Part I: Introduction

Virtual Reality (often simply referred to as VR) is a relatively new form of video

technology that suddenly seemed to hit the commercial marketplace in 2014. Although this

technology has been in development for many years, and initially was developed for many uses,

the first commercial development was to make video games seem more lifelike. Though the

intended purpose of the virtual reality headsets was initially for entertainment, doctors and

scientist have begun using it for a higher purpose. Hospitals and Universities around the United

States have been testing the potential for using VR to assist disabled or hospitalized patients, and

in particular, for patients with limited motor functions.

In the United States, alone there are 2.7 million people who are confined to a wheelchair.

The individuals are natural candidates for therapies that could be assisted through the use of VR.

Additionally, there are millions more patients who are in hospitals and suffer from temporary

disabilities such as injured limbs or behavioral health conditions such as PTSD (post-traumatic

stress disorder). VR could also help these disabled and hospitalized patients to improve their

quality of life. VR has been scientifically proven to help people with their disabilities, whether

its from physical motor functions to pain relief.

Along with this new advancement, scientist are now using Haptic Gloves. Haptic Gloves

are a robotic system that allows the user to feel the surrounding area within the VR systems

simulated environment. Taken together, VR and Haptic Gloves benefit disabled patients by

improving muscle coordination, providing an alternate method for wheelchair practice, and

helping with pain relief, and giving patients the opportunity to have virtual experiences they

otherwise could not.

Part II: Historical Context

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 VR is a computer-generated simulation of a three-dimensional image or environment that

can be interacted with in what seems to the viewer like a real or physical way, using special

electronic equipment such as a helmet with a binocular screen inside of it.

Haptic Glove systems are a related technological development. As the name suggests,

these systems involve a set of gloves that have sensors woven into them. When used with a VR

system, they give the user an additional way to control the systems virtual environment.

Although not a completely new concept in the world of technology, Haptic Gloves finally came

become widely available on a commercial basis in February 2013. Much like VR systems,

Haptic Gloves were developed to help gamers feel as though they are part of the virtual world.

These systems have more recently been brought into hospitals for multiple purposes. Most were

used for physical therapy after car accidents or other traumatizing experiences, but some were

used for pain relief and helping patients with their physical motor function skills.

Part III: Research and Analysis

At the University of Medicine and Dentistry of New Jersey, researchers conducted a test

using VR on children with Cerebral Palsy (CP). Fasoli et al. CP is a condition that involves loss

of motor functions resulting from damage to the brain, and usually occurs prior to birth, during
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the birth process, or in early childhood. (National Institute of Health, www.ninds.nih.gov.) The

test were conducted to see how children with CP caused by moderate damage to one side of the

brain would react being in a virtual simulation. The hope was that this kind of therapy would

help improve the children's motor functions, using Haptic Gloves and VR simulations.

The study included a group of 5-12 year old children. Each study group attended 16

sessions in a basic virtual reality simulation with an assisted mechanical aid. Each session lasted

approximately 60 minutes and the test was done over an eight week period. The results were

very positive. Overall, the children involved in the test showed significant improvements. They

mobility improved by 13 percent in the Quality of Upper Extremity Mobility Test, and 42% in

the standardized Upper Extremity Fugl-Meyer Assessment scores. There were also reports by the

childrens parents that the tests have lasting positive results on the childrens mobility (Gerard et

al. 336).

A second study involving children with more specific brain conditions also demonstrative

similar, positive results. In this study, twelve children who exhibited significant motor

impairment involving the upper part of the body due to lesions in the brain took part in 18 one-

hour sessions. These sessions focused on the goal of having the children simple targets using the

same VR system employed in the previous study by Fasoliet al. [15]. This time, the [s]ubjects

averaged a 3.33 point (9%) improvement in UEFMA score and a 6.71 point (12%) improvement

in Melbourne Assessment of Unilateral Upper Limb Function score. These improvements in the

scores were also accompanied by 63% improvements in smoothness and 40% improvements in

speed of the trajectories measured during reaching training (Gerard et al. 336).

Later, the same researchers broke the children up into three separate groups each using

the same system for the same amount of time. Nine children gathered in groups of three which
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were identified in their respective numbers. Each group used the VR system for an hour, three

days per week, over a three week period. "The children performed identical tasks during a pre-

testing period, three days before starting the training, and then were involved in a post-testing

session three days after the VR training (Gerard et al. 338). The children played a series of five

games, where they would race cars, explode bubbles, reach for cups, engaging tasks involving

hammering objects, and catching falling object. When each child reached the end of the

simulation, the virtual room would explode, and display would say game over.

