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This time last year, visitors to Mobile World Congress 2016 in Barcelona remarked on the sudden prevalence of virtual reality (VR) tech on many of the stands.
Then, memorably, Samsung brought the technology to global attention when it enlisted Facebook’s Mark Zuckerberg for a viral demonstration at the launch of its Galaxy S7 handsets.
Consumer virtual reality is all well and good, but in the 12 months since Samsung’s PR stunt, most of the VR headsets that were given away free with new smartphones have gone largely unused, treated as a curiosity for a few weeks before ending up in a cupboard.
More attention is being paid to the idea of augmented reality (AR), which like its more immersive VR cousin had a viral moment in the summer of 2016 when millions took to the streets to hunt and collect cute little animals in the hit AR game Pokémon Go.
It would probably be fair to say that VR is walking a long path to widespread acceptance and use, but even if consumers aren’t yet doing much with it beyond playing video games, the technology continues to advance at pace, and is finding new use cases in many fields.
Some of the most interesting applications, and perhaps the most relevant to society, are to be found in the field of healthcare.
Once upon a time, Wendy Powell of the University of Portsmouth worked as a private chiropractor, but she returned to academia to take a degree in computing and IT, which she followed up with a doctorate in creative technologies, for which she studied walking behaviour in VR.
Now reader in VR at the university's School of Creative Technologies, Powell conducts extensive research into the use of VR and interactive technologies for health and well-being, and regularly represents the Institute of Electrical and Electronics Engineers (IEEE) on VR topics.
“My key interest is physical rehabilitation and how we can leverage VR tech for physical rehabilitation. There are a wide variety of different applications there,” she tells Computer Weekly.
A wide field of research
As previously explored during the early stages of her research, a great deal of Powell’s work to date has centred on the use of VR for stroke patients, using certain properties of VR, such as the ability to change where people see their hands moving, to regain control of their movements.
Stroke patients can also benefit from programmes that help them simulate basic tasks that may have to be relearned after an attack. This could include boiling a kettle safely, with no risk of scalding oneself, says Powell, or relearning how to cross a road in an environment where there is no danger of being struck by a vehicle.
VR is proving to be of similar use in fields such as physiotherapy, where it is being used to make mundane exercises a little more interesting for patients.
“If you can gamify exercise in VR, where your movements are tracked and get feedback, the patients are more actively engaged”
Wendy Powell, IEEE
“If you have to get somebody to do a specific exercise 100 times, it’s incredibly boring, and as soon as the patient starts to feel a bit better, they stop doing it,” says Powell.
“If you can gamify the exercise in VR, where your movements are being tracked and there’s feedback from those movements, the patients are more actively engaged.
“That’s only part of it,” she continues. “If you go away and do 100 repetitions, you might have done them really badly, but if you’re doing it inside VR and using full-body tracking at the same time, you can look at your performance over time.”
Amputees use VR to visualise phantom limbs
One of the most interesting areas of research for VR practitioners in the healthcare sector is to help amputees manage their conditions. Statistics show that over 90% of amputees continue to “feel” their absent limb as if it was still there, a condition known as phantom limb.
People experience these sensations in a number of different ways, such as tingling, itching or twitching, or even trying to make a gesture. However for many amputees the experience of having phantom limb is overwhelmingly painful. It is very common for patients to be on very strong doses of medication to manage that.
Using visualisation to reduce the pain is one technique that has gained some traction, but this is quite difficult to do and depends a lot on the ability of the patient to internalise and believe that, for example, a reflected image of a complete limb in a mirror box is their own.
However, researchers are now beginning to understand that there is actually something about VR that reduces pain.
Trials with amputees have shown that by using electromyography (EMG) – a diagnostic technique that detects the electrical potential of muscle cells when they are activated – muscle movements made in the amputee’s upper arm, for example, in an attempt to control and move the absent forearm can be rendered in a VR environment.
“So if I use the upper arm muscles that clench my fist, the EMG reads the intent to clench the fist, even if there is no fist. We can use that to clench an animated fist, so that when they have the headset on they can see the animation,” says Powell.
“This is what we call visuo-motor feedback. The patient connects the loop back and tells the brain that the hand is okay and they can move it. That seems to be a very powerful tool not just to reduce pain, but to allow the patient to mentally let go of some of the problems of having a missing limb.”
Obviously, amputees cannot spend the rest of their lives in a VR environment, but Powell envisages that in the future, once prescription protocols for VR are properly developed, people may use it a couple of times a day to help them manage their pain without needing to fall back on powerful drugs. This would, however, require extensive clinical trials.
