SEASON 2:
EPISODE 9
Virtual Reality & Health Care

Virtual Reality continues to be embraced by researchers, health care providers, and patients alike. Although the field is still relatively new, there seem to be more and more examples of virtual reality having a positive impact on health care delivery, treatment, and training both here at home and around the globe. In this episode we will explore examples of how research in the area of virtual reality could help address current gaps and in our healthcare system and improve patient care today and in the future.

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Missions: Healthy People & Health Care Systems

Jordan Sheriko 00:06
When we think about learning a new skill, whether that's driving a power wheelchair or any new skill that we learn, it's really about practicing that task. It sounds sort of simple, but rehab is really about how we practice a task. And we need to practice a whole lot to be able to learn those skills. And that's one thing that virtual reality has been shown in the early literature so far in the rehab field is, it's a really great opportunity to maximize that opportunity of repetitive task-oriented practice, have a motor skill, and probably an opportunity to do more of that practice in a shorter timeframe compared to how we can achieve that in the real world.

Megan Brydon 00:49
Research is really powerful and supporting any intervention, be it VR, or best practice or whatnot. The thing about research is it is evidence and it's data. And sometimes it's a very precise, limited scope, very particular set of criteria that applies to a specific population. And like that's how it applies. Maybe it's dosing for medicines, but with virtual reality, because it's so large in potential, it can really impact outcomes at the patient level, at the system level, the care level, the professional level. And I think because of that, it's not a matter of if, it's a matter of how, and with a big ship with a system, like a health system, sometimes it takes a while to be able to deliver on best evidence. But I think particularly in the last couple of years, we've learned that you can do things in a way that doesn't look like it always has, and maybe even better.

Rhys Waters 02:11
Welcome to Beyond research, a podcast brought to you by research Nova Scotia. Virtual Reality continues to be embraced by researchers, healthcare providers and patients alike. Did you know that it is possible to swim with whales in the ocean while still lying in a hospital bed? Have you imagined experience in life as a person living with dementia, or even following a complicated surgery from your couch? Leveraging virtual reality and healthcare continues to present fascinating possibilities. Although the field is still relatively new, there seems to be more and more examples of virtual reality having a positive effect on healthcare delivery, treatment, and training both here at home and around the globe. In this episode, we will explore examples of how research in the area of virtual reality could help address current gaps in our healthcare system and improve patient care today and in the future.

Jordan Sheriko 03:11
So, we've been working over the last few years on how we can leverage virtual reality technology to support different solutions for children with physical disability. When we first started brainstorming this a few years ago, one of the priorities for us particularly think about our wide population of kids with physical disabilities are really around mobility and importantly, independent mobility. And one of the pieces of technology that we have is power wheelchairs. And we thought that there was an opportunity to look at leveraging VR as an opportunity to augment some of the training that we can provide in having children learn how to use that piece of equipment that supports their independent mobility.

Rhys Waters 04:04
This is Dr. Jordan Sheriko, Medical Director of Rehabilitation Services at the IWK Health Center in Halifax, Nova Scotia. Jordan and his team are actively researching ways to incorporate VR technology into rehabilitation practices. Specifically, his current research project aims to help youths learn to operate their power wheelchairs using immersive VR. Immersive Virtual Reality is commonly described as the presentation of an artificial environment that replaces a user's real-world surroundings convincingly enough that they are able to suspend disbelief and fully engaged with the created environment.

Jordan Sheriko 04:44
For this project, we did want to leverage immersive VR. There's been a few groups across Canada and internationally that have looked at more sort of two-dimensional virtual reality. And of course, VR encompasses a huge range of technology. But we wanted to leverage an immersive VR platform. So that's with a head mounted display, so that the individual who's in that environment is really fully immersed.

Rhys Waters 05:09
The virtual reality program could teach kids aged four to 18. How to use a power wheelchair. The idea is that the game aspect of VR would help engage youth while helping the wheelchair user gain the necessary wheelchair driving skills all in a safe environment. This program is something Dr. Sheriko would love to see patients be able to take home.

Jordan Sheriko 05:30
Thinking also long term in terms of how we can design a system that allows for a lot of practice doesn't necessarily always require you to come into a health center. And we serve kids from across Nova Scotia and PEI. How can we also have that so that you could potentially take the system home, so not needing a whole lot other than the computer, the software, the head mounted display, the joystick interface, recognizing that some children that are going to benefit from a power mobility device have significant degrees of mobility impairments, that would require quite a lot of support a seating environment. So those are things that we're going to tackle as time comes in, we see the variety of kids that can use this training platform. But essentially, that we hope that gives us an opportunity to really think about getting this type of technology to practice learning these skills outside of the health center into you know, perhaps your home for example.

