Walter Greenleaf PhD Transforms Healthcare with Emerging XR Technologies
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Virtual Reality Technology, Machine Learning, Biosensing Converging to Transform Healthcare By Walter Greenleaf The oncoming wave of Virtual Reality and Augmented Reality technology will impact medicine, clinical care, and personal health and wellness. Although entertainment, social connection, and gaming will drive the initial adoption of VR and AR technology, the deepest and most significant impact of the next generation of VR/AR technology will be to enhance clinical care and to improve personal health and wellness. VR and AR technology will also help facilitate the shift of medicine to direct personal care. We know from decades of clinical research that VR/AR technology can provide breakthrough solutions that address the most difficult problems in healthcare - ranging from mood disorders such as Anxiety and Depression to PTSD, Addictions, Autism, Cognitive Aging, Stroke Recovery, and Physical Rehabilitation, to name just a few. VR technology can also improve clinical measurements and assessments by making them more objective and functional, and improve medical training such as surgical skill training and procedure planning by applying simulation-based learning principles. Personal health and wellness will be improved by using VR to promote healthy lifestyles and to reduce stress and anxiety. As the cost of healthcare rises, VR technology can serve as an effective telemedicine platform to reduce costs of care delivery, and improve clinical efficiency.
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Walter Greenleaf PhD Transforms Healthcare with Emerging XR Technologies
- 1. Walter Greenleaf PhD Virtual Reality Technology, Machine Learning, Biosensing Converging to Transform Healthcare
- 2. VR / AR Technology and Healthcare The Digital Health Revolution Emerging and Confluent Technologies Overall Landscape of XR Technologies Neuroscience – Why XR Has Impact History of VR - and Why it Matters Current Status – Where There is Traction Future Perspective and Predictions – Also, Impact of COVID
- 3. The Stanford Laboratory for Brain Health Innovation and Entrepreneurship VR-IT Stanford Virtual Reality Immersive Technology Clinic Academic Affiliations
- 5. Healthcare Crisis: Aging Populations 0 50 100 150 200 250 300 350 400 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2015 2020 2025 Age 85+ Age 75-84 Age 65-74 Age 45-64 Age 5-44 Under Age 5
- 6. Transforming HealthCare with Technology
- 8. Digital Health Revolution • Mobile Health / eHealth • Machine Learning • Wearable Sensors • Patient Centered • Leverages Internet: social, quantitative, collaborative
- 9. • Prevention and Wellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery Digital Health technology will significantly impact Medical Care
- 10. Every Medical Device Reinvented
- 12. Digital systems are not just measuring the physical parameters of our health. New methods are being developed that will allow us to collect and analyze biomarkers that reflect our cognitive and emotional status. Here are four examples… Brain Health BioMarkers - Passive Data from Smart Phones Voice Analytics as a BioMarker of Depression Facial expressions in response to a VR Challenge Cognitive function assessment using AR and smartphone sensors
- 13. Digital Health Platforms deliver interventions to patients, and parse data for enhanced analysis and improved protocols
- 15. 5G connections will surpass one billion by 2023 Single-digit millisecond latencies with Edge Computing Cloud-Rendered AR and VR content Real-time Analytics for Machine Learning, Predictive Modeling
- 16. Machine Learning
- 17. Digital Twin Paradigm For Precision Healthcare
- 18. Sensors Are Evolving, Connecting, Promulgating Sensors 1.0 Sensors 3.0 Sensors 2.0 Measure and record Integration with web; Sharing and accessing data Passive data gathering; Aggregation and meaningful interpretation
- 19. Ready or not… The wearable tech, always on, always online world On the way - arriving soon.
