted a study with
500 participants that found VR
can augment obesity therapy
by changing a patient's body imagery
and by teaching coping
behaviors around food (Thacker, 2003).
A recent study by Dr. Riva and his colleagues examined the use of the Integrated Experiential
Therapy to treat patients with binge eating disorder and obesity in a controlled clinical trial. The
results were very promising, especially VR treatment’s effect on relapse rates. Six months after
treatment, 77% of the patients who had used VR still had no binging problems, while only 56%
of the group who had received traditional cognitive-behavioral therapy and 22% of the group that
had received nutritional education still did not binge (Riva, 2006).
The ability to fight smoking through VR opens up a whole new world for those seeking
treatment. VRMC is building an Internet-based VR world for teen smokers which will reach
those that are not comfortable in face-to-face interventions. The Internet also reaches the youth
on a personal level through a medium they are comfortable with using. It provides an informal
and convenient support system in this fast-paced society. The Internet is relatively low-cost, is
operational at any time, and can provide a multitude of health information for young adults.
Drs. Mark and Brenda Wiederhold are experts in the field of VR and have done several studies
regarding smoking cues. In a study for nicotine craving, virtual environments contained different
smoking cues such as a bar with a pack of cigarettes on the counter, or a party where someone
offers a cigarette. Overall, the study determined exposure to virtual cues helped reduce cravings
in those who were nicotine dependent. Dr. Brenda Wiederhold was also involved in a study
conducted in Seoul, Korea using fMRI to study cue-induced smoking cravings in virtual
environments. With the help of the fMRI, Dr. Wiederhold was able to see how the brain reacted
to the smoking cues, and which areas were most affected. Another study involving the Drs.
Wiederhold showed that cue exposure techniques, which try to extinguish this learned
association, have been increasingly promoted as a potential treatment for addictive behaviors,
including cigarette smoking.
VR enhances distraction therapy.
For over a decade, the technique of distraction has been researched and successfully applied in
clinical practice in order to reduce pain associated with certain medical procedures. The use of
distraction is based on the assumption that there is an important psychological element in the
perception of pain, with the amount of attention given to the harmful stimulus affecting the
perception of the pain. Distraction techniques are based on the patient's limited capacity for
attention, resulting in a reduction in the patient's attention to the stimulus and therefore a
reduction in the stimulus itself. It was assumed that the ideal distractor would require an
optimum amount of attention involving various senses (visual, auditory and kinesthetic), an
active emotional involvement, and participation from the patient to compete with the signals of
the harmful stimuli. One of the most important advantages of VR is the flexibility this tool
allows clinicians during treatment. For example, the headphones on the head-mounted device
(HMD) which project the sound of the virtual environment to the patient serve the added
function of blocking out clinical noise that might sidetrack the patient in conventional distraction
techniques. The duration of the immersion can be increased or decreased, depending on the
clinician’s needs and the length of the treatment. VRMC is a leader in the on-going
examination of VR as an adjunctive therapy for distraction from acute pain during painful
and unpleasant medical and dental procedures.
One way to help cancer patients to cope with chemotherapy-related side effects is through the
use of distraction interventions. Some forms of distraction are inexpensive and presumed to be
only minimally effective—as in the case of television viewing—and others have empirically
demonstrated to be minimally effective—such as listening to music. VR provides distraction and
improves interest and absorption by drawing the patient into a three dimensional fantasy world
and by allowing the patient to independently move around in and interact with the VR world. In
an early study of VR to treat nausea, 80% of 10 cancer patients reported a decrease in the
frequency of vomiting and level of nausea. VRMC is working with patients at the Naval
Hospital to create immersive environments to further test this hypothesis.
Such results will mean not only decreased suffering among chemotherapy patients, but possibly
increased survival rates among the more than one-third of patients currently unable to tolerate
full dose-intensity chemotherapy treatment (Associated Press, 2004). This system will be
inexpensive both in initial cost (less than 7,000 Euros for a turnkey operation) and in facilitation
cost, since the patients can start and operate the systems on their own, rather than requiring a
therapist to be present to deliver the intervention.
In preliminary clinical studies, researchers have found that immersive VR distraction can reduce
patient’s pain ratings during severe burn wound care by 30%–50%. Relative to medications
alone, patients receiving adjunctive VR during physical therapy reported large reductions in the
amount of time spent thinking about pain, pain intensity (worst pain), and in how unpleasant they
found their pain.
A recent study conducted by the VRMC for the National Institute on Drug Abuse (NIDA) tested
the efficacy of VR as a distraction intervention for burn patients. Participants in the study
were 6 volunteers (2 women, 4 men) recruited from the patient population at Naval Hospital. All
6 participants reported a drop in pain while in the VR environment, and the magnitude of pain
reduction from the VR compared to the pain focus condition was large (75.8%) and significant.
VRMC is currently conducting an expanded controlled study with 180 patients at 6 sites in 4
countries. Exploratory hypotheses address maintenance of treatment effects across sessions,
effectiveness of VR for both chronic and acute pain distraction, and uniform results across
cultural boundaries.
In another NIDA research project, VRMC’s objective was to test a custom-designed VR
environment’s effectiveness in distracting from the pain of dental procedures. Results showed
that heart rates showed a statistically significant decrease during the VR session. Typically, a
decrease in heart rate signifies a reduction in physiological arousal, and thus a state of relative
relaxation in the participant. Skin conductance also showed a statistically significant decrease
between during VR. A decrease in skin conductance also typically indicates a reduction in
physiological arousal and an increase in relaxation in participants. Participants’ exhibited similar
temporal trends regardless of the order in which they experienced the virtual environments. This
same software is now being used with chronic pain patients as well and shows initial positive
In addition to reducing pain associated with severe burns and dental procedures, VRMC is
planning future immersive virtual worlds that encourage and motivate patients to perform
specific therapeutic movements and to make physical therapy and wound care more bearable
for patients. Reducing excessive pain also may reduce the stress experienced by the patient’s
family and health care givers. Opioid doses could one day be reduced for patients who respond
well to adjunctive VR analgesia, reducing the opioid side effects.
