Four years ago, Michael Heinrich was riding his motorcycle on
the University of Michigan campus when a rotted tree fell on him and snapped
his neck, causing him to permanently lose use of the lower half of his body. He
spent weeks in intensive care and then went to inpatient rehabilitation for
more than two months,
اضافة اعلان
About halfway through his rehab stint, his occupational
therapist, Michael Blackstock, asked whether he was interested in trying
virtual reality for his therapy. Heinrich, now 26 — who is returning for his
master’s at the university — was game.
“What I really enjoyed was being an eagle trying to go through
rings,” he said, describing a virtual reality experience. “From an emotional
standpoint, coming off an injury where I lost the majority of the use of my
body, Virtual Reality (VR) pushed the boundaries of what I thought was
possible.”
Virtual reality, long used for gaming, has, over the past
several years, moved into the health field for such things as pain management
and relieving post-traumatic stress disorder.
And now researchers and therapists say it has shown great
promise for physical and occupational therapy.
“I’ve been through Physical Training (PT) for various injuries,
and you know, sometimes I get home and I’m sort of like, well, I forget exactly
what I was supposed to do,” said Brennan M. Spiegel, a professor of medicine and
public health and director of health services research at Cedars-Sinai Medical
Center in Los Angeles. “How am I supposed to set up my body for this? And also,
do I have the motivation to do it right now? And VR can help both of those,
both by reproducing precisely what that physical movement is supposed to be and
hopefully providing some additional motivation to do the exercise.”
Using virtual reality for rehabilitation was growing before the
coronavirus pandemic for a variety of reasons, including rapid advances in
hardware and software technology and a younger generation of practitioners more
comfortable using such technology. But the greater acceptance of telehealth
during the pandemic has further spurred its use.
For one thing, it’s simply a lot more fun than traditional
rehabilitation exercises. And “VR has this uncanny ability to kind of nudge the
human brain in ways that other audiovisual media cannot,” said Spiegel, who is
one of the foremost experts on the use of virtual reality in health. “The bottom
line is it motivates us to do things that we might not be able to do.”
That’s what Pamela Pleasants, 59, found when she started doing
virtual reality therapy for an injured shoulder. An associate dean at an
independent school outside Boston, she learned that she was eligible to get
virtual physical therapy, which she did through a company,
XRHealth.
She did an intake over a video call with a physical therapist
provided by the company, and then the VR headset arrived in the mail. Based on
the intake, the therapist decided what applications — out of eight currently
offered by the company — that Pleasants would use, as well as for how long and
how frequently, and then trained her how to use them.
The therapist could also adjust all the settings within a program.
For example, when Pleasants found the range of motion in one application caused
her too much pain, the therapist adjusted it lower. The patient can change
programs either using a controller or by eye gaze.
She loved the different programs, especially Balloon Blast,
Pleasants said, which consisted of popping balloons with a virtual sword in
each hand.
“In the background was how high my range of motion should be,”
she said.
Pleasants also found the programs geared to reduce stress, such
as a guided meditation while walking through a forest, very useful for her
shoulder and mental health. She continued meeting her physical therapist on
video calls semiweekly.
“After four months, my shoulder felt tremendously better,” she
said.
XRHealth is one of the few companies focused on providing VR
physical and occupational therapy at home; based in Boston, it is covered by
many insurance programs in Massachusetts and nationally by Medicare. The
company is working to get more insurance companies to cover its services.
Without insurance, people can pay $179 monthly for the headsets and two
physical or occupational therapy appointments monthly from a panel of
therapists the company provides.
The company has all of its programs registered with
the Food and Drug Administration (FDA),
said Eran Orr, founder and chief executive.
Not all the programs offered for VR rehab are games; some
clinics allow a patient to virtually practice real-life skills they may have
trouble doing, such as grocery shopping or dishwashing.
To really push the use of virtual reality for physical and
occupational therapy, “we’ll need to build a body of evidence that shows it’s
effective, how we pay for it and how we can develop it in a way that’s easy to
use,” said Matthew Stoudt, chief executive and a founder of Applied VR, which supplies
therapeutic virtual reality. “We have to be able to demonstrate that we can
bring down the cost of care, not just add to the cost paradigm.”
While research specifically on VR use in physical and
occupational therapy is in the early stages, an analysis of 27 studies,
conducted by Matt C. Howard, an assistant professor of marketing and
quantitative methods at the University of South Alabama, found that VR therapy
is, in general, more effective than traditional programs.
“Does it mean VR is better for everything? Of course not,” he
said in an interview. “And there’s a lot we still don’t know about VR rehab.”
Much of the research uses small samples with varying degrees of
rigor, and more needs to be studied about how a patient’s activity in the
virtual world translates into improved performance in the physical world, said
Danielle Levac, an assistant professor in the department of physical therapy,
movement and rehabilitation sciences at Northeastern University. Levac
researches the rational for using virtual reality systems in pediatric
rehabilitation; many of the children she works with have cerebral palsy.
“We have to consider the downside of a lack of one-on-one
contact with therapists,” she said. “I view VR as a tool that has a lot of
potential, but we should keep in mind it should fit in — and not replace — an
overall program of care.”
Robert Ferguson, a neurorehabilitation and therapeutic
technology clinical specialist at Michigan Medicine, which is part of the
University of Michigan, has treated numerous patients over the past four years
doing in-hospital VR occupational therapy.
In fact, his first patient to use virtual reality was Heinrich,
who made him realize the potential of VR to get patients to move in a way they
— and their therapists — didn’t think they could. But, he said, clinicians must
be well-trained on how to use the technology in the most helpful and effective
way.
While older people — who are more likely to suffer from strokes,
Parkinson’s or simply falls, that will require physical or occupational therapy
— may seem less able or more hesitant to use such technology, Ferguson and
others say that typically isn’t the case.
“We’ve treated people from 18 years old up to 90,” he added.
And in fact, VR therapy has been shown it can be particularly
helpful for those with Parkinson’s and other central nervous system disorders.
And he has repeatedly found that people have unknowingly done
things while using virtual reality that they didn’t think they could. He
remembers a patient in his 50s whose leg had been amputated. He couldn’t
balance when trying to do seemingly simple movements, such as pulling up his
pants.
The man was a hunter, and Ferguson suggested he try a virtual
reality program involving bow hunting. As part of the program, the patient was
standing on one leg “and changing his center of gravity all over,” something he
had not been able to do in regular therapy.
“When we showed him the video, he said, ‘I can’t do that,’
Ferguson recalled. “We said, ‘you just did.’”
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