- 20. Virtual Humans - Voice Recognition, Emotion Detection- Dynamic Response
- 21. Virtual Humans For Education, Training, Support “Smart Avatar” with a virtual voice, image and mannerisms via AI
- 23. THE LANDSCAPE VR + AR + MR = XR GAINING MOMENTUM EVOLVING RAPIDLY
- 24. The Next Computer Platform Work Play Educate Socialize Shop Entertain Communicate Etc
- 25. Now is the time for VR & AR XR technology is now affordable, scalable and accessible Facebook - Oculus HP - Reverb Sony – PlayStation VR Microsoft - HoloLens HTC - Vive Apple - Varjo HMD - 60 PPD for 20/20 vision resolution
- 26. Why use XR? Uniquely Capable Extension of existing virtual capabilities Intuitive “spatial” language natural interactions streamlines engagement Deeply Personal Learning content made meaningful through user’s interaction & feedback Immersion enhances engagement, retention Making experiences “personal” drives motivation to learn & keep learning Highly Functional Experimenting with systems & concepts to better understand Applying learned concepts in practice Can do things are otherwise expensive or impossible -e.g. due to safety/cost
- 27. Fully immersed in an environment Virtual Reality
- 28. Digital objects and overlays in the real world Augmented Reality
- 29. The spectrum between AR & VR: From blending ourselves with digital environments to anchoring digital objects in the real world Mixed Reality
- 32. 11.3 16.9 27.3 41.5 56.2 68.0 Year 2 Year 3 Year 4 Year 5 Year 6Year 1 Within 3 years, VR will likely be adopted by 30 million users Within 6 years, XR will likely be adopted by 70 million users
- 33. XR Technologies Currently Disrupting Education & Training Manufacturing Maintenance Product Design Process Design Healthcare Simulation & Modeling
- 34. • Prevention and Wellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR Technology Impacts All Sectors of HealthCare
- 35. Acute Pain Addiction Medicine ADHD Anxiety Management Autism Spectrum Disorder Chronic Pain Cognitive Assessments Depression Disability Solutions Emergency Medicine Medical Education &Training Ophthalmology Orthopedics Palliative Care Patient Education Phobias PTSD Physical Medicine and Rehabilitation Preventive Medicine Respiratory Medicine Senior Care Stroke & TBI Surgical Procedure Planning Surgical Skill Training Uncomfortable Procedure Mitigation More Than 200 Emerging Medical VR/AR Companies Targeting Multiple Clinical Sectors and Specific Indications
- 36. Significant Investment in XR for HealthCare The Medical VR / AR Market is projected to be $5.1 B in 2025
- 37. The Neuroscience of How VR Promotes Behavior Change VR can promote behavior change by taking advantage of the way our brain’s learning and reward systems function Activate neuroplastic change via reward systems Shorten the reward feedback loop – show progress Leverage mirror neuron systems VR systems can:
- 38. VR is More Effective than Imaginal or In Vivo Exposure Techniques VR exposure floods the visual thalamus and cortex, activating both subcortical, threat detection and response pathways as well as cortical, conscious pathways In this manner, VR exposure therapy is more effective than imaginal exposure therapy - it activates both exposure/cognitive processes and threat extinction processes. In vivo exposure is inconvenient, expensive, time- consuming, difficult to standardize, difficult to monitor, and imposable to provide in a graduated or controlled manner. Sensory Inputs Sensory thalamus -> amygdala path -> (non-conscious) Sensory cortex -> PFCvm -> amygdala path (conscious) HPA Axis
- 39. Ability to change attitudes and behavior after “being” one’s future self. Leveraging Mirror Neurons
- 40. Addition Mechanisms of Impact Active Involvement: XR systems provide users with immersive experiences that maximize cognitive engagement. Feedback: learning is reinforced by direct, immediate and relevant feedback that reinforces the experience and the lessons learned. Engaging and Motivating: the dynamic nature of VR/AR systems provides users with agency and can provide immediate rewards for progress. Team Training: Multiuser experiences can provide and leverage group skill building. Cost Effective: XR systems extend the reach and reduce the cost of face-to-face training. Novels Theater Film Games AR/VR
- 41. Wired for Narrative Stories Research shows that STORY: • Provides superior retention (memory and recall) • Provides improved understanding • Creates context and relevance • Creates empathy • Promotes engagement and participation • Enhances the creation of meaning and personal relevance
- 42. First general purpose and commercially available VR systems. VR Technology Has Evolved 1987
- 44. Academic research has indicated that Virtual Reality can effectively treat a wide variety of clinical problems – ranging from addictions, to stroke, to PTSD
- 45. • Prevention and Wellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR technology will significantly impact Medical Care
- 46. • Clinical Skill Training • Surgical Skill Training • Interpersonal Skill Training • Use of Equipment and Tools • Team Training - eg: Emergency Department, Surgical Team • Emergency Response Training and Rehearsal • Facilitate Empathy Medical Training
- 48. Anatomy and Physiology Training • Response to the acute shortage of human cadavers • Allows for repetitive training and self-study • More detailed examination of micro- features of organs, tissue etc. • Integration of text, video and other media to further enhance learning
- 49. Virtual Patients for Clinical Skill Training
- 50. Preparation and Training for Difficult Situations
- 51. • Prevention and Wellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR technology will significantly impact Medical Care
- 52. • Medical Image Review • Neuropsychological Assessments • Activities of Daily Living Assessments • Physical Medicine – OT / PT • Behavioral Medicine – psychology, psychiatry DIAGNOSTIC ASSESSMENTS
- 53. Standardized Environments for Neurocognitive Evaluation New Approaches for Cognitive Assessment Migrates traditional paper and subjective evaluations to a more sophisticated level. Provides robust assessments that can challenge cognitive skills in a more natural, standardized, objective and reproducible manner.
