Using VR to Enhance Patient Engagement and Outcomes

Melanie Hamilton (00:09):

Welcome to this Physical Therapy Products podcast episode sponsored by Penumbra. I’m the Chief Editor of Physical Therapy Products, Melanie Hamilton-Basich. I’m joined today by Emily Daviss, PT, DPT, of Penumbra, to talk about how physical therapists can use virtual reality to enhance treatment for their clients and improve health outcomes. Thank you for joining us today, Emily.

Emily Daviss (00:33):

Thank you so much for having me, Melanie. I’m excited to talk about virtual reality and how I can support the physical therapist in the field.

Melanie Hamilton (00:40):

To start things off, can you tell me about Penumbra?

Emily Daviss (00:44):

Yes, absolutely. So Penumbra, they’re a global healthcare company. They focused on developing technologies to address more complicated medical conditions, in a novel way. Penumbra’s initial focus was mainly to address stroke causing blood clots, and [00:01:00] for nearly 20 years now, Penumbra’s commitment to helping stroke patients and patients’ overall health in general led to the company addressing patients post procedurally. And by doing that, Penumbra has created this access to immersive therapeutics and for virtual reality to augment the conventional therapy and help enhance therapy for physical therapists, occupational therapists, and speech therapists.

Melanie Hamilton (01:25):

What are some of the key benefits of VR or immersive therapeutics for physical therapy in areas [00:01:30] like health outcomes, adherence to treatment and mental well-being?

Emily Daviss (01:35):

So when you’re going and thinking about how can virtual reality help and support physical therapists? In a recent survey that Penumbra conducted of PTs across the us, nearly 75% of therapists said patient compliance is by far our biggest challenge that we face. So when we think about how to help our patients engage in rehab [00:02:00] and want to continue to come and engage in their therapy to ultimately help their outcomes, we think about how VR is an adjunct to enhance our therapy. It’s basically looking for ways to provide more intense and more full body system integration when recovering from injury. So more efficient, faster recovery, decreasing that risk of recurrence of the patient possibly getting a recurrent injury or going back into the hospital. [00:02:30] So it can also improve that patient’s relationship with therapy and rehab. So thinking about the ability to increase the intensity and enrich their treatment session, we go about that idea of use it or lose it using neural circuits not actively being engaged in a task performance for an extended period of time, that those neural circuits can start to degrade.

(02:53):

So when you think about that, being able to increase that intensity and the basic motor control, [00:03:00] the movement planning, redundancy of therapy, the problem solving and experience, being fully immersed in a system will help the patient engage more in their rehab, have higher repetitions and higher intensity. So being able to utilize that and leverage these evidence-based practices to deliver it in an immersive way, it helps to drive that engagement of the patient and empower the clinicians to challenge and support their patient over their rehab journey and ultimately [00:03:30] improve their outcomes and see better independence overall.

Melanie Hamilton (03:35):

What are REAL System y-Series and i-Series?

Emily Daviss (03:39):

Yes. So there are two separate products. We have our REAL y-Series. Our REAL y-Series is a fully immersive technology. It uses upper and lower body sensors. It can be done in sitting or standing, and it allows the clinician to track a full body movement. The system has clinically designed activities. It’s [00:04:00] to engage the patient in therapy and drive higher intensity sessions. So this system is adaptable with the ability to adjust parameters and meet the patient’s needs for rehab and optimizing their recovery. Our sensors not only just provide that full presence of the patient in the system where they can interact with the environment and be able to be a part of their rehab and activity within the immersive system. It also gathers and delivers informative [00:04:30] data insights to support documentation as well as deliver for objective and data-driven decision-making for the therapist. And being able to utilize that type of information to be able to adjust and change our treatment process for our patient really can affect how the patient is involved, engaged, and the intensity of their treatment can be adjusted over time.

(04:56):

So the Y-Series can provide that for us because it is a [00:05:00] fully immersed and sensor driven technology within the therapy world. With the REAL i-Series, which is our other product that we have out there, it is for mental wellness, cognition, relaxation, positive distraction. Also, it has over a hundred different environments that the patient can self-guide themselves through within the headset. There’s a vast expansive use case for this examples, possibly like pre or [00:05:30] post procedurally we’ve seen it, anxiety, depression, or loneliness. We’ve seen a lot of therapists utilize that for those patients. And diagnoses, wound care, pain, distraction, and those are just to name a few of how we’ve already utilized this in the field. And experiences are designed using evidence-based concepts. So all of our different experiences, whether it be a guided meditation or cognition to help the patient work on [00:06:00] progressing over time with memory or cognition or functional tasks.

(06:04):

We can also utilize these with one of which a new application of ours is called Breathe. And this application has four different breathing patterns and it helps that patient with relaxation and the distraction of pain. Even the deep inhalation breath training can be utilized for patients going through radiation or cancer treatments. So we have adjusted different types of activities to support the needs of our patients in the field. [00:06:30] But the REAL i-Series also includes what we call real connect and with a real remote, it’s the first to market virtual reality communication capability. So this provides one-on-one real time and audio communication to allow the patient to be able to share the experience with either a loved one or even a clinician to help clinician guide the patient within the experience.

Melanie Hamilton (06:51):

Can you expand on how REAL y-Series helps physical therapists engage and motivate patients?