Rhys Waters 06:32
Dr. Sheriko lends, much of the research program success to date on the deep collaboration that was formed with an industry partner with software design and VR experience.

Jordan Sheriko 06:43
We were lucky in getting connected with an industry partner they originally started as Halifax VR. And as we began to collaborate that spawned the new company of Mars VR Lab, and that was an embodiment of wanting to leverage their experience in software and VR development to help other people. That connection was facilitated by IWK Innovation Services. And really brought us together to say, here we are as rehab clinicians. And here you guys are as computer programmers, VR experts, how can we bring those expertise is together to co-develop that solution. And that's really where we started with power wheelchair training, knowing that we wanted to look at how we could augment some of the great work that we're it's already happening in in training youth how to use a power wheelchair, and really leveraging VR as a relatively new technology and demonstrating hopefully, that there are huge applications for that technology as a training tool in rehab for kids.

Rhys Waters 07:53
IWK health and Mars VR Lab will co-develop the program and will share revenue if it is successfully commercialized. technology and business entrepreneurs, along with their expertise and connections in collaboration with leading medical experts can build solutions that medical establishments truly need. These industry partnerships are unique, and in this case, have been critical to moving the research forward.

Jordan Sheriko 08:18
I think what’s really interesting and exciting about this is that we've approached it from an innovation lens, and sometimes in in public healthcare and academia. collaboration with industry is a bit of a challenge. And you know, there are some pitfalls to that for sure. But it's really allowed us to build something that if we only had public funding or grant funded research we may never have gotten here. By leveraging an industry business partner, we're able to leverage large amount of investment to go towards supporting the research costs supporting the development costs. And it's been really exciting to see that this idea that we started with a couple of years ago is spun off a new company, it spun off into several high paying jobs in Nova Scotia, all because of that idea, and it's gotten us where research grants wouldn't have gotten us before.

Rhys Waters 09:15
Dr. Sheriko believes that there are obvious benefits to using virtual reality technology in a youth Rehabilitation context.

Jordan Sheriko 09:23
We certainly understand that in order to learn a new skill, there has to be something obviously that that is a goal of ours, you know, an intrinsic desire that we want to have to improve. So that's the first step to that engagement. It has to be something that's important to us, but then creating, you know, a therapeutic space. Creating a therapeutic program really is important around maximizing that engagement and certainly kids and youth today more so than ever, gaming is a big part of their lives. Those are some of the aspects and then really also looking at VR as providing, you know, an engaging environment where kids are focused on playing a game. While in order to do well at that game, you are doing the tasks that we think are going to then translate into that real world application of driving your chair. So, you know, by learning that I can navigate through this virtual environment by moving this joystick in these certain ways. We think that that's going to translate to that into that real world driving up a power wheelchair.

Rhys Waters 10:33
The idea is that the game aspect of VR should help engage youth while helping the wheelchair user gain the necessary wheelchair driving skills. Dr. Sheriko, and his team recently started their first stage of research trials. And if successful, this platform would increase the data available to clinicians, potentially increasing the accuracy of identify and physical limitations and progress in skill acquisition.

Jordan Sheriko 10:59
We were able to get launching in our first phases of our research trials, the last few months, where we've been bringing clinicians that have experience and training youth how to use a power wheelchair and having them work through that virtual environment and giving us some feedback. And now this is a really exciting opportunity where we're bringing in other people to give us their thoughts and feedback. And we've had some really rich and wonderful feedback from clinicians so far. Our next phase that we're about to get started on is bringing in youth that our current power wheelchair users. So, these are kids that we know that can drive their power wheelchair really well. We're bringing them in having them experience that virtual environment and giving us their feedback, you know, does it seem like it drives like your power wheelchair? You know, was it a cool and engaging game? How could we make it better?

Rhys Waters 11:48
Currently, power wheelchair training involves several clinicians, the patient and family, and at times the wheelchair vendor to help the patient learn to navigate with a power wheelchair in the real world. The wheelchairs themselves can cost anywhere between $35,000 to $50,000. The virtual training environment eliminates the risk of injury or damage to property. So, if successful, how could Dr. Sheriko’s research program benefit youth here in Atlantic Canada, and around the world,

Jordan Sheriko 12:18
Our ultimate hope that we're able to leverage this technology to better support training and use of a power wheelchair. And I think there are lots of possibilities of what that could look like. Ultimately, my hope is that this is something that we can package, and you know, you can have at home for a few weeks, where you're doing more intensive gameplay, building those motor skills. So that's providing a lot of opportunity to train and learn those skills before your power chair comes in. And also, not reliant having to rely on a lot of travel into a health center or having the therapy team going to you with a power wheelchair. So hopefully breaking down some of those barriers or current challenges that we have.

