Top 4 Areas of Virtual Reality In Medical Research

Virtual Reality (VR) is an exciting technology that replaces a user’s visual reality with a computer-generated simulation. While the possibilities may be obvious in gaming and entertainment, VR is also making an impact in other industries—including healthcare and medicine. 

Given that immersive reality categories like VR and AR (or augmented reality) are still very much in uncharted territory, a great way to begin hypothesizing the potential future impacts of these technologies is by examining current research that explores the efficacy of health (or medical) interventions and treatments that utilize virtual reality. 

We examined articles from PubMed, the largest repository of medical research, to determine the top areas of medicine where VR solutions are being explored. Using the search term “virtual reality,” we focused on journal articles from the years 2015 through 2021, excluding review articles. While the modalities, devices, and levels of immersion varied amongst studies, this collection of research provides insight into the impact we might see virtual reality having in the healthcare industry in coming years.

The top four areas of study made up over 80% of all 778 articles that we reviewed. These four areas of study were:

• Neurology (29.4%)

• Education & Training (24.6%)

• Mental Health (17.2%) 

• Pain Management (11.4%)

Neurology

In the articles we reviewed, neurology was the largest category of VR-related research. The studies examined cognitive functioning, processes, and abilities, as well as rehabilitation for stroke, Parkinson’s, and other chronic conditions. 

Stroke Rehabilitation

Most often, VR was assessed as a rehabilitation tool for stroke patients. While some of these rehabilitation studies addressed cognitive limitations like memory and attention, most targeted physical limitations like paralysis. 

Many of these studies demonstrated real promise in VR as an adjunct to more conventional rehabilitation methods. Some even found VR methods to work better than traditional methods. For example, in a clinical trial with stroke patients, researchers from Portugal found that using a “VR system for the training of ADL’s (activities of daily living) has more impact than conventional methods.”

Neurological and Neurodevelopmental Disorders

Another common area of VR research within neurology focused on patients living with neurodevelopmental disorders like Cerebral Palsy, Autism, ADHD, Down Syndrome and Fetal Alcohol Syndrome. Most of these studies were geared towards pediatric patients. Like the studies that involved stroke patients, this research focused on physical rehab and (in lesser instances) cognitive rehabilitation.

Physical rehabilitation was also a common focus in studies involving patients with other neurological disorders like Parkinson’s Disease, Multiple Sclerosis, and ALS. The research often aimed to use VR interventions to help improve stability issues with gait and balance.

Many VR studies addressed physical rehabilitation for neurological issues

Cognitive Function

Outside of patient-focused studies, another area within neurology measured cognitive processing and abilities such as memory, learning and creativity. The use of VR often allowed researchers to design unique environments to test the effects of certain stimuli on cognitive function. 

For example, a Harvard study placed participants into simulated offices that utilized biophilic designs (i.e,. the incorporation of nature into building spaces) to research the effects on stress and creativity. Not only did the researchers find higher creativity scores in participants placed in the nature-infused office spaces, they could also differentiate responses based on the type of office space (open vs. closed) and the type of biophilic elements being displayed.  

Education & Training

Education was the second largest category of VR-related research in the articles we reviewed. Most often, this involved analyzing VR as a tool to train and educate current and future healthcare professionals. 

Medical Procedure Training

The training of professionals to perform medical procedures (such as complex surgeries) made up 68% of the studies in Education/Training, and 16.7% overall—making it the largest subcategory of all the articles we reviewed. 

Some studies found encouraging benefits to surgery training in VR, including increased motor skills and proficiency, reduced surgery times, and increased confidence. For example, a German study found a “positive transfer of motor skills” in surgical novices that trained for “laparoscopic abdominal procedures” using a VR simulator. Meanwhile, a UK study found that participants who received VR dentofacial surgery training reported “significantly greater perceived self-confidence levels” than those in the control group.

Outside of surgery, VR was also explored as a training tool for other medical procedures such as catheter placement, ultrasonography tasks, bronchoscopies, and colonoscopies.

Training medical professionals to perform medical procedures was the top area of research using VR

Scenario Simulations

VR was also used to train healthcare professionals in responding to a variety of clinical or emergency scenarios. Simulated situations included everything from interacting with virtual patients to strengthen communication skills to simulating ambulance transport to test how driving patterns affected the quality of CPR. 

Like with procedural education, the importance of scenario simulations is that they can help to prepare medical professionals to deal with high stress situations, while lowering the actual consequences of risky mistakes during the training process. In theory, this could mean that, when professionals are faced with actual challenges in the real-world, they are likely to be better equipped and more confident in their abilities to perform.

