The Lancet Technology: December, 2011

Abstract

Let the games begin“What we tend to focus on are projects that really can help people get physically better, or see the world in a different way.” I'm talking to Bob Hone of Red Hill Studios about a series of games his company has developed in collaboration with Glenna Dowling and Marsha Melnick of the University of California San Francisco (UCSF), with the aid of an NIH grant.It began in late 2006: the UCSF researchers had been trying to get funding to further a project for people with Parkinson's disease. The idea was simple: an exercise programme to help with balance and stability. They initially thought Red Hill might be able to provide visual aids for their proposals, perhaps a video. Bob took the idea one stage further: “I said ‘Why not make the programme interactive? And by the way, there's this thing called the Wii.'”Bob poses the question to which every clinician would like to know the answer: “How do you get people to do the things they should be doing but that are boring and tedious?” He believes video games can be used to engage patients with the day-to-day work of physical therapy.“Have you ever downhill skied?” he asks. I reply that I am trying to forget. Undeterred, he tells me that he uses skiing as a metaphor for designing games. “When you're on a slope that's too hard for you, it's incredibly frightening; but when you're on a slope that's too easy for you, it's boring. You want games to be more challenging in a way that's beneficial to the patient.” Bob also hopes that feedback from the games could be developed to give longitudinal assessment of function. “Health is a dynamic process. If you have more datapoints, you have a better reading of what's going on.”The Parkinson's games, involving whole-body interaction with a series of challenges in different environments, have yielded promising initial results in trials. They're also a hit with the target audience. “Seniors jumped on this. They're not thinking about all the technology involved—they're thinking about hitting the ball across the net.”Winter wonderlandHunter Hoffman, a cognitive psychologist and researcher at the University of Washington, has been working with virtual reality (VR) since the early 1990s. “Helmets were 8 pounds back then”, he says, “and the computers were 175 000 dollars”.He first used VR therapeutically for spider phobia, creating a spider-infested virtual environment, Spider World, augmented with a model that gave tactile feedback to the patient: “We put a position sensor onto a toy tarantula with a bad toupee, and when the patient reached out in the virtual world to touch the virtual spider, their real hand would simultaneously touch this little furry toy spider, and their brain would unify the sensory input.”Success here led him into other areas: notably Snow World, a North-Pole-like fantasy environment he developed with his colleague David Patterson to help patients with burns during wound care sessions. “Snow World is the antithesis of fire. We deliberately tried to make it as different from a car accident or an explosion as possible. The colours are blues and greens and whites, there are no reds or oranges. We've had a number of patients say it kind of reminds them of Christmas or skiing—pleasant memories.”Although Hunter has helped create virtual environments to allow patients to relive traumatic memories in a therapeutic setting (eg, 9/11), this is not the aim here. “When treating PTSD we want patients to access their memories for traumatic events, but when using VR to distract patients from their intense physical pain during wound care we actually encourage them to avoid unpleasant thoughts to try to minimise their pain.” Hunter adds that “One of the tragedies of being a burn patient is not only do you have all these painful wound cares on a daily basis, but you've got people telling you what to do. Basically you're getting bossed around all day, and it's really nice to have control—at least be the king of the virtual world.”Ongoing projects include making lighter, cheaper VR goggles and getting VR used more widely for analgesia. We end by discussing technology and psychology. “Here's an interesting point”, says Hunter. “The therapies for treating anxiety disorders make use of imaginative exposure. What I think is fascinating is that in any parts of the treatments that involve using self-generated images, we can now use the computers to amplify the effectiveness of that. It's been a very interesting intersection of my interests.”Parkinson's gameView Large Image Copyright © 2011 Red Hill StudiosVR distracts a soldier from pain during wound careView Large Image Copyright © 2011 Hunter Hoffman, www.vrpain.comFor more on Red Hill Studios see http://www.redhillstudios.com/#/projects/games/pdwiiFor more on VR pain reduction see http://www.hitl.washington.edu/projects/vrpainFor more on VR for PTSD see Perspectives Lancet 2011; 378: 869 Let the games begin“What we