Rhys Waters 13:01
Although his area of expertise is in rehabilitation, Dr. Sheriko sees no shortage of opportunity to implement virtual reality technologies across the healthcare sector. If anything, the issue was narrowing in on an area of focus.

Jordan Sheriko 13:16
I really think and hope that virtual reality will provide us with opportunities to really augment how we're able to train people to learn new things, but also to experience new things and whether that's in preparation for a surgical procedure. And I think that goes both ways that can be both on a patient lens but also in training healthcare providers.

Rhys Waters 13:43
So, if virtual reality can be employed in a rehabilitation setting, what about if you could allow healthcare workers to experience a patient's perspective? A study published in the Journal of Medical Imaging and Radiation Sciences suggests that the use of virtual reality may be effective in eliciting empathy and carers. Megan Braden, and her team at the IWK health center, concluded that VR may provide an effective tool for healthcare workers to experience the perspective of key recipients.

Megan Brydon 14:18
Our research project was to evaluate existing literature and see whether or not virtual reality could be used to improve or develop or elicit empathy in people who care either as a profession or after hours and for their families.

Rhys Waters 14:38
Megan Brydon is a PACS application specialist at the IWK Health Center. For those who are unfamiliar, Medical Radiation technologists’ roles can span a range of functions.

Megan Brydon 14:49
Medical Radiation Technologist is one of a few professions. My background is in nuclear medicine technology, so it's based on physiologic imaging for your body It could also be an MRI technologist, a CT technologist and X-ray technologist. So, it's all of us in the diagnostic imaging space as well as the radiation therapist space. So, radiation therapists are also Medical Radiation Technologists. Radiation therapist would be someone who develops and provides radiation therapy and treatment for cancers. And a Medical Radiation Technologists who works in imaging would do the imaging that would go if you're having surgeries, or you are looking for a diagnosis or you have something a bump or a lump or a month that hurts. Were the ones that we'll look into and investigate why? What's going on and help provide the images for diagnosis.

Rhys Waters 15:43
As Medical Radiation Technologists, Megan and her team are interested in the intersection of care and technology. And when assembling her research team, Megan took a unique approach. She was not only looking for expertise, but for passion as well.

Megan Brydon 15:59
I was looking at doing your project and was Ken curious about virtual reality. And a few of my colleagues had reached out and said, “if you're ever doing your research project, I'd love to be involved.” I don't have very much experience, but I'm willing to learn. And anybody can learn anything. What you can't learn is passion. So, I rounded up a few of my colleagues who are incredibly passionate from here to think the furthest away on our research team was from Manitoba, and a variety of different clinical experiences and academic experiences. And we dove into this project to look at how virtual reality or whether virtual reality is an effective tool for eliciting empathy and carers, were paid to care, that sounds terrible, but it's our job. It's our nine to five or our 12 to 12. To do night shifts to 24/7 365. But you know, we're paid to do this, and it is our job, and then we go home and have the rest of our lives. There are a lot of people who do their job, and then they go home and then continue to provide care whether it's for somebody who has got cancer or dementia or any sorts of plethora of things going on. So, we included carers, meaning informal carers, families, spouses, friends, church, community groups, people who provide care that aren't necessarily getting paid to do it. So, a lot of the research has been in the health care space, but we wanted to include the broader definition of cares to really capture, you know, the people who are, for lack of a better term really carrying the burden of care outside of you know, the organized health system.

Rhys Waters 17:38
Have you ever wondered what it feels like to live with dementia? How it feels to not be able to lift your hand above your head? How it feels to recover from a stroke? Experience in such conditions through VR can help students and young healthcare professionals develop a critical ability to become a physician or care provider: empathy. Megan believes that more research and virtual reality applications can help close key gaps by allowing clinicians and everyday carers to get a glimpse into the lives of the individuals they're providing care for. We can all make assumptions about an individual circumstances, but until you live it, even virtually, you can never fully understand.

