Extend Your Reality: Educational, Clinical, and Mental Health Applications of Virtual Reality

by Roxanne Hawn

EXTENDED REALITY TECHNOLOGY ALREADY ASSISTS IN EDUCATIONAL, clinical, and mental health settings. It’s mind boggling to imagine where virtual technology might go—maybe even giving veterinarians tools that feel like superpowers.

Brian Vogelsang works in Qualcomm’s extended reality business. He explains that extended reality (XR) is the umbrella term for all the ways technology can affect our experience of the physical world.

“Augmented reality (AR), as a broad term, is when you sort of overlay digital onto the real world,” Vogelsang said. “It typically can be done a couple of different ways. One way is through your smartphone, where you turn the camera on, and then you look through the smartphone at the real world.”

The mobile game Pokémon GO and Snapchat app filters that add features to someone’s image are good examples.

AR can also be done through a head-mounted display, such as smart glasses. “It looks more real. It looks more immersive because you’re not looking through your smartphone. You’re actually looking at the real world as you normally would, and you’re overlaying digital onto the real world,” Vogelsang said.

True virtual reality (VR), in the way most think of it, provides total immersion by completely blocking and replacing the real world. People currently use full simulation environments for things like gaming and entertainment, but VR is increasingly used in medical work and training scenarios as well as for patient rehabilitation from things like strokes, concussions, and acute or chronic stress.

“In 10 to 20 years, we think these technologies are going to converge,” Vogelsang said. “So you’ll be able to have a lightweight pair of augmented reality glasses, which you will wear throughout your day, and then those will be able to go into a mode that’s more like virtual reality, where you can block out more of the real world and be in more of a fully digital world, but it’s going to take some time for those technologies to come together.”

Educational Uses

Christianne Magee, DVM, PhD, DACT, assistant professor in the Department of Biomedical Sciences at Colorado State University, includes other virtual tools and even telepresence options for connecting with students, colleagues, or clients in these discussions of virtual technology. She expands the definition in part because of accessibility and participation issues of only and always using VR goggles.

“We’ve been developing a virtual anatomy tool at CSU since 1999,” Magee said, “and it’s more likely to be used in the veterinary profession or by individuals who have an interest in animal anatomy for whatever reason, whether they’re a farrier or horse owner or a layperson, because it doesn’t require the hardware necessary for true immersion virtual reality.”

During the pandemic, CSU helped more than 100 schools move to online instruction through its Virtual Animal Anatomy, all for free from March to July 2020. Those schools represent more than 12,000 students around the world—from kindergarten through professional schools. Scaling up that fast and reaching so many diverse students would have been impossible with VR-only solutions.

Magee said, “We are moving into that [full-VR] space for some applications, but for the majority of the world, true VR, in terms of the immersive environment with the goggles, is inaccessible. We can create a tool that can go in either direction, but because it’s more accessible on a tablet or a laptop, we have chosen to stay in that environment as much as possible.”

Until recently, the Virginia–Maryland College of Veterinary Medicine at Virginia Tech taught anatomy and other core courses in the first year of veterinary school—saving physical exam instruction for year two. Now, anatomy content is integrated in systems courses, and students begin working with dogs, horses, and cows right away. Michael Nappier, DVM, DABVP, associate professor of community practice there, says that while studying anatomy and parts of the physical exam concurrently made the content extra relevant, students’ “mastery and spatial visualization concepts of where things were inside the dog were not that good.”

Funded by a grant, Nappier’s original plan to create a small program that students could load on their laptops and use in lab while examining patients changed once he found a partner in the School of Visual Design. Nappier explains that the design and visual graphics skills required for the true VR anatomy tool are “fairly basic,” using CT and MRI data. So visual design students create the VR programming their fellow veterinary students use to learn anatomy. The free, open-source code is available for download, usage, and modification.

“We have a dog. We have about 70% of a cow, and we have the funds for a horse,” he said. The development team is also working on additional functions where instructors can create their own quizzes inside the VR program.

While many pedagogical questions remain, Magee points to several strengths of virtual tools in anatomy education:

• Scaling anatomical samples, which can be heavy, cumbersome, and difficult to obtain and maintain, so students don’t have size as a key indicator when, let’s say, deciding whether a shoulder bone is from a horse, dog, cow, or cat
• Making content usable from anywhere
• Gamifying learning to better engage students
• Providing a consistent and repeatable learning experience
• Enhancing learner control, which improves self-confidence and self-efficacy
• Providing opportunities for “productive failure,” where students can fail safely and grow from the attempt

Students use virtual tools to prep for labs, for example. “It’s like reading a recipe before you start cooking,” Magee said. “Students who don’t use the virtual tool ask more questions, need more time, and need more guidance, whereas the other students just get right through and get it done. They both do well, in the end.” However, it saves time and effort for instructors, not having to answer the same question 140 times.
Other examples of AR or VR uses in veterinary education include:

• Stereoscopic surgery VR videos as preparation for doing first sterilization surgery on a dog
• Intravenous injection AR simulator
• Clinical case processing via the Second Life online virtual world
• Emergency preparedness and response via Second Life for scenarios with mass casualties requiring triage decisions

Currently, a primary challenge in AR/VR for simulations and educational use is a lack of haptic feedback, or physical sensations. Researchers continue to work on VR accessories, including gloves and even ultrasound arrays that can simulate touch and other sensations, Vogelsang explained.

