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Walter Greenleaf - presentation for med vr webinar - June 2020
Virtual and augmented reality (VR/AR) technologies have the potential to significantly impact healthcare by enabling objective assessments, improved interventions, and more effective training. VR/AR can address major health problems costing billions annually such as chronic pain, smoking cessation, and post-traumatic stress. Current medical applications of VR/AR include surgical training, rehabilitation, pain distraction, and treatment of conditions like PTSD, anxiety, and phobias. VR/AR holds promise for advancing prevention, healthcare access, and medical education.
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Walter Greenleaf - presentation for med vr webinar - June 2020
- 1. Walter Greenleaf PhD TranslatingVR Research Into Medical Impact
- 2. The Stanford Laboratoryfor Brain Health Innovation and Entrepreneurship VR-IT Stanford Virtual Reality Immersive Technology Clinic Academic Affiliations
- 4. Healthcare Crisis: Aging Populations 0 50 100 150 200 250 300 350 400 19001910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2015 2020 2025 Age 85+ Age 75-84 Age 65-74 Age 45-64 Age 5-44 Under Age 5
- 5. Transforming HealthCare withTechnology
- 6. Digital Health Revolution • MobileHealth / eHealth • Machine Learning • Wearable Sensors • Patient Centered • Leverages Internet: social, quantitative, collaborative
- 7. • Prevention andWellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery Digital Health technology will significantly impact Medical Care
- 8. Every Medical DeviceReinvented
- 9. Entering the Eraof Medical Wearables
- 10. Digital systems arenot just measuring the physical parameters of our health. New methods are being developed that will allow us to collect and analyze biomarkers that reflect our cognitive and emotional status. Here are four examples… Brain Health BioMarkers - Passive Data from Smart Phones Voice Analytics as a BioMarker of Depression Facial expressions in response to a VR Challenge Cognitive function assessment using AR and smartphone sensors
- 11. Digital Health Platformsdeliver interventions to patients, and parse data for enhanced analysis and improved protocols
- 12. Prescription Digital Therapeutics CombinationTherapy - Digital Health Platform App-based system designed to enhance medication efficacy Medication with clinical benefit Prescribed combination product with enhanced efficacy =+
- 13. Medical Applications of VirtualReality & Augmented Reality (XR) Technology Digital Health Revolution
- 14. XR Technologies Currently Disrupting Education& Training Manufacturing Maintenance Product Design Process Design Healthcare Simulation & Modeling
- 15. • Prevention andWellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR Technology Impacts All Sectors of HealthCare
- 16. Acute Pain Addiction Medicine ADHD Anxiety Management Autism Spectrum Disorder ChronicPain Cognitive Assessments Depression Disability Solutions Emergency Medicine Medical Education &Training Ophthalmology Orthopedics Palliative Care Patient Education Phobias PTSD Physical Medicine and Rehabilitation Preventive Medicine Respiratory Medicine Senior Care Stroke & TBI Surgical Procedure Planning Surgical Skill Training Uncomfortable Procedure Mitigation More Than 200 Emerging Medical VR/AR Companies Targeting Multiple Clinical Sectors and Specific Indications
- 17. Significant Investment inXR for HealthCare The Medical VR / AR Market is projected to be $5.1 B in 2025
- 18. Medical XR CanAddress Several Key Problems Annual cost of problems in the U.S. alone: WEIGHT LOSS $289B SMOKING CESSATION $528B ADDICTION $181B CHRONIC PAIN $635B POST TRAUMATIC STRESS $300B Stroke & TBI $86B Alcoholism $223B Autism $126B
- 19. Conferences and IndustryOrganizations Extreme Innovation in Healthcare
- 20. The Neuroscience ofHow VR Promotes Behavior Change VR can promote behavior change by taking advantage of the way our brain’s learning and reward systems function Activate neuroplastic change via reward systems Shorten the reward feedback loop – show progress Leverage mirror neuron systems VR systems can:
- 21. VR is MoreEffective than Imaginal or In Vivo Exposure Techniques VR exposure floods the visual thalamus and cortex, activating both subcortical, threat detection and response pathways as well as cortical, conscious pathways In this manner, VR exposure therapy is more effective than imaginal exposure therapy - it activates both exposure/cognitive processes and threat extinction processes. In vivo exposure is inconvenient, expensive, time- consuming, difficult to standardize, difficult to monitor, and imposable to provide in a graduated or controlled manner. Sensory Inputs Sensory thalamus -> amygdala path -> (non-conscious) Sensory cortex -> PFCvm -> amygdala path (conscious) HPA Axis
- 22. Ability to changeattitudes and behavior after “being” one’s future self. Leveraging Mirror Neurons
