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Albert "Skip" Rizzo was inspired to combine virtual reality with medicine by a patient playing a GameBoy. Rizzo was having a difficult time motivating the young boy, who suffered from mental illness, to participate in his exercises. But, the patient was fascinated with the game "Tetris" on the hand-held device.
"He was like a ‘Tetris' warlord," Rizzo recalled.
Rizzo, who has a Ph.D. in clinical psychology, began hypothesizing about the potential of using games for rehabilitation. Realizing he couldn't further this idea in the clinical setting, Rizzo returned to academia at the University of Southern California (USC), with the mission of building medical virtual reality simulations. In 2004, Rizzo joined USC's Institute for Creative Technologies (ICT), where he leads research in medical virtual reality.
The MedVR Lab at ICT employs medical simulation in a variety of ways, such as mental health, motor rehabilitation, virtual patients and neurological simulation. The lab's mental-health tools, Virtual Iraq and Virtual Afghanistan, are in use for post-traumatic stress disorder (PTSD) rehabilitation at 55 installations throughout the country, including Air Force bases and Veterans Affairs sites, hospitals and clinics. The virtual environments are used for exposure therapy after a patient has had a traumatic experience.
Recently, the lab received funding for a new project called Stress Resilience in Virtual Environments (Strive). Strive leverages the environments from Virtual Iraq and Afghanistan to provide pre-deployment training on emotional coping skills and building resilience. The lab has secured seed funding from the U.S. Army Medical Research and Material Command and congressional plus-ups to produce three five-to-10-minute simulation episodes, Rizzo said. He anticipates the Strive project will eventually include 30 episodes spanning the deployment cycle and introducing soldiers to the range of emotional stressors reported by people who undergo treatment for PTSD.
"We're not aiming to turn people into robots," Rizzo said. "Instead, we're trying to give them perspectives and ways to understand and cope with very extreme and horrible things that are part and parcel of war."
The MedVR Lab is also relaying the technology used in its Virtual Patient project. Initially, the focus was on building virtual patients for clinicians to practice on, complete with artificial intelligence, natural language processing and gestural behaviors. Rizzo said the same concept has been applied to create SimCoach, an online interactive health support character for service members and their families who may be reluctant to seek professional help.
"It's probably the most advanced intelligent agent that can run on the Web," Rizzo said. "It's more than just a chatbot. It's a character that builds a model of the user to interact with them."
Users are able to anonymously select a coach and undergo light assessment activities to help them better understand their situation. The SimCoach can guide the user to proper online content specific to military personnel, such as the resources offered by the Defense Department's Military OneSource website, which Rizzo describes as grossly underutilized.
"All samples say people do a Google search before going to a military-sponsored website," he said.
SimCoach isn't meant to replace the clinical setting, but to allow users to dip their toes in the water and understand what help is available, Rizzo said.
Neuro rehab
Belinda Lange, who leads the MedVR Lab in game-based rehabilitation, is focused on adapting commercial off-the-shelf video-game platforms for a range of uses, such as therapy for victims of stroke or traumatic brain injury (TBI). Wii, Wii Fit, PlayStation 2 EyeToy and Microsoft Kinect, all of which respond to a player's body movements, are among the gaming devices MedVR has adapted for the clinical setting.
"Clinicians have accepted these games and believe that they have potential, particularly in neurological rehab," Lange said.
Lange's team recently received a grant to tailor "Jewel Mine," a balance training game based on Microsoft Kinect, for the military population. "Jewel Mine" places players in a mine full of gems strategically placed to meet their rehabilitation needs, and players are prompted to reach for the gems as they light up. The technique is intended for patients recovering from trauma such as TBI or limb amputation.
The technology has considerable potential outside of the clinic, to allow patients to engage in rehabilitation at home, while providing the doctor with quantitative data, Lange said.
"There are a lot of different challenges that I think if we can solve with the military population, we can make the link back to the civil population," she said.
War has historically driven innovation in medicine. For example, Rizzo points to the field of clinical psychology, which was created during World War II because of a shortage of psychiatrists to treat psychological trauma.
TBI and PTSD as areas that have been extensively researched as a result of the wars in Iraq and Afghanistan, he said. The significant amount of money being put into research for the smaller military population will benefit the civil population, Rizzo said.
"One of the signature things that these wars will promote is the use of simulation technology in mental health and rehabilitation," Rizzo said. "It's a turning point."
The MedVR Lab will demonstrate Virtual Iraq, Strive, SimCoach, and possibly its Kinect technology at I/ITSEC 2011 in Orlando, Fla.
