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00:00:01
okay well thank you so much my french is very pour so i apologise
00:00:05
rise up to speak in english i speak spanish with that will help
00:00:11
so i wanna thank you for inviting me and for repartee to visit
00:00:16
your beautiful country beautiful value really enjoyed my two days here
00:00:20
and i'm pleased to present today our experience using virtual reality
00:00:25
to treat patients in our hospital in los angeles
00:00:30
our cost was the largest hospital in the western united states we
00:00:34
have about a nine hundred and thirty beds in a hospital
00:00:38
and we have virtual reality treatments everyday right now
00:00:42
i have probably four five people not possible using virtual reality
00:00:47
yeah we've treated over five hundred patients so far today i want to
00:00:50
share some of our experiences using virtual reality what works and
00:00:56
also what doesn't work for managing these patients so wanna start by
00:01:00
showing you a picture of one of our hospital rooms
00:01:05
and this is a nice room to private room we have over nine hundred of these rooms
00:01:11
but being in a room like this is not a place
00:01:15
of healing this is not a place of rest
00:01:20
our patience in these rooms are suffering they supper seriously they stuff for
00:01:27
physically based stuff for emotionally they suffer socially socially isolated and stigma
00:01:34
ties to this is not a good place to be this is like a jail cell for patients who are in the hospital
00:01:42
so i took a picture what it looks like to be a patient and our hospital in the bed
00:01:48
and as the patients look up this is what they see all their base your television
00:01:53
and they see the ceiling and there's two things on the ceiling there's that one right there and then there's that one and then there's that
00:02:01
one and all day long people look back and forth at things on the ceiling that's in every so often something like this will happen
00:02:10
and you'll notice that i'm not smiling staring at the patient
00:02:14
and talking interrogating questioning and then we disappear and
00:02:21
come back again all day long back and forth this is what life is like in the hospital
00:02:26
whether you're in los angeles or in switzerland or anywhere in the world this is what life is like in the hospital
00:02:34
so we thought for starters there must be a way that
00:02:37
we can improve experience of our patients just experience
00:02:41
and then later determine if it improves clinical outcomes
00:02:46
could we use virtual reality to provide our patients with the opportunity to escape the four walls possible
00:02:54
to go on a tour of iceland to stand on the stage of circus
00:02:58
away and watch the performers or to go away and leave the hospital
00:03:05
and that's what we've been doing and this is a picture of one of my patients this particular young man
00:03:13
is experiencing severe pain because he has sickle cell and nina
00:03:17
very severe disease very very painful he's hospital lies he's
00:03:23
on o. p. o. it's narcotics pain medicines
00:03:26
but you can't tell that right now because at this moment he's in a helicopter over fjords in iceland
00:03:33
and i wanna show you know the idea of him and i'll show you a video of him and one other patient
00:03:39
uh these are two patients that are among the five hundred we've treated the
00:03:44
first man i told you about the second is an older woman
00:03:48
who has liver disease very severe psoriasis she's dying
00:03:54
she's in severe pain but you also won't be able to tell that from
00:03:58
what you'll see in second since this video was may this patients died
00:04:05
as many of our patients unfortunately due in virtual reality i don't know if it saves lives yet
00:04:13
but you'll see that they can improve people's self we can improve the way
00:04:16
people feel and i say this video now and you can save yourself
00:04:25
well
00:04:47
ah
00:04:50
oh
00:04:54
oh oh
00:05:27
well
00:05:36
oh well
00:05:42
i i i
00:05:49
well
00:05:55
i
00:06:01
okay
00:06:04
so you can see i don't know how you were able to hear that um but you
00:06:08
can see the experiences patients are having so what we've been interested in is studying
00:06:15
rigorously with a control research trials whether these
00:06:20
interventions are proving pain or other clinical
00:06:24
outcomes and uh this is i'll show you what would the patients are seeing
00:06:28
