Augmented, Virtual and Mixed – The Changing Realities of Healthcare

Imagine being able to see your own heart pumping outside your body. To cross-section it and check for any irregularities, then spin it around to look at it from different angles. To watch the steady pumping action that you know is keeping you alive. No, you’re not having an out-of-body experience or going through intensive surgery. It’s just a routine check-up with your doctor, who’s using augmented reality to get a real-time, accurate visualisation of your internal organs.

What are the different ‘realities’ available to us now?

  • Augmented Reality (AR): Think Pokemon GO and you’ve basically got the idea. AR overlays virtual objects, like pokemon, on the real-world environment. A quick experiment you can try to experience AR for yourself is by using Google’s AR Search function here.
  • Virtual Reality (VR): Unlike AR, VR immerses you in a fully artificial, digitally created environment. It’s like you standing in your room but looking around at the summit of Mount Everest. A device like the Oculus headset is needed for you to view and interact with the virtual environment.
  • Mixed Reality (MR): A combination of AR and VR, MR ventures into Ironman and JARVIS territory. MR starts off with a physical space and places virtual objects into the space, like AR, but goes one step further by allowing you to interact with the objects, like VR. The first minute of this Microsoft Hololens demonstration should give you a good idea of how MR works.

How are these being applied to healthcare today?

To learn more about some of the technologies available on the market, we visited Silver Wings, a company specialising in AR and VR, for a brief peek into what a digitally enhanced future might look like. Silver Wings provides AR and VR solutions across a multitude of different industries, and were kind enough to give us an overview of AR and VR as well as allow us to experience some of their programmes and gadgets.

1. Medical Training

Medical training using VR

As healthcare professionals ourselves, this was an area we were keen to explore. From learning where different organs are situated in the human body to surgical simulations, AR and VR will definitely play big roles in the future. The ability to experience in first-person something you would not get to do yourself is a vital experience.

We got to try out a mixed reality program on the Hololens for human anatomy, where a projection of a human body appears in front of you, complete with virtual labels. The ability to look into a human body, or walk around it to identify placement of organs is an important and useful one, especially when it comes to diagnosis of medical conditions. NUS’ Yong Loo Lin School of Medicine also employs a VR program called Virtual Interactive Human Anatomy, with self-narrating modules to delve into our human physiology. Back in school, we were given the opportunity to learn anatomy from examining cadavers, or ‘silent mentors’, to understand how everything fit into our human bodies. However, as these were in short supply, we were not able to have a truly individualized experience, which AR or VR programmes like this could offer.

Another AR program similar to the Human Anatomy Atlas allowed us to pick up a holographic heart and study it from multiple angles. We could also increase or slow the heart rate to see how the heart responded. Seeing how the atria and ventricles inside of the heart worked to pump blood around the body really brought the subject to life, and we couldn’t help but wonder how much easier biology classes would have been if we had access to these models. Another benefit of AR rendered models is that the model itself is digital, and can be easily manipulated without being damaged by clumsy hands. One memory that stands out from anatomy class other than the eye-watering smell of formaldehyde was when my own heart skipped a beat after a preserved heart I was holding slipped out of my hands and bounced purposefully down the length of the table before coming to a rest in front of my mortified professor. 

2. Pre-Surgery Preparation

Explaining surgical procedure using VR

It’s natural to feel anxious before any procedure, especially since most of us are not doctors ourselves and don’t know exactly what goes into each surgery. A local clinic in Singapore has started pioneering the use of VR to guide patients through their surgeries in detail. This use of immersive visual techniques allows the doctor to explain the process step by step and the patient to have a concrete understanding what the procedure will entail. This also gives them the chance to ask their doctor important questions to set their minds at ease before undergoing surgery.

3. Reduction of Acute Pain During Procedures

Although its mechanisms are not fully understood as of yet, VR has been shown to calm and reduce the pain felt by patients during painful procedures such as treatment of burn wounds, chemotherapy and dental procedures. VR is also being considered for use in routine medical procedures for children like blood draws and vaccinations, to reduce the unpleasantness and fear associated with them whilst increasing their cooperativity at the same time. It is possible that the immersive VR environment distracts our brains from the pain signals being sent, causing us to feel less pain. One example of a VR distraction program is SnowWorld, which allows users to glide through a snowy 3D canyon whilst flinging snowballs at virtual snowmen, igloos, robots and penguins.