CrossComm has seen some of the benefits of medical simulation training in our own work. We recently created a remote, virtual STEM camp experience in partnership with FocuSStem NextGen. Through a custom VR app, students could experience realistic medical scenarios that would be impractical (and even unsafe) for them to be a part of in the real world. The experience helped them gain empathy for healthcare professionals while also exploring their own interest in a healthcare career.

Anatomy Visualizations and Imaging

VR also offers unique possibilities in areas such as imaging and anatomy education. The ability to use VR for complex visualizations can mean displaying the human body and its processes in vivid detail, with nearly infinite scaling opportunities to improve visibility. While virtual 3D imaging is already integrated in medical school curriculums, much of these visualizations are still viewed on 2D screens. 

The greater levels of immersion available in virtual reality offer unique experiential learning opportunities. For example, students given a “3D animated tour of the third ventricle” in a Switzerland study found the experience superior to 2D teaching in the domains of “spatial understanding, application in future anatomy classes, effectiveness, [and] enjoyableness.”

While the research examples targeting VR for anatomical visualizations and imaging are not as numerous as the training examples, it is still exciting to imagine the possibilities. For example, using interactive virtual reality applications, one could interact with anatomy visualizations using their hands (i.e., bringing objects closer, rotating, inspecting, etc.) for a more realistic engagement. We look forward to more research in this area in the coming years.

Patient Education and Public Awareness

Outside of training future and current medical professionals, the research also showed examples of VR being used as an educational tool for patients and the general public. For example, one study used 3D video to teach patients about the stroke-risk associated with atrial fibrillation, while another study examined if 3D, immersive imaging improved comprehension during the informed consent process.

While these were the only two studies that we categorized as “patient education,” other cases existed. For example, there were several studies that observed how the pre-procedural education of patients impacted anxiety and/or pain. Regardless of the end objective, one can imagine how educating a patient about a condition or procedure through an immersive platform like VR might offer visual and contextual advantages.

Studies using VR to educate the general public were mostly campaign oriented—intending to support public health and safety initiatives. Some of the campaigns covered included driver and pedestrian safety, fire safety, bullying and violence, suicide prevention, and Covid vaccine intention. 

Mental Health

17.2% of the studies we reviewed focused on treating patients with psychiatric or other mental health issues including anxiety, depression, phobias, PTSD and addiction. 

Exposure Therapy and VR

VR was most frequently used as an exposure therapy tool for patients with situational anxiety, phobias, PTSD, or even addiction. Virtual Reality Exposure Therapy (VRET) allows a safe environment for patients to receive visual stimuli of their fears or triggers with the purpose of gradually decreasing the distress or harm caused by these triggers.

In the studies targeting situational anxiety and phobias, the triggers examined were related to very specific scenarios including encounters with feared animals (such as spiders); feared social situations (like public speaking), or other feared scenarios like flying or storms. 

PTSD studies using exposure therapy seemed to take VRET a step further, asking more complex questions about the use of VR in exposure therapy. For example, does VRET increase emotional engagement? Are results better when VRET is used in conjunction with other treatments such as cognitive enhancers or electrical brain brain stimulation?

Improving exposure therapy efforts with immersive technology is something CrossComm has experience with. We collaborated with Wayne State University researchers to build an extended reality (XR) exposure therapy tool to help patients with phobias and PTSD gradually become comfortable with feared objects and scenarios.

Cognitive Behavioral Therapy and VR

While exposure therapy was the predominant therapeutic approach when using VR in psychiatry and psychology research, it was not the only one. VR was also used as an adjunct to cognitive behavioral therapy (CBT), a form of psychotherapy that addresses psychological problems by focusing on a patient’s unhelpful thinking and behavior patterns.

In the CBT approaches, exposure to triggers were still often present, but there was also more emphasis on the mental reasoning behind the perceived threat levels. For example, one study had mothers with postnatal depression interact with a virtual home environment with home, toddler, and neighbor-related stressors. The purpose was to help them apply CBT techniques they had been taught, such as “grounding in the present moment,” to manage stress.

Treating Anxiety For Upcoming Medical Procedures

Another area of research explored anxiety reduction in patients scheduled to undergo a medical procedure or operation. Studies ranged in scenarios, including patients in the ICU to those about to undergo dental procedures. As mentioned earlier, some of these studies (such as this one from South Korea) had educational components to them—testing theories that patients who better understood their procedure would be less anxious. Others attempted to reduce preoperative anxiety by using VR to generate relaxation stimuli, visual or audio distractions, or even virtual tours of the operating room.

