Regulatory Science Virtual Symposium: “Emerging Technologies in the Medical Device Industry” Session 3: Clinical Virtual Reality: Seven Ways that Virtual Reality Will Change the World of Mental Healthcare! (2022)

1. Clinical Virtual Reality:
   1. Change the world of mental and physical health care.
   2. Dramatic evolution in the field in the technological advances, more high fidelity, realistic, scientific literature that has evolved
2. USC Institute for Creative Technologies:
   1. Since 1995, has focused on cognitive virtual humans.
   2. 3-D projection technology. Virtual reality classroom. Physical occupational therapy uses a camera to help make therapy more fun and engaging.
   3. Cerebral palsy foundation: motor impairments but one movement was used as the interface to help play the video game.
   4. Virtual humans (patients) for clinical training helps novice clinicians
   5. SimCoach: Aviation Simulation: tests, trains pilots in training
3. Virtual Reality:
   1. Integrates real-time computer processing, interface technology, body tracking & sensory displays to support a user to interact with and/or become immersed in a computer-generated simulated environment.
4. The three “I’s”: Immersion, interactivity, and imagination
   1. Immersive (hands are shown, and used in VR)
   2. Interactivity (balance, moving body around) interaction with virtual training characters.
   3. Interactivity: An example is utilizing it for adults with autism searching for a job.
5. Clinical virtual reality:
   1. In VR, you can fool the brain. Frontal lobes may say, “It's not that realistic,” and it still activates anxiety and other reactions.
   2. Five core elements: Can help measure, engage, motivate, expose, and distract people.
6. Clinical virtual reality helps to:
   1. Overcome fear.
      1. Exposure therapy: gradually expose themselves to mostly irrational fears and help them by confronting that fear. Emotionally provocative technology. Phobias are different from fear of an objective threat.
      2. In a VR Anxiety Disorders Meta-Analysis, those people changed their behavior…this is a functional tool for exposure therapy.
   2. Overcome trauma. There is relief as you avoid it. Examples: Trauma from PTSD, Virtual Vietnam, World Trade Center.
      1. Didn’t get much traction until an article came out to claim it was helping to treat PTSD. Startle response/cortisol activity reduces over time. 
      2. Natural Navigational Control.
      3. People with morbid depression will do well with VR, since they are hard to activate in person.
      4. No adverse effects; significant reductions in PTSD. starting to be looked at as civilian treatment. 76.7% would have picked VR therapy.
      5. High-trauma occupations: police (training to deal with difficult people/ situations), firefighters, vets, raped adults, battered women, and abused children.
      6. VR can help address the needs of doctors and nurses. High levels of suicide levels. COVID-19 Impact on healthcare professions was significant.
      7. Ukraine Project: significant mental health problem there… mockup of metaverse for fostering social support.
   3. Experience less pain
      1. Distract: Video games helped distract burn victims. Users had less perception of pain; less activation in the brain by using VR to help distract from the paint.
      2. VR with autism patients going to the dentist.
      3. Placing IVs.
      4. Great for children but would also benefit adults.
      5. Shows promise for chronic pain (rewires our brains).
      6. Reduces discomfort for chemotherapy patients—helps make the treatment feel shorter than it was)
   4. Rehabilitate brain or spinal cord injury
   5. Virtual reality exercise and relaxation applications
   6. Test and train cognitive function
      1. Neuropsychological methods
         1. Neuropsychological assessment
         2. Cognitive training and rehabilitation
         3. Scientific study of cognitive & functional processes
      2.  Challenges around traditional assessment methods
         1. History Taking and Behavioral rating scales: Limited to bias and subjective impressions of the person doing reporting and ratings.
         2. Psychometric & paper and pencil tests: Ecological relevance/validity for predicting real-world performance.
         3. Computerized tests: Ecological relevance/validity for predicting real-world performance.
      3. Fun and Engaging: using gaming elements in a more motivated and focused way.
7. Head tracking data for ADHD kids.
   1. Virtual Human Interaction Augmented Reality: no data on augmented reality but VR outperforms interactions with humans for those with autism.
8. Summary:
   1. Five core elements of VR: Expose, motivate, measure, distract, & engage.
   2. There are general VR ethical issues and clinical VR ethics.
   3. Can navigate the world using a virtual character version of yourself in Metaverse.
   4. Hardware is no longer expensive.
   5. Over 5g connectivity to have access to libraries and content to select therapy for clients.
   6. Translation from academics to a bigger business. There is a vibrant marketplace for this kind of technology.
   7. Typically, therapy is confidential information kept between a therapist and the patient… is VR therapy kept confidential?
9. Questions?

Accompanying text created by Roxy Terteryan | RKS Project Administrator, SC CTSI  atertery@usc.edu