Is Virtual Reality the Future of cognitive Medicine? Skip Rizzo Ph.D.

Join us on the latest episode of the Crackin' Backs Podcast where we sit down with Dr. Skip Rizzo, Director of Medical Virtual Reality at the Institute for Creative Technologies at USC, to explore the innovative world of virtual reality in medicine. Contrary to popular belief, VR goes far beyond gaming and entertainment—it's at the forefront of modern healthcare, revolutionizing diagnostics, treatment, and training across the globe.

In this episode, Dr. Rizzo unveils how virtual reality is not only a tool for creating immersive gaming experiences but also a pivotal element in medical treatment and training. He'll delve into how VR competes with traditional biofeedback methods, improving patient engagement and treatment outcomes. We'll explore the significant advantages of VR in treating mental illnesses, including specific conditions where VR outshines conventional therapies.

Dr. Rizzo also shares compelling insights on how VR helps athletes recover from traumatic injuries and manage conditions like TBI, including real-life success stories and outcomes. Additionally, we'll discuss the customization of VR technology for individual cognitive health needs and the role of personalized medicine in advancing VR therapies.

Discover how virtual reality is shaping the future of healthcare training, with successful programs aimed at improving treatments for ADHD, PTSD, and cognitive impairments. Whether you're a healthcare professional, tech enthusiast, or just curious about the future of medicine, this episode offers eye-opening discussions that promise to enlighten and inspire. Tune in to see how virtual reality is not just a game changer—it's a life changer.

We are two sports chiropractors, seeking knowledge from some of the best resources in the world of health. From our perspective, health is more than just “Crackin Backs” but a deep dive into physical, mental, and nutritional well-being philosophies.

Join us as we talk to some of the greatest minds and discover some of the most incredible gems you can use to maintain a higher level of health. Crackin Backs Podcast

Transcript

Dr. Spencer Baron: 0:01

Welcome to the cracking backs podcast. On today's show, we are discussing the groundbreaking intersection of virtual reality and healthcare with our esteemed guest, Dr. Skip Rizzo, Director of Medical virtual reality at USC Institute for Creative Technologies. Think VR is just for gaming. Think again, Dr. Rizzo is here to shatter that myth sharing how VR is revolutionizing the way we diagnose, treat, and manage everything from cognitive decline, to mental illness, and even how we train our healthcare professionals. Whether it's helping athletes recover from traumatic injuries, or tailoring therapies for mental health conditions, VR is transforming medicine. Get ready to have your mind blown. This episode will change the way you think about healthcare and virtual reality. Forever.

Dr. Terry Weyman: 0:57

All right, well, we're really excited for this show. Today. We got Dr. Skip Rizzo, from my favorite college. Well, I can't say it because I work at Pepperdine, but USC Trojan man. And we're gonna we're gonna continue to talk to his head a few weeks ago about VR. And but now we're gonna talk to the man and the science of the brains behind some of this VR stuff. So welcome to the show. Dr. Skip, we're so blessed to have you on the on today.

Unknown: 1:26

I'm psyched to be here.

Dr. Terry Weyman: 1:32

To start off, a lot of is talking about VR, a lot of people it's funny, because when I was talking about this show, a lot of people still both in healthcare patients still think of VR as a gaming platform. Yeah, they still still think it is for kids running around the room, and parents yelled down to put the VR down and get outside and live a reality life, not Virtual Reality life, yet. It's not being studied for health and medical applications. And, and it's all over the world. In fact, I think it's probably more outside the US than inside us. And, and you're the head of a department, when I tell people, there's a department for medical VR, they're blown away. And so these devices are used for diagnostic purposes for treatment. And such like ultrasound, people think of ultrasound as a device, but it's also a diagnostic device. It's also a treatment device. So can you talk about VR, and the possibilities of prevention and use for cognitive therapy?