- 23. Addition Mechanisms ofImpact Active Involvement: XR systems provide users with immersive experiences that maximize cognitive engagement. Feedback: learning is reinforced by direct, immediate and relevant feedback that reinforces the experience and the lessons learned. Engaging and Motivating: the dynamic nature of VR/AR systems provides users with agency and can provide immediate rewards for progress. Team Training: Multiuser experiences can provide and leverage group skill building. Cost Effective: XR systems extend the reach and reduce the cost of face-to-face training. Novels Theater Film Games AR/VR
- 24. Wired for NarrativeStories Research shows that STORY: • Provides superior retention (memory and recall) • Provides improved understanding • Creates context and relevance • Creates empathy • Promotes engagement and participation • Enhances the creation of meaning and personal relevance
- 25. • Prevention andWellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR technology will significantly impact Medical Care
- 26. • Clinical SkillTraining • Surgical Skill Training • Interpersonal Skill Training • Use of Equipment and Tools • Team Training - eg: Emergency Department, Surgical Team • Emergency Response Training and Rehearsal • Facilitate Empathy Medical Training
- 27.
- 28. Anatomy and PhysiologyTraining • Response to the acute shortage of human cadavers • Allows for repetitive training and self-study • More detailed examination of micro- features of organs, tissue etc. • Integration of text, video and other media to further enhance learning
- 29. Virtual Patients forClinical Skill Training
- 30. Preparation and Trainingfor Difficult Situations
- 31. • Prevention andWellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR technology will significantly impact Medical Care
- 33. • Medical ImageReview • Neuropsychological Assessments • Activities of Daily Living Assessments • Physical Medicine – OT / PT • Behavioral Medicine – psychology, psychiatry DIAGNOSTIC ASSESSMENTS
- 34. Standardized Environments forNeurocognitive Evaluation New Approaches for Cognitive Assessment Migrates traditional paper and subjective evaluations to a more sophisticated level. Provides robust assessments that can challenge cognitive skills in a more natural, standardized, objective and reproducible manner.
- 35. BioMarkers - Cognitiveand Emotional State Collecting and analyzing emotional and physical responses in VR
- 36.
- 37. We use braincircuit biotypes to connect brain imaging with VR Neuroimaging measures 1. Scan brain at rest 2. Emotion regulation task 3. Cognitive control task Virtual Reality: 1. Relaxing scene 2. Emotion regulation task 3. Cognitive control game
- 38. We envision aprecision health model using VR to elicit biotypes to help refine the intervention choices Cognitive training TMS Eliciting biotypes using normed environmentsHeterogeneous Disorder Quantify and refine biotypes Relaxation Negative Scene Positive Scene Cognitive Game 1st line Antidepressants Mindfulness-based. TMS Non-drug and new drug options Matching biotypes to the intervention “menu” Default Mode Negative Affect Positive Affect Cognitive Control
- 39. With corresponding ratingsof arousal, emotional valence, and other measures A Public Database of VR Environments
- 40. • Prevention andWellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR technology will significantly impact Medical Care
- 41. Some Examples –VR and AR in Use Today
- 42. Preoperative Planning &Image Guided Surgery
- 43. Stroke and TraumaticBrain Injury Physical / Occupational Therapy New Approaches to Physical Medicine & Rehabilitation
- 44. New Approaches toMental Health
- 45. VR for PainDistraction Clinical Research and Validation Interactive virtual environments significantly reduce pain from as much as 44% during the most painful procedures (ex: burn wound treatment) Diverts patient attention away from perceiving and feeling pain; (selective attention theory) Decreases pain-related brain-activity Reduces need for anesthesia, opioid medication No pharmacological side effects
- 46. PTSD, Phobias, AnxietyDisorders • Exposure-based treatments can be conducted in the safety and comfort of an office setting • Effective tools for treating a variety of clinical problems, in particular anxiety and addictive disorders • Fully immersive environments, with include the use of a head mounted display, 3D sound, tactile stimulation via shaking platform, and olfactory stimulus are used for PTSD therapy
- 47. RISK AVOIDANCE TRAINING Refusalskill training, Situational Confidence
- 48. ! Generalized AnxietyDisorder ! Phobias ! Obsessive Compulsive Disorder ! Anger Management ! Eating Disorders ! Schizophrenia Virtual environments are used clinically to treat several important mental and behavioral health problems
- 49. • Social AnxietyDisorder • Depression • Chronic Pain • Mild Cognitive Impairment • Autism Spectrum Disorder • ADHD Virtual environments are used clinically to treat several important mental and behavioral health problems
- 50. Multiple Programs -One Platform DTx Programs BALANCE Foundation Mindfulness Relax Regulate Chronic Pain Acute Pain Relief Addiction General Wellness Programs Stress + Rx Adherence + Efficacy Anxiety / Depression Acute + Chronic Pain Cloud-based System Dynamic Experience Biometrics Service Social VR Engine*Analytics Permissions & Security
- 51. Virtual Hospital ToursUsed To Relieve Pre-procedure Anxiety
- 52.