Other applications of VR in pain management are being discussed among researchers in the
United States and Europe. Steven Palter M.D., assistant professor and clinic chief of
reproductive medicine in the Department of Obstetrics and Gynecology at Yale School of
Medicine, reports that VR headsets are being used by women undergoing in vitro fertilization
(IVF) under local anesthetic. His study has shown that women who wore a virtual reality headset
during a painful surgical procedure for infertility found the soothing scenes and music greatly
reduced their anxiety and discomfort. In tests conducted at Children's Hospital of Oklahoma,
while undergoing lumbar punctures, adolescent cancer patients who wore VR glasses and
watched a video said the VR glasses helped to distract them from the procedures. Subjects rated
their pain as being lower when using VR glasses. VR has been considered by many as a
distraction therapy for the acute pain of labor and delivery in childbirth. Like many conditions,
patients and doctors are searching for ways to reduce the use of drug therapies which may have
long term side effects impacting both mother and baby. The same conditions that have made
other VR distraction therapies successful have huge potential in palliating the excruciating pain
associated with giving birth.
VR is a tool for physical and cognitive rehabilitation.
One of the newest and most exciting applications of VR is in the field of rehabilitation. In
cognitive rehabilitation, VR can be used for vocational training and as a way to train cognitive
tasks in brain damaged patients. VRMC’s research with VR in the field of motor rehabilitation
includes applications for stroke, acquired brain injury, Parkinson’s disease, orthopedic
rehabilitation, balance training, wheelchair mobility, and training in functional activities of daily
living. Research in VR applications for stroke patients in particular have made considerable
progress; fMRI studies of VR used in conjunction with traditional physical therapy in stroke
patients have resulted in neuroplastic changes in the brain and corresponding improvements in
motor functions. Further research has studies the application of VR-enhanced rehabilitation
with developmentally delayed and autistic children.
There are many reasons that VR applications are so effective. VR, for one, is an interactive,
experiential medium. In the same way that computers are grasped intuitively by children and
teenagers, users become directly engaged with the effects of the VR experience. Another reason
is that VR is a unique setting where patients can explore and act without feeling threatened.
Patients can make mistakes without fear of dangerous, real, or humiliating consequences. VR
allows people with intellectual disabilities to explore environments without the distracting or
restricting presence of other actors. Unlike human trainers, computers are infinitely patient and
consistent. VR can also simulate many situations that may otherwise be difficult to control for or
simulate in real life, such as a fire emergency, resulting in ecologically valid and dynamic
assessment and training. While controlling outside distractions, VR can systematically introduce
distractions; using this in a virtual classroom has allowed researchers to diagnose ADHD in
children. VR can be manipulated in ways that the real world cannot. For example, VR can
convey rules and abstract concepts without the use of language or symbols for patients with little
or no grasp of language.
In motor rehabilitation, there are essentially three major advantages that VR offers over
traditional therapy alone. One is that VR allows a safe, controlled environment for repetitive
practice, and repetitive practice is crucial in learning motor tasks. The second is immediate, real-
time feedback about performance. The third is, because of its interactive nature, VR can increase
motivation by making the experience fun. Patients are much more motivated to complete
exercises when presented with an engaging virtual reality video game environment than simply
gym equipment. In addition, virtual treatments can be individualized to each patient and
monitored to test his or her ability to perform certain tasks over time (Burdea, 2003). Progress is
documented, and, as patients begin to develop strength and coordination, the tasks can be made
increasingly more difficult, creating challenge and continual rehabilitation.
rehabilitation medicine with VR permits impaired individuals to explore worlds not otherwise
available to them, allows accurate assessment and therapy for their disabilities, and helps
architects understand their critical needs in public or personal space.
The possibility of VR tele-rehabilitation is another advantage of VR. The delivery of medical
rehabilitation services, such as VR rehabilitation therapy, to a patient’s own home via the
Internet would be beneficial to those who live far from the nearest rehabilitation facility or who
have trouble securing transportation to such a facility. VR could be combined in such a way that
patients could interact with other patients and see each other’s rehabilitation progress from the
comforts of their own home. Such a system would hold many potential advantages; the presence
of other people would increase compliance, improve the quality of life, reduce depression, and
reduce social isolation.
VR can assist the brain’s ability to reorder neural pathways in response to new experiences or
needs. Neuroplasticity processes are assisted with VR simulations that enable patients to work
through the process of regaining skills in small and achievable segments. VR can break a skill
down into discrete tasks – difficult in real life but easy in VR – and simulate repetitive
increments more efficiently than live training. VR provides the opportunity to present specific
and controlled stimuli to patients, as well as advanced methods for recording responses Studies
have shown that what the patients learned in the virtual reality was transferable to real life.
Haptics technology allows for tactile interactions in VR, giving the user the ability to grasp and
manipulate virtual objects. The manipulation of virtual objects is accomplished with the use of a
“data-glove,” a flexible glove with both tracking and movements sensors embedded in the
material. Haptics-VR allows researchers to custom-design the virtual environment so that it
targets specific motor skills in patients. In a pilot study, patients who had weak lower extremity
muscles improved the strength capabilities of some of their ankle muscles when they used a
haptics-based ankle rehabilitation system Studies with VR/haptics rehabilitation have shown
improvements in the upper extremities as well. For example, one patient suffering from left arm
paresis improved fine manual dexterity, grip force, endurance, and motor control of his affected
area after playing a 3D game with haptic feedback
VRMC’s partner, The Media Convergence Lab (MCL) at the University of Central Florida’s
Institute for Simulation and Training (UCF / IST) in Orlando, has recently developed haptics-
based rehabilitation utilizing a mixed reality system involving multiple senses and conducted a
case study examining the benefits and shortcomings of the technology. It is this equipment that
the Virtual Reality Medical Center (VRMC) will utilize to rehabilitate patients with upper
extremity injuries. VRMC and MCL/IST have arranged a strategic, signed business agreement
such that VRMC will license this technology for medical and clinical use.