Megan Brydon 18:25
So, I think ultimately, we are perceiving beings, and we want to relate to people. And I always think about like maybe the core of what we're drawn to with virtual reality is actually you know, when you watch a TV show, and there's something you really dislike, and then six episodes go by, and you get their backstory, and you're like, wow, you've had a really hard time I do like you. And I think like that's sort of the power of virtual reality in terms of empathy is that you get to see the experience or appreciate the experience of another. And the virtual bit allows you to interact in a way that maybe you wouldn't necessarily have access to. And with carers, it gives you kind of two options because there's immersive and non-immersive virtual reality. So, with immersive virtual reality, you're in it, you have the headset on, you're completely sort of submerged in the virtual environment and allows you to interact that way. But clinically, you can have a situation with non-immersive virtual reality where you're interacting with a patient or a family member with a specific experience and allows you to practice. So, there's sort of two sides, you can get the experience yourself, you can be immersed in what it feels like perhaps to have dementia or be a patient receiving life altering news, or you can be a care provider and interact with somebody who's receiving that news and learn and practice those skills in sort of a safe to fail. No stakes environment with me. Maybe a breadth of exposure that you wouldn't have in a clinical program.

Rhys Waters 20:05
I have heard about virtual reality being used to train aspiring surgeons to practice operations. Typically, only a few students can look over a surgeon shoulder during an operation. And it's sometimes difficult to see everything. Magen considers the work to date, the foundation for future VR applications in healthcare.

Megan Brydon 20:24
So, in my project, we didn't look at specific outcomes related to health outcomes, we were more or less laying the groundwork to evaluate whether in fact, virtual reality in whatever strain, immersive or non-immersive, could elicit an empathetic response? And that seems like a really basic question to ask. But before we dig into changing outcomes, and before we dig into which type of VR is the best for certain situations, or which type of patient experience is most reflective or best reflect reflected in the virtual reality experience, we needed to be certain that it did, in fact, do that the nice thing about the virtual reality is across different scenarios, it was still effective, and at least as effective as patient actors in eliciting some of that empathetic response. So, the nice thing is, we know that it's not a result specific to one type of scenario. So, you only get an empathetic response if you're wearing a headset, if you're immersed in if you're in the experience of a patient, or you only get an experience if it's you're interviewing a patient who looks like you who sounds like you and you can relate to. We found that there is an empathetic response in that whole range of experiences, which is really promising.

Rhys Waters 22:04
Expanded on the research focusing on carers, Megan and her team have taken on a new challenge, exploring the interpersonal traits associated with a person's willingness to work during the COVID 19 pandemic.

Megan Brydon 22:17
Sometimes willingness to work can be something that gets people's backs up a little bit because no one wants to be perceived as unwilling. Especially if you're in health care, we are very proud of being people who show up. I've said this already, but 24/7 365, rainy days, holidays, birthdays, snow days, were there, we show up. But in an unprecedented experience, like COVID, it does rattle you in a way that's not theoretical. So, a lot of theoretical work has been done around people's willingness to work during a crisis. But you don't actually know until it happens. So, we got a grant to look at that relationship between empathy, resilience, compassion and an individual's self-report willingness to work during pandemic. And we found actually that the medication technologist population is very resilient, very compassionate, very empathetic. And we found that young, or new professionals, I should say, less than 10 years, statistically significantly higher rate of personal distress than the rest of the experience range. So that was 10 to 20 and 20 years plus experience working. So, it actually helped us identify a risk group for professionals who perhaps you need or could use additional support. And for us, that was really meaningful, to be able to walk away from that project. And it's in the process of being published now, but to have a tangible outcome that actually provides meaningful, real clinical frontline life experience for these workers, so that they can, hopefully when all of a sudden done to, to be able to provide supports for people who are feeling personal distress is what is going to sustain your workforce long term. And if it is hard in the beginning, because of COVID, or because of whatnot, we have a duty as experienced professionals to help navigate that and to recognize it and provide a solution because it's not fair.

Rhys Waters 24:45
So, Megan’s research suggests that the use of virtual reality may be effective in eliciting empathy in Medical Radiation Technologists and may provide an effective tool for healthcare workers to experience the perspective of care recipients. But what we've learned is that this technology could not only healthcare providers better understand their patients, but also their coworkers. This is an important point, as pressures on our healthcare system continue to be tested, but are the consequences of empathy?