4. Rehabilitative Therapy

Rehabilitation using VR

Rehabilitative exercises can be a much more engaging process with the use of VR and AR. One area where VR-based games and exercises have been used is in post-stroke rehabilitation. Patients who participated in the VR rehabilitative exercises reported greater improvement in activities of daily living. For patients with chronic pain requiring physical therapy, the interesting VR-based games also increased their motivation to comply with the prescribed exercises. We can imagine why! Picture yourself cycling through the beautiful rolling meadows of France or along the Great Ocean Road, taking in the extraordinary scenery, all from the air-conditioned comfort of a stationary bike in your own home. We’d cycle for hours too!

5. Mental Health

With everything that has happened in the past year, our mental wellbeing could really use some tender loving care. There are a variety of VR and AR apps that are aimed at reducing stress and helping us to relax. They include the use of soothing ambient music or sounds and natural landscapes. Google Earth even has a VR version that allows you to go on a (free) breathtaking tour around the world and relax in remote locations. Aside from this stress-reducing function, VR has also showed promise in remote counselling sessions for patients with mental health conditions. The unfortunate stigma that still surrounds mental health in our society means that many people who need help don’t dare to seek it out in person. VR offers an opportunity to speak to a psychiatrist or therapist as an avatar, which can increase openness and engagement between patient and healthcare provider.

6. Specific Phobias

Exposure therapy is a method often used to help people overcome the anxiety associated with a phobia. For example, if you are deathly afraid of cockroaches, a therapist might ask you to look at pictures or videos of cockroaches first. Then, they could ask you to hold a toy cockroach, before sitting beside a live cockroach. The final step would ideally to be able to hold a live cockroach. This gradual increase in the level of exposure allows the patient to gain control over their fear. However, it can be very expensive or downright dangerous for exposure to certain phobias, such as fear of heights. AR and VR have allowed therapists to craft exposure intensity and sessions in a safe and controlled environment. Virtual public speaking sessions or conversations can be held in VR for the patient to practice speaking and overcome social anxiety. AR spiders or snakes can be created to give exposure without harm to both the patient and the creature.

As we were a bit skeptical about how realistic a VR environment could be in contributing to the exposure therapy, we were given a brief taste using an Oculus headset of how it might feel for someone with height phobia to be exposed to heights in a game similar to Richie’s Plank Experience. In this pretty well-known game, you take an elevator up to a high floor of a building and then walk out onto a plank to retrieve some cake (because that’s a totally logical place for cake to be).

Using VR to overcome phobias

We have to say, perception is reality indeed. As someone who isn’t even afraid of heights, the moment the elevator doors went ‘ding’ and opened, a sense of vertigo kicked in and I felt my body immediately stiffen as my legs quivered a little. The surround sound of the wind and helicopters whirring overhead contributed to the whole experience, as the visual signals sent to my brain persuaded me into believing that there was empty space on either side of the plank and that falling off it was a no-go. After some rational thinking and convincing my brain that there was in reality solid ground on both sides of the plank, it still took a lot of courage (and a desire to ‘save face’) to step off the plank to the side. Once my foot touched the carpeted floor of the office and not empty air, the illusion created by the VR program was broken and my senses recalibrated to where I was really standing, even though in VR I was plummeting down toward the ground.

Skepticism erased, we can now attest to the fully immersive power of VR.

7. Disease Awareness

Understanding disease condition using VR

It can be difficult to empathize with someone who has a medical condition because we are unable to experience it for ourselves. This makes it hard to understand their actions or why they behave in certain ways sometimes. In Singapore, the Alzheimer’s Disease Association has developed a VR programme, Enabling EDIE, to allow caregivers to understand what it’s like for people with dementia so that they can better care for them. Sensory-perceptual changes and challenges not apparent to us, such as perceiving a carpet as a hole in the floor, are revealed in the VR experience. Autism is another condition which VR is helping to shed light on, as sensory stimuli such as lights and sounds that could not otherwise be accurately experienced are conveyed through VR. Improving understanding of these conditions leads to greater empathy for others, which is always welcome in a world that could do with a little more kindness.

In addition to the AR, VR and MR technologies we currently have, we can look forward to even more enhancements for healthcare in the future. Remote consultations and examinations, AR-assisted surgeries, early detection of diseases, the list goes on and on. Healthcare as we know it might soon be a thing of the past, and science fiction could become reality. Exciting times lie ahead, and we can’t wait to see what’s in store. After all, new ways to improve patient care are always a win!

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