Virtual Reality can make you feel like you’re in another world, and it turns out that this can have quite a therapeutic effect for people experiencing chronic pain. VR pain management has been researched in clinical studies for over a decade, and it’s been shown that VR can help significantly reduce pain, relieve stress, and build resilience.
Howard Rose has been working in VR for over 20 years, and his company DeepStream VR is focusing on building VR applications for the healthcare market. They’re focusing on pain management applications for burn victims, wound care, deep tissue injections, and a number of other different conditions that require hospitalization.
They’re able to modulate the VR experience using biofeedback sensors like heart rate monitors and galvanic skin response in order to maximize the amount of pain relief that you need. They create a pain profile, and then use the feedback as inputs to help maximize the focus and level of immersion. They’ve worked on classic VR experiences for pain management including SnowWorld VR, and they’re also creating a new pain management experience called Cool with more interaction as well as a labor and delivery VR application. Some crucial elements of creating a compelling and effective pain management VR experience include having a wide field-of-view above 60 degrees, visual flow, and engaging interaction. They also found that feeling vection and motion down a river created a more compelling experience.
VR pain management compares favorably to other techniques, and does especially well when paired together with opioids. Because pain medicine can be so effective, then there can develop an over-reliance and subsequent addiction issues. However, if VR is provided an option, then it can engage and develop a resilience in patients in a way that distracts them from the pain, but also prevents them from relying too heavily on their morphine drip.
Howard also talks about some of his lessons learned for making grounded VR experiences, as well as some of his experiences with the River Accelerator program.
Finally, DeepStream VR is ultimately trying to go beyond the normal health consumption model to a model that empowers people to become a health producer by using our innate abilities to heal ourselves. He sees that VR can help people become more independent, and to more easily integrate wellness into our lives in a way that’s more accessible and affordable. DeepStream VR is doing this by creating the VR experiences and pioneering the approaches that enable this type of paradigm shift.
Here’s a TEDMED talk by Howard Rose from September 2014.
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Rough Transcript
[00:00:05.452] Kent Bye: The Voices of VR Podcast.
[00:00:12.135] Howard Rose: My name is Howard Rose, and I'm the CEO of DeepStream VR. And DeepStream is a software company building virtual reality applications for the health care market. And our focus is on using virtual reality as a way to relieve pain.
[00:00:26.782] Kent Bye: Great. So maybe you could tell me a bit about what that looks like and how that works.
[00:00:30.953] Howard Rose: Well, VR is really an effective way to help people who are going through burn treatments or wound care or different kinds of procedures at the hospital. If you get burned or you have a wound or even a disease or Whatever and you end up in the hospital that you know, the treatment can be anxiety provoking and just going through the procedures and the care and also there's a big problem with opioids and lots of drugs and it's really tempting to hit the morphine trip a lot and And so virtual reality turns out to be an amazing way to help people kind of escape those, you know, take their mind off and take them mentally and physically someplace else. So we're building applications that use biosensors. So we're using things like heart rate monitors and galvanic skin response, which is skin conductance. And all of these things measure your state, your level of anxiety and your level of stress and your level of pain. And what we do is our games modulate, they change according to what you need. So our goal is to maximize the amount of pain relief that you get.
[00:01:42.995] Kent Bye: Wow. And so tell me a bit about the inputs a little bit more and elaborate on that in terms of like, are you looking for, if the heart rate is going up, you want to make it more calming. And then, you know, how do you actually change the game play based upon the bio feedback?
[00:01:57.015] Howard Rose: Well, let me give you an example that illustrates what we do differently than other games. So, if you have somebody who's going through labor and delivery, for example, you've got a woman who has experienced contractions, and those contractions will be a spike in their heart rate and other kinds of biosensors, and then the contractions are pretty short, and then you have a kind of a calm period between the next contraction. So, first of all, we're aware of their treatment situation. And so, we understand that that's what's going to happen and we anticipate it. So, while contraction is coming on, we use techniques to maximize their focus and get them maximally immersed and engaged with the virtual world. And then they get to the other side. And so, it's not just a matter of throwing lots of intensity at them. You want to ride that wave, so to speak. And so, we follow the pain profile and so, We might build intensity while the contraction's coming on and help them through that. And then they get to the other side and they want some relaxation and visualization and other kinds of experiences. So within a single game context, we're able to modulate and handle all of those kinds of situations. So labor and delivery is a great example. We've done a lot of work. We've been doing this for about 10 years with the founders of the field. And we've created iconic games like Snow World, which many people in the virtual reality field have heard of. And Snow World's been used primarily with burn patients. So burn patients who go through these procedures where they have to every day change their bandages and, you know, scrub the skin and stretch the limbs and all of that. It's really painful. And we're talking about extensive third-degree burns. So the amazing thing is that virtual reality is a really engaging experience that is actually, if you do a comparison, so if you compare VR to opioids, things like morphine, VR actually does really well in a head-to-head. And then when you put them together, as an adjunct, so you're in the hospital, they give you a morphine drip, but just lying there and using the drip, people tend to, you know, they just, they're hitting the button way too much. So we give them VR, and then what we find is that they're so engaged in that process that they're actually less reliant on drugs. So that's kind of our underlying goal, is to help people develop the resilience and other kinds of ways of handling pain.