- 55. BioMarkers - Cognitive and Emotional State Collecting and analyzing psychophysiological responses in VR
- 56. Standardized Environments for Neurocognitive Evaluation New Approaches for Cognitive Assessment
- 57. We use brain circuit biotypes to connect brain imaging with VR Neuroimaging measures 1. Scan brain at rest 2. Emotion regulation task 3. Cognitive control task Virtual Reality: 1. Relaxing scene 2. Emotion regulation task 3. Cognitive control game
- 58. • Prevention and Wellness • Objective Assessments • Functional Training • Improved Interventions • Facilitate Adherence • Distributed Care Delivery VR and AR technology will significantly impact Medical Care
- 59. Some Examples – VR and AR in Use Today
- 60. Preoperative Planning & Image Guided Surgery
- 61. Stroke and Traumatic Brain Injury Physical / Occupational Therapy New Approaches to Physical Medicine & Rehabilitation
- 62. New Approaches to Mental Health
- 63. VR for Pain Distraction Clinical Research and Validation Interactive virtual environments significantly reduce pain from as much as 44% during the most painful procedures (ex: burn wound treatment) Diverts patient attention away from perceiving and feeling pain; (selective attention theory) Decreases pain-related brain-activity Reduces need for anesthesia, opioid medication No pharmacological side effects
- 64. PTSD, Phobias, Anxiety Disorders • Exposure-based treatments can be conducted in the safety and comfort of an office setting • Effective tools for treating a variety of clinical problems, in particular anxiety and addictive disorders • Fully immersive environments, with include the use of a head mounted display, 3D sound, tactile stimulation via shaking platform, and olfactory stimulus are used for PTSD therapy
- 65. RISK AVOIDANCE TRAINING Refusal skill training, Situational Confidence
- 66. ! Generalized Anxiety Disorder ! Phobias ! Obsessive Compulsive Disorder ! Anger Management ! Eating Disorders ! Schizophrenia Virtual environments are used clinically to treat several important mental and behavioral health problems
- 67. • Social Anxiety Disorder • Depression • Chronic Pain • Mild Cognitive Impairment • Autism Spectrum Disorder • ADHD Virtual environments are used clinically to treat several important mental and behavioral health problems
- 68. Virtual Hospital Tours Used To Relieve Pre-procedure Anxiety
- 69. Senior Care
- 70. Multiple Programs - One Platform DTx Programs BALANCE Foundation Mindfulness Relax Regulate Chronic Pain Acute Pain Relief Addiction General Wellness Programs Stress + Rx Adherence + Efficacy Anxiety / Depression Acute + Chronic Pain Cloud-based System Dynamic Experience Biometrics Service Social VR Engine*Analytics Permissions & Security
- 71. • Improve Cognitive Function • Promote Exercise & Weight Management • Stress Management • Mood and Resilience HEALTH AND WELLNESS • Disability Solutions • Addressing Isolation • Grief Counseling
- 72. Ability to change attitudes and behavior after “being” one’s future self. Have a Dialog With your Future Self
- 74. XR Technology Trends Impacting The Future
- 75. XR - A Key Component Combination Therapy - Digital Health Platform XR system designed to enhance medication efficacy Medication with clinical benefit Prescribed combination product with enhanced efficacy =+
- 76. Digital Health Platforms deliver interventions to patients, and parse data for enhanced analysis and improved protocols
- 77. A data stream for physicians to manage patients between visits Includes specific Rx compliance tracking capabilities Focus on issues disease worsening, new symptoms Includes Alerts to Care Team and integrates at POC Sensor Tech PatientApp Wearables PATIENTS PhysicianApp PHYSICIAN Office Visit Office Visit Injection issue GI issue Relapse?Sleep issues Tingling, weakness Actionable, avoid events, costs, ROI path to payment
- 78. Pediatric Resuscitation Training The CHLA residency program and hospital use VR as part of a required curriculum for interns - required prior to setting foot in the emergency department.
