Virtual Reality Turns Games Into Treatments

Joe O'Connor, 62, who lives near Worcester, Mass., was diagnosed with Parkinson's disease six years ago. Exercise is one of the only things that slows the progress of the chronic disease, so he works out avidly -- often in a virtual reality world. He dances. He plays tennis. He enjoys games that help him work on his short-term memory and hand-eye coordination. "VR has been a very big help with Parkinson's, both in slowing the progression and in helping me calm down," O'Connor says.

Virtual reality has been around for years to help treat physical ailments and improve mental health, but it took lighter, less expensive headsets that could be used without a computer for VR to really take off. The headsets can now cost hundreds instead of thousands of dollars. Primarily used in hospitals and clinics, virtual reality is quickly segueing into the home and senior center market where VR programs enhance physical therapy, help combat acute and chronic pain, and potentially address a variety of mental health challenges, including post-traumatic stress disorder. The programs consist of games and scenarios that headsetwearing patients manipulate either through hand-held controllers or eye tracking, and the technology has become more lifelike and interactive.

A patient's progress or lack thereof can be tracked in real time and through data sent to a doctor or therapist's computer. "This is by no means a substitute for humans, but 99% of your life is far away from the examination room," says Brennan Spiegel, director of health services research at Cedars-Sinai Medical Center in Los Angeles and a leading expert in the use of VR to treat pain. "We're trying to augment the 99% of your life spent away from therapists."

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Virtual Reality as a Pain Management Tool

Unlike simple video games, virtual reality immerses the player in a 3D world, nudging the brain in a way other audio-visual media can't, Spiegel says. But unlike ordinary VR games, these specially tailored health programs are designed as treatments.

Some applications can lessen acute pain by distracting a patient and reducing the person's perception of time. Patients who are transported virtually to glacial lakes, forests or outer space become calmer when their attention is diverted. Some games are custom-made for pain relief. For example, players of SnowWorld, which features a snowy scene, score points by throwing snowballs at snowmen, penguins and other animals. Studies of burn victims undergoing wound treatment found that these patients reported significantly less pain while playing the game. Even women in childbirth who were immersed in virtual reality reported a 20% reduction in the perceived length of time they had been in labor, Spiegel says. One study that allowed patients to reduce their own painkillers and sedation during colonoscopies found that those using VR needed substantially less sedation than those who didn't, he adds.

Programs that distract the patient are good for acute pain. For chronic pain, "it's about building skills," including how people experience and perceive pain, he says. "We can't cure arthritis or cancer, but we can profoundly change how you think about it."

Because chronic pain often leads to depression and anxiety, VR treatments train patients to regulate discomfort through breathing exercises, mindfulness, relaxation and education about how pain is processed in the body, says Matthew Stoudt, CEO and founder of AppliedVR, a Los Angeles-based company that supplies therapeutic virtual reality. Stoudt anticipates that doctors will start prescribing the company's eightweek program to address chronic lower-back pain by late next year for patients to use at home. His company is working with several health plans to get VR therapeutics covered by insurance. "For VR to be successful, it has to be easy for the patient to use, engaging and affordable," Stoudt says.

The technology shows great promise, but unless insurance covers it, even middle-income patients will have little access, says Urmimala Sarkar, a professor of medicine at the University of California, San Francisco. VR content also has to work for different people, she says. "For example, the image of a crackling fire while camping in the woods is soothing to me," she says, "but if someone had experienced war or violence, the sight and sound of fire might evoke very different emotions."

Virtual Reality as Phyiscal Therapy

VR games are also useful for getting players to move in beneficial ways while, for example, bursting balloons with a sword or tracking a dragon as it flies around a medieval city. Someone who needs help with gait training might explore a mountain town virtually. Although the patient is just walking in place, it feels as if they are going up and down, says Veena Somareddy, CEO of Neuro Rehab VR, a company in Fort Worth, Texas, that builds immersive software for physical and occupational therapy.

The idea is for the VR game or activity to be far more engrossing than ordinary physical therapy so that people are more likely to do it regularly at home. Plus, while playing, patients may reach up or twist in a way they were afraid to before because they are so intent on the activity that they forget their fear of pain.

Patients who have suffered a stroke or brain injury can use virtual reality to practice specific tasks, says Skip Rizzo, director of medical virtual reality at USC Institute for Creative Technologies in Los Angeles and a research professor in psychiatry and gerontology. Through VR, users can be placed in a restaurant-like scenario, where their cognition is tested based on their responses to orders for certain items.

Another scenario is "buying" at a virtual store, where users must find a certain brand or product. The activity tests the brain and gradually increases the person's flexibility; as people get better, they're asked to grab items from higher and lower shelves. "You have to do something functional, but it keeps it fun and engaging," Rizzo says. "We're doing what people have done forever with paper and pencil, but it's gamified and it gives performance feedback."

Although adults 65 and older may be reluctant to try VR, once they do, "they have the largest reduction in pain compared with younger individuals," Spiegel says. One reason is that older people may have lower expectations of the technology than young adults and are more wowed when immersed in a virtual world.

Boston-based XRHealth is one of the few companies that currently provides VR occupational and physical therapy to patients at home. Initially, the company worked with AARP to design programs suitable for older participants, and now the average age of its customer is 72. Prospective patients meet remotely with a therapist first -- the company employs a stable of them around the country -- to ensure that the therapy is the right option. If so, the company sends the headset to the patient's home, where in another remote session the therapist teaches the patient how to use the headset. Different programs, which are registered with the Food and Drug Administration, can be prescribed depending on the patient's needs.

Health insurance now covers the cost of the therapy in XRHealth's home state of Massachusetts, but Medicare also pays for a certain number of sessions nationwide, says Eran Orr, the company's founder and CEO. The hope is that by the end of the year insurers in 10 states will cover it, he adds. Otherwise, the cost, including the rental of a headset, ranges from $69 to $119 weekly, depending on how frequently you see an online therapist. If you complete the prescribed number of sessions and want to continue on your own, you can rent the headset for $29 a month. "About 5% of users start and say, 'It's not for me,' but for most it's very successful," Orr says. The company is also branching out into mental health programs for VR.

O'Connor, the VR user with Parkinson's and a former XRHealth customer, says the programs helped him with balance and gait, but he was knowledgeable enough about virtual reality to work on his own.

Bringing VR therapy into senior centers, which is just beginning to happen, Somareddy says, could not only boost new types of therapy and pain relief but also new ways to stimulate the brain. Rizzo says his 89-year-old mother, who lives with him, used one of his VR headsets to visit a foreign city she remembers fondly. "It whisked her right back to when she and my stepdad went to Rome," he says. "It pulled up all these positive memories."