VR is a resource for surgical planning and performance:
For the discipline of surgery, the surgical console is the interface between the real and the
information world. From the console, the surgeon can perform open surgery, minimally invasive
surgery, remote tele-surgery, surgical pre-planning, surgical procedure rehearsal, intra-operative
image guided surgery and surgical simulation. All these actions are possible from the single
point of the surgical console.
VR surgical simulation development has been concentrated on Minimally Invasive Surgery
(MIS)-partly because the paradigm for MIS already involves a physician looking at a monitor.
An MIS simulation involves putting the instruments through openings and displaying a computer
generated model overlaid upon visuals of surgical representations. Organs for VR surgery not
only look like real organs, and they should act like real organs. Research is underway to even
add smell to VR surgical simulations.
A VR surgical planning device takes actual physical data from an individual patient and
combines it with computer-generated data. It incorporates real-time interaction with computer
graphics that mimic a patient’s anatomy. This is then used to make a simulation that will help
plan and rehearse a surgical procedure - both for training and advanced planning of an operation.
Data fusion, the fusion of virtual patients onto real patients as a navigational aid in surgery, is the
newest frontier of VR application in surgery. Eventually, medical care with multiple
professionals will be provided in a shared virtual environment that incorporates shared decision
making for an actual surgical intervention or a rehearsal.
VR is a tool in prevention of physical and emotional illness.
The many manifestations of virtual reality coupled with their ability to objectively monitor
medical and psychological conditions support the promotion of effective healthcare and disease
prevention. VR has proven its ability to increase access to healthcare by providing methods of
intervention to populations who would not or could not take advantage of traditional avenues to
care. Quality of care has improved with the objective measurements of success in discrete
increments and overall cure rates. Because VR can be delivered through laptop computers and
internet platforms, it is available “anytime, anywhere” and can be customized to a wide range of
symptoms and stages of disease. It has proven to be a pleasant adjunct to traditional treatments
and, as such, motivates and encourages patients to engage in and complete difficult therapies.
Science is constantly learning about the impact that stress has on overall health. Stress is or may
be a contributing factor in everything from backaches and insomnia to cancer and chronic fatigue
One of the best strategies for dealing with stress is learning how to relax. However,
relaxing is difficult to achieve in typical real world situations.
Stress Inoculation Training
(SIT) is a technique to help “inoculate” individuals to future potentially traumatizing stressors.
Deployed personnel must often perform in extremely stressful environments, and optimum
performance under such conditions requires the management of physiological, psychological and
emotional responses to stressful stimuli. During preventive SIT, military personnel “experience”
highly stressful situations in a virtual environment while being physiologically monitored.
Repeated exposure enables performers to gradually become desensitized to stimuli that may
initially elicit such strong physiologic arousal that performance is impeded and psychological
trauma is more likely.
VRMC has provided VR-enhanced SIT to more than 11,000 military personnel in order to
reduce the incidence of PTSD. The training follows a protocol used at the Naval Hospital and
Camp Pendleton 1
Marine Division. In this approach, patients use biofeedback to learn how to
relax their bodies and cognitively attend more fully in the moment. After this is achieved, troops
are placed in the virtual environment (e.g., combat exposure, firefights in Fallujah, convoys,
medical treatment tents). First neutral, and then progressively combative scenarios are presented
and their physiological and subjective arousal is measured. The outcome is “hardened” troops
prepared to handle difficult combat scenarios, even though they have never actually experienced
them before.
SIT is being provided by VRMC to Polish troops who are part of the Coalition fighting in Iraq.
SIT has been demonstrated to help prevent or reduce rates of PTSD in returning troops. A group
of 106 male British soldiers preparing for a 6-month tour of duty in Bosnia received a
combination of pre-deployment stress training in combination with psychological debriefing and
demonstrated a drastically reduced incidence of PTSD and other psychopathology approximately
10 times less than figures reported from another military samples (Deahl, et al, 2000).
Tobacco is the single largest cause of avoidable death in the European Union accounting for
over half a million deaths each year and over a million deaths in Europe as a whole. It is
estimated that 25% of all cancer deaths and 15% of all deaths in the Union could be attributed to
smoking (Europa, 2006). Recent updates of indirect estimates of global tobacco mortality
indicate that in 2000, 5.0 million premature deaths were caused by tobacco. About half (2.6
million) of those deaths were in low-income countries. Males accounted for 3.7 million deaths,
or 72 percent of all tobacco deaths. About 60 percent of male and 40 percent of female tobacco
deaths were of middle-aged persons (ages 35 to 69).
In high-income countries and former socialist economies, the 1 million middle-aged male
tobacco deaths were largely composed of cardiovascular disease (0.45 million) and lung cancer
(0.21 million). In contrast, in low-income countries, the leading causes of death among the 1.3
million male tobacco deaths were cardiovascular disease (0.4 million), chronic obstructive
pulmonary disease (0.2 million), other respiratory disease (chiefly tuberculosis, 0.2 million), and
lung cancer (0.18 million) (Disease Control Priorities Project, 2006).
The prevention of smoking is one of the world’s greatest healthcare concerns. The Virtual
Reality Medical Center (VRMC) is currently under contract with the National Institute on Drug
Abuse (NIDA) to produce an Internet-based VR game aimed at adolescents that will guide
smokers through several rooms and scenarios containing smoking cues. Teens will then learn
how to face the cues and urges to smoke, and overcome them. In addition VRMC has a business
agreement in place to deliver this program to Department of Defense dependents via
DefenseWeb’s Xtendable Server (a .NET open standards modular application platform and
content management system developed specifically to meet the changing requirements of the
Department of Defense. Through this VR game, adolescents will be provided with an engaging
tool to beat their smoking addiction and prevent a lifelong habit with significant health
VRMC been commissioned to work with “Renasterea Romania” Cultural Foundation to
develop and implement a smoking prevention program for high school aged youth in Romania.
The project will be piloted in Iasi County where there are over 150,000 pupils in more than 350
VR is a diagnostic tool.
