The Oculus Rift – Changing Virtual Reality for Healthcare

Posted in Research and Development by Chris Wiltz on July 17, 2013

Video gamers are raving about the new Oculus Rift virtual reality headset, and researchers are finding it ideal for healthcare applications. 

Don't worry if you haven't heard about the Oculus Rift. It probably just means you're not a video gamer. But there's reason for the excitement that goes beyond shooting aliens and fighting mythical creatures.The virtual reality (VR) headset has been making inroads into healthcare and has found footing as a therapeutic device.

The Occulus Rift (image courtesy Oculus VR)
The idea behind using VR for healthcare is to completely immerse patients in a computer-generated world where they can undergo therapy and training in a safe, artificial environment controlled by a clinician. In a keynote speech at The Games for Health Conference held in Boston in June, Palmer Luckey, the founder of Oculus VR, the company behind the Rift, talked about the potential of VR technology. He says the greatest advantage is that VR makes you feel present in a space. “Rather than controlling something on a screen you can be present in a virtual space and control everything in a natural way,” Luckey says. “[We can] introduce sensations that are very hard, if not impossible, with traditional games. You're trying to actually tap into the fact that if you trick the brain into thinking something is real, then it treats it as if it is real.” This enables Rift users to experience a variety of sensations such sense of space and scale, sensations of falling, and more. Research has shown that VR makes it easier to evoke emotions in users as well, whether it be positive emotions like happiness and exhilaration or negative ones like fear and panic.
It's this ability to evoke strong emotion that has made the Rift a staple in Skip Rizzo's virtual reality therapy (VRT) research. Rizzo, a clinical psychologist and associate director for medical virtual reality at the University of Southern California's Institute for Creative Technologies (a research group Luckey was once a member of), works to implement VR into a variety of clinical psychology applications – most prominently enhancing what is known as exposure therapy to treat soldiers with PTSD. “Evidence-based treatment for PTSD in the traditional format asks the patient to close their eyes and imagine the kinds of things they're traumatized by,” Rizzo explains. “They imagine it, narrate it in the first person, and usually try to do it in a progressive fashion. The principle of this is real meat and potatoes. The idea is that as you confront the fear memories you'll feel some anxiety, but in the safety of the clinician's office. Eventually anxiety tends to extinguish as you become habituated.”
In 2003 Rizzo and his group began creating a virtual simulation using assets from the Xbox war simulation game Full Spectrum Warrior – rendering a VR combat exposure environment that could give clinicians control over patient exposure. The program, Virtual Iraq, has since been adopted by several military medical centers and 55 veterans affairs clinics in the United States. Having realtime control over every aspect of the simulation, from time of day, weather conditions, and even ambient sound, allows clinicians to create simulations for a variety of experiences be it driving a Humvee down a desert road or mountain pass or even re-creating an IED explosion or insurgent attack. By pacing the exposure in a much more controlled fashion and in a way that engages the user, clinicians can control the progression of therapy. Studies have shown that VRT is effective in significantly reducing PTSD symptoms and studies are currently underway to compare its effectiveness with more traditional approaches.
The Oculus Rift running a PTSD Therapy System
To understand what's so special about the Rift you really have to go back decades. VR was all the rage in the 80s and 90s among technophiles because of its ubiquity in science fiction, thanks to authors like William Gibson. VR has been used in various applications from gaming to automotive design for years and has even been used in high-end medical applications long before gaming. But this doesn't come without a hefty price tag and being a literal pain in the neck. Annette Mossel, a PhD candidate, research assistant, and lecturer at the Interactive Media Systems (IMS) Group at Vienna University of Technology in Vienna, Austria, talks about some of the challenges of implementing older VR headmounted displays (HMDs). She says previous HMDs were large, cumbersome and uncomfortable to wear for extended periods. What's more, the field of view (FOV) was often not so much immersive as it was like standing very, very close to your television. Turning your head, rather than mimicking the real thing, involved a delay of several milliseconds – not a large amount of time, but certainly noticeable when you're shifting your head and waiting for the world to catch up with your head movement. “First, this limits the amount of immersion and hence the feeling of presence,” Mossel says. “Furthermore, with those HMDS, you needed to move your head to see the entire volume in VR that you would see in reality without any head movement (horizontal and vertical). This limits the capabilities for VR training scenarios, where this 'artificial' head movement cannot be provided due to patients' impairments or time constraints.” Mossell adds that older VR HMDs offered a wider FOV (150°), but at a very high price that many institutions cannot afford.