Unknown: 2:35

Well, you know, you have to think about virtual reality, from the perspective of a game technology in the sense that we use technology that's similarly applied in the development of computer games. But we're using it to develop applications that create a totally different experience, we may leverage gaming elements to enhance motivation, and so forth. But essentially, when we talk about VR, we're talking about simulation technology, it's a way to create digital worlds that simulate the experiences that somebody would have in their everyday life. And by developing these sorts of applications, we can embed within them the challenges the fearful stimuli, the activities of everyday life, and so forth. We can do that in a systematic way. So that we can put people in environments that we can test, train, teach or treat a wide range of functioning. And probably, you know, I have to go back to the metaphor I've been using since the late 90s, when I'd go to the American Psychological Association convention, and everybody thought I was just some psycho. And I would say, Look, you know, I know this is kind of new, but think about when you're flying home from this conference, would you prefer that your pilot had been trained and certified? for how to deal with wind shear or fog landing or turbulence in a simulator? Or would you rather they learned that skill, and learn emotional regulation needed to deal with it? From a book, or death by PowerPoint? PowerPoint was just coming on in late 90s. So people started to get that I'm an old guy. Or, you know, better still, how about on the job training? Would you like that? Or would you like the simulator, and then people started to get that, okay. It goes beyond piloting skill. We can create the ultimate Skinner box, if you will, a controlled stimulus environment that we can systematically manipulate the stimuli and we can monitor performance in ways that give us grand opportunities to reshape the face of mental health and physical rehabilitation.

Dr. Spencer Baron: 4:50

That was pretty cool. That was a great example. So skip, I like to talk more about like biofeedback. Brain Mapping is something is always fascinated me, but you know, traditional sense of biofeedback, everybody thinks of certain, you know, stimulus and then emotional control. But how do you use VR in the medical treatment compared to, you know, traditional to the way you would do it or with VR? How would that work?

Unknown: 5:18

Well, the integration of VR and biofeedback is just another useful combination of these types of enabling technologies. So, for example, you know, I actually did my master's thesis in a biofeedback context back in the late 70s, back when biofeedback was really just starting to be recognized as something that could be useful. And, you know, the idea was that you would change the pitch of a tone based on changing your heart rate, or your skin conductance, or your temperature, body temperature at some location. And that was a way to get feedback that maybe the person didn't have the internal cues or couldn't recognize the internal cues to learn how to modify those things. Well, now, think about integrating that with VR, where you can create an everyday environment where some key element that the person is well connected to can change based on them changing their body state, one of the better examples that hasn't really got a lot of traction, but was Jesus blanking on the woman's name? Dammit, she's from from Canada, and she's done pain management work, where she has people with, you know, difficulties ambulating has him on a treadmill, walking through a forest is really beautiful for us, but it's all shrouded in fog. And as they lower their skin conductance, galvanic skin response and calm themselves, the fog starts to lift, and it becomes more clear, wow. And I will get you for your show notes later the name of this person, I'm so embarrassed, I can't recall her name right now. But it's early in the morning for me. But, but that is an example of how you can integrate the two technologies in a way where you're providing the stimulus input that you want the person to manipulate in a more natural, ecologically relevant context. And, you know, who knows, maybe the just a simple sound pitch is sufficient. This, all the VR stuff is just, you know, bells and whistles. But on the other hand, maybe you have more convincing case for a patient to get their buy in when you have some of those bells and whistles. And, you know, so we're always making this judgment as to how much is enough? And the I mean, the concept of bringing these two things together is sound. I mean, it's basic experimental psychology, it's not really that exotic. It's just a matter of what is the what's the bang for the buck for all the development costs and the complexity of creating these applications, does it lead to better outcomes? Or does it lead to better patient engagement?

Dr. Spencer Baron: 8:13

On an earlier podcast, we had, you know, Amir was on it mentioned something about phobias. I thought that was fascinating. Can you elaborate on that?