Megan Brydon 25:15
When you look at empathy, and for lack of a better term, potentially the consequences of empathy, I think that while a lot of people think that it's very altruistic to get into health care, a lot of us can do it because it feels good. It feels good to care for people, it feels good to be part of somebody's journey. It feels good to be there when someone is struggling. I think, you know, when I began as a baby tech at the IWK, I was not expecting to go to the volume of funerals that I was going to be going to. And I think that that's a very real thing. And, you know, some people might say, well, “is your therapeutic relationship with a patient and their family has gone too far” if that's what you’re going to, you know, when a young person loses their life, or you're going to these funerals and having an interaction. But I think like, that's the actual humanity of it. So that's the closure. And I think that we're not really good at closure, and healthcare. And I think that if you're not taught or prepared for the cost of what that empathy is, or the cost of what the care is, or the cost of that interaction, and befriending, and in some cases, even loving patients and their families after time, because you've known them for 15 years, or 20 years, I think that the reality is we're doing a disservice to our new professionals to not acknowledge that that's part of it. And maybe that's a scary thing, that you're gonna see some frightening and sad things. But if you don't tell people that that's part of it, and give them tools to cope with that, then that's cruel. It's the opposite of empathy.

Rhys Waters 27:11
So, does virtual reality have the potential to strengthen healthcare delivery by alleviating current strains felt by healthcare professionals?

Megan Brydon 27:22
I think that VR can create space in a lot of ways. It can alleviate some of the pressures that healthcare providers have a managing patients that are maybe necessarily not as typically compliant. And that doesn't necessarily mean only pediatrics, it can be somebody with cognitive deficits or cognitive changes, you know, dementia, those sorts of things. But it also is an opportunity where it creates access. And I think, you know, in Canada, we like to think of ourselves as you know, universal health care that by law is accessible to people. But we know that we have long waits for very specialized services. So, if we can implement VR, in a way that gets people through to the time when they're going to have the procedure or diminishes the recovery time for that procedure or helps manage people's pains in the meantime, while we're trying to provide as much as we can, with the little that we have. I think that that really is where that space comes from.

Rhys Waters 28:30
Virtual Reality continues to be embraced by healthcare providers and patients around the world. With the seemingly endless potential for virtual reality in healthcare narrowing in on a single research question can be the most challenging part. While the technology grows out of its infancy in the field, we will continue to see new innovative application that have become more commonplace in our healthcare systems. We've heard how these new VR technologies can help strengthen healthcare delivery, expand training opportunities, increase access, advance treatment, and prevention, and helping practitioners better care for our most vulnerable populations. So, it's difficult to imagine a future healthcare system without VR. The perseverance of dedicated researchers like Megan Brydon, and Dr. Jordan Sheriko, are transforming ideas into reality. We need to continue to give our researchers space and permission to think boldly in hopes of creating a stronger healthcare system.

Jordan Sheriko 29:30
I think there's a huge opportunity to leverage virtual reality technology. And it really kind of goes back to some of the ways that VR can really support the fundamental principles in rehab that we know helps people in gaining new motor skills, we know that in order to get better at something, if it's something that you're motivated in doing, you need to practice that task over and over and over again. And VR gives us an opportunity to design that in a way that's engaging and motivating, certainly, for kids, but I think for adults, as well. And I think it's really exciting to think about all those possibilities, obviously, to try to rein yourself in and keep it, you know, specific, and keep yourself kind of grounded to a project and purposeful at moving that forward. But I think there are a lot of opportunities. And that's really exciting to think about, you know, really leveraging technology.

Megan Brydon 30:25
Empathy is a tricky thing to describe. Because depending on your perspective, you may feel like that it is defined a certain way. And there's all sorts of academic ways that it's been described with domains and multifaceted and all sorts of things. For me, empathy is the insightful awareness of the experience of another. And I think that that is not only key to empathy, but it's key to what makes us people and to be insightfully aware that you're going through it, I'm going through it, the person who's lifting the lever at the bridge when the cars are honking is going through it. That is what lets us come together and be real after and ongoing what's been a heck of a couple of years and probably will continue to be a struggle that if we can find opportunity to have awareness and be insightful and be appreciative of the experience of someone else, we’re golden. We're laughing. Take that to the bank.

Rhys Waters 31:42
Thank you for listening to beyond research brought to you by research Nova Scotia. We would like to extend a special thank you to our guests Megan Brydon and Dr. Jordan Sheriko. To learn more about the research shared on this podcast, visit researchns.ca/beyondresearch. I'm your host Reese Waters, and we will see you next time.

Dr. Jordan Sheriko is the Medical Director of Rehabilitation Services at the IWK Health Centre in Halifax, Nova Scotia.

Megan Brydon is a a PACS Application Specialist at the IWK Health Centre.