this is one of many visualisation is that we use we use about forty different visualisation is
00:06:34
and we have a pharmacy virtual reality pharmacy and we pick
00:06:39
and choose which visualisation to use for which patient
00:06:43
this is one of them this is a program called anxiety reliever
00:06:49
and you sit on the beach you interact with the environment
00:06:53
and there's a voice over in that your phones which is a mindful
00:06:57
meditation patients meditate they breathe slowly relax and uh it's extremely powerful
00:07:04
we're doing a study right now to see what impact this has
00:07:09
on pain and anxiety and also on hormone levels court is all stress hormone levels in the blow
00:07:15
so we're doing a study right now i understand how this is working but this is one of the experiences that they see
00:07:22
so we just published this paper which you can see find online it's open access free paper
00:07:30
and in this study we had two groups the first group was a group of fifty patients like the ones
00:07:36
i showed you and we gave them a ten minutes
00:07:39
of virtual reality we measured pain before and afterwards
00:07:44
and there was a drop in pain but then we have a control group and the control group watch
00:07:51
this video very relaxing high definition video on a two
00:07:55
dimensional screen in close proximity to the patient
00:07:59
and we show that for ten minutes as well and then we looked at the pain reduction in that group
00:08:05
and that work to that also work to reduce pain but the virtual reality work
00:08:10
more than the two dimensional screen is statistically significantly better at pain reduction
00:08:17
so this is one of the first controlled trials uh a virtual
00:08:21
reality in a diverse group of patients in the hospital
00:08:25
with pain scores of three or greater on a ten point scale
00:08:29
right now we're doing a new study with samsung
00:08:32
electronics it's a large prospective randomised control trial
00:08:37
two groups and we keep the virtual reality in the room the entire hospital stay
00:08:42
and we're looking at pain and we're looking at pain medications sleep
00:08:48
and how long they're in the hospital and their satisfaction with their stay in the hospital
00:08:53
and we will recruit a hundred and forty patients in that study we have a hundred and ten
00:08:57
so far so we will be reporting those data open the next four to six months
00:09:04
when we look at this more closely we looked at whether the
00:09:08
patient tell better or not which is an important consideration
00:09:12
and there's a sixty five percent response and b. r. verses forty
00:09:16
percent in control that's a difference of twenty five percent
00:09:20
one way of thinking about that is the statistical the number
00:09:24
needed to treat and and t. number needed to treat
00:09:27
how many people do we needed she would be our instead
00:09:31
of a control in order to provide one benefit
00:09:34
the numbers for if you do the calculation that better than pain medicines much better it's better than most
00:09:41
former pro therapies that we haven't that's so that's important finding and you can read more in it
00:09:49
this is the cover of the january edition of clinical neuroscience
00:09:54
and this is the paper that we just published a review systematic
00:09:59
review of the literature evaluating randomised control trials in virtual reality
00:10:06
and this also isn't open access paper if you're interested you can you can read this
00:10:11
this is a summary of what we found in this review we look throughout
00:10:16
the entire published medical literature and we found there are uh leaven studies
00:10:20
that are a randomised control trial in in patients in hospital based patients
00:10:26
comparing virtual reality versus control and these are mainly in a burn injuries
00:10:33
like the work work a pointer hoffman and others but also an obesity in cancer
00:10:38
pain physical trauma stroke course you know you're with my name is here
00:10:43
dramatic brain injury now the main thing i wanna point out is that in
00:10:47
these studies virtual reality is almost always a factor and well tolerated however
00:10:53
the studies need to be better we need better
00:10:57
studies higher quality studies better methyl logically
00:11:02
larger studies the studies we have are not good enough in general
00:11:06
so that's why we're trying to do larger prospective randomised control trials
00:11:12
with an active control and we'll be reporting that's it
00:11:16