VR and Stress

The American Psychological Association explains that stress differs from anxiety in that, “stress is typically caused by an external trigger,” while anxiety consists of worry that persists “even in the absence of a stressor.” Studies that examine stress responses often will put study participants into some sort of a stress test to examine changes in different physiological responses. 

Like in the previously mentioned exposure therapy examples, some studies used VR to introduce a virtual version of a stress trigger. For example, a German study had participants undergo a VR version of the popular Trier Social Stress Test after five days of either receiving one of two medications, or a placebo. Another study used simulations of different neighborhoods (disadvantaged or affluent) to see if they triggered stress responses in the participants. In other cases, simulated scenarios (such as ostracism or social support ) were administered to participants in VR to evaluate their impact on stress.  

Outside of using VR as part of stress tests, VR was also evaluated as a stress management solution. For example, a VR-guided meditation app was “associated with a significant decrease in emotional exhaustion” in Otolaryngology residents. Another study from Spain found that “VR exposure may enhance treatment adherence” to mindfulness-based programs attempting to reduce stress in university students.

Other Mental Health Issues and Scenarios

The scope of mental health issues is rather wide and, not surprisingly, the studies using VR varied as well. Some studies sought to improve symptoms of depression, apathy and loneliness, while others targeted the effects of psychotic disorders like psychosis and schizophrenia. 

Pain Management

Considering the current Opioid Crisis, alternative pain treatments are particularly attractive in medicine. In the articles we examined, VR was studied as an adjunctive treatment in a variety of cases, from treating burn victims to those with phantom limb syndrome. Techniques varied across studies. For example, some used VR as a visual distraction, while others used it as a tool for biofeedback training. 

Procedural and Post-Procedural Pain

VR was commonly used to address pain associated with medical procedures. Pediatric patients were most often the subject of these studies, especially for procedures involving venipuncture (i.e., giving shots or drawing blood.) Other studies focusing on pediatrics patients explored pain associated with procedures like circumcisions, dental work, and even minor plastic surgery. In most studies addressing procedural pain in pediatric patients, VR was used as a distraction tool and was shown to decrease pain levels. 

Outside of pediatrics, VR pain-reduction research was implemented in a broader collection of medical procedures including labor and delivery, colonoscopies, hysterectomies, and vasectomies. 

Chronic Pain

Chronic pain research was another area that explored the use of VR. Studies addressing lower back or neck pain were most common, though other sorts of chronic pain, such as knee pain and fibromyalgia, were addressed as well. While most studies addressing procedural pain used VR as a form of distraction, interventions addressing chronic pain often used VR to encourage therapeutic movement—including in instances of kinesiophobia, a fear of physical movement due to anticipation of pain or reinjury. 

Burn and Wound Recovery

While most studies addressing pain dealt with procedural pain and chronic pain, one area of interest was decreasing pain associated with wound or burn recovery. For example, researchers from the University of Washington found that burn patients receiving VR distractions while performing range of motion exercises “reported significant reductions in several aspects of pain (e.g., intensity, unpleasantness, and time spent thinking about the pain) than those who did not receive the VR intervention.

Phantom Limb Syndrome

Virtual reality was also used to address phantom limb syndrome. Phantom Limb syndrome occurs when a person experiences sensations (often pain) that seem to come from a limb that is no longer present. Traditional mirror therapy places a mirror between a person’s limbs so that a working limb creates the illusion of movement in the inactive or absent one—stimulating key parts of the brain. Similarly, researchers used virtual limbs in VR  as a new iteration of mirror therapy. 

An Exciting Future for VR in Medicine

The uses of immersive technologies in medical research are varied and encouraging, from training surgeons to perform complex surgeries, to rehabilitating stroke patients, treating phobias, or addressing debilitating pain. Many of these studies demonstrate promise for the future of these modalities in patient care and medical treatment. 

While the top four areas of study (neurology, education/training, mental health, and pain) make up over 80% of the research, the remaining 17% consists of a number of interesting areas as well. For example, several studies examined VR as an adjunct to physical therapy addressing orthopedic issues, aging, and mobility. Other study topics included weight management and exercise; ear, nose, and throat; cardio and pulmonary rehab; and ophthalmology.

At CrossComm, we are excited to continue working with medical researchers to find new ways to use existing and emerging technologies to promote a healthier society. If you have a research study idea that requires custom software, and are interested in taking the next step, we would love to hear from you and discuss whether CrossComm is the right fit for your needs. Tell us more and receive a free assessment from CrossComm.