The capacity of virtual environment technology to create dynamic, interactive, three-dimensional
stimulus environments, within which all behavioral responding can be recorded and measured,
offers clinical assessment and intervention options that are not available using traditional
methods. Technology for diagnostic imaging, compared to the other medical specialties, is
large and well developed. Simulated three dimensional reconstruction of organs from
radiological cross sections has become an important diagnostic tool by providing clinicians with
a more naturalistic view of a patient's anatomy. The latest generation of these systems has the
capability to collect large amounts of high-resolution data but lacks the sophisticated software to
easily navigate through this data. Adding interactive 3D visualization software to the existing
hardware base provides value by reducing personnel time and costs and improves clinical
efficacy. The imaging modalities that represent computer-aided applications of VR in radiology
include CT, MRI, x-ray imaging NM, ultrasound and computed radiography.
Virtual reality has singular application in the field of fMRI. VRMC is testing its custom-
designed goggles that can withstand the magnetic environment of the technology and display
virtual images and environments as the fMRI records brain response to the stimuli. Data
collected will reveal the level of a patient’s immersion in the virtual world as well as the specific
part of the brain triggered by the sensory cues.
VRMC has worked in the field of hyperspectral imaging technology that has been used to
detect cancerous and precancerous abnormalities in human tissue in all areas of the human body
accessible through endoscopy. The 3-dimensional optical imaging system employs high spectral
resolution and narrow bandwidths to create highly detailed imaged that distinguish cancerous
tissue from healthy tissue. A comparison of these tissue segments and cells permits diagnosis
and delineation of suspect tissue.
VRMC has pioneered the use of physiological monitoring to collect real time data depicting
patients’ level of arousal while in virtual reality. Physiological monitoring serves as an objective
measure of symptoms for the purpose of disease diagnosis. In addition to the subjective self-
report measures, the VRMC’s patients’ physiological responses to exposure to virtual
environments are monitored with non-invasive sensors that record ECG, EEG, skin conductance,
skin temperature, and respiration measures using commercially available systems. All sensors
are interfaced to PCs so that data can be easily displayed in real time and collected for later
Virtual reality may one day be the preferred method of diagnosing and rehabilitating attention
deficit hyperactivity disorder (ADHD) among students, according to a researcher from the
University of Southern California who is investigating the use of virtual reality therapy in a
number of clinical applications. For this ADHD diagnosis, a child sits at a physical desk wearing
a head-mounted virtual display. Generally, tests for ADHD involve behavior observation or
questionnaires, with no direct control over the stimuli. Because virtual-reality technology is
immersive, interactive, and computer-generated, the tester can control the environment
completely. The technology also can distinguish between video and audio distractions. The VR
world can systematically record reaction to controlled stimuli in an automated environment.
Logically and rationally, virtual reality environments will be better at testing and assessing than
their random, uncontrolled counterparts.
A vestibular disorder occurs when the vestibular system, which provides us with sensations of
our body’s motion and orientation in space by responding to the flow of fluid through canals
located in our inner ear, is not functioning properly. If this system, for whatever reason, begins
sending inconsistent cues that disrupt a person’s ability to function under normal circumstances,
a vestibular disorder is diagnosed. Patients often experience symptoms similar to panic attacks
while driving. To determine whether the problem is a vestibular disorder, patients are immersed
in a virtual environment complete with a real car seat, seat belt, gas and brake pedals, and
steering wheel in front of a large screen. The scene projected in front of them simulates driving
down a freeway. Often motion of this type will aggravate a vestibular disorder, allowing it to be
diagnosed. Patients who become cybersick (side effects such as dizziness and nausea related to
exposure to VR) are referred to an Ear, Nose, and Throat physician to be treated for a vestibular
“Telemedicine” is broad term and refers generally to the use of information technologies such as
satellite transmission, video conferencing or electronic data transfer for healthcare education,
consultation, and delivery. Telemedicine overlaps Virtual Reality in the use of 'telepresent'
medical experts who have the ability to act and interact remotely from a patient by making use
of VR technology. Ideally, this will reduce the cost of medical practice and bring expertise into
remote areas. Telemedicine will also include telesurgery- the provision of VR-based systems to
enable telepresent surgeons to perform surgery on remote patients.
VR supports the development of sustainable and efficient healthcare systems.
Sustainable and efficient healthcare systems require well-trained practitioners who have access
to cost effective equipment, therapies, and partnerships that promote consistent, state-of-the-art
treatment to patients anytime, anywhere. Under the current medical educational model, doctors-
in-training learn their craft during training periods known as residencies. This model of learning
by doing, or “see one, do one, teach one,” has been the standard for more than 100 years and is
dependent upon patient flow and the availability of high-quality instructors. It fails to guarantee
that a trainee gains experience in all of the vital areas, nor does it provide an objective measure
of a doctor’s abilities.
VR-based instruction is now being used to train a broad range of individuals—from medical care
professionals, such as in anatomy instruction and surgery simulation,, to teenagers in driving.
Unlike human trainers, computers are infinitely patient and consistent. VR can also simulate
many situations that may otherwise be difficult to control for or simulate in real life, such as a
fire emergency, resulting in ecologically valid and dynamic assessment and training.
VR is increasingly being used in medical training and education. Applications focus on the
use of three-dimensional inter-active graphics to give the students and clinicians a much better
feeling for and understanding of anatomy than can be gained by looking at two-dimensional
pictures or by reading text. Computerized three dimensional atlases of human anatomy,
physiology, and pathology are about to revolutionize the teaching of these subjects. In the
United States, advancements in digital image storage, retrieval, and manipulation, made
accessible by the National Library of Medicine’s Visible Human project, have produced an
online resource from which VR systems continue to be developed and commercialized. Unlike
textbook examples, VR simulations allow users to view the anatomy from a wide range of angles
and “fly through” organs to examine bodies from the inside. VR would can useful in teaching
procedures involved in breast and genitalia exams in which it is difficult to find subjects. VR
saves money and improves testing in examinations that assess manual skills.