i wanna show this to you 'cause this is an important lesson what you're looking at here is the c. t. scan
00:11:23
of the abdomen it's looking at the major blood vessels in the abdomen this is a eighteen year old one
00:11:31
who i was asked to evaluate for abdominal pain i'm aghast rounder our just wanna click and i
00:11:38
was asked to evaluate this one and for abdominal pain eight months of severe abdominal pain
00:11:44
the doctor said that every test they could think of every test was negative no reason for about
00:11:50
opening very severe abdominal pain she's losing weight and the doctors thought that she they psychiatric problem
00:11:58
i thought she had your double bowel syndrome and anorexia and was losing weight because she had psychiatric problem
00:12:07
so i evaluated her and i agreed i couldn't find an explanation
00:12:13
so i decided to use virtual reality and we thought virtual reality would help her
00:12:20
it did not help or not one bit in fact she target after the virtual reality i said what did you think and she said
00:12:30
nothing i still have pain in faxes that i had pain through the entire experience the entire time
00:12:38
and it's so unusual to have no benefit zero benefit that we wondered are we missing
00:12:43
something here are we missing a problem because there's no response to virtual reality
00:12:49
so we did the only task to laugh that we can find and this is that what you're looking at here
00:12:55
is a black stripe that does not belong or diaphragm
00:13:01
has crashed or major blood vessels and she has
00:13:05
no blood flow to her abdomen she has a serious problem and she needed surgery to fix it
00:13:13
the reason we found that was a negative response to virtual reality so in digital health
00:13:19
in general we always wanted positive response but we should always think when somebody
00:13:24
does not respond to an intervention that also
00:13:27
has clinical relevance that too can be
00:13:30
clinically important and in this case the fact that she did not respond
00:13:36
was extremely important and this is not repeated itself many times
00:13:40
i use virtual reality in some regards the diagnostic test
00:13:45
to help me understand the degree to which the mind and the body are communicating and whether
00:13:50
painting is more in the mind or more in the bar you're somewhere in between
00:13:55
and in this instance she did not need virtual reality she needed surgery of picture problem
00:14:03
i've said this that a virtual reality is the therapy we need a virtual reality pharmacy
00:14:09
we need a way to pick what is the right visualisation for the right patient
00:14:15
virtual reality is just like a syringe right medicine going through it it's not
00:14:21
about the syringe it's about what medicine do you put through the search
00:14:26
so virtual reality it's it's just a platform what matters is what are we putting through
00:14:30
that platform what experiences what visualisation is that what matters so what we're doing now
00:14:36
is creating a new uh tasks a cycle matcher
00:14:39
profile the computer program second helpless profile
00:14:43
each patient individually and then use the results to map to the right prescription
00:14:50
how frequently how for how long what kind of intensity just
00:14:55
like i'm a doctor i write a prescription for medicine
00:14:58
i need to be able to write a prescription for virtual reality and that's what we're working on that
00:15:04
i wanna show you another example of how we're using virtual reality
00:15:08
this is the samsung three sixty a cure or um camera
00:15:12
it fits in the palm of your hand i don't know if anyone hears used it very small
00:15:17
what we're doing now is we're taking a summer giving it to the family of the patient
00:15:23
patients in the hospital and the family takes it home to the house
00:15:29
they then turn it on and the patient could be transported directly
00:15:33
from the hospital bed to their home to the park to
00:15:37
be with their family so wanna show your video now we'll see how the sound is what happens when we do this
00:15:45
or patient a young man he's been in the hospital almost a hundred days
00:15:50
and in this case he wants to go home but he cannot go
00:15:55
so we bring him home this was during christmas last december and
00:15:59
you'll see the christmas tree in the back around and he gets to go home to be with his family in the house
00:16:06
and we then bring him to the park where he starts to meditate but
00:16:11
it all happens from his hospital bed so first to introduce himself
