As long as video games have existed, the ability to physically interact with a virtual reality has existed in some capacity. From the earliest days of playing Tennis for Two on an oscilloscope and the roaring arcades of the Eighties, bathed in glowing neon lights and 8-bit soundscapes, to the modern uncanny valley that video games currently reside in, with their too-realistic texture mapping and ultra high definition graphics, video games have routinely offered an escape from the reality we inhabit, into one where anything is possible.
With the innovations in video game technology came virtual reality headsets. Inspired by science fiction, using concepts taken straight from Neal Stephenson’s seminal novel Snow Crash, where transferring one’s conscious into the internet is simply a daily occurrence, virtual reality headsets allowed users to enter the virtual world and interact with their surroundings in a way that a simple controller would not allow.
While NASA trialled the technology in labs in the 80s, the 90s saw the first commercial headsets become available: in 1995, you could be the proud owner of a Forte VFX1 headset for a cool $695, or own a Sony Glasstron, the 1998 model of which would set you back 298,000 yen – or just under £2012 when adjusted for inflation. If your interest was specifically in video games, you could own Nintendo’s first (and last, due to its disastrous reception and sales) foray into VR, the Virtual Boy, which displayed in jarring red monochrome, and was mounted to a tripod, preventing movement, or a true VR experience.
The release of the Oculus Rift, funded on Kickstarter in 2012, saw a renaissance begin for VR. When the project was purchased by Facebook in 2014 for an incredible $2 billion, they opened up the device to unlimited non-gaming uses, including social applications, use as a cinema, sports and professional uses.
Already highly useful in a number of fields, virtual reality headsets are used in the medical field as a training aid, allowing doctors to perform highly complex surgery in a safe, virtual environment, providing them with hands-on experience in a controlled environment. The military use VR for flight training and battlefield simulation; athletes and trainers use VR to improve their performance using biomechanics. The system’s applications are vast and varied.
How, then, does this help occupational therapists? Dr Rachel Proffitt, assistant professor of Occupational Therapy at the University of Missouri, who is leading the push in incorporating VR into OT treatment, said: “VR can engage both the body and the mind. VR, in some situations, can be customized just as we would traditional therapy.
“VR can be complementary to traditional therapy or it can be the focus of a therapy session. VR can be used across treatment settings in hospitals, rehabilitation centres, clinics, community centres, and in the home. VR will NEVER replace the need for a skilled occupational therapist. It is a tool that can be used in a myriad of ways but still requires the skilled knowledge of an OT to maximize its use.”
The Wayback Project is one such application which shows how the technology could be utilised by OTs in a way it is not currently. The project sees elderly people with dementia using VR technology to be transported back into the past, in order to bring back pleasant memories and reconnect them with their memories. The brainchild of marketing executives, it was born out of the team’s interactions with family members with dementia. Noticing that showing photographs triggered memories, and inspired by the 2015 immersive movie Catatonic, the team were inspired to create the Wayback Project.
Dan Cole, one of the founders of the project, says “it lets you see the person as themselves for a moment,” which, if even for a second, allows their carer the joy of experiencing them as they were. The team created a series of VR videos, painstakingly recreated from memories. The team obsessed with details: from costumes to food, everything featured in the videos was painstakingly recreated by hand, down to even the smallest detail, including the shoes the children wear. Cole noted that those who viewed the videos were especially excited to see fish paste sandwiches appear, a staple of their youths.
The Wayback Project shows the potential of VR as a therapeutic device for patients with degenerative conditions, such as Alzheimer’s, dementia, or other conditions which affect memory. While it may not treat the condition directly – at least for now – it has an application with therapeutic means, which may assist in memory recall.
Research done by the Faculty of Medicine at Aalborg University in Denmark shows that virtual reality can be used as a means of treating phantom pain. Their testing has shown that VR can trick patients into thinking that their missing limb is present and usable within a virtual reality. Given that eight out of ten amputees experience a feeling of discomfort in their limb which no longer is there, the use of VR can create the impression that signals are coming from the limb, comforting the feelings of phantom limb. This works the same as tests which show that holding a mirror in the centre of the body to create the illusion that the body is symmetrical, which has proven to be an effective therapeutic treatment for amputees.
Occupational therapists may find that using VR can be an excellent way to carry out pre-discharge home visits, helping to propose changes to the home which will help patients function more independently in the home after discharge from hospital. A study by Brunel University showed that, through this process, the patient would feel more empowered to operate independently in their home, having explored it with the safety net of VR underneath them. It allowed them to make more confident and founded decisions regarding their care, and work more closely with the OT performing their discharge.
The safety net created by VR is one of its most vital uses in occupational therapy, and is one of the main reasons Kim Lawther, adaptive technology expert for Scope, uses it as part of the therapy of children and young adults in her care at Craig y Park School in Wales.
“It’s a safe way of looking at a variety of things,” said Kim. “For example, we have been looking at how it can help our students out and about, that they can navigate their local environment safely, so it does give it a bit of a safety bubble to try new things before going out and doing the real thing.
“Currently, we’re looking at setting up for the environment, so I’ve been working with two types of students, so we’re working with PMLD students, that tends to be more of a sensory based situation, so putting them into calming, river landscapes, very sort of mellow places to see whether or not that helps them. Similar to a sensory room, but within the pair of goggle.”
Kim uses VR as a way to ensure that her students have a way to safely understand how the outside world works, and allows them to fully understand the dangers of living in a large city, and allow them to engage safely in activities which may be dangerous to attempt without supervision in reality. She also uses VR as a method of relaxation, using it to create a relaxation room of sorts which can be used for sensory activities.
She said: “We’ve been looking at our students who go out into the community, but perhaps don’t fully appreciate the dangers of things like traffic and things like that, so before a trip, for example, we virtually take that trip, and we understand the dangers that may come out there, and how we can navigate a big city like Cardiff for example, where there’s lots going on – lots of people and lots of traffic – and how we can navigate that safely.”
VR does have its downsides, however. Kim said: “One being the price – I know you can get the cheaper goggles, such as Google Cardboard, but also I think that you have to be very careful. You have to tread that fine line, and ensure the psychological wellbeing of the people you’re using it with, and how you use it, for example, if somebody was unable to achieve something in real life, I certainly wouldn’t recommend doing it within a virtual world, because I don’t think, psychologically, that’s a good thing.”
What does the future hold for VR and occupational therapy? Kim believes they could be ideal partners in the treatment of patients:
“I think it could be a match made in heaven, obviously the price of these things are quite high, but hopefully the majority of assistive tech and other technology that OTs use will come down over time, which will mean that more people, more OTs are able to trial things, and then that great practice between everybody all over the globe, all over the UK, that can be shared.”
Hopefully, OTs will embrace this new technology and move forward with it, integrating it into their primary care systems and using it to care for people while embracing the powerful untapped resource that is virtual reality, proving just how brilliantly it can be applied outside of the small circle of video games, and bringing the tech into the lives of ordinary people.