- 79. Acute Pain Addiction Medicine ADHD Anxiety Management Autism Spectrum Disorder Chronic Pain Cognitive Assessments Depression Disability Solutions Emergency Medicine Medical Education &Training Ophthalmology Orthopedics Palliative Care Patient Education Phobias PTSD Physical Medicine and Rehabilitation Preventive Medicine Respiratory Medicine Senior Care Stroke & TBI Surgical Procedure Planning Surgical Skill Training Uncomfortable Procedure Mitigation Considerable Activity
- 80. Acute Pain Addiction Medicine ADHD Anxiety Management Autism Spectrum Disorder Chronic Pain Cognitive Assessments Depression Disability Solutions Emergency Medicine Medical Education &Training Ophthalmology Orthopedics Palliative Care Patient Education Phobias PTSD Physical Medicine and Rehabilitation Preventive Medicine Respiratory Medicine Senior Care Stroke & TBI Surgical Procedure Planning Surgical Skill Training Uncomfortable Procedure Mitigation Relatively Underdeveloped – Significant Opportunities
- 81. Improved Assessments and Diagnostics Addressing Isolation and Loneliness Acute and Chronic Pain Depression and Anxiety Disorders Physical and NeuroRehabilitation Design for Disabilities Post-Discharge Follow-up Staff Training: not just procedures, but empathy Digital Therapeutics for Senior Care
- 82. The Impact of Covid-19 on XR Markets Education Training Manufacturing Maintenance Product Design Process Design Healthcare Simulation & Modeling Location Based Entertainment Gaming
- 83. Covid-19 - The Impact on XR Technologies and Applications XR Systems are poised to dramatically impact several vertical markets Regulatory and conceptual barriers are dropping The need to address Covid-19 is accelerating the process Investments and deployments are continuing Remote work and Telemedicine is gaining acceptance Increased focus on Mental Healthcare Migration from LBE to Healthcare Of course, provisions for disinfection are critical
- 84. Kills 99.99% of viruses, bacteria and fungi, supported by independent lab testing ❖ Utilizes medical grade UV-C light in an LED, eliminating the need for heat, moisture or toxins in the decontamination process ❖ Multi-functionality can include storage, locking, charging and credit card access capabilities ❖ Can be used for any size hardware or products including HMDs, production/broadcaster headsets, earphones, tablets and cell phones ❖ Can be used for other products used on the face, such as sunglasses and eyewear. ❖ 100% Made in the USA—No supply chain constraints or dependencies.
- 85. In Summary
- 86. Current technologies and concepts are founded on more than 30 years of research and development Recent changes in cost and access make VR/AR technology affordable VR and AR Technology Impacts All Sectors of HealthCare After years of study and use by early adopters – validated systems are poised to move to the mainstream On the horizon - enhanced, ubiquitous, informative and integrated VR/AR systems are currently used for - prevention, evaluation, treatment, and chronic disease management
- 87. International Virtual Reality Health Association IVRHA.org
- 88. Walter Greenleaf PhD Virtual Reality Technology, Machine Learning, Biosensing Converging to Transform Healthcare