[00:04:33.058] Kent Bye: Wow, and so has there been women that have given birth while experiencing virtual reality? But some of these experiences that you've created then?
[00:04:41.473] Howard Rose: The labor and delivery is an area that we're very interested in and we're developing some applications there. So the procedures that it has been used, burn patients, wound care, injections, like deep tissue injections, things like that, a bunch of icky procedures. So, you know, labor and delivery is a great example. And I think we're going to have a lot of success there. But one of the reasons that we did burn pain is that this is about as bad as it gets. You know, when you've got third degree burns over 50% of your body, it's just a horrible situation. So not to dwell on the horror, but the really great thing is that VR enables people, even at very high levels of pain, to experience a lot of relief.
[00:05:26.400] Kent Bye: Wow, and so in terms of studies, what types of studies have been done in order to prove that out?
[00:05:32.467] Howard Rose: So we've been involved in this for 10 years with psychologists and clinical physicians and burn doctors and all sorts of different kinds of people. There's over 200 published studies. The National Institute of Health, NIH, has put tens of millions of dollars into this. Applications like SnowWorld were built with funding from NIH and from Paul Allen Foundation and different kinds of stakeholders. And over the years, the kinds of studies have looked at things like comparisons with other types of media. 2D games, DVDs, watching a video, sort of passive kinds of experiences, nurses chatting, sort of the standard of care, other kinds of games. And VR actually does way better than the competition. And, you know, there's lots of ways to sort of distract people. And some of those can last and be effective for relatively short periods of time, but what we find is that VR is, you know, it's the immersion. It's the immersion of using wide field of view. So some of the things that we've looked at is if you change the field of view, what is the effect on paint? And these studies, comparing a 35 degree field of view to a 60 to a 90, what do you get? And of course, more generally is better. but there's this magic thing that happens in terms of immersion at about between 60 and 80 degrees, we'll call it 70, where that thing happens, that immersion and that sense of presence. So a lot of our research has looked at what is it about VR that induces presence both from the field of view and also from, you know, navigation and interaction and all those kinds of things.
[00:07:15.868] Kent Bye: So what's actually happening in Snow World? What does it look like to be in this experience?
[00:07:20.492] Howard Rose: Well, the application SnowWorld is kind of as it suggests, you're moving through an icy canyon and there are snowmen that are throwing snowballs at you and penguins and mastodons and flying fish and stuff like that. We have created a new game which is called Cool, which is what we're showing here today at SVVR, and it's going to be going out to hospitals in about a week or two from now. And our new game sort of takes a lot of those aspects and we're going to the next level. So we're incorporating biosensors as I said and the main character in our game is an otter. We're really into animals and we like that sort of sense of, you know, people like cute animals and that kind of endearment. So we always try to bring that aspect in. So we have animated characters, otters, and you're going through a landscape that is someplace between realistic and fantastic. And we try to bring in lots of different kinds of interactions. So it's not a score-driven game. Like, we want everybody to be successful. And when somebody comes in and they're in pain and, you know, they may be going through a really hard time, you don't want to use score, like, uh-oh, you failed, and da-da-da-da. So the basic premise of our games is that everybody's a winner. It's much more like a playground where you can come in and you can just sit there and watch the snow fall or watch the otters play or you can interact with them and you're throwing paintballs at the otters. We're not hurting the otters. People are very sensitive, which I personally find good. They don't like to hurt little animals, so they're like, you know, I don't want to hurt them, but... Okay, it's a paintball and you throw paintballs at the otters and they turn colors and it's kind of fun. Yeah, so we basically look at our games like a playground. So we want to build all of those possibilities and then people can come to it and use it however they want.
[00:09:17.706] Kent Bye: And because you are creating VR in the context of a therapeutic application, I'm curious some of the other design decisions that make it more therapeutic that you've learned over the years and perhaps some things that you've tried that didn't work.
[00:09:31.398] Howard Rose: Well, you know, there's a whole bunch of aspects to VR that relate to the sort of psychophysical experience. One is that, you know, you want the feeling of motion is actually very captivating. Our environment is a river. You're following a river and there's sort of this really cool human I don't know where it comes from, sort of Jungian archetype or something, but people come in and there's a river and it's like, oh, I'm following the river. It just seems to make sense. So we build the design of the environment to feel comfortable for people. So, you know, it's not a, it walks that line between abstract and fantasy that I was talking about. And that's an important thing for making people feel immediately comfortable. So the feeling of vection and motion down the river, sort of this storyline of things that are happening. And also we try to maximize the sense of immersion by the way we place objects and the dynamics that we build in. So we want them to, if they're using a head mount as display or a headset, that they look around. So we have things that are placed strategically around the environment to get them to look around. I mean, there are a lot of design elements to the game that we build in, but the element of using biosensors, we try to modulate the intensity so that you can kind of play it in a whole bunch of different ways.