Unknown: 8:25

Yeah. You know, virtual reality is one of the first areas where it was applied clinically, aside from the cognitive stuff, because the cognitive stuff also started around the mid 90s, maybe a little earlier, 9394, some great work in England, but one of the first areas was with phobias. And that was because it was so intuitively matched to what's needed for that clinical application. I mean, with with phobia, treatment, if you follow a behavioral or cognitive behavioral approaches exposure therapy, they help the patient to gradually confront the feared stimuli, but in a safe place where they know they're not going to get hurt. And, you know, the, whatever they're fearful of isn't maybe really happening. Maybe their frontal lobes are telling them, I'm in this aircraft, and I have fear of flying, but it's not the real thing, and they'll do it. But what we found from that early work was we could fool the brain. So even though the person knew was a simulation, you know, being on the edge of a skyscraper or seeing or being a roomful of spiders, or whatever the fear was, you know, they live limbic system that was activated, because we were in a 3d environment, you're turning your head, you're looking around, and it's, it fooled the brain and so you got that level of activation needed to do therapeutic exposure where you want to raise a little bit of anxiety at a manageable level, and then do that progressively. So that's where he got instruction. Barbara Rothbaum was a big person in this field, Larry Hodges, Ralph Lampson, who was Kaiser did one of the early studies as well. And that's really where, you know, even in 1995 96, when the some of these early papers came out, you know, people knew about virtual reality, it was still kind of, in its trendy, first wave hype cycle kind of thing, Jaron Lanier, if you're familiar with him, but he was a big promoter of VR back then he had a company called VPL. And it was a media figure. And there was a big hype cycle around VR at that time, but then the reality set in, and the cost for the equipment, the complexity, the unfamiliarity with the technology, all that conspired, and, you know, VR went into a little bit of a mini nuclear winter for a few years. But the it was, at the same time, clinically, there was a whole little pack of clinicians and scientists that still carried the torch, you know, that believed that the vision was sound that whether it's exposure therapy, or building functional environments for testing and training, cognitive function, so on, we believe that that made a heck of a lot of sense versus how it was being done in the old, old way. We hung in there. Now, we, you know, the rest of the story is pretty clear that technology caught up with the vision, people did a lot of the science and did clinical trials. And so at the same time, technology caught up with a vision and we can deliver this stuff at a low cost and so on and build it quickly. We have this science that's evolved around it, documenting that it's not some harebrained Star Trek holodeck, you know, crazy idea, you know, it actually has the science behind it to make the case for it. So that's where I think we're at now going back from those very early days, starting with phobias, and fears and so on. Yeah,

Dr. Terry Weyman: 12:06

that's fascinating. And that, yeah, Dr. Spence brought up something about biofeedback. And the one thing that I was kind of intrigued with is what VR does, it brings into cognitive or kinetic motion, where a lot of the biofeedback just you're sitting in a chair, so you can have play games with your brain, but you're still sitting in a chair and and what VR does, you can do the same thing. But now you're involved in a motion posture, movement patterns. And it's, we know that neurologically that is so important when it comes to brain function. So can you elaborate more on why I feel this is so much more advanced for cognitive health because of the Kinect motion?

Unknown: 12:50

You know, coming from my background in cognitive psychology, I like to talk about embodied cognition. And that's the idea that you're, you know, you learn better when you have physical activity as part of the learning experience, you know, learning by doing, if you will. But it goes well beyond that, I think it's wired into our genetic code, that, that natural interaction really facilitates a whole spectrum of these processes in a really good way. And, you know, it's like, you know, you can, you can sit there and try to recover your function by activating mirror neurons sitting and imagining yourself moving. And there's some research showing that, you know, there's some value in that before some rehab activity, it sets maybe a neural pattern that then you've you actually stamp in by the actual activity, maybe. But you can't be the activity based VR interaction. That's one of the selling points with this. You're not just sitting passive clicking a mouse to respond, yes, no, or, you know, on a cognitive task, you know, you're actually engaged in an actual physical way. And, you know, actually, some of that stuff is being tested out. In the treatment of PTSD is well, you know, taking a lot of our stuff, which is exposure therapy for trauma, where you navigate around and you're standing and you're moving and so on, to some degree, but there's some researchers Mike Roy out at Walter Reed and his colleagues and actually in the Netherlands, they have people on a treadmill, walking and observing the virtual world that they're trying to overcome their traumatic experience from while they're walking and talking and narrating the experience in that element again, of ambulating in a more natural way, they believe that facilitates that kind of trauma focused approach. If you can, you can look at any application and see where physical activity integrated into the whatever the the mental state you're trying to enhance or facilitate is a net plus, oh,

