This blog is a condensed version of a longer report that discusses the neuroscience behind VR, and shows that VR is effective in healthcare because it broadly engages multiple learning and performance systems in the brain in synchrony. We discuss four specific uses cases in healthcare where we see VR providing the greatest good.

These include:

Patient and healthcare provider education and training: medical procedure and device training, hospital familiarization, and empathy building

Senior care and caregiver support: education and training around cognitive, emotional and physical changes with normal aging and dementia, empathy building

Mental health, therapy, and addiction: PTSD, depression, substance abuse and addiction

Pain management: alternatives to opioids or during painful medical procedures like venipuncture, or cancer treatment rehabilitation

Why is VR Effective? It’s All in the Neuroscience

“Learning is an experience. Everything else is just information.”

Albert Einstein

This quote from Albert Einstein is supported by the neuroscience of learning and performance, and is the primary reason why VR is so effective in healthcare. As outlined in Figures 1 and 2 below, the human brain is comprised of at least four distinct learning systems. As Einstein so eloquently stated, experience is at the heart of learning (and performance). The experiential system has evolved to represent the sensory aspects of an experience, whether visual, auditory, tactile or olfactory (Figure 1). Every experience is unique, adds rich context to the learning and is immersive.

Figure 1.The Experiential and Cognitive Learning Systems

Figure 2. The Emotional and Behavioral Learning Systems

The cognitive system is the information system (Figure 1). It processes and stores knowledge and facts using working memory and attention. Critically, these are limited capacity resources and form a bottleneck that slows learning with more information coming in and available to the learner. This system is slow to develop with age, begins to decline in middle age, and is adversely affected by anxiety, stress and pressure. Despite the processing limitations, developmental changes, and susceptibility to stress and anxiety in this system, much of our traditional training relies almost exclusively on this system. This explains why so much training is ineffective and time-consuming.

The behavioral system in the brain has evolved to learn motor skills (Figure 2). This is an amazing system and one that builds the “muscle memory” needed to achieve goals. Processing in this system is optimized when behavior is interactive and is followed in real-time (literally within milliseconds) by corrective feedback.

The emotional learning system in the brain has evolved to provide rich motivational and emotional context and to train situational awareness (Figure 2). Situational awareness is about nuance, but nuance that is vital to success. Whereas one can have all of the facts and figures available, and can have a strong behavioral repertoire, in the end one has to extract the appropriate information and engage the appropriate behavior in each distinct situation. One needs to know what to do, and when.

Although each of the four learning systems in the brain are distinct, they all reside within the same brain with massive, dependent interconnections. In nearly all healthcare situations information needs to be stored and retained (cognitive), motor skills must be perfected (behavior), situational awareness must be strong (emotional), and all of these must be present within the relevant work context (experiential). In other words, ideally all four learning and performance systems in the brain should be activated in synchrony. (Learn more)

VR Applications in Patient and Healthcare Provider Education and Training

Satisfied patients understand their medical needs and upcoming medical procedures because their healthcare provider offers high-quality education and training tools. Healthcare providers with satisfied patients are the providers who know how to impart knowledge effectively on patients, and critically have the people skills needed to put patients at ease throughout their care journey. Without high-quality education and training, patients feel ill-informed and lack confidence, all of which breeds stress, anxiety, and mental and physical discomfort before, during, and after the point of care.

Unfortunately, the overwhelming majority of both patient education and provider training is done through reading text, viewing Powerpoints, or watching videos. These load only on the cognitive skills learning system in the brain when a better approach would be to broadly engage experiential, cognitive, emotional and behavioral learning systems in the brain in synchrony.

VR meets this need.

Immersive VR experiences can be developed to educate patients on particular medical conditions such as diabetes, high cholesterol, or congestive heart failure, to name a few. VR can be used to train patients on how to check their blood sugar levels, or how to operate and manage a colostomy bag, insulin pump, or home dialysis machine. VR achieves these aims by immersing the patient in a relevant experience. Patients can “virtually” see the heart in action or see the kidney and its role in the renal system. Patients can be guided through the steps needed to care and maintain a colostomy bag or insulin pump first-hand.

Similar VR experiences can be used to train healthcare professionals. Imagine learning anatomy and physiology from a virtual cadaver that allows you to see the image from any perspective with each body part being identified when you touch it. The ability to generate a 3D dynamic representation of the human body in your head, will be much easier when the training tool offers a 3D dynamic virtual representation. Empathy and people skills training is ideally suited for VR because the healthcare professional can “walk a mile in the shoes” of a patient, and experience the healthcare environment from their perspective. (Learn more)

VR Applications in Senior Care and Caregiver Support

By 2030, 25% of Americans will be 65 or older (U.S. Census). These statistics suggest a growing need for senior care professionals, with thedirect care workforce expected to grow from 4.4 million to 5.8 million–an increase of 30%– from 2016 to 2026. This places a heavy burden on staffed senior care facilities to recruit, onboard and train direct care workers to meet the complex needs of seniors. The question becomes: how can we do that in a way that is at once complementary to existing methods, while also more consistent, accessible, scalable and available on-demand?

Senior care education and training are ripe for the application of modern technologies like virtual reality (VR), which broadly engages multiple learning systems in the brain in synchrony by transporting learners into realistic situations. What better way to understand how a candidate might react in a challenging scenario; or to help guide new and experienced hires through the rigors of caregiving? VR can be fruitfully applied at every stage of the caregiver’s journey: from recruitment to onboarding and continuous training for the direct care workforce.