tend to focus on are projects that really can help people get physically better, or see the world in a different way.” I'm talking to Bob Hone of Red Hill Studios about a series of games his company has developed in collaboration with Glenna Dowling and Marsha Melnick of the University of California San Francisco (UCSF), with the aid of an NIH grant.It began in late 2006: the UCSF researchers had been trying to get funding to further a project for people with Parkinson's disease. The idea was simple: an exercise programme to help with balance and stability. They initially thought Red Hill might be able to provide visual aids for their proposals, perhaps a video. Bob took the idea one stage further: “I said ‘Why not make the programme interactive? And by the way, there's this thing called the Wii.'”Bob poses the question to which every clinician would like to know the answer: “How do you get people to do the things they should be doing but that are boring and tedious?” He believes video games can be used to engage patients with the day-to-day work of physical therapy.“Have you ever downhill skied?” he asks. I reply that I am trying to forget. Undeterred, he tells me that he uses skiing as a metaphor for designing games. “When you're on a slope that's too hard for you, it's incredibly frightening; but when you're on a slope that's too easy for you, it's boring. You want games to be more challenging in a way that's beneficial to the patient.” Bob also hopes that feedback from the games could be developed to give longitudinal assessment of function. “Health is a dynamic process. If you have more datapoints, you have a better reading of what's going on.”The Parkinson's games, involving whole-body interaction with a series of challenges in different environments, have yielded promising initial results in trials. They're also a hit with the target audience. “Seniors jumped on this. They're not thinking about all the technology involved—they're thinking about hitting the ball across the net.” “What we tend to focus on are projects that really can help people get physically better, or see the world in a different way.” I'm talking to Bob Hone of Red Hill Studios about a series of games his company has developed in collaboration with Glenna Dowling and Marsha Melnick of the University of California San Francisco (UCSF), with the aid of an NIH grant. It began in late 2006: the UCSF researchers had been trying to get funding to further a project for people with Parkinson's disease. The idea was simple: an exercise programme to help with balance and stability. They initially thought Red Hill might be able to provide visual aids for their proposals, perhaps a video. Bob took the idea one stage further: “I said ‘Why not make the programme interactive? And by the way, there's this thing called the Wii.'” Bob poses the question to which every clinician would like to know the answer: “How do you get people to do the things they should be doing but that are boring and tedious?” He believes video games can be used to engage patients with the day-to-day work of physical therapy. “Have you ever downhill skied?” he asks. I reply that I am trying to forget. Undeterred, he tells me that he uses skiing as a metaphor for designing games. “When you're on a slope that's too hard for you, it's incredibly frightening; but when you're on a slope that's too easy for you, it's boring. You want games to be more challenging in a way that's beneficial to the patient.” Bob also hopes that feedback from the games could be developed to give longitudinal assessment of function. “Health is a dynamic process. If you have more datapoints, you have a better reading of what's going on.” The Parkinson's games, involving whole-body interaction with a series of challenges in different environments, have yielded promising initial results in trials. They're also a hit with the target audience. “Seniors jumped on this. They're not thinking about all the technology involved—they're thinking about hitting the ball across the net.” Winter wonderlandHunter Hoffman, a cognitive psychologist and researcher at the University of Washington, has been working with virtual reality (VR) since the early 1990s. “Helmets were 8 pounds back then”, he says, “and the computers were 175 000 dollars”.He first used VR therapeutically for spider phobia, creating a spider-infested virtual environment, Spider World, augmented with a model that gave tactile feedback to the patient: “We put a position sensor onto a toy tarantula with a bad toupee, and when the patient reached out in the virtual world to touch the virtual spider, their real hand would simultaneously touch this little furry toy spider, and their brain would unify the sensory input.”Success here led him into other areas: notably Snow World, a North-Pole-like fantasy environment he developed with his colleague David Patterson to help patients with burns during wound care sessions. “Snow World is the antithesis of fire. We