The Rift, by contrast, is lightweight and adjustable enough that even patients with glasses can wear it. “The Rift is a first approach to offer a low-cost headmounted display that offers great horizontal and vertical field-of-view combined with HD resolution and is comfortable to wear,”Mossel says. The device features HD quality video resolution, the lowest latency seen in VR yet (ensuring little to no lag in head movement tracking), and a wide field of view (90° horizontal, 110° vertical) covering a patient's entire field of vision without head movement. It's good enough to create what is reportedly the strongest immersion experience seen in VR, all at a price point circling $300 - competitive with most consumer electronics.
“The big selling point is the built in trackers,” Rizzo says. “[Oculus VR] found a low-cost tracking system that picks up pitch, roll, and yaw. With modification, for the cost, you've got a godsend for clinical VR applications.” With the Rift, exposure therapies like Rizzo's can become even more effective, and be provided at a lower cost. Rizzo is hoping the lower price will allow him extend the Oculus Rift into other VR applications like his virtual classroom project, which creates a simulated classroom experience for testing children with ADHD and monitoring how well they can pay attention. “Focus groups said the VR classroom was too costly,” Rizzo says. “But here comes the Oculus. It's going to be a a part of the digital homestead like a smart TV or game console. The Oculus will occupy a similar niche and it'll be a standard tool for gamers.”
Mossel works extensively with IMS in VR and augmented reality (AR) research. She first discovered the Rift after Luckey invited her to test an early prototype last August. In 2012, her research group published a paper, "Virtual Reality Training for Upper Limb Prosthesis Patients" which explains how VR/AR technology can be used to train and rehabilitate amputee patients receiving prosthesis. IMS developed a motion capture system that tracks an amputee's arm and head movement in three dimensions within a virtual environment. By combining this tracking data with electromyography to generate input for grasping controls for a virtual prosthesis, researchers can create a realistic training simulating for familiarizing patients with their prosthesis. “No other technology offers a way to realistically mimic the real world while proving the user with an intuitive environment,” Mossel says. “Our recent medical VR training tool demonstrates this in a great way, since the patient has the possibility of realistically learning how to control his prosthesis even if the prosthesis is not yet manufactured.”
Researchers at Vienna University of Technology are using the Oculus Rift to train prosthesis patients.
Oculus VR is currently selling PC-compatible developer kits for the Rift for $300 and plans to release a consumer version, featuring higher-resolution displays, in the near future at a similar price point. Amidst so many emerging applications Luckey still cautions enthusiasts to remain realistic. “VR is still in its infancy,” he said in his keynote. For instance, Mossel says now even with the Rift functioning as a heads up display, the setup for such an immersive environment where the person can walk around is still very extensive, takes time, and is sensitive.
Rizzo adds that VR technology will also never replace the expert human component. “There's nothing magic about virtual reality, it doesn't fix anybody. It's simply a tool that a well trained clinician uses to extend their skills and have more impact on patients when it's called for,” he says. “Exposure therapy, I believe, in its most effective form is not a self-help approach. You need a clinician that's well trained in exposure and knows how to pace the rate of exposure so you don't push the patient too far.”
Still, as more devices are looking like consumer devices and gamification becomes a buzzword among medtech developers, it's not surprising that the multi-billion-dollar video game industry is driving medical innovation. Rizzo says, “Thank God for the gaming industry because there's a giant market that's driving the mass production of these tools that we're going to swoop in and use for clinical tools where immersion is relevant.”

-Chris Wiltz, Associate Editor, MD+DI 

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