Dr. Terry Weyman: 15:14

higher percent. And Dr. Spence and I work with athletes and even the return to play. They're fearful of getting hurt again. And we can see now you can start having them move with this virtuality and see the play that they heard. But now you can take out the injury and have them kind of see the trauma but not experience it. The other question I have is, a lot of people tried VR when it first came out, and the firt, as soon as they put their goggles on, they got dizzy, and they went, Oh, I can't deal with this. And so they've stuck with that thought process. And that thought process permeate through a lot of generations or, or this time, and yet, I looked at this mega three, and the, the technology was so better than even two years ago. Can you talk about how the technology is improved? So people aren't as dizzy, but putting it on?

Unknown: 16:15

Definitely. You know, this has always been one of the points that the critics of VR bring up all the time. Oh, everybody gets motion sick? Well, first off, that's that's not really true. Not everyone. You know, maybe 10 10% Have some ill effect. But certainly, that hasn't been the death knell for cruise lines with motion sickness, because there's a lot of people that get motion sick and still go on cruise cruises, because they want to go on a cruise. And I think it's the same thing with VR, eventually, you know, there's two things, there's certain people look, let's not fool ourselves, maybe there's 10 15% of population, VR will never be any good for them. Okay, fair enough. You've got traditional, traditional things, you know, and that's what we do. But for the rest of the folks, you know, sometimes their first experiences, they feel a little queasy, it's sort of like when astronauts returned from space for the first time, getting, you know, they have like space sickness, where adjusting to gravity, again, is difficult. But then when you look at the adjustment curve for their second, third, fourth, and on returns from space to brain develop sort of a pattern for readapting. And the period of time to adjust to gravity shrinks each time they come back, I think it's the same thing with what I've seen with VR, that if somebody has some mild effects, okay, you acknowledge that if you want to stop anytime you can, but, you know, you kind of hang in there, and, you know, take it in small doses, eventually, people's brains start to adapt to it, you see less cyber sickness over time. And there's some, you know, some virtual warriors that never feel it, I used to be that way. I could sit a headset for hours at a time. Now, I don't know if it's an aging thing, but or I'm good with an hour maybe. And then it's like, okay, but if to your point, you know, with the technology advances, yes, this has been a major advancement, for making the experience more durable for people, or their experience there. For example, with the quest three, like you mentioned, you know, the the update rate and the technical drivers for the simulations that are delivered in that headset, it's, it's a lot faster. So when you turn your head, there's way less lag than a headset from back in the bygone days, 2015 or whatever, you know, and you also have the option for a mixed reality type application where it's like augmented reality, where you're actually seeing the physical real world, that you're in through the headset through video bypass kind of thing, fly through mangling the terms here, but the point is, you can see the real world and then now you can start to populate that real world with graphic content and create the simulation within the real world experience of something you're familiar with. I think the application called first encounter really sold me on the quest series capability for augmented reality where, you know, I looked around and in the device and it was automatically mapping out the space I was in writing a 3d grid. And then all of a sudden, that world broke apart and I was in a a simulated world with robots coming out and everything. And there was that seamless transition from the real world to the virtual world. That may be a way to ease people into this and have had prior difficulty. So, you know, there's so many things that technical drivers, the way you design simulations, you know, people build these virtual rollercoasters. They're basically the vomit comet, you know, I mean, who would want to be on a roller coaster, I'd rather do the real thing. But I mean, really, you're getting the sensory visual cues that are in direct conflict in a deep way to what you would get if you were on a real roller coaster, from your inner ears and your equilibrium and all that, you know, you century Q and congruent is a recipe for disaster. So people learned how to design things, particularly for political purposes, that maybe don't have that same type of provocative incongruence between vision and balance and equilibrium, that oftentimes leads to you know, that feeling that people report motion sickness or cyber sickness, whatever you call it.

