Virtual Reality: Real Rehabilitation

High-Tech Lab Creates Real-World Simulation

By Cary Estes

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Under the direction of Cali Fidopiastis, Ph.D., the lab combines actual objects and people with virtual settings. The goal is to create a realistic environment that gives a more accurate indication of how the brain is reacting during everyday situations.

Take our hungry stutterer, for example. This is a person who does not stutter during casual conversation, but only in social settings. Fidopiastis wants to discover how stress causes the stuttering to begin. But it is impractical to monitor this person in a real restaurant.

That is why the Virtual Grill is now open for business.

“We bring the patients in and have them interact with actors playing different roles. A hostess, a waiter, a busboy—anything and anyone you would find in a regular restaurant,” Fidopiastis says. “But what you’re able to do in the lab is monitor them with psychophysiological measures.

“So if you’re a social stutterer, what is the point that you become so negatively aroused that you start the stuttering process? What biophysiological clues suggest that your internal state has changed you from a calm person to somebody who no longer has control?”

Such questions have long fascinated Fidopiastis. In particular, she is interested in how the brain changes following head trauma, be it post-traumatic stress disorder (PTSD) in returning combat soldiers or the aftermath of lesions in the brains of patients with multiple sclerosis. “Anything that has to do with brain changes due to some sort of disease state,” she explains. “In order to do that, I looked for a platform that I can use to bring in patients, access their capability, and then be able to put them in a more realistic environment. The answer is virtual reality.”

A Brick to the Face

The technology surrounding virtual reality has improved significantly over the past 10 to 15 years. In the 1990s, Fidopiastis says, a person had to wear a cumbersome head mount that weighed about five pounds in order to view the imagery. “It was like strapping a brick to your face,” she says.

As a result, it was far from a realistic experience in terms of how the brain reacted, so the ability to make a detailed patient analysis was limited. MRI machines remained the most effective way to monitor changes in brain activity, but they were limited in how much information they could offer about how the brain functions in the real world.

“Now we have video see-through, which allows me to use real-world objects as well as the computer-generated world,” Fidopiastis says. “The person sees both. It’s what we call ‘mixed reality.’ I place people in a mixed-reality environment that mimics their real world, whether it’s home, work, or some social place like a restaurant. We bring the patient into that environment, and I use different types of portable neuro-sensing devices to monitor their brain activity.”

Since this new technology offers a truer version of reality, Fidopiastis says it provides a more accurate picture of how the brain reacts in various everyday situations. That can lead to a better understanding of brain dysfunction, and in turn to improved treatment options.

“It’s not just a person sitting at a computer screen,” Fidopiastis says. “Patients come in, they put on the equipment, and they can walk around this virtual space and interact with real and virtual objects. So they’re getting to feel for things and perform tasks that they would actually do in the real world. That’s the biggest key here.

“If you lose a limb and have phantom-limb syndrome where you’re in a lot of pain, what’s really happening? With virtual reality I can do physical therapy and monitor your motor cortex and watch that change occur and correlate it back to your pain cycle. You can’t do that in an MRI. We’re able to look at the brain as it functions in the real world.”

Fidopiastis is particularly optimistic about using the technology on soldiers with PTSD, and has already approached the Department of Defense about potential research grants. She says monitoring a person’s brain activity through virtual technology can help better determine “what’s going on inside of them.

“I can watch their behavior all day, and they may or may not show some telltale patterns,” Fidopiastis says. “This way I can better understand why their emotional system is being overtaxed and how they’re overriding the decision-making process with their emotions.

“Then, as a clinician, I can intercede in that. I have a better chance of helping them recover because I know the point where they’re breaking.”

A New Frontier

Fidopiastis says virtual technology is capable of unlocking some of the most complex secrets of how the brain works. “We don’t fully understand how the brain centers—such as the center for language or for vision—coordinate and interact with each other,” she says. “So one aspect of what my lab looks at is brain dynamics. How does the information transfer from one area to another and then interact to create behavior? If we can understand that process, we might be able to introduce drugs or therapies that allow us to have better success and bring the patient to a new level of healing.”

The results are impressive, Fidopiastis says. “We used to think that the brain couldn’t change, especially once you reached adulthood. If you got a brain injury, that was it. Now we have learned that the brain does regenerate itself, and it can learn. We just don’t know what that window of healing looks like. And you can’t really determine that unless you’re acting in the real world.”

Or, in this case, a virtual copy of the real world.