00:16:15
we'll see if you can hear it and then you'll see what happens when we use the camera to bring him back to his house
00:16:24
well
00:16:39
well
00:16:44
uh
00:16:50
oh well
00:16:55
for
00:17:00
oh
00:17:02
oh
00:17:04
oh
00:17:10
huh
00:17:14
full
00:17:17
oh
00:17:19
oh
00:17:26
for
00:17:30
oh
00:17:34
four
00:17:40
oh
00:17:52
if
00:18:00
oh
00:18:05
four
00:18:07
it's
00:18:10
ah
00:18:12
it's
00:18:19
oh
00:18:22
if so i don't know how you heard that but you can see the pictures at
00:18:27
least this is a man who has severe disease and is in severe pain
00:18:33
but again at that moment you can't tell that and we keep that in the room
00:18:37
and if he comes back to the hospital every month in when he comes back
00:18:41
we give him the virtual reality for the entire time that he's in the hospital you can go wherever he wants to go
00:18:47
and he is reported that it's improved his symptoms and troops is i'm experiencing hostile
00:18:53
to the point where he thinks he gets out of a possible faster
00:18:57
as a result of using the headsets gets better sleep is more comfortable
00:19:03
this is an example of what uh we're trying to do
00:19:07
where the walls of the possible can be turned into
00:19:11
any vision but you want even if you don't have the
00:19:14
headsets uh accept this is actually a television show
00:19:19
call up your genius i think some of you for me last night you've seen the
00:19:22
show there's a show that we developed in united states that the t. v. show
00:19:27
and this is actually not a real possible this is a seven million dollars set at universal studios
00:19:34
so universal studios we build entire hospital and tried to demonstrate
00:19:39
what the hospital should look like in the future
00:19:42
and this is this a t. v. show we use virtual reality uh throughout the
00:19:46
t. v. show these are the actors learning how to use virtual reality
00:19:50
uh in our laboratory at cedars sinai and uh this is the scene where we
00:19:55
use virtual reality for a patient with um a phobia and expose sam
00:20:01
uh to his worst fears which is something we hear about later today and
00:20:06
that research is what we tried to depict in this t. v. show
00:20:11
no this is a very online that um we n. b.
00:20:15
c. news and united states posted and what's amazing
00:20:18
to me is there are almost four and a half a million people who have watched this video
00:20:24
and underneath it there are two and a half thousand comments
00:20:30
so we decided to do a research study by just allies inc those
00:20:34
two and a half thousand comments in my graduate students got together
00:20:38
and they used a computer program and they analysed be comments that
00:20:43
we're receiving from the public about the uh the virtual reality
00:20:48
and this is hard for you to see but it demonstrates a variety of different sentiments in pots that people half
00:20:55
people think that they should be used for women undergrad delivering a baby in a brain stand
00:21:01
uh elderly people who can't move or travel as a distraction
00:21:05
for boredom uh for cancer chemotherapy for kidney dialysis
00:21:10
they also have worries and concerns could could uh okay the patient fall a bad because they
00:21:16
can't see is gonna cause cancer in the rice all sorts of concerns so for the
00:21:20
virtual reality research community for the therapeutic the our community this is a blueprint for what we
00:21:26
need to study next and what we need to answer in terms of consumer sentiment
00:21:32
this paper will be published sometime in the next six months or so so you can i can send the slides out
00:21:39
alright so i'm gonna finish now uh this one last example is we're
00:21:43
going into the community now using virtual reality this is very important
00:21:48
because we're on this room we like digital hell we like virtual reality we talk to each other but what about the rest of the world
00:21:55
what about people in community this is in the church and selfless stanza less
00:22:00
and we've you were using virtual reality to treat high blood
00:22:03
pressure we've created a virtual reality treatment for hypertension
00:22:08
where people go in the kitchen and they'll learn about what to to you and then they can
00:22:13
travel through their body and see what happens to their body if they eat too much salt
00:22:18
how it affects their brain the blood vessels are are and we're doing a study right now to see if we can reduce blood pressure
00:22:25