Dr. Terry Weyman: 21:12

Have you have you seen a change like this came out last week with the new three, the 360 cameras now, and they're starting to implement the 360 cameras into the VR as you get that instead of watching a, like you said, robots can be pixelated and it's animated. Now you're getting reality. I mean, I used my VR, a week ago, there's a ski run I've been trying to get. And it's always scared the crap at me and I found a video there was recently a guy that ran it in a 3d camera. And, and he did it and I actually ran the ski run like four times. So when I went up to do it, it was like, I'd been on it five times already. Have you seen the advancement in the cameras now into VR? Making a change? Yeah,

Unknown: 22:05

so you know, spherical video. It's been around for for some time. But now, it's gotten so much more doable by pretty much anyone. I remember a few years back, I bought a camera by Ryko called the theta. And it was had two lenses with fishbowl lenses on each side, two cameras, and it captured seamlessly a 360, spherical 360. By 360 experience, it was quite remarkable. I duct taped it to the top of my motorcycle helmet, and did a wild ride up up the hill with it, my motorcycle, and I've been talking about a vomit comment there. But it's like you're on the motorcycle and everything but the vibration, you know, you're not feeling that vibration, although you could do that with subwoofers. And you could build out a chair and actually feel like you're in a motorcycle, have wind and all that. You could do that. But yes, I mean, this is and, and the ability to capture real world environments that offers a lot for VR, we were doing a project with Penumbra for the exposure therapy for veterans, not of the combat environments, but of the everyday civilian environments that they come back to after they you know, they've been diagnosed with PTSD that is really provocative for them being in arrest a crowded restaurant, and having their back to the door and you know, always turning or just being in crowds, where there's something provocative going on, you know, fireworks going off in the distance. And that's all spherical video. Sometimes, it's really mundane, we did a shoot with a supermarket, you know, and something that we just, you know, we don't even think about we walk in a supermarket but for some veterans going into a supermarket big open space, but people popping out of corners, walking by the rack, you know, they're seeing raw meat for some vets, that is a trigger. And it makes it so that their world shrinks. So now using the these spherical video of the real places, that becomes a therapeutic tool. And let me take one more step, giving these low cost cameras $200 to your patient maybe, and having them walk through their own environment and capture it and narrate it. And then having them put that in it, put it in a headset, which is easily downloadable to request or whatever. And now you've got a representation of their everyday world that they're in that you can see you have a cast who is screened so you can watch and you can you can engage with them in a dialogue about what's going on in their home that is massive, as well. Who? Or what's the environment, get them to go to that environment that freaks them out, in capture, maybe with a friend and a support? I mean, so there's all these opportunities to bring patient engagement and, and patient co construction of a virtual world. That might be therapeutic.

Dr. Spencer Baron: 25:18

That's fascinating. I want to digress for a moment. And I love the fact that you came up with a nomenclature a cyber sickness. I never, I've never heard of that before. But it makes sense. cyber sickness. That's a great term. We were also talking about phobias, but I'd like to expand on mental illness and and therapeutic treatment approaches toward mental illness and, you know, what kind of conditions would be effective? And how are they effective with VR?