The first study group involved two inpatient boys (one 10 year old, and one 16 year old)

who engaged in nine hour long sessions consisting of 60 minutes each. The children were not

physically supported or restrained during the test sessions. The tasks in each session involved

four sets of 10 attempts to reach bubbles in the Bubble Explosion simulation. This part of the

experiment was used to test endurance (Gerard et al. 338).

The second study group involved three different children, this time involving two boys

(age six and twelve), and a seven year old girl. This time, the children were outpatients. The

second group used essentially the same testing and training schedules as the first group. The only

difference was that the hammering simulation was changed to one where the test subject was

sitting upright in a supine position. The tests subjects had their arms secured against their body

so that they could not reach for the objects. The test subjects were also restrained in the chair

using a chest strap (Gerard et al. 339).

The third group again consisted of three test subjects, this time two girls (ages six and

twelve) and one eleven year old boy. The subjects again trained using nine, hour long sessions,

three times per week, over a three week period. This was conducted in a camp environment as

part of a broader training program that also involved five additional hours of training including
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constraint-induced movement therapy (or CIMT), which is a type of rehabilitation therapy that

improves upper extremity function through a combination of restraining, and the repetitive use

of, a patients arms. The CIMT process that was used involved light-weight casts being placed on

the childs non-disabled arm for up to six hours a day for the three week period, except that the

case was removed during the childs VR training sessions (Gerard et al. 339). Other than this,

the third groups VR training used the exact same treatments and testing processes as the second

group.

The results of these tests showed that in each group there were notable changes in the

children's grip strength and smoothness of hand motions. The largest changes were seen in the

third group, while changes were shown in the first groups subjects were the least significant.

The amount of time it took for the children to exhibit arm movement decreased across all nine

children by 26%. The children also showed improvements in hand trajectory smoothness, but

this was not as statistically significant. This change was skewed by one very poor score related to

one child who had a lot of difficulty on her last day. If the next to last training days data was

used for the child, the overall improvement was 46% (Gerard et al. 342).

The researchers were also able to graph the performance of all of the children during the

experiment. Overall, the study demonstrated the effectiveness of therapies involving VR and

Haptic Gloves to help improve the motor functions in their upper and lower body of children

with CP, ranging from significant to slight improvement depending on the testing methodology.

Very few people have heard of wheel chair VR training. However, researchers have been

working closely with the disabled community for many years, to help them grow more

independent. Using VR to do this is a relatively new development.

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 Three researchers from the University of Strathclyde in Glasgow, Scotland have taken the

lead in this form of research. Together they made a machine that allowed disabled citizens to

practice working an electric wheelchair in a safe virtual space. The VR simulation gave test

subjects the chance to use a crosswalk when safe and how to look out for oncoming cars, all

from a safe environment. The VR system used a three-projector system that projected a 150 by

40 high definition image on a small cylindrical screen. Then, the three images were blended to

provide a single display. Using this VR system, the image then fills most of the users field of

vision, providing a highly convincing sense of visual immersion within the scene as indicated by

the results of our user evaluation (523.).

The software used to develop and project the virtual environment was based on a new

and very sophisticated technology, the Silicon Graphics Performer API. This platform involves

a high-performance system that creates a three dimensional environment that can simultaneously

handle several interactive applications. The system that generates the graphics in a way that

coordinates between the software and inputs that are coming from the user (524).

All of this technology would be of little use, however, if the system is not convincing to

the use. In order for the system to really help users practice task that they would later use in the

real world, the VR system had to be realistic. Test users were asked to rank the realism of the

virtual environment from one to six, with one being not realistic at all, to six being the most

realistic. The surveys indicated that most users gave the simulation a score of five.

Being able to practice potentially dangerous tasks is important to the community of

disabled people because without it they would avoid these dangerous situations, which would

then in turn limit their sense of freedom. Without the confidence created by this kind of training

system, most people with disabilities would rely on a helper so they can do things that normal
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people would do on a daily basis. This VR software that they had designed to help people feel

more independent so they would not have to rely on other peoples assistance.

