A few weeks ago, Isai Pochtar told me to step through an open elevator door and press a button. I did as he asked. The door slid shut and the elevator quickly rose to an upper floor of a high-rise building.
When the elevator door opened, instead of the hallway I expected to see, I faced empty space. A narrow wooden plank extended out for six or seven feet. I could see birds flying below me and even further down, many floors and hundreds of feet below, lay a busy city street. Pochtar urged me to step out on the plank. I have never been afraid of heights, but I was terrified. I refused.
I considered telling Pochtar that back problems had recently affected my balance, but I knew that wouldn’t sway him. He put his hand under my elbow to steady me.
“Just take a few steps,” he urged.
After a long pause, I obeyed. Shuffling awkwardly onto the plank, I carefully kept my feet from leaving its surface.
“Now take a step to the right or the left,” Pochtar urged, directing me to step out into the air.
I obeyed again, unwillingly inching leftward. When my feet left the plank, I fell instantly. My descent was swift, yet curiously without a sensation of falling. In what seemed to be no time I felt solid ground beneath my feet. Unhurt but shaken, I breathed a sigh of relief.
That I had felt any trepidation at all was on its face irrational. The entire event was a simulation and I knew it. Its unreality was obvious to my rational mind. The elevator, the street scene, the plank, the whole tableau was cartoonishly drawn, a fact I noted in a corner of my mind. Still, I absolutely believed that if I stepped into the open air I would be facing certain death
“Don’t feel bad,” Pochtar told me as I recovered from the virtual ordeal. “One in 12 people are afraid to step out. My own wife won’t do it.”
A pivot to health care
Pochtar’s background is in banking and finance. A Ukrainian immigrant, he came to the United States with his parents as a 7-year-old and grew up on Long Island. Pochtar moved to Rochester, where his wife is from, a few years ago. Casting about for something to do in this area, he hit on the idea of opening a virtual reality gaming arcade.
Pochtar, 46, says the idea attracted him as a member of a generation that grew up playing video games and a grown man who still does. Student gamers would be a natural clientele, he reasoned. Thinking to go where that market is, in February 2018 he opened VeRacity Video Arcade at Park Point, a commercial plaza located off Jefferson Road on the Rochester Institute of Technology’s Henrietta campus.
Before long, however, Pochtar found that a clientele whose existence he had not suspected might provide as fertile ground—and maybe even more so—to grow a customer base.
“One of my earliest clients was a stroke victim.” Pochtar recalls. “He wanted to try VR to supplement his therapy.”
Pochtar has since discovered a cadre of health researchers, care providers and patients who like the stroke victim are looking to VR’s ability to plunge users into experiences as a potentially powerful therapy tool.
Last June, Pochtar created VeRacity Health, a new arm of his entertainment venture that aims to capture a slice of what Pochtar believes will be a wide-open market for medically focused VR services.
“The potential is unlimited,” he says.
Stephen Dewhurst concurs. He is the University of Rochester Medical Center’s associate vice president of health sciences research and vice dean of research of UR’s School of Medicine and Dentistry. Dewhurst, whose own area of expertise is in microbiology and immunology, oversees UR’s medical research complex, a 3,000-scientist enterprise fueled by some $1.8 billion in government and private funding.
“There are some very exciting areas—pain, autism, surgical,” says Dewhurst, ticking off three areas in which VR and its cousin, augmented reality, are already being applied.
VR immerses a user in a computer-generated environment. AR connects a user to a computer program that alters the flow of real-world sensory data. The elevator ride Pochtar treated me to was a VR simulation. The popular smartphone-based game Pokemon Go uses AR.
“AR/VR is (in) limited use right now, but it’s something you’re going to see more and more of,” predicts Rob Rice, a clinical psychologist and associate professor in St. John Fisher College’s Mental Health Counseling graduate program.
Rice has used VR to treat teens suffering obsessive compulsive disorder. OCD sufferers are plagued by thoughts compelling them to repeat certain behaviors such as hand washing or counting steps.
It can be easier for OCD patients to control obsessive behaviors in a virtual setting, Rice says. The same holds true for phobia sufferers, he adds. A patient he treated began to get a handle on his fear of strawberries by confronting a virtual simulation of the fruit.