Unknown: 25:52

Well, leapfrogging from the the phobia, work, you know, the strain on, you know, irrational fear of things that really pose no threat, then in the next step, you go with that same therapeutic approach is with exposure therapy for post traumatic stress disorder. This is an area that I've worked in for many years, and working with veterans who've come back from Iraq and Afghanistan. Also for military sexual trauma, now moving to civilian sexual trauma. And we have projects in Ukraine, we may be developing a set of systems in in, in Israel, and for the Gazan population, as well. And basically, you put people in very highly controllable simulations of the places that they experienced a trauma. And, you know, this is gonna sound like why the hell would you do this to anybody. But it's hard medicine for hard problem, no doubt, but part of the exposure process in PTSD is to help a patient to confront and reprocess those difficult emotional memories not to avoid thinking about them more to avoid going into places that remind them of it. And so you gradually help a patient to go into, say, a combat world say their trauma was getting blown up in a Humvee driving to Fallujah, or maybe you can put them in a desert experience in a Humvee, with all their buddies in the Humvee, or with only one person under you can control all that in VR, it may be the first session is just sitting in that Humvee, looking out maybe the sound or wind, you know, the clinician can control all this. And then the next session, you know, maybe it's like, you invite the patient, right, hit this button, and let's drive, and the vehicle sorts of pull out on a roadway. And it's still a sunny day, you know, nothing provocative, calm desert. And patient, meanwhile, is narrating the experience. And then, you know, as they progress through the therapy, eventually they get to the point where they're actually confronting the event, not an exact replica of the event. But as close as you can mimic in a VR experience. The core elements of it, you know, being blown up having a Humvee, having a ID blow up next to their Humvee, hearing the sounds of people screaming, or jets flying over bombs in the distance, eventually, the patient can get to that, and begin to talk about it. And that process of confronting and reprocessing is at the core of that kind of trauma focused therapy that is an evidence based approach. And we've got a number of studies documenting it safety and feasibility as well as clinical efficacy in that area. So that serves as one of the, one of the core psychological processes that VR can extend or amplify, traditionally, that was done in imagination only, you know, and that's a pretty tall order to, you know, having a paid toe to pay your patient have closer eyes. Now, imagine you're in that home be no and then you go through these guided imagery, but you don't know what's going on a hidden world of imagination. And you're basically essentially asking someone to do what they've spent months, years or decades avoiding doing and that's thinking about it. And so we have an emotionally evocative technology here, and that's what psychologists would what I'm in the business of is activating emotions in a safe and manageable way, and helping a patient to process those emotions or adapt to them or find alternative ways of thinking about them or alternative ways. So behaving in that context, whatever the whatever you're aiming to do you create that. So you see that, and I'm very curious to hear about your thoughts with the sports stuff. Because I think, you know, you're in the same, you're in the same mode. But you know, again, you're bringing into body, the full body into this. And athletes, you know, I'm a long term rugby player, and I've gone through my suffering of feeling injured, but still playing, or having, you know, have any anxiety all week, because my knee is bugging me, and I'm not sure if I'm gonna be ready for the big game. And I'm going to let everybody down. You know, all that, that stuff, there's a complex thing, especially with high performing athletes. And VR is a way to put people in these sorts of contexts, whether it's to foster their rehabilitation, you know, and get them to do the rehab, as boring and repetitive as it might be in a way that you know, is going to improve their functioning in a real world. Or just help them to get over the challenges or prepare for the challenges they might face on the field. I'm really curious about how you guys look at this stuff.

Dr. Spencer Baron: 31:16

Well, one of the big things would be Mike curiosity on how VR could help with traumatic brain injury or mild traumatic brain injury, concussions, things like that, you know, I guess, you know, what you started to talk about with, you know, regular injuries, like a, like a, like a knee injury, and then recreating the environment for them. And, you know, overcoming that fear of a physical injury, What about to the brain? And then there's obviously the, the therapeutic aspect for managing the concussion symptoms?

Unknown: 31:52

Well, you know, we got to look at what's the science on brain injury, assessment and rehabilitation, you know, without VR, and, you know, there's a lot of mixed views about whether you should do intensive rehabilitation right out of the gate, or if you gotta give the brain time to, you know, I don't know if this come down from the swelling or, you know, what is the proper pacing. But certainly, I believe that, and maybe this is more belief than research is that helping somebody after brain injury is whatever pace is appropriate for them, to begin to take on the normal challenges without pushing them over the edge. That's a good thing to do. That's what we do. That's what how I got my start in VR, I worked in brain injury rehab, and got frustrated with the limited tools, we had to take someone like you or me that had a car accident, or fell off a ladder or got a bullet wound, whatever. And how do you how do you make these kinds of rehabilitative activities engaging, so that people will do it, sometimes people with compromised attentional abilities because of the brain injury, to how to gamify it, to put it in a world that is very compelling and rich? Can you systematically titrate the stimulus presentation, so that it starts off at a pace that is almost like breathing, it's just naturally you can do the task. No matter how you perform? You know, the task is so easy, but then systematically ramp up the challenge. Like, if you look in the gaming industry, they refer to the flow channel. And that is the idea of not making a game so easy, that it becomes boring, but not making it so hard. That, you know, you lose your interest in it because you're getting your butt kicked every at every turn. So, you know, how do you systematically keep people in that channel where they're challenged, and engaged, and so on. And that's where the complexity I think of brain rehabilitation, brain assessment first, certainly, rehabilitation comes in, you know, you got to look at what works in the real world, what do we know work, or what we know works in, and what's our theoretical model, and then design the simulations around that, to be able to pace a person's experience, number one, to keep them motivated, engaged in the activity, which is the first challenge and then be able to deliver the kinds of challenges and activities that would facilitate a healing process in the brain. And again, going back to what you guys said earlier about the integrating the physical element into that I think is a key thing. People don't just learn or don't recover in the abstract, they they learn through an engagement and an ecological space with affordances. You can go back to the early perceptual literature Gibson and all that stuff. You know, I think that a lot of that early theory, from what the 40s 50s, whatever it was, still informs, you know, stuff that we do in 2024.

