Gaming to health care-virtual reality in physical rehabilitation | Christopher Rhea | TEDxGreensboro



you [Applause] from 2008 to 2009 I was in graduate school studying a very simple task walking now walking is a fundamental skill the practically everybody on earth figures out how to do within the first year of life however walking is incredibly complex if you think about all of the pieces that are involved your body is made up of 206 bones over 600 muscles and millions of nerves and neurons and all of those pieces have to work together in order to keep you from falling down and falling is that one of the leading causes of injuries in the United States so we did a lot of work trying to figure out how do all these pieces talk to each other in order to reduce fall risk now as I was studying this in grad school the story got very personal for me I saw my father fall for the very first time and many of you in the room can attest to the feeling of the very first time you see your parents in a vulnerable situation it shakes you to the core now I knew my father was human and eventually aging would catch up to him I wasn't ready to see it my parents were high school sweethearts got married right after high school had me one year and 15 days later so I had the privilege of growing up with rather young parents and my father was always available to play outside with me of course he was much bigger and stronger than I was but he always let me put up a challenge this combined with the fact that my father worked a manual labor job led me to see my father as a larger-than-life figure someone who was strong full of wisdom and could do anything he set his mind to now the first time I saw my father fall that shook me to the core I wasn't ready to see that but it's inevitable and it happens so aging combined with some numbness in his feet that stem from back surgery a couple of decades ago I knew would eventually catch up with him and it did now I'm happy to report that my father has lived a relatively injury-free life since then he's figured out how to cope with the numbness in his feet to walk around without having more false but not everybody has that luxury I ask you to perform this thought experiment with me close your eyes now imagine all the sudden your ability to walk was taken away how would you get out of this auditorium how would you cross the street how would you walk up the stairs in your home now open your eyes I ask you to perform that thought experiment with me because all of the activities that just described are called activities of daily living if your ability to do them is diminished or even taken away that can severely change how you interact with the world and it also can change your quality of life so we'd studied in graduate school all of the pieces of the body how it all works together ultimately so we could better understand how to reduce fall risk and enhance quality of life and one way we could potentially do that is through the use of virtual reality now you may be wondering how a scientist that studies how we walk around without falling over ultimately ends up using virtual reality to keep us from falling down well in graduate school we weren't just studying fall risk what we're actually studying is how when humans walk around the world they use visual information to control their walking behavior now I presume all of you walked into this building today without running into each other or into a wall but how did you do that as someone was approaching you on the sidewalk you didn't stop and say okay you go this way and I'm going to go that way you didn't do that we don't have that verbal communication when you're moving throughout the world what you did was you look to see well what direction are they going how fast are they going where's the edge of the hallway okay I'm going to choose this path and we use that visual information to ultimately drive our walking behavior so that we don't run into things or trip on things and ultimately reduces our fall risk so we did a lot of studies in graduate school trying to figure out how do we use this visual information ultimately to control our walking behavior this is when the lightbulb went on for me what if we could control the visual information coming into the system to ultimately get the desired motor output what if we could put someone in virtual reality have them interact with that virtual environment and ultimately use that to drive their walking ability so this is what led me to a two-and-a-half year postdoc in a virtual reality lab where I studied how we can merge virtual reality and physical therapy together now virtual reality is simply an environment in which the user can interact with it's a computer-generated environment and we can make that computer-generated environment to be whatever we want it to be in this particular example we've created a virtual road and some virtual Cooper minis were imported into that road and they just zoom up and down that road and your job is to cross that road so this is just one example of how we can create a virtual environment and there's lots of different ways in which virtual environments have been shown or can be shown to the user one way is through the use of a big projection screen in front of a treadmill and as the participant is walking on the treadmill that virtual environment is moving toward them in this case a virtual hallway so it sort of feels like they're walking through this virtual hallway now this is somewhat realistic because it kind of feels like you're interacting with the virtual environment but in your periphery you can still see the room isn't moving that virtual environment is so it's somewhat realistic if we want to make it even more realistic we can use a headset such as the one here in the picture this headset allows the user to see the virtual environment through the lenses but there's sensors in that headset and those sensors update the virtual environment as you move around so you take a step forward that virtual environment comes at you as you take a step backwards