VR is still an unknown quantity
Powell is at pains to point out that there are still many other unknowns when it comes to VR. She compares its development to something like a drug trial being conducted in reverse. “We’ve found a drug that works, which is called VR,” she says, “but what we don’t know yet are the ingredients, or precisely how it’s working.”
The need to find out exactly VR reduces pain is an urgent one. Functional magnetic resonance imaging (FMRI) scans of the human brain do indeed show that the pain sensors of the brain do indeed dull their activity when the patient is in VR, Powell explains, but the jury is still out on why this should be the case, or at what level of the brain it is being driven.
In physiotherapy work, the very fact that VR is being used to change how people are behaving means there can be other negative effects. Powell compares it to the early days of the Nintendo Wii games system, when there was a brief fad for exercise games, such as Wii Tennis.
However, players very quickly discovered that they could trick the system to win more easily by swinging from the wrist – instead of from the shoulder as a tennis player would. This caused a lot of cases of repetitive strain injury (RSI).
“Yes, you can use VR and experiment with it but you have to be very aware that it changes how people behave and lets them cheat – because patients cheat and VR doesn’t stop them from doing that,” says Powell.
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The other, more publicised problem with VR is that it can make users feel slightly nauseous, which is not ideal when they may already be ill. In the early days of VR, this was largely a hardware issue, with graphics taking too long to render if the user moved their head too quickly. This problem has largely been developed out now, but others have taken its place.
“One is what we call accommodation convergence conflict, which sounds terribly complex but really it’s that VR is tricking my eyes into thinking that you’re sitting over there but the screen I’m looking at is here, so my eyes are focusing on a screen here but trying to interpret you as being further away,” says Powell.
“That conflict between where my eyes are actually focusing and where they’re virtually focusing can cause eye strain as well, so that’s one issue we haven’t solved yet. Some of that is about good VR design and where you get people to look.
“Most of the cyber sickness problems now are either core design or the conflict between what you expect to feel and what you actually feel. So if I’m sitting in a motionless chair and in VR I’m hurtling down a rollercoaster, I’m going to feel sick because I’m not moving and yet everything in my vision is.”
As an example, one demo tried at Portsmouth saw Powell being “floated” around a VR Roman villa environment, an experience she found very nauseating because it gave her the sensation of moving without actually physically moving.
One way to solve this could be to build moving elements into the external environment, such as a vibrating chair like you might find in a fairground flight simulator. Meanwhile, inside the VR villa the user’s avatar could be being carried around in a litter chair, and both the external and internal stimuli would match up. Of course this would be very expensive, so in practice it is more likely that the problem will be solved through closer attention to VR scenario design.
“If designers can match the narrative to their input technique, it’s much better,” says Powell. “If the user is sitting, have the VR narrative have them sitting, or teleport them instantaneously. Don’t make them walk as an avatar if they’re in a chair.
“There’s a lot of research being done on this. The IEEE VR conference is doing a great deal of technical underpinning research to look at things like stable horizons and frame of reference; things we can use to reduce nausea.”
VR finds acceptance among patients and doctors
Nevertheless, Powell has found that, whether it is being used to help elderly people learn exercises to keep active and remain in their own homes; to make sure people with broken bones keep on top of their physio; or to help amputees relieve their pain, VR is being well accepted across the board.
“When I was first using VR, there was an inherent bias where I expected elderly people in particular to be very resistant, but they actually often engaged with it very well as long as was not complex or cumbersome,” she says.
“That’s why mobile VR excites me, because were using that with people in their 80s and above who put a headset on and there are no wires, there’s nothing to worry about catching their hands, it’s not uncomfortable, and they just engage with it.”
Amputees, particularly those with injuries sustained during the wars in Afghanistan and Iraq, tend to be even more enthusiastic. Young and otherwise fit people don’t want a lifetime of taking morphine or other similar drugs to manage their pain; they prefer to be as drug free as possible.
“A lot of them will say ‘I will try anything, literally anything that can solve my pain.’ One of them told me ’if I could stick it in a fire to get rid of it I would, if I could have it amputated again I would’,” says Powell.
“So when you find something that’s not just helpful but is actually quite fun too, people get pretty excited. The pain can be intense. But where you can repurpose something like VR to help, why wouldn’t you try it?”
Clinicians, too, are increasingly open to the power of VR in healthcare, says Powell, much more than they were in the past, because the technology has advanced to the point where all you need to use it is a smartphone and a headset.
“It’s another tool for doctors to use, and they want everything they can get to help their patients manage their pain,” says Powell.
“If they have another tool in their armoury, particularly one they can send patients home with like mobile VR, that helps with pain management and improves quality of life for their patients, then they will try it.”