Dr. Spencer Baron: 35:26

You know, you brought up a good point, I think there's a sequence of how mild traumatic brain injury or concussion would be managed with VR. Because there, you made a point. It's true, there's so many different systems to identify concussion and what areas of the brain and that, you know, initially, it's always been, you know, for the first 24 hours or 48 hours sit in a dark room, you know, that was one of the approaches or and stay off your phone? Maybe. So maybe that

Unknown: 36:00

seems to be the cure for everything these days. Yeah.

Dr. Spencer Baron: 36:07

I think that the pendulum may be swinging back to the Stone Age, you know, but the truth is, you know, as you were talking about it, because VR could actually help with a system of tests that could be somewhat fun to identify, you know, is it a balance problem? Is it a cognitive processing? Is? Is it a recall problem? Is it uh, is it your saccadic movement problem? So, are you able to follow the dots and to the target and speed to the target? And, you know, oh, my gosh, there's so many.

Unknown: 36:45

Absolutely,

Dr. Spencer Baron: 36:46

I didn't even realize that how how, how great that can be for someone that first discovery, one area of the brain, and then being able to slowly rehab. You

Unknown: 36:57

know, there's, there's a lot of people that have played around in this space. And it's almost like, I'd like to have the file drawer, Library of people who have experimented with this stuff, in the early days, didn't have the technology to really do it well enough. And they ran out of money, or their funding ended, or whatever. But I recall, there was a group at Emory University that developed a field side assessment for, for concussion. And it's exactly what you're saying here. It had to have a computer or laptop, you know, on a little cart and tethered headset. But I mean, really, when you're in a headset, I mean, you could do I mean, you turn the headset off, and you're doing balance, you know, stand on one foot and hold your balance, you know, or, you know, then you turn the headset on, and you've got the saccadic eye movements, if you had the eye tracking in there, you have the eye hand coordination, you perturb the visuals of the balance and see if that affects someone's sway. All of that is measurable. It was measurable then, but at great expense and complexity, the I just putting eye tracking into a VR headset, prior to 2014 was a costly and cumbersome type thing. And that's where some of these early efforts in this area failed. It wasn't that the concept wasn't sound, it was the the implementation costs. Now, you've got headsets where eye tracking is is like part of the part of the package you know, there's support fovea rendering so that you get a clear image in the phobia as opposed to the rest of the display. You've got a built in like the HP on the Sept headset. That was a big one with eye tracking pupillary dilation heart rate sensor in the front panel of the headset, from your forehead and so on. I'm sorry, I got a visitor here say hi and then goodbye. He always comes by with me up and on. Big Cat. Yeah, it's a big one. It's big homemade food. So but you know that this is all built baked into these standalone headsets. So I'm sure there are companies now that have these kinds of field side post concussion assessment tools. And you know what, you know, back in the day, you know, it was like, Alright, we're gonna have to, to run 30 people that we think have, you know, post concussion and 30 You know, you have their pattern before they start the game. Well, now that you have these headsets, that should just be standard part and parcel. You should have an assessment before a high school kid gets on the field in the locker room. The two three minute assessment, kind of like what the virtually, folks are aiming towards with these brief assessments, and you get their baseline before they walk on the field. And then if there's a provocative event on the field, you know, come on over here, put the headset on, to run through it again and have the comparison, right there from, you know, the, the assessment from 30 minutes ago, whatever. And then you do that with every kid every provocative incident. And now you're building the database. And then you do the clinical follow ups. And now you got this giant database with, you know, the future of AI doing some of the hard thinking for us, or at least being able to detect patterns. Now, you've got a tool that with time, and relatively low cost, you know, gets incrementally better with each use, because you're adding to the aggregate data queued to their age future, maybe they're some measure of their fitness level, or their experience level or whatever, how many beers they had the night before, whatever, you know, it's just a wonderful world we have it, it goes back to the ultimate Skinner box, you know, a controlled stimulus environment where we can systematically deliver stimuli in a controlled fashion and measure performance in precise ways cue to that. So