Clinical Uses

AR is sometimes used for assisted reality such as telemedicine or telepresence consults—for example, teams doing an ultrasound examination of a veterinary patient with the radiologist or other expert participating from a distance. The AR setup seems to work fine inside traditional animal hospitals with good WiFi. The bandwidths and speeds required pose more challenges for equine practitioners out in the field who wish to share video and audio. In one report in the journal Equine Veterinary Education covering 36 equine cases, teams experienced internet connectivity issues in 33% of telepresence consults. However, only once was the consult not completed because of these issues.

For a number of reasons, human medicine sees greater advancements in XR technology uses than what’s available for veterinary medicine. However, it gives us a view into what’s possible, such as neurosurgeons at Stanford University visualizing patient-specific surgical plans using VR before opening someone’s skull and as reference during surgery, and reconstructive surgeons using AR of patient-specific three-dimensional vascular details before and during extremity repairs.

Since human medicine is already doing it and the veterinary educational XR tools use MRI and CT data, it’s possible that veterinarians will have access to such powerful visualizations via AR or VR in relatively real time. Such advancements could have profound impacts on case diagnostics, decisionmaking, treatment, and even informed consent and client education.

Mental Health Uses

Mental health strain in the veterinary profession is well known and documented. Pressures of adapting to COVID-19 protocols as well as the backlog of cases and increasingly crankier clients add to the burden teams feel.

That’s why it’s interesting to explore VR uses for mental health conditions including depression, anxiety disorders, post-traumatic stress disorder, phobias, eating disorders, body dysmorphia disorders, addiction, and social anxiety.

Laurie Fonken, PhD, director of the DVM counseling and wellness program at CSU, prefers to use the term empathetic distress rather than compassion fatigue to describe the emotional toll of being in veterinary practice. The pandemic has compounded what veterinary teams already felt. She said, “It feels like there’s more and more demand, maybe less and less resources or recognition. And so, it can sometimes feel like no matter how hard they work, they’re never going to be able to meet all the needs.”

Fonken hopes to add VR tools by perhaps partnering with the Tech Innovation Network, which is a program within the National Mental Health Innovation Center (NMHIC) at the University of Colorado Anschutz Medical Campus.

The network’s goal is to form partnerships where “technological solutions can be rapidly developed, iterated, tested, and validated.”

In a December 2018 TEDxMileHigh talk, Matt Vogl, executive director of the NMHIC, explained VR’s potential uses in healthcare settings, including helping providers decompress between patients, giving hospice patients the opportunity to cross things off their bucket lists through VR experiences, and offering patients pain relief that requires lower doses of medications.

Vogl also described a pilot program the NMHIC did with a prison in Alaska that involved helping inmates handle the stresses of incarceration as well as giving them opportunities to practice life skills they’ll need after release, such as handling crowds with people bumping into them after years of defending their personal space at all costs, navigating job interviews and discussions of their crimes and incarceration, and developing conflict-management skills for relationships with family and friends.

In National Health Service hospitals in the United Kingdom, Rescape Innovation deployed its DR.VR product to help healthcare workers on the front lines of the pandemic. Informed by both cognitive behavioral therapy and dialectical behavior therapy, the pilot program, conducted in Wales between March and May 2020, offered 21 healthcare workers in a variety of roles, including intensive care nurses, access to five VR distraction experiences, such as a wildlife safari, forest immersion, and underwater adventure, and three meditative VR spaces with guided breathing exercises.

Users reported feeling relief from work pressures, feeling more relaxed, and experiencing less stress and anxiety. One person felt mild motion sickness, and another felt that the menu of scenarios got repetitive.

Fonken said, “I think there are many different applications for [VR], where it can be used, confidentially and privately. I think people would access it more readily than maybe a therapist, if they have that stigma or even fear around talking to someone. This could be maybe a gateway or a way to start addressing challenges they’re having.”

Superpowers?

Vogelsang explains that the purpose of various XR tools now and in the future depends on the problem being solved. Whether it’s specialists and practitioners sharing firsthand case observations via AR glasses or clinicians using a full VR experience to diagnose and game-plan treatment or even surgery, these tools can vastly expand opportunities for patient care.

“If I can blend all this data together in real time in front of me, that’s kind of like a superpower,” Vogelsang said. “It’s a way to enhance my senses and bring together all this information that otherwise I’d have to synthesize myself.”

Roxanne Hawn is a freelance writer living in Golden, Colorado.

 

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