For roughly a decade, Rice has worked with game developers at RIT’s digital and media research Magic Center to create video games to help OCD patients overcome their compulsions.
Gaming therapies are particularly effective with teens for whom gaming is second nature, but reasons why such therapies work are not yet entirely clear, Rice says. Oddly, he notes, in VR therapies, less-realistic simulations can be more effective. With his strawberry-phobic patient, for example, a less-realistic simulation of the fruit might have let the patient put enough distance between himself and the fear-invoking berry to begin to get a handle on the fear.
(Photo credit: St. John Fisher College)
Last year, Rice started working with Pochtar. In August 2018, along with Easterseals New York, Rice secured a $1.9 million grant from the federal Health Resources and Services Administration, which four of his students used to design and implement a therapeutic VR program for autistic children and their families. As part of the project, four students arranged a VR game day at VeRacity.
At the event, autism-spectrum children and their families played VR games such as Audio Shield, Google Earth Experience, and Space Pirate. By creating a safe space in which autism-spectrum individuals can have experiences they would otherwise find intimidating, such games can have therapeutic value, Rice says. Similarly, virtual recreations of activities such as skiing can benefit physically disabled individuals.
A nascent market
At this point only a few VR systems specifically designed for medical purposes are commercially available. A company called Floreo Inc., headed and co-founded by a former Amazon official and father of an autism spectrum son, sells a VR-based educational tool for autistic children, for example.
Researchers at the University of Southern California’s USC Institute for Creative Technologies have developed and are working a number of AR/VR projects including a VR training app that lets medical providers practice on virtual patients and a VR therapy for PTSD sufferers.
The online medical publication Docwirenews.com reported last month on a recently completed VR medical training study at Tufts Medical Center in Boston. In the study, medical students from several disciplines practiced working together as an interdisciplinary team using a specially designed Second Life VR program. Students generally found the experience useful, but some missed actual human interaction.
Stanford University’s Stanford Medicine health care system has used a software program that lets surgeons and surgical patients virtually view and manipulate 3D models of medical images like MRIs. Surgeons wearing VR helmets can use the VR simulation to practice tricky procedures while residents can train on virtual patients. Doctors also use the system to educate patients, the California medical center reported in a 2017 post.
At URMC’s UR Health Lab, teams whose members include physicians, data scientists, researchers, computer scientists and electrical engineers are investigating medically focused AR/VR systems.
A team assembled by Health Lab co-director Michael Hasselberg, for example, has developed a prototype smartphone app that connects a patient to a virtual mental health therapist. The patient answers a series of questions. Algorithms guide the app to present the patient with appropriate 3D environments and the virtual therapist to suggest therapies such as mindfulness exercises. The goal is to provide patient with sessions on demand.
While AR/VR medical applications are already in use, they are in some ways in their infancy, say Hasselberg and Health Lab co-director Dave Mitten. Like Dewhurst, Mitten and Hasselberg see the potential as limitless.
The most obviously immediate AR/VR medical applications lie currently in use of applications like medical training and behavioral health, Mitten says.
But, he notes, behaviors and attitudes can and do influence physical health. Biofeedback exercises, for instance, have long been used in cancer treatment. AR/VR can amplify and hone such treatments, and someday may apply more broadly in the medical arena.
That thinking, Mitten says, builds off the biopsychosocial model. First developed at UR’s medical school by doctors George Engel and John Romano, the biopsychosocial model stresses the relationship between mind and body in treatment of disease. It does not discount physical factors such as infection or genetic disposition but emphasizes that psychological and social factors also play a role.
“Thoughts have consequences,” says Mitten, an orthopedic surgeon. AR/VR has tremendous potential to guide patients in exercises that help them direct and organize thoughts in ways that affect physical conditions.
How soon AR/VR might become part of standard treatment methods is not clear. Mitten and Hasselberg say the next step needed before such treatments can move into the mainstream is to subject AR/VR therapies to controlled trials like those the Food and Drug Administration puts pharmaceuticals through to certify that new drugs are safe and effective.
The UR Health Lab, Mitten says, plans to start controlled testing of a VR app this winter.
Will Astor is Rochester Beacon senior writer.