VR is especially applicable in simulations for surgical training. A visual environment showing
anatomic structures is experienced and changes within the field of view in accordance with the
actions taken using the virtual instruments (and with changes in the field of view). Such an
approach is useful in learning the basic surgical maneuvers. This environment allows for
unlimited practice, limited only by the realism of the virtual surgical field, until the trainee-
surgeon demonstrates sufficient manual and visuospatial adaptation to warrant treating actual
Virtual reality applications in surgery are mediated through the computer interface and as such
are the embodiment of VR as an integral part of the paradigm shift in the field of medicine. VR
surgery systems consist of two components, the surgical workstation and remote worksite. At the
remote site there is a 3-D camera system and responsive manipulators with sensory input. At the
workstation there is a 3-D monitor and dexterous handles with force feedback. The VR surgical
simulator might include a stylized recreation of the human abdomen with several essential
organs. Using a helmet mounted display and a data glove, a medical student can learn anatomy
from a new perspective by
flying inside and around the organs, or can practice surgical
procedures with a scalpel and clamps.
VR allows surgeons to practice hundreds of procedures prior to patient contact-and the practice
carries no risk to live patients. Since doctors with less experience are in general more likely to
produce errors, VR simulations could theoretically reduce physician error. VR will also reduce
the high costs of training resources such as lab animals and physician's time and increase surgeon
proficiency and thereby decrease the number of mal-practice suits. The most profound change is
that the simulators can now be used to set criterion which the students must meet before
operating upon patients. The expert (or experienced) surgeons perform on the simulator; their
score is the benchmark which the student must achieve before being allowed to operate.
Students do not train for a given period of time (eg, 10 trials on the simulator, or for 2 days);
instead they must train until they reach the same performance (criterion-based or proficiency-
based) as the experts. Some take only a few trials, while others take much longer – however no
student operates upon a patient until they perform as well as an expert.
Trauma response skills and experience are important in the successful resuscitation and
operative care of injured patients. Lack of training opportunities makes it difficult for medical
care providers to learn and maintain these trauma care skills. Studies have demonstrated that
virtual reality trauma simulators are likely the best long-term answer to this problem.
VRMC is developing trauma training programs with support from the U.S. government’s
Telemedicine and Advanced Technology Research Center (TATRC) as part of a commitment to
support the development of commercially viable products that will ultimately meet the needs of
both military and civilian populations. Since 1999, TATRC’s medical technology program has
supported the research and development of medical products and procedures that apply
physiological and medical knowledge, advanced diagnostics, simulations, and effector systems
integrated with information and telecommunications to enhance operational and medical
decision-making, improve medical training, and deliver medical treatment across all barriers.
The program scope is to identify, explore, and demonstrate key technologies and biomedical
principles required to overcome technology barriers that are both medically and militarily
The U.S. military is investing millions of dollars on training for soldiers, yet the methods for
training combat medics continue to leave a void in their preparation. While static virtual sets and
real-world training scenarios are being employed, they are not providing the soldiers with full
immersion into combative medical situations. VRMC’s Combat Medic, an interactive virtual
reality video game (VRVG), has been demonstrated to prepare combat medics to produce better
results in real-world testing than those receiving traditional training methods. The purpose of the
VR video game is to provide an inexpensive training tool that allows medics to experience
situations outside of their everyday training. The game tests the medics’ knowledge of medicine,
combat training skills and ability to function under the pressure of a battlefield situation. The
video game contains virtual scenarios of terrain the medics are not able to experience in real-
world training. It allows medics to learn from their mistakes and repeat scenarios until they
successfully compete the task. When medics reach an injured soldier, they are given a closer
view than in other games. The medic is able to turn the soldier over to examine bullet exit
wounds or to tie on a tourniquet. The VRVG is interactive for the medic; for example, the mouse
acts as scissors when it is necessary to cut off the soldier’s vest to better see the wound, or
become hands to tie on a tourniquet.
The game replicates the stressful environment of warfare and requires medics to perform under
dangerous and complicated conditions. Testing financed by the U.S. Defense Advanced
Research Projects Agency (DARPA) project for soldiers has shown that training does transfer
from a video game to real-world simulation training. Game enhancements are planned to tailor
the game to military surgeons, aeromedics, emergency room physicians and other trauma-related
environments. Combat Media is an example of the type of video-game adaptation that is being
financed and tested by all branches of the United States Military. Games that accurately
simulate the real-world environment provide a low cost alternative that better prepares
inexperienced soldiers to save their own lives while saving the lives of others.
Communication networks have the potential to transform virtual environments into shared
worlds in which individuals, objects and processes interact without regard to their location. In
the next five years, such networks are predicted to merge VR and telemedicine applications,
allowing us to use VR for distance learning, distributed training and e-therapy. Today military
medics are using hand-held computers with entire medical references and which can download
the information from a soldier’s “electronic dog tag” into the computer right on the battlefield.
Now the medic “knows everything, about medicine and the patient”. In addition, once the
wounded soldier is placed upon the Life Support for Trauma and Transport (LSTAT), which is a
portable intensive care unit (ICU), the surgeon back in the Mobile Advanced Support Hospital
(MASH) can receive by telemedicine the vital signs, and even change the respirator settings,
control the flow of the intra-venous fluids and medications. The LSTAT has been used since
2000 in the conflict in Bosnia and Kosovo. From the time of wounding when the soldier is
placed on the LSTAT, to the helicopter evacuation, to the ambulance transfer to the MASH, to
the emergency triage, to the operating room and finally in the post-operative ICU, the casualty is
continuously monitored and the medical record is automatically recorded. In the Afghanistan
and Iraq Wars, the LSTAT was recalled for servicing, however the medics would not send them
back because they were so valuable.
The Virtual Reality Medical Center continually investigates new uses for VR in improving
human performance. One of the things which sets our work apart is our continual emphasis on
objectification through careful physiological monitoring during VR therapy and training, as well
as additional testing in the real world setting to ensure a transfer of skills from the simulated
world has indeed occurred. In addition, we work in multi-disciplinary teams to ensure that each
part of the problem is appropriately addressed by a subject matter expert. The combination of
these elements gives our systems and their users a critical edge.