that virtual environment moves away it feels like you're inside the video game this can now have a whole lot more applications because you're truly immersed within this virtual environment now researchers have long had a pipe dream of using virtual reality within a clinical setting but one of those barriers is the cost and another one is the bulkiness the cost of the headset that you see here in the picture is the first headset that we purchased for our research laboratory six years ago cost thirty seven thousand dollars it's more than a lot of new cars so this was never something that was going to be widely accepted in a clinical community the cost and price point was just too high so how in the world can we use virtual reality than for physical therapy if we have these barriers well luckily there's been some acceleration in the virtual reality community in the last several years and that acceleration has been fueled by Facebook the first tour the social interaction company social media company Facebook has been on the leading edge of social interaction since its inception and they've always been looking for new ways that they can have their users socially interact and one way that they think that this may happen in the future is you put on your headset in your home and you put on your headset in your home and poof you're in the same virtual environment having a social interaction now this was not going to work if we had $37,000 headsets out there this isn't something that was going to be widely adopted but Facebook was thinking about this several years ago at about the same time there was a company in California called oculus VR and that company had the goal of creating headsets for the masses primarily for the gaming industry and they created a product that was starting to catch a lot of people's attention so in 2012 they had a Kickstarter campaign and raised 250 million dollars for their headset company yeah a lot of people took notice of this including Facebook who was thinking about using social interaction but they needed a deliverable and a headset that more people could use two short years later Facebook purchased oculus VR two billion dollars in 2014 Facebook at that point jumped headfirst into the virtual reality community there are a lot of other large companies that were thinking about how they could use virtual reality for their users primarily for the entertainment industry so what that caused was a acceleration across a large number of companies to say Oh Facebook's in here they're Greeks they're doing their research and development we need to get into it too and many of you may have seen a lot of the commercials Samsung and some other companies of how they use their own headsets for their entertainment purposes in fact the smartphone many of you have in your pocket can be used as a headset these days so depending on the resolution fidelity so forth there's lots of options and the price point has significantly dropped the price point for headset this headset was $37,000 the price point for headsets these days I'll show you an example here in a moment is on the order of hundreds of dollars six short years virtual reality has become a reality for us now virtual reality then two or three years ago as the headset industry was developing was still primarily used in the gaming industry so think about how the typical gamer experience goes it's a user sitting on a couch with a controller and they're staring at the TV screen and that TV screen has their virtual character running through the virtual environment and they're controlling that with the headset or thick controller now through the use of a headset that puts that user inside the video game they are literally seeing everything from a first-person view in the early versions you still had to control your movement with a controller like you see here in the picture but at least it made it a more immersive experience you weren't just staring at a TV screen off in the distance now there's been advancements even in the last year that have made this even more realistic the gaming experience no longer necessarily feels like a game but a truly immersive experience and that's through technology that has motion capture cameras small little cubes that you can put on opposite sides of your living room those cubes track exactly where you are with your headset so once you put on your headset if you walk forward those cubes now up he just went forward better update that virtual environment and it does it all in real time what this is done is turned your living room into the game you can now move around in a virtual game and more dynamically interact with some of these characters and the controllers that you see in the picture here are also linked up to that virtual environment so you as you are in virtual reality you see your virtual hands and those controllers even have small little tactile sensors basically little vibration mechanisms in them so if there's a little virtual dog that is jumping around at your feet you can bend over and pet that virtual dog your controller will vibrate this immersive experience has really been changed and accelerated to make it a much more realistic experience because of the advancement in the entertainment and social media industries we're now at a place where we can start thinking about repurposing this technology to address human health challenges if you think back to the previous picture we researchers were long thinking about using this but the headset was too big and too bulky too expensive the headset you see in the pictures eight hundred bucks down from thirty seven thousand dollars six or short years ago it's also portable comes in the size of about a briefcase so we're no longer constrained of just being in the laboratory we can go to the patient we no longer have the burden of the burden of that patient coming to us so this opens up a whole new world of ways that we could virtually train people one of those ways that we started using virtual reality to retrain people is through showing an avatar on a