okay well i mean and because another time but i wanna show you this this is amazing
00:22:30
to me you may have heard of the web the awards this is for the best
00:22:34
of the internet every year the web awards are given out and we were nominated for
00:22:38
the best technology and the internet up against in gadget in wired magazine and nike
00:22:44
and then uh s. which i couldn't believe and just last week
00:22:48
or two weeks ago we won the best technology on
00:22:51
the internet and the web your words i don't even know what the web you word as i'm not research doctor
00:22:56
but apparently this matters to some people so there's just demonstrates a that's
00:23:01
a virtual reality squarely very important and has tremendous opportunity and growth
00:23:07
so since i'm from los angeles and from hollywood i'm showing you my closing
00:23:10
credits like this is a movie 'cause there are many many people
00:23:14
involved in this research we have sciences social scientists computer scientists we have
00:23:20
clinicians we have nurses doctors uh from all sorts of different departments
00:23:25
from oncology from surgery or or therapeutics from urology
00:23:30
uh from almost every department in the hospital is involved in this and the study
00:23:35
so up and finish their ah saw thing i thank you very much again for uh the opportunity and you can't call
00:23:41
that number because this is an interstate so that's amateur move that so sorry i can't take your patients in switzerland
00:23:48
uh but otherwise thank you very much appreciate your attention yeah
00:23:58
mm thank you very much for having troops who these experiences in
00:24:05
and so on the um the question
00:24:10
i think you were mentioned vernon speech um i was wondering
00:24:15
or mid to focus uh some units uh of maturity
00:24:20
um maybe some some patient would be we'll oh this is much
00:24:25
better than my real life so please send me away right
00:24:29
well that's a concern not just for patients but for gamers for the read the
00:24:35
book ready player one some of you may have read that book you've
00:24:38
no this to stop in future where people are no longer interested in real reality
00:24:44
but are only living in virtual reality from my standpoint of
00:24:47
the doctor or patience are suffering cancer severe pain
00:24:53
i'm not yet is concerned about that considering some of the other things we do the patients that are much more harmful
00:24:59
like giving opiate waves which causes suicide alley and death and thirty thousand people
00:25:04
per year in united states just from over dosing on mccain medicines
00:25:08
so it's a little early for me to get too concerned about that to still be in future
00:25:14
but it's still very much in my mind and yeah so there's always a concern that we can use too
00:25:18
much virtual reality uh or could be used responsibly uh but that's a very big important ethical question
00:25:28
read digits
00:25:30
with my i think integrated on the potential with yellow eyes huge one of the problems up with you know
00:25:38
something's emotions a semi uh_huh i was happy t. who
00:25:42
is it that you patients what'll rated the dimension
00:25:45
would you comment on yeah motions in this problem yeah motion sickness is usually consequence of that d. r.
00:25:52
what i mean by that is b. r. with for a graphical
00:25:55
will processing speed from you know it's is the latency
00:25:59
between the head movement and the visual uh than the visual a scene
00:26:04
uh however yes there's still that ten percent of people
00:26:07
that have some degree of transients of vertigo
00:26:11
and could get nauseous our patients have not generally experience that however we are not
00:26:16
using it in people who have not as yet or vomiting or very sick
00:26:21
so we not trying it in those patients 'cause we don't wanna make them worse so we've excluded those patients but
00:26:27
for the most part well tolerated if they feel sick they take a headset often get better quickly uh yeah
00:26:36
question concerning the o. o. p. h. present in the beginning
00:26:42
and the control group now the you know the uh it was a huge video or a
00:26:47
picture that you showed is this if they don't yeah alright p. in their names engine
00:26:54
with the actual there is this to their pain therapy is giving people pain medicines
00:26:59
and that's um unfortunate but um we don't have sort of a standardised um visualisation and
00:27:05
what that's like their you're alright therapy yeah absolutely not be there for sure