A third medical application of VR technology is a very recent one. Hospitals around the

United States have begun using VR to ease pain for burn unit patients. Although its development

is recent, it is also one of the most researched uses of VR to date. One team of researchers,

(Hoffman et al.) have studied the effectiveness of VR compared with using a typical,

commercially-available video game. The test involved two teenage subjects (16 and 17 years

old) who were undergoing burn wound care [14]. VR was found to decrease the two patients

pain levels, anxiety, and the amount of time they spent thinking about pain (Li).

The University of Washington Seattle and U.W. Harborview Burn Center have also

started using a game called SnowWorld in treating burn patients. SnowWorld is a game where

users play as a penguin who throws snowballs at evil snowman. The game was designed in a

cooler (i.e., snowy) setting so the patient would not focus too much on the heat sensation that

accompanies the pain from burns.

Once doctors and researchers found out about the effect on VR on reducing pain, they

began experimenting to see what other aspects of burn treatment it could help with. Another team

of researchers (Das et al.), conducted a study comparing treatment using standard analgesic pain

killers with analgesic and VR therapies, involving children between 5 and 18 years old who were

receiving burn wound care [15]. The showed that the use of an analgesic along with the VR

therapies was more effective than standard analgesics alone in reducing pain (Li.). The study

also showed that the VR therapies also helped patients reduce their level of stress than the

methods the doctor were currently using.

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 Similarly, researchers looked at the use of new waterproof VR systems to help burn

patients while they were receiving wound cleanings. The study involved using a waterproof VR

system on eleven patients between nine and forty years old. The study showed that using the VR

system reduced pain (and increased the reported fun ratings) for those who reported feeling

engrossed in the VR game (Li.).

Researchers have also started using VR to treat cancer pain, particularly treatment

involving painful treatments like chemotherapy, lumbar puncture and treatment that use port

that are implanted in the body to allow access. A study by researchers Schneider and Workman

used eleven subjects between the ages of ten and seventeen who were receiving chemotherapy.

The study showed that 82% of the children indicated that the treatment with VR was better than

previous treatments and that they would like to use VR during future treatments. (Li.)

Although formal studies have yet to appear on the subject, VR has great potential to have

an important side benefit for people who are restricted to a given environment, such as patients

within hospitals or people in restricted living spaces.

A researcher named Chris Milk initially studied the effect of telling the stories of people

about both tragedy and laughter. He wanted to prove that there is a way that we can connect and

tell each other through their stories. As an extension of his original work, he considered creating

a virtual environment so that people felt that they were in an enchanted world. His first attempt

was called, a visual display trptich on several frames called The Treachery of Sanctuary. He

was surprised by the result. He saw people having even more visceral emotional reactions to

this work than the previous one. But then he started thinking about the frames. A frame was just

a window, he thought. I mean, all the media that we watch -- television, cinema -- they're these
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windows into these other worlds. (Milk). He wanted to provoke emotions in people so that they

could feel as though they are part of his art by creating VR experiences where people can enjoy a

new place without actually having to travel there. This would allow the viewer to enjoy the world

while staying right in there living room. Chris wanted people to hear the voices of millions by

allowing them to tell their stories. So he made a three dimensional camera that allowed him to

make virtual reality videos. With this new technology he created a new way to tell stories that

made you feel as though you're sitting right there with them.

So what I'm going to show you is not a view into the world, it's basically the whole

world stretched into a rectangle, Milk stated. His first VR film was called "Clouds Over Sidra."

It was made in partnership with the United Nations and a virtual reality company that Milk

formed called VRSE, and a co-collaborator named Gabo Arora. The VR film was made in a

Syrian refugee camp in Jordan, and tells the story of a 12-year-old girl there named Sidra. The

film tells Sidras story as she and her family flee from their home in Syria and into the Jordanian

desert. It also tells the story of the refugee camp that she now lives in for the last year and a half

(Milk). Milk is now working with the United Nations to make a series of videos. He has recently

finished shooting a video in Liberia, and is now working on a new one in India. Milks hope is

that his VR films will help change peoples perceptions of places far away from their usual

existence, and in the process help people even those whos ability to travel is restricted to

understand both the good and bad things in the world around them.

Although many of the potential benefits of VR have been well document, there may be

less well-documented down sides to VR as well.

