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| EDITORIAL |
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| Year : 2019 | Volume
: 5
| Issue : 3 | Page : 93-95 |
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Virtual reality and immersive experience technologies for cognitive health and well-being
David John Wortley
International Society for Digital Medicine (European Chapter), The Old Barn, Alderton, NN12 7LN, Northants, United Kingdom
| Date of Web Publication | 30-Dec-2019 |
Correspondence Address:
David John Wortley
The Old Barn, Pury Road, Alderton, Northants, NN12 7LN
United Kingdom
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/digm.digm_17_19
How to cite this article:
Wortley DJ. Virtual reality and immersive experience technologies for cognitive health and well-being. Digit Med 2019;5:93-5 |
| Introduction | |  |
From early childhood, games have played an important part in human learning and development. Games provide a “virtual” learning environment in which interaction with other humans, various challenges, and the world we live in allows us to explore and experiment and, as a consequence, develop a range of skills and competencies we can apply in the “real world.” Games allow us to “role-play” and at their most effective totally absorb us and provide an enjoyable and satisfying experience that can enhance our relationships with other humans and provide a sense of well-being.
Today, however, games which are based on technologies that create virtual scenarios and use simulated environments are often seen as being responsible for negative and/or damaging behaviors that, instead of fostering positive developmental changes, lead to social isolation and unhealthy mental states. They are perceived as encouraging “fantasy” scenarios that do not relate to positive social behaviors. This article, while recognizing that virtual reality (VR) and immersive experiences (such as many other applications for technology) have the potential for negative impacts on mental health, focuses instead on how these technologies can and are being used for positive clinical benefit.
| Virtual Reality and Burns Patients | | |
An early example of the use of VR and immersive experience was SnowWorld,[1] an application developed by researchers at the University of Washington. The research was carried out on burns patients who experience severe pain and trauma during procedures, such as changing dressings. The initial research used patient reporting on the widely accepted subjective pain scale but more recently used magnetic resonance imaging-friendly VR headsets which enabled the researchers to analyze brain activity linked to pain.
The research findings showed that patients reported 30%–50% less pain when using SnowWorld which reduced the need to use drugs such as opioids for pain relief and is therefore potentially a much safer and more effective technique for this type of patient.
The findings in SnowWorld [Figure 1] reinforce previous studies carried out to assess the success of especially designed video game to address issues such as patient adherence to treatment regimes. A video game called “ReMission2” developed by HopeLabs to support young cancer patients used the “first-person shooter” games genre to enable children to view simulations of cancer cells and “zap” them. Researchers concluded that a carefully designed video game can have a positive impact on health behavior in young people with chronic illness and that video-game–based interventions may constitute a component of a broader integrative approach to healthcare that synergistically combines rationally targeted biological and behavioral interventions to aid patients in the prevention, detection, treatment, and recovery from disease.[2] | Figure 1: Burns patient using SnowWorld and screenshot from SnowWorld virtual reality application in public domain (Photo courtesy of Hunter Hoffman)
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| Virtual Reality and Immersive Experiences for the Elderly | | |
VR and immersive experiences provide an opportunity for citizens with restricted mobility and cognitive capacity to enjoy events and places denied to them by their situation [Figure 2]. In the USA, a company called Rendever has been working with care homes to develop immersive experiences,[3] which help senior citizens reminisce about their lives, which research at Harvard [4] has shown to benefit people with dementia and Alzheimer's disease. | Figure 2: Author's Elderly Family Member watching a recording of a family christening in virtual reality (Photo courtesy of David Wortley)
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In the UK at St Andrews Hospital in Northampton, research is currently in progress to assess the effects of VR and immersive experiences on people with moderate-to-severe dementia. Although the project is still in progress, early results illustrate that certain types of immersive environments such as sandy beaches and forests can have a distinct and positive impact on the well-being of these types of patient.
| Virtual Reality for Cognitive Training and Assessment | | |
Currently, there are emerging VR applications that are cleared by the Federal Drug Agency in the USA for clinical use. This is an important development for digital medicine. There is a range of applications which the author has tested on an Oculus GO VR headset for this article. An example of one of the applications is illustrated by the screenshots in [Figure 3]. The virtual environment which hosts these applications is a peaceful lakeside scene with gentle music and relaxing sounds. The player chooses one of the training games from a screen and the virtual environment changes to suit the nature of the application and its clinical objectives. These applications use games' mechanics and psychology to engage the player. The “Re-Act” application is designed to monitor, assess, and develop spatial awareness, image recognition, and mental reaction times. The background environment is a funfair and the challenge involves reacting to colored balls lighting up and hitting them as quickly as possible with a colored boxing glove. The colors of the ball and the glove change without notice, and the player has to hit the correct ball that matches the color of the glove. The game can be configured for difficulty and length of gameplay time, and the results of each session are not only displayed after each game session, but they are also logged on a secure web site for performance tracking and assessment potentially for all registered stakeholders such as patients, carers, and clinicians. | Figure 3: Screenshots from XR Health Virtual Reality Cognitive Training Apps (Photo courtesy of David Wortley)
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There are other applications to help assess, monitor, and develop working memory, and in the latest development targeting meditation and mindfulness, we are seeing the beginnings of integrated sensor technologies capable of measuring mental and physiological states during the use of these applications.
| Future Developments | | |
We are at the beginning of a new era in digital medicine and mental health. VR and immersive technologies, by their nature, have the ability to isolate users from outside distractions and create a focus on the immersive environment and the applications within that environment.
It has already been demonstrated by some of the research mentioned in this article that, for a range of reasons, technologies which immerse patients in virtual environments and activities can have a positive clinical impact. The latest developments in wearable technologies which accurately measure physical and psychological states in real time provide developers and researchers with new tools which not only impact mental health and well-being but also intelligently adjust the virtual experiences to the needs and moods of the patient.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to b'e reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
| References | | |
| 1. | |
| 2. | Kato PM, Cole SW, Bradlyn AS, Pollock BH. A video game improves behavioral outcomes in adolescents and young adults with cancer: A randomized trial. Pediatrics 2008;122:e305-17.  |
| 3. | |
| 4. | |
[Figure 1], [Figure 2], [Figure 3]
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