HOW VIRTUAL REALITY WILL TRANSFORM

MEDICINE

TRACK 2 – VR & GAMESMONDAY 31ST OCTOBER, 2016

GAMES FOR HEALTH EUROPE 2016VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

• …CAN MAKE EXISTING TREATMENT MORE EFFECTIVE / TOLERABLE

• …IS A NOVEL THERAPEUTIC MODALITY• …CAN IMPROVE EDUCATION & TRAINING FOR PATIENTS & DOCTORS• …CAN INCREASE EMPATHY AND BREAK DOWN BARRIERS

• THE TOOLS ARE READILY AVAILABLE, CHEAP, AND IN COMMON OWNERSHIP

VIRTUAL REALITY…

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

MY LIGHTBULB MOMENT• 50’S, LOVES RUGBY, BUILT LIKE A PROP FORWARD• CHRONIC LEG ULCERS• TEARFUL AT LEVEL OF PAIN FROM DRESSINGS• “IF ONLY SOMETHING COULD DISTRACT ME FROM THE

PAIN!”• AT THAT TIME ONLY HAD GOOGLE CARDBOARD…

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

THEORETICAL BASIS: VR FOR ACUTE PAIN• POORLY UNDERSTOOD• GATE THEORY (MELZAK & WALL, 1965)• LIMITED CAPACITY FOR ATTENTION TO PAIN (MCCAUL &

MALLOTT, 1984)• MULTIPLE RESOURCE THEORY(WICKENS, 2008)

• VR IN BURN CARE – HOFFMAN (2000)• SNOWWORLD – FIRSTHAND TECHNOLOGY• COOL! - DEEPSTREAMVR

© Deepstream VR

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

DISTRACTING MARY• 30’s, recurrent pilonidal

abscess• Post operative wound

dressings• Painful, distressing• VR distraction using Gear VR• First session 9th May, 2016

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

‘I’M ADDICTED TO VR’• 4 SESSIONS WITH VR OVER 1 WEEK OF DRESSINGS• BETWEEN 50-90% REDUCTION IN PAIN• SIGNIFICANT REDUCTION IN ANXIETY• PATIENT HAS CONSENTED TO HAVING FURTHER

OPERATION• NURSING STAFF FOUND IT VERY HELPFUL

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

• IN-PRACTICE DIGITAL HEALTH AUDIT

• WOUND CARE, INCISION & DRAINAGE, AND JOINT INJECTIONS

• ‘HIGH ANXIETY’ PROCEDURES WORK BEST

• MALE GAMER - 20’S PILONIDAL ABSCESS

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

• AFFECTS UP TO 70% OF PATIENTS WITH AMPUTATION (DIJKSTRA ET AL, 2002)

• GLOBAL BURDEN 11.1M AMPUTEES -> 7.8M PLP AND RISING• DIFFICULT TO MANAGE WITH MEDICATION• MIRROR BOX THERAPY (RAMACHANDRAN, 1996)• VR CAN HELP TREAT BILATERAL AMPUTEES• 2 PATIENTS WITH BELOW KNEE AMPUTATIONS

VR & PHANTOM LIMB PAIN

© Goran Levin

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

WWW.VIRTUALANALGESIA.NET

• NHS Hack Day May’16

• Virtual Limbs in Unity• Distraction • 360 video• Mirrored 360 video• Livestream 360 video

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

POST-OPERATIVE DELIRIUM

• AFFECTS 14-24% OF ADULT HOSPITAL ADMISSIONS• UP TO 83% OF CRITICALLY ILL• CAUSES ARE MULTIFACTORIAL• PREVENTION & TREATMENT

• MEDICATION• PRE-OPERATIVE OPTIMISATION• EARLY ORIENTATION & MOBILISATION

• COULD VR HELP WITH ‘PRE-EXPERIENCING’ PATIENTS IN ICU?• COULD VR HELP WITH ICU PTSD?

© Wolfgangfoto

VR & Games, Games 4 Health Europe, 31st October, 2016 - Dr Keith Grimes - @keithgrimes

HOW DO WE OPERATIONALISE VR IN MEDICINE?

• PERSONALISING VIRTUAL ENVIRONMENT COSTLY & TIME CONSUMING• CAN WE COLLABORATIVELY CREATE?

• SOCIAL VR: ALTSPACE VR• MULTIPLAYER VR GAMING: MINECRAFT• CLINICAL CREATIVITY: TILTBRUSH

• DO WE NEED A CLINICAL VE CONSTRUCTION PLATFORM?