VR can be used to enhance frontline senior care recruiting efforts for the direct care workforce. Imagine having a recruit put on a VR headset and experience a “Day in the Life of Caregiving” where they watch the rules being followed or broken — along with the consequences for each path taken. Users might shadow a seasoned professional who is mitigating a fall, or experience the many challenges associated with memory loss. They might also have VR experiences that emphasize communication, responsiveness, and empathy by allowing the recruit to “walk a mile in a senior’s shoes”. Learners can obtain a first-person virtual experience with an apathetic or non-communicative frontline worker, or obtain a first-person virtual experience of the senior’s frustration when a frontline worker states that they will “only be a minute”, but don’t return for ten to twenty minutes. Recruits who are not “cut out” for this kind of work will choose a different line of work, or perhaps will not be hired in the first place. Those who are ultimately hired will have a better understanding of what to expect and show higher levels of confidence. The hiring professional can rest assured that the frontline worker is prepared and that the residents will receive excellent care.

VR can also be used during the onboarding process. This can begin with a virtual tour of the facility to familiarize the learner, through experience, with the layout of the facility. During the virtual tour, standard operating procedures that are most relevant in a given location can be described by the CNA tour guide. During the tour the new recruit can witness a challenging situation between two residents or between a resident and a CNA. The recruit can observe as a seasoned CNA diffuses the situation, then offers the recruit tricks and tips on how to mitigate similar situations that they might face. The new recruit can even experience an emergency situation and observe the seasoned CNA follow the emergency protocols in a calm and methodical manner.

 

VR can also be used for ongoing training. A series of VR experiences focused on dementia and memory care, sundowning, and physical changes associated with normal aging could be utilized. All of this training can be accomplished in a familiar, safe environment for the learner, which not only results in better prepared hires, but also goes a long way towards demonstrating an organization’s commitment to its employees. (Learn more)

VR Applications in Mental Health, Therapy, and Addiction

Mental health issues are a serious problem in the United States.  Over $200 billion in lost earnings per year are due to mental illness, such as depression or PTSD. Substance abuse and addiction are also a serious problem in the U.S, and often co-occur with mental health disorders.

Although anyone suffering from mental health disorders or addiction should seek professional help from medical professionals and mental health experts, we believe that tools like VR show great promise for mitigating mental health problems, facilitating therapy, and for “unlearning” addictive behaviors.

A growing body of research suggests that VR can complement therapy in many positive ways. VR is available 24/7 so could complement daily or weekly in-person therapy sessions. If one is feeling depressed or anxious, they can don a VR headset and be transported to their favorite beach or to a forest landscape with soothing music in the background. Many mental health disorders are associated with feelings of isolation. With VR one can visit with friends and family in real time in virtual spaces, and feel that connection. VR therapy sessions are also growing in prevalence.

Applications of VR for PTSD and anxiety disorders are growing as well. For example, a PTSD patient can be slowly habituated to anxiety and stress provoking environments but within VR. The “unlearning” of perseverative behaviors like rumination, anxiety and stress require multiple exposures to anxiety provoking situations. VR offers a perfect tool to address the need for multiple exposures because it is available 24/7 in almost any location. The number of mindfulness, relaxation, and mediation related VR experiences is also growing.

VR also holds great potential for addressing addiction. With VR you can put the user in any context that you like. Imagine incorporating VR into the rehabilitation process by transporting an addict into a virtual environment that shares many of the contextual cues associated with their typical “using” environment. Now imagine incorporating some of the behavioral extinction or unlearning procedures, commonly utilized during rehabilitation, into this virtual environment. Since the addict is in a virtual environment that is similar in context to their “using” environment, true unlearning of the addictive behaviors within this virtual “using” context could take place. By incorporating VR environments that share many contextual cues with the using environment into the rehabilitation setting, true unlearning is more likely to occur. Unlearning requires many exposures, but VR offers a perfect tool to address this need as it is available 24/7. (Learn more)

VR Applications Pain Management

The two most common approaches to pain management are the “grin and bear it” approach and a broad range of pharmacological approaches. Fortunately, a third option is on the rise, and in many cases it relies directly on VR. VR offers a great tool for addressing problems of acute and chronic pain management by putting patients in a rewarding virtual context that distracts them from the pain. Significant progress has been made on a number of fronts worth highlighting here.

With respect to acute pain management in children, especially around immunizations and venipuncture, much progress has been made. Solutions that address the more challenging problem of chronic pain, such as those involving back pain, cancer recovery and rehabilitation, or for burn victims during dressing changes continue to be explored and tested. Despite significant challenges, progress is being made. Patients have been able to reduce, and in some cases cease completely, their reliance on addictive drugs like opioids. Applications for pregnant women while in labor are being explored to reduce the need for and reliance on epidurals.

Summary and Future Directions

The use of VR technology in all aspects of healthcare is increasing. We outline four use cases that have grown significantly in the last several years. In all cases, the success of VR can be attributed to the way in which it engages the user’s brain. The success of VR applications in patient education and healthcare provider training, senior care and caregiver support, and mental health, therapy, and addiction are all grounded in the fact that VR broadly engages experiential, emotional, cognitive and behavioral learning systems in the brain in synchrony. The majority of other tools and technologies recruit only cognitive systems in the brain, and are thus much less effective. In pain management, VR has the capacity to transport an individual from the pain that they are experiencing to another place where they do not experience the pain. Whether activation in pain centers is reduced, or whether the user is simply being distracted, the outcome is a reduction in pain.

The future of VR in healthcare is bright, and we look forward to being a part of this future – one experience at a time. (Learn more)

Find the full 5-part Promise of VR in Healthcare series here.

About Blog Writer :

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Tim Fitzpatrick

CEO at IKONA Health

https://pages.ikona.health/main

Todd Maddox

Learning Scientist at IKONA Health

https://pages.ikona.health/main