projection screen and that avatars in a virtual environment and we control how that avatar walks and when the participant is walking on the treadmill we ask them to play the same game many of us played in kindergarten follow the leader so whatever that avatar does you do your best to mimic those motions and we've had stroke survivors come into the laboratory to participate in these experiments because stroke survivors commonly have an asymmetrical walking pattern one leg one leg lags behind the other sometimes and one of the goals of physical therapy is to make their walking patterns more symmetrical which helps reduce fall risk so we control that virtual environment we can make that avatar have an asymmetrical walking pattern but not quite as asymmetrical as the patient this gives that patient a visual prescription of what we want them to do but also an attainable behavior that they can slowly move their beat their pattern their walking patterns to toured as the patient gets better and becomes a little bit more symmetrical then we take that avatar and make it more symmetrical so it's the carrot in front of the horse model where we're always giving the patient and attainable task but we slowly bring them along to have them walk more symmetrical this is an example of the utility virtual reality we can make it do whatever we want to tailor our rehabilitation to the patient population of interest this opens up a world of possibilities for us to think about precise and individualized medicine for a variety of different populations another way that we've used virtual reality through this projection screen system is we've created virtual obstacles for the participants to step over and these are primarily for people who are at a higher risk of falling so we teach them to step over these virtual obstacles as they're doing this training in virtual reality now these aren't just virtual reality isn't just useful in a physical rehabilitation context but can be used to address a wide range of human health challenges it's been used to overcome phobias such as public speaking there are companies out there that have created mock-ups of auditoriums for people that have a phobia of speaking and for in public the public and then what they do is they put on the headset and have 200 avatar staring at you as you walk around this is a way to overcome that stressor it's also been used in other areas such as veterans who have PTSD there's a group that has created virtual Iraq and it's for veterans that are part of an immersion therapy program in which they slowly get immersed back into virtual Iraq to desensitize them to that stressor so across a wide range of human health challenges virtual reality can be adopted to help address those problems now all of those examples that I described to you were primarily done in the research laboratory until recently but because we have these new affordable and portable systems we can now dream about getting out of the laboratory however there's one missing piece here there's one missing piece that if we ask someone to get better at the game and they do does that matter and the answer that is no I don't really care if the patients that we're working with get better in the game that's not the end game for me the end game for our research team is does it transfer to the real world because if it doesn't transfer that change in behavior doesn't transfer to the real world then what are we doing and why are we doing it so there's the next phase of experiments that have been looking at this retraining and virtual reality and then looking at transfer to real-world behavior in our lab and a number of other labs have looked at this and I'm happy to report to you that there are studies now showing that if we retrain you how to walk over virtual obstacles that transfers into how you walk over real obstacles and the real world so we now have a system where we can retrain behaviors in a very precise and specific way and in a safe way so that we can transfer it to the real world and ultimately reduce fall risk it also offers the opportunity to more dynamic research projects and when we ask people to do these more activities of daily living so in this case going back to the example of crossing the street this is a game that we created called human Frogger many of you may remember the old arcade game called Frogger where you had to get a frog across the street before he got run over by a car that's an activity of daily living a lot of us probably did before we walked into this building but it's a challenge J activity for a number of patient populations and so with human Frogger we put on a helmet we put you at this street intersection and your job is to cross the street now if a patient has a real challenge in walking we can make that a single lane road with a virtual car moving really slow but if it's a more advanced patient then we can make an eight Lane superhighway and virtual cars going all over and said good luck okay so it gives us a really unique way to test functional capabilities and mobility across a variety of populations so where do we go from here I've taken you through the historical development of this and we're right on the precipice of repurposing virtual reality to address human health challenges there's an effort right now across the North Carolina system all the schools in the UNC system to link up the virtual reality labs that all are addressing human health challenges and these are folks in computer science and kinesiology and physical therapy and biomedical engineering and others we now have the ability to link up these labs so we can address human health challenges in a very unique and synergistic way and ultimately address human health challenges at the grandest level in ways that we've never thought about before so I ask you to consider participating in these experiments if you hear about them virtual reality is no longer this futuristic tool it's here and the future of your health may rely on it thank you

2 comments

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