How virtual reality could help treat stroke patients

Med-Tech Innovation News web content editor Ian Bolland went to check out the technology that could be used to rehabilitate stroke patients in the future.

Virtual reality could be used to rehabilitate stroke patients if trials are successful thanks to work undertaken by experts at the University of Chester.

The Medical Graphics team at the university, in partnership with the Countess of Chester Hospital and 3D scanning firm Cadscan, have developed a method of using virtual reality in order for patients to relearn certain tasks.

The project is currently at the start of its two-year funding period from Innovate UK. The first six months will be spent developing software prior to the trial and if the trial is successful then Cadscan could commercialise it and market it to the NHS.

Scenarios that have been developed so far include putting bread into a toaster, pouring water from a jug into a glass and applying toothpaste to a brush with scope for more.

A trial using 60 patients will take place that will last for 12 months involving a more professional version of the application they have currently developed. The aim is that virtual reality can be used to compliment other aspects of rehabilitation – with one of the knock-on effects potentially saving the NHS money.

Professor Nigel John from the University of Chester said: “What we’re interested in is being able to prove that this has an effect so our hypothesis, if you like, is that people who use the VR training improve faster than the people who don’t, and if they are improving faster they can go home faster and it starts to save a lot of money for the NHS then.

“Having patients in a hospital is quite expensive so if they can turn (them) around quicker then to a point where they are satisfied they can cope at home – it could be a few days, a week earlier than normal that they leave the hospital setting, that’s where the money savings are.”

Professor John added the idea came about following a conversation with Professor Kausik Chatterjee, consultant physician at the Countess of Chester Hospital, who saw the potential in using virtual reality as part of patients’ cognitive rehabilitation, while Professor John talked about how treating it like a game could make things easier for patients.

He said: “We put together a basic prototype, took it into the hospital, got some of the patients to have a go and they loved it. It’s much better than the tasks they are currently doing.

“They would be pouring water into a jug but using a real jug and a real glass. It’s ok to do it once but if you have to do it 20 times it gets a bit laborious. (With VR) you can sort of gamify it, give you timings, see improvements, we can increase difficulty as you’re going up levels in the game.

“You’ve got the side of making it more difficult as they get more familiar and successful with simple tasks you can give them something a bit more challenging – a bit like doing a game that’s got levels the game gets harder. This would be the same.”

The team says there is also scope to extend the use of the technology to include garden tasks and shopping, as well as other tasks within the house.

Professor John added: “There’s a whole suite of daily living tasks that we could implement – a lot of kitchen-based tasks. So, one idea is to have a virtual kitchen and they can work themselves around parts of the kitchen to do something else such as chop up some vegetables, put something in the oven.”

Tom Day, who has been working with Professor John on the project, added: “(They could) make a cup of tea or just generally drinks, cooking a full meal and obviously the kitchen is just one room in the house you can do it.

“I was talking to Cadscan and we were asking ‘what about the garden?’ Planting flowers in the flowerbed; that is something we know how to do, that is an activity of daily living for most people, general gardening is. But obviously after a stroke that is something you may not be able to do or remember how to do. For us we remember that you need to dig a hole, get a plant, put it in, fill it over and give it some water.

“To someone who has had a stroke they may not remember how to do that. And also doing the garden puts them into an outdoor scene so they’re not cooped up in a hospital all day, every day until they get sent home. So, putting them in a garden in virtual reality might be a nice little escape for them as well.

“The kitchen is just one room. You’ve got stuff in the bathroom like brushing your teeth. You could potentially go shopping if you were to set it like a supermarket.”

The software was demonstrated using Oculus Rift with the aid of a computer but the platform of Oculus Quest is likely to be used going forward – which effectively has a smartphone within the headset meaning there is no need for a laptop.

The researchers say that the use of the technology is only intended to be part of the rehabilitation process for stroke patients as opposed to replacing any of its aspects, and allows patients to get reacquainted with familiar movements without the strain of picking up heavy objects. The more tech-savvy a person is, the easier they would find it to operate, and families would be able to start up the virtual reality kit like any other game, the researchers say.

Professor John said: “We focus really on how we get the brain to relearn how to do these tasks, not so much the physical rehabilitation. There will be some help with the physical rehabilitation because you are using your arms – you’re not lifting up a heavy jug a water you’re just lifting a hand controller but the brain is relearning: ‘this is what I need to do, I need to reach over, I need to grab the handle, I need to pick it up, I need to bring it to the glass,’ all of these things you just have to relearn how to do them.”

Tom Day added: “We never saw this as a replacement, this is always a supplement. So patients will obviously get their normal therapy, their normal care routine, occupational therapists, therapy assistants – what they do normally.

“If the equipment is free and the patient is willing to do a bit of rehabilitation without an occupational therapist they can just take the system sat in bed or on the chair and practice in this VR and what’s nice about this is when we created the system we were thinking that maybe family would want to help. So, instead of getting someone on the ward to run it you could have a family member help the patient, put on the headset, start up the application. The families always, always want to help out with their relative’s rehabilitation.”