One VR system, called Oculus Rift, a Virtual Reality headset that was designed for use
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with games has already recognized one of these. The warning label on its headset specifically

warns that headset use can cause motion sickness, lack of hand-eye coordination, and can even

cause serious injury.

There also have been recent studies involving a new side effect of VR use known as

Cybersickness. Cybersickness involves symptoms are the feeling of dizziness, headaches and

nausea. The University of California, Los Angeles Keck Center for Neurophysics has recently

completed a study that showed the negative effect of virtual environments on lab rats.

Specifically, the study showed, [n]egative side effects including "cybersickness" and abnormal

patterns of activity in rat brains, including 60 percent of neurons that simply shut down in virtual

reality environments (Magyari, Doug "Virtual reality: Are Health Risks Being Ignored? "

CNBC, Jan. 8, 2016, print edition). The study with lab rats showed that there may be more

negative side effects then were originally anticipated.

Along with the cybersickness, some people have also experienced problems with eyesight

after extensive use of VR systems. Using a VR system causes the user to strain their eyes to

focus on the pixelated virtual screen. This uses the same eye muscle functions that allows you to

see near field objects. When users take off the VR devise, the eye strain may cause difficulty

with focusing on objects that are near to the viewer.

VR headsets may also cause additional possible problem with stress and anxiety. Oculus

Rifts warning label goes so far as to indicate that, [u]sing the device can make your muscles,

joints or skin hurt. If any part of your body becomes tired or sore while using the headset or its

components, or if you feel symptoms such as tingling, numbness, burning or stiffness, stop and

rest for several hours before using it again (Oculus Rift Warning Label). The label also warns

about using the headset if the user has a medical device implanted into his head: [t]he Headset,
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Sensor, and Remote contain magnets or components that emit radio waves, which could affect

the operation of nearby electronics, including cardiac pacemakers, hearing aids and defibrillators.

If you have a pacemaker or other implanted medical device, do not use the headset without first

consulting your doctor or the manufacturer of your medical device. (Given this, it is not

surprising that the Oculus Rift is not a VR device that hospitals are using in their experiments. In

most instances, however, tests have indicated that there are few effects of motion sickness or

seizures.

Another problem is that most medical practitioners are slow to adopt new technologies.

Even though studies have shown that using VR can help people with pain relief, doctors have

been very slow to adopt it. Most doctors do not want to depart from their traditional ways of

treating condition. They believe that the old methods are more reliable.

Part IV: Conclusion

Although it is a new technology, VR has already become a big part of our lives. It already

has demonstrated its ability to improve our quality of life through entertain and education. But

research is demonstrating that its most substantial and lasting effect may be outside of

entertainment. The early studies have shown that VR systems can be used to help relieve pain

and anxiety for burn patients, and to help improve children with CPs motor functions. The

benefits of VR are really just starting to be explored, however. VR is still new to the commercial

market, and new technological advances and further studies will undoubtedly lead to additional

advancements. Though this change will not happen overnight, hospital and other medical

providers will give VR a try as the technology begins to be adopted within the typically-

conservative health care industry. Further research will need to be done in order to improve the

reliability and realism of the technology, while reducing the potential side effect. However, many
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potential benefits remain undiscovered and un-researched from helping to strengthen weak eye

muscles to helping slow memory loss in Alzheimer's patients. All of these are valid reasons to

keep on researching the new world of VR.

Bibliography

Fluet, Gerard G., et al. "Interfacing A Haptic Robotic System With Complex Virtual
Environments To Treat Impaired Upper Extremity Motor Function In Children With Cerebral

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Palsy." Developmental Neurorehabilitation 13.5 (2010): 335-345. Academic Search Premier.
Web. 19 Jan. 2017.

Harrison, Colin S., Mike Grant, and Bernard A. Conway. "Haptic Interfaces For
Wheelchair Navigation In The Built Environment." Presence: Teleoperators & Virtual
Environments 13.5 (2004): 520-534. Academic Search Premier. Web. 30 Jan. 2017.

Magyari, Doug "Virtual reality: Are Health Risks Being Ignored? " CNBC, Jan. 8, 2016,
print edition

Milk, Chris How virtual reality can create the ultimate empathy machine TED. Apr.
2015. Lecture.

Sveistrup, Heidi. "Motor Rehabilitation Using Virtual Reality." NeuroEngineering and

Rehabilitation (12/10/04): 1-8. BioMed Central. Web. 12 Jan. 2017.

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