He finally got his chance at a March 17 breakfast, when he spoke at the Binghamton Club to the Binghamton University Forum about how virtual reality technology is being used to treat and assess individuals suffering from post-traumatic stress and other disorders.
Rizzo, who earned his doctorate in psychology working with Bartle Distinguished Teaching Professor Stephen Lisman, is director of Medical Virtual Reality for the University of California’s Institute for Creative Technologies and research professor in the University of Southern California’s Department of Psychiatry and School of Gerontology. But what he does is use technology – specifically virtual reality technology – to improve lives.
At the cutting edge of virtual reality for years, Rizzo took the audience through its evolution as a clinical tool that can help people overcome phobias such as fear of flying or claustrophobia. Traditional, behavioral approaches to helping people overcome such phobias meant physically taking the individuals onto an airplane or putting the individuals into smaller and smaller rooms. Today, that paradigm has shifted, Rizzo said, with the use of virtual reality opening up tremendous opportunities for clinical research and assessment.
Rizzo said virtual reality technology is being used not only in clinical settings to help soldiers overcome post-traumatic stress disorder (PTSD), but also to conduct cognitive tests for memory, attention and multi-tasking, to train clinicians and even to create virtual humans to interact directly with patients.
“There are virtual classrooms to test children for ADHD that build all kinds of distractions into the environment,” he said. “How well can they focus on the blackboard or what the teacher is saying while common distractions abound?”
Occupational and physical therapy are also benefiting, as patients are using virtual reality headsets to capture movement in real time, making the often boring, repetitive activities of physical rehabilitation fun and engaging by embedding it in the home.
The use of headsets is common for many virtual reality applications, but that same technology is being put online and made available as well, Rizzo said. With a combination of technologies including computers, visual displays and tracking systems, more “human-centric” uses have been developed. “This provides a way for people to interact with computers in a more natural fashion,” he said. “We’re no longer limited to hunting and pecking on a computer; now we can do so much more.”
There are different ways of creating virtual reality environments that move beyond head-mounted displays. “Call of Duty or World of Warcraft video games – those are virtual reality environments,” he said. “They have 3D graphic environments that you can navigate. Now, we can deliver virtual reality on a flat screen for clinical purposes.
“With a low-cost system and webcam, we can meaningfully develop interactive scenarios for rehabilitation as we can also use real controls to simulate driving a car,” he said. “The interface device can be adapted with the software to provide training.
“We also know that good rehab tasks must be measurable, have real-world relevance and must motivate participation and virtual reality meets these criteria,” Rizzo said. “Attention, novelty and reward are all elements of well-designed games, so maybe we can promote rehabilitation in game-based environments to have an impact on the brain.”
A variety of activities have been developed for breathing exercises, pronation and reaching, balance training and range of motion activities. “This is a big game changer with new off-the-shelf sensors. Kinect for example,” Rizzo said. “It’s a revolution in low-cost motion tracking for movement rehabilitation.”
These advances in virtual reality are making a difference, Rizzo said. A 2008 study showed that virtual reality typically outperformed traditional behavioral therapy (real-world exposure). His work with servicemen suffering from PTSD has capitalized on it. “This solid research showed it could have a clinical effect and it opened the door for PTSD sufferers by helping a person confront the experience instead of avoiding something that is anxiety provoking,” he said. “This avoidance becomes the standard behavior, so we try to put people in environments similar to their trauma in a graduated fashion to help them confront the emotions and learn to deal with their reactions. We need to do our best to help returning servicemen out.”
Though war is a bad thing, it drives innovation, including for virtual reality, and now that innovation is being translated into civilian applications, Rizzo said. Some examples he noted were the successful use with fire victims to distract them from painful rehabilitation, for spatial navigation and wayfinding for children enrolling in a new school, and for training children with autism or Asperger’s Syndrome to choose safe alternatives when they don’t respond to other methods.
Virtual human agents are the most recent examples of strides in what virtual reality can affect. With today’s graphics, it’s possible to develop virtual humans that allow for credible interaction with patients, or with clinicians during training.
One such program, called SimCoach, allows PTSD patients to interact with a virtual human to get confidential healthcare information. “This doesn’t replace a real clinician, but provides a safe place for war fighters and their families to talk about their concerns online,” said Rizzo. “The SimCoach is here to listen and to help, it’s confidential and you get to choose the SimCoach that’s right for you. SimCoach listens and responds and people can pull in tips on sleeping and other concerns. It was developed by doctors, computer geeks, experts and writers and the more it’s used, the better it gets.
“Virtual reality allows us to create environments to test, train and treat human function and performance within the environment,” Rizzo concluded. “If you look at what the telephone did over last century, I think we have a bright future ahead of us.”
Binghamton University, State University of New York