VRMC’s Product Development Team specializes in creating simulation software and virtual
reality systems to facilitate medical therapy. The mission of PDT is to create, test, and deliver the
highly effective virtual reality systems using innovative technology integrated with medical
science. Having extensive knowledge in the creation of interactive software for clinical
treatment, our graphics and software teams are skilled in the development of interactive 3D
worlds using variety of cutting edge development tools. The products VRMC is currently
developing range from various pain distraction tactics to clinically validated anxiety treatments.
The products include Airport and Flight VR, Fear of Heights VR, and Virtual Reality Pain
Distraction. The Product Development Team also supports military medicine by providing
PTSD treatment, Stress Inoculation Training, and Combat Medic VR training systems for
military medical personnel.
For more than a decade, Dr. Brenda Wiederhold and Dr. Mark Wiederhold have been critical
players in the effort to exploit virtual reality technology to benefit their combined passions:
improvement of the citizen’s individual mental and physical health through technology. They
have participated in national and international symposia on the subject and exchanged insights
and findings with every player in the medical technology arena. In that process, they have met
and collaborated with Europe’s leaders in VR research and have hosted conferences and
workshops across the Continent. Their current project, a book that chronicles existing
knowledge of the application of virtual reality in the treatment of eating disorders and obesity, is
a joint project with Dr. Giuseppe Riva of Italy and other European contributors.
For over a decade, the Wiederhold’s have had formal collaborations with colleagues in Europe
and Asia. To show further commitment to these collaborations, in 2004, VRMC established an
official presence in Basel, Switzerland. In 2006, this expansion continued with the formation of a
European corporation in Brussels, Belgium: Virtual Reality Medical Institute. This corporation
will serve to more effectively allow for the exchange of ideas and promotion of the use of
technology in the rapidly changing eHealth environment. Dr. Brenda Wiederhold is committed to
the creation of a European network that continues to encourage EU researchers to contact US
experts as well as venture capitalists in an effort to fund innovative research concepts and bring
them to successfully to market. The CyberTherapy Conference will return to Europe once again
in 2009, in addition to a more specialized meeting being planned in Austria, Wounds of War:
Reducing Suicide Risk in Returning Troops, scheduled for October 2007. With unparalleled
experience in the field, VRMC is in a position to jump-start the technological transformation of
healthcare in Europe in ways that enhance all aspects of the goals of the European Commission’s
Framework. We stand committed to helping the commission achieve their goals to improve
the healthcare of all citizens.
... [1][2][3][4] Use of VR interventions has been studied in a wide range of medical conditions, including anxiety, phobias, obesity, chronic pain, and eating disorders. 1,[5][6][7][8][9][10] In recent years, VR technology has become increasingly affordable, immersive, flexible, and portable, enabling its use in a broad range of environments, including the inpatient medical setting. 1,7,11 The capacity of VR to modulate subjective experience makes it a compelling intervention in inpatient medical settings, where VR may offer respite from the confining nature of medical wards, or where it may augment or replace analgesics in pain management. ...
... 1,[5][6][7][8][9][10] In recent years, VR technology has become increasingly affordable, immersive, flexible, and portable, enabling its use in a broad range of environments, including the inpatient medical setting. 1,7,11 The capacity of VR to modulate subjective experience makes it a compelling intervention in inpatient medical settings, where VR may offer respite from the confining nature of medical wards, or where it may augment or replace analgesics in pain management. To date, no systematic review has been conducted on the use of VR in the inpatient medical setting. ...
... 12 VR has been utilized in many studies to distract (often pediatric) patients during wound redressing in burn care, and in exposure therapy for phobias or posttraumatic stress disorder (PTSD) as a substitute for imagination of a feared environment. 7 VR has been used to treat eating disorders and obesity, allowing patients to improve body image perceptions and promote healthier eating habits by inhabiting realistic avatars in stressinducing virtual situations, such as food shopping. 7 VR is also used for patient motor rehabilitation, aiding patients to reacquire specific skills and improve body movement in virtual environments that are less dull or discouraging than standard gym exercises. ...
Full-text available
Objective: We evaluated the evidence supporting the use of virtual reality among patients in acute inpatient medical settings. Method: We conducted a systematic review of randomized controlled trials conducted that examined virtual reality applications in inpatient medical settings between 2005 and 2015. We used PsycINFO, PubMed, and Medline databases to identify studies using the keywords virtual reality, VR therapy, treatment, and inpatient. Results: We identified 2,024 citations, among which 11 met criteria for inclusion. Studies addressed three general areas: pain management, eating disorders, and cognitive and motor rehabilitation. Studies were small and heterogeneous and utilized different designs and measures. Virtual reality was generally well tolerated by patients, and a majority of studies demonstrated clinical efficacy. Studies varied in quality, as measured by an evaluation metric developed by Reisch, Tyson, and Mize (average quality score=0.87; range=0.78-0.96). Conclusion: Virtual reality is a promising intervention with several potential applications in the inpatient medical setting. Studies to date demonstrate some efficacy, but there is a need for larger, well-controlled studies to show clinical and cost-effectiveness.
... A review of the literature was undertaken to identify published reports on the use of VR in pain management Wiederhold (2006) . reported that VR was useful as adjunctive therapy for distraction from acute pain during painful and unpleasant medical and dental procedures. ...
... This includes the use of VR as a distraction intervention in patients with burns, during extensive dressing changes, wound care, physical therapy, lumbar punctures, in vitro fertilization procedures, labor, and childbirth. VR has also been used to help cancer patients cope with chemotherapy-related side effects through distraction activities ( Wiederhold, 2006 ) Garrett et al. (2014) . completed a rapid evidence assessment regarding immersive VR and found strong overall evidence for shortterm pain reduction. ...