deliberately tried to make it as different from a car accident or an explosion as possible. The colours are blues and greens and whites, there are no reds or oranges. We've had a number of patients say it kind of reminds them of Christmas or skiing—pleasant memories.”Although Hunter has helped create virtual environments to allow patients to relive traumatic memories in a therapeutic setting (eg, 9/11), this is not the aim here. “When treating PTSD we want patients to access their memories for traumatic events, but when using VR to distract patients from their intense physical pain during wound care we actually encourage them to avoid unpleasant thoughts to try to minimise their pain.” Hunter adds that “One of the tragedies of being a burn patient is not only do you have all these painful wound cares on a daily basis, but you've got people telling you what to do. Basically you're getting bossed around all day, and it's really nice to have control—at least be the king of the virtual world.”Ongoing projects include making lighter, cheaper VR goggles and getting VR used more widely for analgesia. We end by discussing technology and psychology. “Here's an interesting point”, says Hunter. “The therapies for treating anxiety disorders make use of imaginative exposure. What I think is fascinating is that in any parts of the treatments that involve using self-generated images, we can now use the computers to amplify the effectiveness of that. It's been a very interesting intersection of my interests.”VR distracts a soldier from pain during wound careView Large Image Copyright © 2011 Hunter Hoffman, www.vrpain.comFor more on Red Hill Studios see http://www.redhillstudios.com/#/projects/games/pdwiiFor more on VR pain reduction see http://www.hitl.washington.edu/projects/vrpainFor more on VR for PTSD see Perspectives Lancet 2011; 378: 869 Hunter Hoffman, a cognitive psychologist and researcher at the University of Washington, has been working with virtual reality (VR) since the early 1990s. “Helmets were 8 pounds back then”, he says, “and the computers were 175 000 dollars”. He first used VR therapeutically for spider phobia, creating a spider-infested virtual environment, Spider World, augmented with a model that gave tactile feedback to the patient: “We put a position sensor onto a toy tarantula with a bad toupee, and when the patient reached out in the virtual world to touch the virtual spider, their real hand would simultaneously touch this little furry toy spider, and their brain would unify the sensory input.” Success here led him into other areas: notably Snow World, a North-Pole-like fantasy environment he developed with his colleague David Patterson to help patients with burns during wound care sessions. “Snow World is the antithesis of fire. We deliberately tried to make it as different from a car accident or an explosion as possible. The colours are blues and greens and whites, there are no reds or oranges. We've had a number of patients say it kind of reminds them of Christmas or skiing—pleasant memories.” Although Hunter has helped create virtual environments to allow patients to relive traumatic memories in a therapeutic setting (eg, 9/11), this is not the aim here. “When treating PTSD we want patients to access their memories for traumatic events, but when using VR to distract patients from their intense physical pain during wound care we actually encourage them to avoid unpleasant thoughts to try to minimise their pain.” Hunter adds that “One of the tragedies of being a burn patient is not only do you have all these painful wound cares on a daily basis, but you've got people telling you what to do. Basically you're getting bossed around all day, and it's really nice to have control—at least be the king of the virtual world.” Ongoing projects include making lighter, cheaper VR goggles and getting VR used more widely for analgesia. We end by discussing technology and psychology. “Here's an interesting point”, says Hunter. “The therapies for treating anxiety disorders make use of imaginative exposure. What I think is fascinating is that in any parts of the treatments that involve using self-generated images, we can now use the computers to amplify the effectiveness of that. It's been a very interesting intersection of my interests.” For more on Red Hill Studios see http://www.redhillstudios.com/#/projects/games/pdwiiFor more on VR pain reduction see http://www.hitl.washington.edu/projects/vrpainFor more on VR for PTSD see Perspectives Lancet 2011; 378: 869 For more on Red Hill Studios see http://www.redhillstudios.com/#/projects/games/pdwiiFor more on VR pain reduction see http://www.hitl.washington.edu/projects/vrpainFor more on VR for PTSD see Perspectives Lancet 2011; 378: 869 For more on Red Hill Studios see http://www.redhillstudios.com/#/projects/games/pdwii For more on VR pain reduction see http://www.hitl.washington.edu/projects/vrpain For more on VR for PTSD see Perspectives Lancet 2011; 378: 869