Emily Daviss (06:58):

Absolutely. So the REAL [00:07:00] y-Series, we have over 52 activities. All of these activities were created with different types of motivational and engaging activities. So examples, we have a virtual athletic club. This motivates the patient for practicing upper body and more compound movements, even reactive movements. But we also have so many activities that focus on all different types of our patient’s function. So if you think about core control or cervical rotation, [00:07:30] cervical mobility, gaze or visual tracking, we even have upper and lower body, so lower body strength and endurance. So we’re thinking in regards to being able to support the patient where they’re at, and being able to navigate them through with these different activities. And we can absolutely consider just having fun with therapy, but in a functional way with this, it can impact basically their therapeutic activities, therapeutic exercises, thinking about being able to kind [00:08:00] of compartmentalize the different movements within the activity and doing the different movements to help them ultimately improve the function outside of the system.

(08:10):

I had a patient actually in the system be able to, she had neglect and she was struggling with being able to navigate and transfer to her left side. And we did some visual scanning activities and we did some trunk movement to work on her lateral trunk movement. And once we got her out of the system, she [00:08:30] ended up needing to go to the bathroom and get up and go and transfer from the table, the mat table to her chair again. And the therapist saw her be able to look to her left, find her chair, reach with her left hand, and that was immediately getting out of the system. So seeing that carryover really has gotten to the point where it can engage the patients, but also get the therapist to see it can improve the patient and see the carryover of how the patient is doing.

Melanie Hamilton (08:58):

What types of data and insights [00:09:00] can REAL y-Series offer physical therapists?

Emily Daviss (09:04):

So when it comes to our data and insight, we have those full body sensors. They, like I said earlier, have a dual purpose. They provide the avatar and the system so the patient can actually see how they’re moving, but they also can create an actual and give us actual accurate, highly accurate data coming out of the patient’s movement and activities while they’re doing their functional movements within the side. The Immersives [00:09:30] rehab system. So delivering this information, you get functional range of motion, balance measures, trunk measures, sit to stand measurements or counts, full body measurements, and then time spent in session and by the focus area. So when we think about what this can help with, I actually had a patient in the system who we thought had a vestibular hypofunction and we were trying to do a little bit of balance work and a little bit [00:10:00] of visual guidance and visual gaze tracking.

(10:03):

So when we were in the system, the patient was actually doing really well within their balance and looking to their right and being able to support themselves. But what we found was that his balance and the patient, the stance and where they were within their stance and their balance measurements, when it came out at the end of the session, he was more focused on leaning to the left. And the therapist then took those measurements and saw where [00:10:30] they were. He was throughout the session and realized that maybe this was not necessarily as much of a vestibular hypofunction that she thought, and it was more, she ended up measuring the leg length after the patient had just had a total knee replacement and found that it was more of an orthopedic issue where the leg length discrepancy was causing the patient to have a weakness and a balance deficit.

(10:57):

And then she focused more into the orthopedic [00:11:00] injury and the orthopedic issues that had occurred because of a total knee replacement. So she changed the focus of her treatments and ultimately ended up improving the patient’s balance and safety outside of the system. So being able to get that data and being able to utilize that to change up or be able to effectively pick the correct treatments that we need to do for our patient, that is something that the immersive healthcare and the immersive therapeutics can provide [00:11:30] by being in a virtual reality system and getting that objective data coming out of it being so accurate can allow us to make better decisions and how we treat patients.

Melanie Hamilton (11:40):

That’s great. How is VR changing physical therapy in the future?

Emily Daviss (11:46):

How fast VR is enhancing our ability to treat our patient and many different things that are coming out within the research that is supporting virtual reality in [00:12:00] our treatment process as physical therapists, we are seeing now virtual reality is showing up in our clinical practice guides and the ability to utilize that to support the outcomes of our patients. It’s only going to enhance the ability of how virtual reality can be used. It can be able to utilize it and increase the ability to get better assessments and better documentation for our patients and more accurate documentation. [00:12:30] So we can see assessments being created possibly in the future with virtual reality, being able to work more into a more accurate data that is being provided by these assessments and being able to utilize that and see how it can ultimately improve our patients. So considering potential clinical assessments, measurements, ability to customize the treatment and experiences, all of that is going to only get better over time with our virtual reality systems that are [00:13:00] out there.

(13:01):

And with the research that is being done, we’ll be able to enhance the systems and cater it to how therapists are going to need to use it and be able to adjust what is needing to be done to help it be the most optimal way of how to use virtual reality to support our patients’ outcomes in the future. So I can see so many different possibilities of virtual reality just improving over time, and not just improving [00:13:30] for the patient’s experience, but for the clinician’s ability to utilize it and provide more appropriate customized treatments for the patient because of the documentation and because of the data that is being pulled from sensors and the sensors’ ability to give us better clinical assessments.

Melanie Hamilton (13:49):

Thank you, Emily, for sharing your insights and expertise about the benefits of using virtual reality and physical therapy. And thank you to Penumbra for sponsoring this podcast episode. Thank you also to our [00:14:00] listeners. You can find Physical Therapy Products podcast episodes on our website as well as anywhere you listen to podcasts. For more podcast episodes as well as news and articles, and to subscribe to Physical Therapy Products enewsletters, go to ptproductsonline.com.