The term Virtual Reality (VR) has been popping up everywhere, especially in the entertainment industry, and is increasingly being used for games. Users are now immersed in virtual worlds via VR-goggles, after the evolution of the game environment beyond just monitors.
For a long time now, VR is used for more than just entertainment, with applications in the medical field, specifically in therapy.
What is Virtual Reality?
Virtual reality refers to a virtual world programmed by a computer. "Virtual" means "not existing in reality, but appearing real" (source). Through the so-called VR-glasses, which users put on like diving goggles, they enter a virtual reality that surrounds them. The VR-goggles are also known as head-mounted displays.
Immersion with VR goggles
Diving into VR is also called immersion. There are no limits to the design of the environments in the VR therapy with with CUREO®. Users find themselves e.g., on the rings of Saturn, relaxing by a lake, or launching paper airplanes at the top of a canyon.
Designing the virtual worlds requires special programs, such as the Unreal Engine, which allow developers to give free rein to their creativity. Based on this software, a lens system and the use of stereoscopic vision », a three-dimensional environment is created. Cameras on the VR-goggles record users' movement and transfer it to the virtual world. A calibration ensures that the environment is analyzed before the therapy, so that the real world matches the virtual one, e.g., the real table located in front of the user is also integrated into the VR.
Users are represented as avatars in VR and can see their own movements in real-time. Additionally CUREO® offers movement features that are not possible outside of VR, e.g., sonification - the production of sound through movement.
Through multi-sensory feedback, which is used in mature VR systems like CUREO®, users also receive audio signals that indicate, e.g., that they have performed a task correctly or verbalize hints for the next step.
What is the difference between VR, AR, MR and XR?
In addition to virtual reality (VR), terms such as augmented reality (AR), mixed reality (MR) and extended reality (XR) are joining the ranks.
Thanks to VR glasses, the user finds himself in a virtual world, completely blocking out his actual surroundings and experiencing VR as his new reality. Via the head-mounted display, the user can see the new world visually, but also receives acoustic stimuli that make the immersion perfect.
Augmented reality focuses on the user's actual environment, which is enhanced with additional information through digital programs. One example is the transparent head-up display used in modern vehicles, which displays information such as speed.
Mixed reality refers to a combination of VR and AR. For example, the real environment is displayed, but so are virtual elements. The difference to AR is that MR is even more advanced, the physical and virtual worlds interact with each other, and the boundary between real and virtual is becoming increasingly blurred.
Extended Reality is understood as a combination of all real and virtual worlds, and is considered the generic term for VR, AR and MR.
VR in medicine
Education and training
Virtual Reality is often associated with VR games, in which a wide variety of tasks must be performed interactively in a three-dimensional space. However, the use of VR is also becoming increasingly important in the medical sector, opening up entirely new possibilities compared to analog approaches.
VR can also be used for the education or training of medical professionals. Whereas in books the human anatomy can only be depicted in two dimensions, in virtual reality a 3D image of the body is created. Organs can be rotated and thus viewed from different perspectives.
VR in hospitals
For example, hospitals and clinics are using VR technology to support surgery and test the procedure in detail before the treatment is carried out in reality.
A major advantage of using VR is that it is cost effective. With just a few clicks and little effort, a wide variety of scenarios can be played out, whether for anxiety patients or to simulate a certain situation.
VR anxiety therapy
Another area of application extends to the treatment of phobias through the use of virtual anxiety therapy.
Fear of heights
Fear of flying
Other panic disorders
Patients are placed in different, virtual situations in a controlled manner in order to learn how to cope with their fear. For example, our VR system CUREO®offers different environments that can expose patents to fears, e.g., sitting on top of a high mountain or looking down the valley of a canyon. Playful elements can be used to distract from the negative feelings and instead focus on positive emotions.
Development of VR
Especially in the years from 2016 to 2018, there was a lot of hype around the topic of virtual reality. However, the technology used at that time was far from being clinically suitable. CUREosity recognized the potential of VR and started the development and clinical testing of CUREO® to ultimately bring a mature VR therapy system to the market that meets the therapeutic demands.
The gamification approach used in VR applications transfers seamlessly into therapeutic uses based on virtual reality. Games add joyful elements to the therapeutic exercises easing a potential resistance to therapy.
However, in order to use VR in therapy, a scientific foundation is essential. Our VR therapy system CUREO® was designed together with clinics, doctors, therapists and patients, but also with game designers and software developers. A system was created that fulfills both medical requirements and a playful character. Our VR software for therapy is CE-certified meeting the requirements for a medical device.
Our VR therapy offers exercises for sensorimotor as well as cognitive rehabilitation and addresses particularly the upper extremities and the trunk. Six modules focus on a wide range of therapy fields: The finger module focuses on exercising the fine motor skills of the hands and fingers, while the daily module trains the application of everyday life tasks. Therefore, CUREO® can be ideally used for virtual physiotherapy as well as occupational therapy.
More fun through VR
With CUREO®, therapy should be fun while effectively support the rehabilitation of patients. One of the biggest challenges in the rehabilitation of patients with motor impairments is the recommended frequency of therapy next to the large number of repetitions required for improvement. For example, patients who have paresis after a stroke can find even small movements difficult and often lack motivation for therapy. Gamification in virtual reality not only makes everyday repetitive tasks interesting for patients, but also supports rehabilitative goals by increasing patients' adherence to therapy.
A low latency, i.e. almost direct translation of the users' movements into VR, prevents the occurrence of motion sickness. Thus far, we are not aware of any case where our users experienced motion sickness.
Achieving different goals
For the therapy of various indications such as stroke, neglect, Parkinson's disease or anxiety disorders.
For an efficient application of different therapy methods due to short set-up times and a user-friendly software.
To promote motivation, for example when conventional therapies no longer promise success.
For a gamified and competitive challenge reinforced by visible progress in the form of point scores
To distract from pathologizing hospital environments and pain
For relaxation trough to tranquil landscapes within VR
Short setup times, and space-saving
Wide range of functions
Safe VR environments
High therapy frequency
Clinical evidence of virtual therapy
VR therapy offered alone or in addition to traditional therapy achieves increased success rates and increased treatment outcomes (Karamians et al. 2020; Afsar et al. 2018).
VR-based therapy is an accepted method of rehabilitation for stroke patients (Laver et al. 2017). A systematic review by Massetti et al. (2018) recommends incorporating VR therapy into stroke rehabilitation programs.
VR therapy shows improvements in upper limb rehabilitation (Karamians et al. 2020; Mekbib et al. 2020; Lee et al. 2019) and motor function (Massetti et al. 2018).
Several studies have reported improved scores on tests assessing motor learning and motor skills following the use of VR-based rehabilitation approaches (Yeo et al. 2019).
Improvements in tasks of daily living (Massetti et al. 2018), cognitive function (Dehn et al. 2020), and proprioception (Cho et al. 2018) were observed with VR therapy.
In addition, high patient satisfaction as well as improved participation and motivation have been reported with VR therapy (Yeo et al. 2019 and Araujo et al. 2019).