00:27:11
so all all sorts of non medical highly effective adjunct slippage interesting to
00:27:16
compare preacher yelling these kind of intervention yes it would yes
00:27:21
it words so this was a ten minute intervention so something like art therapy is hard to standardise over ten minute you could
00:27:27
uh we have to start somewhere so this is how we started but i agree that it would be
00:27:31
very helpful look against a variety of other interventions which there are many and the pain literature
00:27:38
i mean 'cause to with with them
00:27:43
okay the question the boat the pain reduction oh experiments you didn't
00:27:48
so what was the time window to beat was not during o. decision
00:27:54
that you mention these pain or you had effects that plastic tsunami needs or even longer yes
00:28:01
yeah so that's what unclear uh so for the study we did it uh before
00:28:07
and then usually uh was about ten minutes after the end of therapy and we
00:28:12
did the same protocol on both arms the question that comes up is okay
00:28:16
is that pain reduction sustained there's a continue hours later days later and
00:28:22
that's what we're studying now but what we have definitely seeing
00:28:25
is that the pain reduction can be sustained even after the virtual reality is discontinued
00:28:31
it is somehow in some patients change their mind set in a way that we don't yet fully understand
00:28:37
uh we need more basic science understand why but we do
00:28:40
see that there's a reduction pain many patients that persists
00:28:44
for hours in some cases even days but we need a booster effect so we're treating three
00:28:49
times a day ten minutes per session ten to twelve minutes three times a day
00:28:54
um during the hospital stay and for breakthrough pain if somebody continues to have pain
00:29:00
uh but our current study will answer your question more uh better with evidence that we're doing right now
00:29:07
we're going through
00:29:11
uh the most will you mention ye ah zero um i'll call does all differences
00:29:17
so we do have so the right now and i don't have any data yet to present to you
00:29:22
but uh i think i said let but we're actually measuring saliva a seller very
00:29:27
uh of course all levels and we're in the middle of doing that right now and
00:29:30
i haven't actually seen any of the data so i'll report back when we know

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Conference Program

Mot d'introduction
Sébastien Mabillard, Coordinateur projets e-health, Fondation The Ark
June 8, 2017 · 6:05 p.m.
376 views
Les Technologies Cognitives ou l'Homme Augmenté
Jérôme De Nomazy, IBM Suisse
June 8, 2017 · 6:09 p.m.
115 views
Les Technologies Cognitives ou l'Homme Augmenté - Questions du public
Jérôme De Nomazy, IBM Suisse
June 8, 2017 · 6:41 p.m.
Mot de bienvenue
Sébastien Mabillard, Coordinateur projets e-health, Fondation The Ark
June 9, 2017 · 9:04 a.m.
Présentation de Swiss Digital Health
Frédéric Bagnoud, CimArk
June 9, 2017 · 9:07 a.m.
138 views
Présentation des instituts de recherche HES-SO Valais-Wallis
Laurent Sciboz, directeur Institut Informatique de Gestion | HES-SO Valais/Wallis
June 9, 2017 · 9:11 a.m.
119 views
Virtually Better: How Virtual Reality is Easing Pain, Calming Nerves and Improving Health the Drug-Free Way
Brennan Spiegel, Director of Health Services Research, Cedars-Sinai Health System
June 9, 2017 · 9:21 a.m.
193 views
Augmented Reality-assisted surgery
Luc Soler, Directeur de la R&D et Professeur PAST, IRCAD, IHU
June 9, 2017 · 11:22 a.m.
287 views
Réalité virtuelle dans le traitement des troubles mentaux
Eric Malbos, Psychiatre et spécialiste du traitement en réalité virtuelle, CHU Conception
June 9, 2017 · 11:56 a.m.
378 views
La Simulation Numérique pour les Professionnels de Santé
Xavier Abadie, Directeur du Développement International, SimforHealth
June 9, 2017 · 12:28 p.m.
105 views
AR for different medical use cases
Antoine Widmer, Professeur HES & co-fondateur d'Adventures Lab
June 9, 2017 · 2:04 p.m.
Augmented reality for medical applications
Henrique Galvan Debarba, Chercheur senior, Fondation Artanim
June 9, 2017 · 2:15 p.m.
110 views
Virtual reality solutions for stroke rehabilitation
Andrea Serino, Responsable de la recherche en neurosciences, Mindmaze
June 9, 2017 · 2:34 p.m.
123 views
Virtual Reality combined with haptic robotics for rehabilitation
Aurélien Fauquex, Directeur Exécutif et co-fondateur, Lambda Health System
June 9, 2017 · 2:48 p.m.
101 views
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