- 53.
- 54. • Improve CognitiveFunction • Promote Exercise & Weight Management • Stress Management • Mood and Resilience HEALTH AND WELLNESS • Disability Solutions • Addressing Isolation • Grief Counseling
- 55. Ability to changeattitudes and behavior after “being” one’s future self. Have a Dialog With your Future Self
- 56.
- 57. XR - AKey Component Combination Therapy - Digital Health Platform XR system designed to enhance medication efficacy Medication with clinical benefit Prescribed combination product with enhanced efficacy =+
- 58. Digital Health Platformsdeliver interventions to patients, and parse data for enhanced analysis and improved protocols
- 59. Acute Pain Addiction Medicine ADHD Anxiety Management Autism Spectrum Disorder ChronicPain Cognitive Assessments Depression Disability Solutions Emergency Medicine Medical Education &Training Ophthalmology Orthopedics Palliative Care Patient Education Phobias PTSD Physical Medicine and Rehabilitation Preventive Medicine Respiratory Medicine Senior Care Stroke & TBI Surgical Procedure Planning Surgical Skill Training Uncomfortable Procedure Mitigation More Than 200 Emerging Medical VR/AR Companies Targeting Multiple Clinical Sectors and Specific Indications
- 60. Acute Pain Addiction Medicine ADHD Anxiety Management Autism Spectrum Disorder ChronicPain Cognitive Assessments Depression Disability Solutions Emergency Medicine Medical Education &Training Ophthalmology Orthopedics Palliative Care Patient Education Phobias PTSD Physical Medicine and Rehabilitation Preventive Medicine Respiratory Medicine Senior Care Stroke & TBI Surgical Procedure Planning Surgical Skill Training Uncomfortable Procedure Mitigation Considerable Activity
- 61. Acute Pain Addiction Medicine ADHD Anxiety Management Autism Spectrum Disorder ChronicPain Cognitive Assessments Depression Disability Solutions Emergency Medicine Medical Education &Training Ophthalmology Orthopedics Palliative Care Patient Education Phobias PTSD Physical Medicine and Rehabilitation Preventive Medicine Respiratory Medicine Senior Care Stroke & TBI Surgical Procedure Planning Surgical Skill Training Uncomfortable Procedure Mitigation Relatively Underdeveloped – Significant Opportunities
- 62.
- 63. Current technologies andconcepts are founded on more than 30 years of research and development Recent changes in cost and access make digital health technology affordable Digital Therapeutics for Medicine After years of study and use by early adopters – validated systems are poised to move to the mainstream On the horizon - enhanced, ubiquitous, informative and integrated Digital Therapeutics are currently used for - prevention, evaluation, treatment, and chronic disease management
- 65. Improved Assessments andDiagnostics Addressing Isolation and Loneliness Acute and Chronic Pain Depression and Anxiety Disorders Physical and NeuroRehabilitation Design for Disabilities Post-Discharge Follow-up Staff Training: not just procedures, but empathy Digital Therapeutics for Senior Care
- 66. Walter Greenleaf PhD TranslatingVR Research Into Medical Impact