Background The management of acute pain in patients with pre-existing opioid tolerance or opioid use disorders presents unique challenges. In light of the concerns regarding opioid use, safe and effective alternatives to opioid medications are of increasing interest. Aims This study was conducted to determine if the use of guided meditation delivered through immersive virtual reality can reduce pain in patients with opioid tolerance or opioid use disorders, including opioid abuse or opioid dependence. Design A quasi-experimental pre-test and post-test study design was used. Settings A 31-bed inpatient orthopedic/trauma unit in the southeastern United States. Participants/Subjects Subjects of the pilot study were hospitalized adults over the age of 18 with pre-existing opioid tolerance or opioid use disorder who were experiencing acute pain. Methods This pilot study examined the effect of a 10-minute guided meditation activity through immersive virtual reality on the reported acute pain of hospitalized adults (n = 11) with pre-existing opioid tolerance or opioid use disorders. The Calm® application on an Oculus Go® virtual reality head-mounted display was used for the meditation activity. Results Before the intervention, the mean patient-reported pain rating was 6.68, and the mean pain score after the virtual reality experience was 3.36. Using the Wilcoxon signed rank test, this was a statistically significant difference (p = .003). Patients were also observed and queried regarding any significant side effects or other incidental findings, none of which were reported. Conclusions This study demonstrates that the use of guided meditation through virtual reality can result in statistically significant reductions in patient-reported pain scores.
... The use of avatars is one of the most recent technological developments [24][25][26][27]. VR has been used to treat obesity by immersing patients in realistic avatars in stressful virtual scenarios, such as grocery shopping, which helps patients improve body image perceptions and encourage healthier habits [28]. The so-called Proteus effect, a phenomenon in which individuals are more likely to perform a certain behavior when they see an avatar of themselves performing that behavior in a virtual environment, has led to more interest in using VR to encourage healthy eating behavior [29][30][31]. ...
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Obesity is one of the world's most serious health issues. Therefore, therapists have looked for methods to fight obesity. Currently, technology-based intervention options in medical settings are very common. One such technology is virtual reality (VR) which has been used in the treatment of obesity since the late 1990s. The main objective of this study is to review the literature on the use of VR in the treatment of obesity and overweight to better understand the role of VR-based interventions in this field. To this end, four databases (PubMed, Medline, Scopus, and Web of Science) were searched for related publications from 2000 to 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). From the 645 articles identified, 24 were selected. The main strength of this study is that it is the first systematic review to focus completely on the use of VR in the treatment of obesity. It includes most research in which VR was utilized to carry out the intervention. Although several limitations were detected in the reviewed studies, the findings of this review suggest that employing VR for self-monitoring of diet, physical activity, and/or weight is effective in supporting weight loss as well as improving satisfaction of body image and promoting health self-efficacy in overweight or obese persons.
... Consequently, Virtual Reality (VR), another emerging technology found a great influence onto several sectors such as tourism, where Beck J. displays its growth and impact on tourism with a comprehensive state of the art study on VR systems and their potential capabilities [1]. Additionally, healthcare has also been a primary point of focus according to Brenda Kay Wiederhold [2], as she investigates the notion of Virtual Medical Centers to improve human performance through careful physiological monitoring during VR therapy and training to eventually reflect the results onto the real world. Far from limitations, Virtual Reality has also been embraced in industrial fields, such as Autonomous vehicles [3] to help avoid risks of physical setups where people could be injured. ...
The integration of technology, namely virtual reality, with arts is implemented in this paper. An observational study is performed by replicating an actual museum by a Swiss-Lebanese artist and having user experience it in a virtual immersive environment. Data is then collected to monitor the user experience and its effects on his emotional and psychological state. This information is used to reflect on future developments and enhancements to elevate the user experience and potentially upgrade it with further advanced technologies.
... These IoMT applications are depicted in (Javaid & Abid, 2020). Virtual reality technology provides an interactive, artificial three-dimensional computer-generated world that simulates physical reality in a virtual setting (Brenda, 2006 Engineering uses ArcGIS Online to track the spread of COVID-19 (Maged & Estella, 2020a, 2020b, WHO also implements ArcGIS ...
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COVID-19 pandemic affects people in various ways and continues to spread globally. Researches are ongoing to develop vaccines and traditional methods of Medicine and Biology have been applied in diagnosis and treatment. Though there are success stories of recovered cases as of November 10, 2020, there are no approved treatments and vaccines for COVID-19. As the pandemic continues to spread, current measures rely on prevention, surveillance, and containment. In light of this, emerging technologies for tackling COVID-19 become inevitable. Emerging technologies including geospatial technology, artificial intelligence (AI), big data, telemedicine, blockchain, 5G technology, smart applications, Internet of Medical Things (IoMT), robotics, and additive manufacturing are substantially important for COVID-19 detecting, monitoring, diagnosing, screening, surveillance, mapping, tracking, and creating awareness. Therefore, this study aimed at providing a comprehensive review of these technologies for tackling COVID-19 with emphasis on the features, challenges, and country of domiciliation. Our results show that performance of the emerging technologies is not yet stable due to nonavailability of enough COVID-19 dataset, inconsistency in some of the dataset available, nonaggregation of the dataset due to contrasting data format, missing data, and noise. Moreover, the security and privacy of people's health information is not totally guaranteed. Thus, further research is required to strengthen the current technologies and there is a strong need for the emergence of a robust computationally intelligent model for early differential diagnosis of COVID-19.
... VR is one of the strategies that have been identified as cognitive-behavioral intervention. These interventions are thought to affect symptoms by changing symptom-related thoughts, diminishing those beliefs that exacerbate symptoms, and increasing personal perceptions of control over symptoms (Anderson et al., 2006;Kwekkeboom et al., 2003Kwekkeboom et al., , 2010Malloy & Milling, 2010).Use of VR interventions has been studied in a wide range of medical conditions, including anxiety, depression, pain, and fatigue that represent four of the most common symptoms present in individuals in many diseases (Chirico et al., 2016;Indovina et al., 2018;Llobera et al., 2013;McCann et al., 2014;Wiederhold, 2006). ...
