Banner by Korrina Gidwani
Ready Shopper One
By Korrina Gidwani
“Milk, eggs, Cheerios, paper towels…” echoes in your mind as you internally recite your grocery list. You continue pushing your shopping cart down the aisle, maneuvering around other shoppers until you arrive at the shelf containing paper towels. You toss a pack of paper towels into your cart and proceed to the checkout line. Seems straightforward enough, right?
Unfortunately, for the 8 million Americans affected by vestibular balance disorders, seemingly simple tasks can become increasingly difficult. Shopping for groceries, riding an escalator, and other daily activities may feel challenging and inconvenient as these tasks require optimal balance and body orientation in space. After recognizing the debilitating nature of vestibular disorders, researchers from around the world have collaborated to develop a unique treatment method: virtual reality.
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Over the past two decades, novel scientific research has revealed the complexity of the balance system in humans. Researchers have established that sensory, motor, auditory, and proprioceptive information are integrated in the vestibular system, located within the inner ear. The intricate neuronal network within the vestibular system utilizes sensory and motor inputs to produce smooth, coordinated movements and relies on proprioceptive information to maintain posture and balance.
Damage to one of the aforementioned systems – sensory, motor, auditory, or proprioceptive – can trigger the onset of a vestibular balance disorder. Damage may result from ear infections, traumatic brain injury, adverse reactions to medications, or other issues within the inner ear. Although dozens of vestibular balance disorders have been identified over the years, the most prevalent types are Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s Disease, and vestibular migraines. Individuals with these disorders typically experience vertigo, faintness or lightheadedness, unsteady gait, loss of balance, dizziness, and blurry vision.
Researchers have teamed up internationally in an attempt to minimize the severity of these symptoms and improve the quality of life for people with vestibular balance disorders. Dr. Susan Whitney, a physical therapist in the School of Health and Rehabilitation Sciences at the University of Pittsburgh, has been influential in shaping these international efforts from the moment she joined this newly emerging field in the 1990s. Through active partnerships with physical therapy groups and bioengineering companies in Argentina, France, and other countries, Dr. Whitney has undertaken efforts to develop virtual reality interventions to assist in vestibular rehabilitation.
For instance, Dr. Whitney and a group of physical therapists, neurologists, otolaryngologists, and bioengineers teamed up to design and build a life-size virtual reality room. They replicated daily tasks, such as grocery shopping, in a virtual format and incorporated high-quality visuals and environmental stimuli to enhance the VR experience. In fact, the designers incorporated life-sized shadows and unique textures in the grocery store aisles to boost realism and a sense of presence. Patients with vestibular disorders could position themselves in front of a real shopping cart and virtually stroll down the grocery store aisles on a custom-made treadmill. Simultaneously, the virtual grocery store scene would transform in response to a patient’s head, neck, and body movements. These VR rooms were programmed in a manner that not only monitored patients’ external movements and symptoms, but also served as an effective form of rehabilitation as patients could practice their balance and maneuvering skills in progressively difficult “levels”, or aisles with more predominant visual cues, environmental stimuli, and physical obstacles. Dr. Whitney reported that VR technology has had transformative effects, such as reduced dizziness and improved balance, on most patients. “One patient could not enter grocery stores at first, but the VR intervention has allowed her to enter and navigate through grocery stores again,” Dr. Whitney recalled about one of her patients, who adhered to a VR-based treatment regimen and thus experienced reduced physical and psychological challenges when performing daily tasks.
This remarkable technology has been applied to other areas as well. Currently, Dr. Whitney works in collaboration with the Department of Defense (DOD) to construct life-sized virtual environments that can be viewed and experienced through head-mounted devices. Similar to the grocery store setup, the environment is chock-full of interactive stimuli. Soldiers can hear and respond to realistic sounds and listen to directions and comments through their headphones. Dr. Whitney explained that, by evaluating soldiers with vestibular balance disorders in a VR room, the DOD can “craft objective criteria to determine if these soldiers are ready to return to combat and perform adequately in the field.” Specifically, they can evaluate soldiers’ symptoms by testing balance using a platform that measures forces and assesses eye and head movements in response to rapidly changing stimuli.
As seen from these efforts, VR technology has evolved extensively over the past few decades, transforming into a powerful technology that is utilized in a plethora of fields. What does the future have in store for this noteworthy technology?
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Firstly, Dr. Whitney discussed the application of her VR ideas, which were initially used to treat balance disorders, to another field. She hopes to obtain funding from the National Institutes of Health (NIH) for use in a novel project that treats Osteogenesis Imperfecta (OI), a rare genetic condition that results in dangerously brittle and weak bones, in children using VR technology. However, children are usually uninterested in grocery shopping and similar scenes, so how can researchers keep them engaged? You guessed it… games! Dr. Whitney and her collaborators are planning a unique, specialized approach in which children can virtually participate in race car driving and other captivating games. Young children may be asked to perform the virtual grocery store task, but in the setting of a lively candy shop instead. By observing children’s ability to control their eye and head movements in response to stimuli, researchers hope to further understand OI and help children to regain control over their body, balance, and spatial orientation when presented with certain stimuli. Dr. Whitney will analyze these responses in children and young adults living with OI in hopes of producing specialized rehabilitation efforts that will improve their balance and subsequently reduce their likelihood of breaking bones.
Dr. Whitney is invested in bringing children with OI together while simultaneously using VR as a unique, exciting form of treatment. She recalls talking to a child, who shared that he had “never seen anyone else with OI because it is a rare disease.” By gamifying VR software and boosting engagement, whether through friendly competition or feedback about one’s performance, Dr. Whitney hopes that children with OI can meet others with similar conditions and build a unified community.
Similarly, Dr. Whitney sees continued potential for VR as a treatment for vestibular balance disorders. For instance, VR technology has been redesigned and incorporated into iPhone and iPad applications that can be downloaded onto a patient’s technological device. In fact, Google manufactured the “Google Cardboard”, an inexpensive cardboard apparatus that can be transformed into an immersive VR platform. “Anyone can buy a Google Cardboard for 10 dollars, download the VR software, and put their phone into the Google Cardboard,” Dr. Whitney explained, thus revealing the accessible, affordable nature of modern VR-based approaches. She has high hopes for the future of VR and expressed that she has “absolutely no doubt that, if the data continues to suggest the effectivity of this technology, it will continue to be used in homes.”
Dr. Whitney enjoys working in physical therapy with a VR focus since each patient is unique and allows her to expand her knowledge in a constantly evolving field. She finds it rewarding to apply novel scientific research when treating vestibular balance disorders and OI. For identical reasons, the intersection between VR and medicine will likely garner even more public interest and involvement in the future. In the future, it is imperative that researchers continue to study and treat vestibular balance disorders and expand on the use of virtual reality, a groundbreaking technology that exhibits immense potential to rehabilitate vestibular balance disorders and conditions in other branches of medicine.