[00:10:55.107] Kent Bye: And were there things that you tried that didn't work?
[00:10:58.430] Howard Rose: Oh, yeah. So I've been doing VR for about 23 years. And believe me, I've had my failures. You know, I think that there's a temptation. I mean, this is sort of a general interesting thing. So I'm a designer. My background is actually in educational technology. And I look at VR as this great way to create environments where people can be self-directed and they can control what is happening. And if it's an educational environment, they can take control of that process instead of being dependent on a teacher, for example. And this is sort of a general thing about design, but a lot of people don't know, I mean, VR is so unfamiliar to most people that you need to have enough of the familiar and enough of the virtual there, and that's a fine line to play with. For example, if you get into a world and it's the world of very abstract, whatever it is, gravity, we're going to play with the phenomenon of gravity, or we're going to use abstractions in very interesting ways, people are not grounded. They don't understand what they're supposed to do, they don't understand the symbolism, and it takes them a while to learn how to do it. So, I think there's a temptation as a designer to want to kind of push the edge and say, okay, what's the coolest thing that I can make? And over the years, I think I've really learned to appreciate that we need to help people along from where they are into where they're going. They're not going to make this giant quantum leap from, you know, using a cell phone app to, oh, now I'm in a virtual environment and I feel totally fine and I can navigate and all that. So I think that as we see the transition of VR as an industry, from now you've got phones that you can drop into headsets and all of these consumer devices, they're going to help people move and make that transition. I think that it's important as designers that we find a way to bring them along and not lose what's really cool about VR. Because I think when you get too literal, it's like, what's the point? But when you get too far out, then you kind of lose people. So it's really playing with that dynamic.
[00:13:14.468] Kent Bye: So what's it been like to be a part of the River Accelerator then with this project?
[00:13:19.697] Howard Rose: Well, it's been very exciting to be part of River. So Rothenburg Ventures, I think they've put a commendable amount of effort into trying to understand the emerging VR space. There's a lot of people in the investment community who are really interested, but they're kind of out there kicking the tires. And I think Rothenburg decided, you know, they're just going to run with it. And they gathered up a group of companies that they thought had high potential, and we were happy to be offered a spot. So DeepStream is kind of unique in that we've been, my partner Ari Hollander and I have been in VR for a long time, so we have a lot of experience in the technology, but the best part for us is getting access to the sort of the investor pool and the groups of companies and VCs and angels and all sorts of people who are interested in funding VR and also the companies, the manufacturers of the gear and all of that. you know, it's kind of become a focal point. And it's been really exciting to be there, and especially in the first group, and really see how that, all of the potential, and right now, this is really cool. I mean, we're at SVVR, this is year two, and it's enormous. I mean, I'm just totally impressed by Carl Krantz and Nana have put this together. It's just amazing. Because last year it was much smaller, and this is like a full-on conference. So that's really cool and it's cool to be here and have access to demo and show our stuff here too.
[00:14:49.834] Kent Bye: And finally, what do you see as the ultimate potential for virtual reality and what it might be able to enable?
[00:14:57.619] Howard Rose: You know, my bent is for practical applications. And I think in general, already, computer games, it's a bigger industry than movies and music combined. And I think that VR, for what would be called serious applications, has the potential to surpass entertainment games. So, you know, I don't think the vision, my vision is not to have people in headsets 24 hours a day. I think that's just not realistic nor desirable. I think that VR is best for these kind of intense experiences that are either for entertainment, but also for useful applications, for purposeful applications. So in health care, I'm really interested in health because I think that VR has the possibility to transform how wellness happens. So right now, if you think about health, we're health consumers. And when you think about health consumers, the way that we interact with the health system is as patients and we come when we're sick and we go to the doctor and the doctor is going to make us better and we give up our power and the biggest problem is that it underutilizes our innate human ability to make ourselves well. So I think VR is this great opportunity to change that dynamic. So from changing from a health consumer to a health producer. and make people more independent and you can integrate wellness into your life. And I think that that's a great example of the kind of things that VR can enable, because it's a multi-sensory and it's an immersive process. If we design really good applications, I think it's going to be amazingly successful.
[00:16:47.322] Kent Bye: Great, thank you so much.
[00:16:49.132] Howard Rose: Yeah, well thank you very much.
[00:16:51.114] Kent Bye: And thank you for listening. If you'd like to support the Voices of VR podcast, then please consider becoming a patron at patreon.com slash voices of VR.
