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Brain-injured pt studied in a virtual kitchen
IRB must review alternative screening method
As virtual space technology improves, researchers are beginning to study how it can be used to help patients who've suffered traumatic brain injuries or other impairments that require rehabilitation.
At the Institute for Simulation and Training at the University of Central Florida in Orlando, FL, researchers worked with a man whose brain injury had impaired his memory to the point that he couldn't remember anything that happened after his accident, says Cali Fidopiastis, PhD, associate director for applied cognitions for active lab at the Institute for Simulation and Training.
"When we saw the patient in the clinic, he didn't remember who we were and didn't remember doing this type of therapy," Fidopiastis says. "But he still had an implicit memory system in which under a level of consciousness, he still had memory for a task."
So the institute replicated his apartment in virtual space, recreating his coffee maker and oven in a 3-dimensional display, she explains.
The room was replicated using basic construction materials to make cupboards and table tops, all of which were painted a color that allowed chromoscheming, Fidopiastis says.
"It's like when the weather person projects a map of a city and state and shows the weather coming through," she says. "We did the same thing with a head-mounted display."
The patient wore a head mount that combined video stream of the real kitchen.
"The participant stood in a 3-dimensional environment with painted plywood and would see the textures of his own kitchen, and he could walk in that 3-D space because it was a real space," Fidopiastis adds.
"We reconstructed the kitchen almost to scale and had the patient walk in this environment," she adds. "Within six, one-hour training sessions he was able to go home and maneuver around his own kitchen, finding pots and dishes in the cupboards."
Before the virtual training sessions, the patient was unable to use his own kitchen, she says.
This use of virtual reality is an exploratory research design that is making no marketing claims that would make it subject to Food and Drug Administration approval, Fidopiastis notes.
"Once we go forward and show this kind of therapy could be used in a therapy environment we would need FDA approval," she says.
Fidopiastis suggests that any IRB reviewing a protocol that uses virtual reality technology would have some basic safety concern questions to ponder, including the following:
"The IRB understood these issues," Fidopiastis says. "Even with the head trauma patient, we had to show the patient wasn't experiencing anything that would be outside the normal every day activity despite the fact the patient is wearing a head-mounted display."
Working with a brain-injured participant poses its own ethical challenges, particularly when screening tools use questions that require at least short-term memory.
With the brain-injured patient, it quickly became apparent that the screening tool used to assess whether a person is experiencing simulator sickness would not work.
"We gave him the questionnaire, and he'd say he was totally fine," Fidopiastis explains. "He wasn't wandering all over the place, but he couldn't touch his fingers to his nose."
A more hands-on screening method was necessary.
"The typical simulator sickness questionnaire gives you written feedback, and this patient doesn't know after five minutes what he experienced five minutes ago, so that test isn't appropriate for this population," Fidopiastis says. "So we had to go with a more physical type of testing that correlated to the simulator sickness questionnaire."
There are three parts to the questionnaire, including ocular motor, nausea in general, and disorientation, and we had to pick a task that could be performed by the participant for each of those parts, she explains.
"We'd have the patient walk in a straight line and we'd ask questions at the beginning of the hour and at the end of the hour about how the patient felt," Fidopiastis says.
The IRB approved changes to the screening method, and a therapist stayed with the patient while he was in the virtual space, she adds.
"There wasn't a time when the patient was by himself," Fidopiastis says. "He could see the therapist, and she could see him."