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In recent years, virtual reality (VR) has become an interesting alternative to traditional exposure-based therapies for many symptoms. VR involves immersion in a computer-generated virtual environment that minimizes avoidance and facilitates emotional processing. The objective of this systematic review is to evaluate evidence on the intervention effect of VR on anxiety, depression, fatigue, and pain. The research strategy of this systematic review included three electronic databases (MEDLINE/PubMed, Cochrane Library, and ScienceDirect) based on predetermined inclusion and exclusion criteria. Published quantitative studies from 2000 to 2020 were identified, which examined the effect of VR intervention on four different symptoms related to symptoms experienced by cancer patients. Quality assessments, data extractions, and analysis were completed on all included studies. A total of 882 titles and abstracts were screened, and 23 studies were included in the review. The studies were grouped according to the symptoms: anxiety and depression, fatigue, and pain. The review showed that VR intervention is more effective compared with the control (i.e., standard care) for anxiety, depression, fatigue, and pain. VR can reduce effectively these symptoms in different contexts and diseases, including cancer. The evidence suggests that there is value in exploring this intervention as a potential crossover treatment for these symptoms in patients. This study contributes to evidence that distraction is an effective symptom management mechanism. The findings are congruent with the theoretical framework, supporting the premise that VR, as an emotion-focused distraction intervention, decreases the severity of these symptoms.
... Yetişkin ( (Wiederhold, 2006). ...
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Teknoloji günümüz çağında hızla gelişmektedir ve bu gelişmenin sağlık alanındaki yansıması kaçınılmazdır. Teknolojinin sağlık alanındaki yansıması cerrahi alanda olduğu kadar standart tedavilerde de kendini göstermektedir. Fizyolojik ve bilişsel tedavilerde teknolojinin kullanımı, elektronik ve dijital ortamların geliştirilmesi ve sağlık alanına daha çok uygulanmaya başlaması ile bariz bir şekilde kendini göstermektedir. Sağlık alanında teknolojinin kullanıldığı alanlardan biri de çeşitli hastalıkların tedavi edilebilmesi amacı ile geliştirilen dijital oyunlar ve beraberinde kullanıldığı cihazlardır. Bu çalışmanın amacı; bilişsel ve fizyolojik destek sistemi olarak dijital oyunların sağlık alanında kullanımını gerçekleştiren deneysel çalışmaların sistematik analizin yapılarak sonuçlarının incelenmesidir. Bu kapsamda 2000-2019 yılları arasında ulusal ya da uluslararası dergilerde yayımlanmış makaleler, konu ile ilgili yapılan lisansüstü tez çalışmaları ve çeşitli kongrelerde sunulan bildiriler çalışma kapsamında incelenmiş, deneysel bir yöntem kullanan ve spesifik olarak bir dijital oyun platformu içeren 21 araştırma çalışmaya dahil edilmiştir. Analiz sonunda elde edilen bulgular tartışılarak oyunların sağlık alanında kullanımına ilişkin bazı önerilerde bulunulmuştur.
... Bu uygulama sezgisel bir anlam ifade ediyordu ve çoğu klinikte bugün%90'ın üzerinde başarı oranına sahip olmuştu. (Brenda K. Wiederhold, 2006) 1.1. ...
Conference Paper
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Sanal gerçeklik (virtual reality - VR), 2014 sonrası iletişim teknolojilerinde üzerinde çok yoğun durulan ve konuşulan konulardan biridir. VR, içeriği tüketmenin sadece yeni bir yolu olmaktan çıkıp, şimdi işletmelerin çoğunun bu konuyla ilgilenmek istediği seviyeye gelmiştir. Sanal gerçeklik (VR), simetrik bir ortamda yer alan, özellikle işitsel ve görsel olan, aynı zamanda dokunma gibi duyusal geri bildirimleri içeren, bilgisayar tarafından oluşturulan etkileşimli bir deneyimdir. Bu sürükleyici ortam, gerçek dünyaya benzer olabilmektedir ya da olağan fiziksel gerçeklikte mümkün olmayan bir deneyim yaratarak fantastik bir ortam oluşturabilmektedir. Artırılmış gerçeklik sistemleri, canlı bir kamera beslemesi üzerinden sanal bilgiyi bir VR gözlüğüne ya da bir akıllı telefon cihazı aracılığıyla kullanıcıya üç boyutlu görüntüleri görüntüleme kabiliyeti veren bir VR biçimine dönüştürmektedir.
... VR simulation is used to distract patients when they undergo painful treatment. VR is also used in treating obesity and eating disorders by promoting healthy eating practises with the help of convincing avatars [3]. Yin et al [4] has instituted that VR technology has no major side effects and is safe for the users compared to the traditional therapy techniques that may cause fatigue. ...
Virtual reality (VR) technology has the potential to make a person experience anything, anytime, anywhere. It has the ability to influence the human brain that it assumes to be present somewhere that it is really not. In this paper, we exploit this application of the VR technology to simulate virtual environments that can help with PTSD therapy for people affected by trauma due to accident, war, sexual abuse and so on. Several sensors are used to gather the user movements on a motion platform and replicate it in the virtual environment with the help of a Raspberry Pi board and Unreal Developer’s kit. It has flexible interfaces that the clinician can modify the virtual environment according to the requirement for the patient.
... In particular, in VR, we can simulate many situations that it is difficult to control in our real life without excessive cost, and treat patients in a manipulable way within a safe environment. Under these conditions, VR is considered as a promising tool which worth exploring numerous valuable healthcare applications for medical therapy, preventive medicine, surgical procedures, rehabilitation, medical education and training, and so forth [14]. ...
Conference Paper
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Relaxation techniques can relieve us from stress, anxiety, pain and maladies. Many researchers succeed in relaxing subjects by various methods. However, few concerned about the ability of relaxation. Hence, the main goal of this study is to help people relax faster. We developed a virtual reality neurofeedback relaxation training system, called Virtual Sophrologist, which 1) immerses users in fantastic environments by a Virtual Reality headset, 2) guides users to follow the Sophrology instructions by a female voice, and 3) displays feedback in real time, which are translated from the Meditation Score collected by EEG. To evaluate this system, we recruited 6 subjects to participate in our 8-session relaxation training and collected their subjective data (by self-report) and objective data (by EEG) to measure from psychological level and to calculate the Time Interval to Relaxation that they took to reach the maximum Meditation Score. The results show 1) decreases in Anxiety and Depression Score from the psychological level, 2) a decrease in Time Interval to Relaxation and 3) an increase in the maximum Meditation Score. Therefore, our system will be useful as a training tool for users who need or want to relax fast and deep whenever they need.
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