Dr. Spencer Baron: 41:26

is that out there? Is there a system of tests that you can do pre and post that are rivaled that rival all the other stuff that's out there? Like,

Dr. Terry Weyman: 41:38

I'm gonna jump into the will second, I'm glad you mentioned them, virtually, I'm glad you mentioned them. And because I'm gonna jump up because I downloaded their program. And so years ago, probably five, six years ago, I had a concussion. And I've noticed that there was something off ever since then. Now I've been tested by brain mapping. I've been tested by every pro computer program out there, everything comes back normal, every comes back, you're perfectly normal. And I've even gone through the whole brain performance stuff. I've gotten through functional neurologists error because you're fine. But I knew there was something off and so but three weeks ago I downloaded their program but the PERT the mend the thing on, and I went through all their 14 tests. And you know what? I it I got the report. Everything was normal, except one blip that was abnormal. And that was the problem I've been experiencing for five years. It was the first program to ever pick it up. Was

Dr. Spencer Baron: 42:38

it it was the name no joke it was

Dr. Terry Weyman: 42:42

it was I couldn't put commas in in a sentence when I wrote it periods periods Yeah, I don't know how to structure a sentence so but it was a part of a working memory that was that wasn't working and when I add the other part was spatial hearing spatial and and so I was those two showed up like way below average everything was above average. And so I started playing the games that shift focus on those two and because of that game I went out and got hearing aids to fix the hearing part. And when she tested me she says Oh your left ear is a little off compared to your right ear your that your when the first patients ever come in this early in hearing loss she says most people wait till it's too gone your your your nervous starting to atrophy, but you caught it and she was you have a hard time differentiating like CAT and CAT and there's certain mental programs it was all because of this virtual leap that picked it up. Then I got the hearing aid I'm starting to hear stuff I haven't heard in PI five six years. And your wife wishes me right it's more than mumbling and my son but also I'm starting to see the My improvement on the game and all sudden I'm not missing words anymore and all sudden I'm not doing this anymore. So now I can tailor a cognitive workout for finally find out what the problem was I was blown away and that's what got me so excited to talk to you and and all that because I'm like there is something to this that is so amazing that to the look at playing computer games doing that to the function we're missing him. So to answer this Messrs QUESTION Yeah, these baselines are amazing. And and they're picking up stuff that now we can flow it into other tests, other baseline tests and by find out other stuff. So, yeah, I'm sorry for rambling on, but it's not

Unknown: 45:04

a ramble. That's not a ramble, you hit it, you hit the nail on the head. You know, I would challenge any traditional neuropsychologist or anybody who works in brain injury, how would you have uncovered this in the pragmatics of the real world with traditional methodology, and, you know, it would be super labor intensive, super costly, constant follow ups, I mean, to detect that problem that you picked up in, you know, maybe a couple of hours of interacting in a VR environment. You know, I mean, this is where this is where we're filling in the gaps that are just not possible in the current medical system is not pragmatically possible is not a big enough workforce, there's not enough attention that's going to be spent, you know, your doctor is gonna say, well, try to avoid places where there's provocative movement, or where the, the salad where you have large sounds in the background or whatever, whatever, you know, homespun wisdom, they may toss at you they don't have the specific data that is generated in the systematic experiences that we can deliver in VR. I think that's a that's a classic case, right there.

Dr. Spencer Baron: 46:22

That was fantastic. So skip, how about in healthcare, you know, healthcare delivery, like patient treatment? And what are the conditions, you know, things that you can identify early like Alzheimer's, or Parkinson's or dementia, or Cat Scratch Fever, something like that?

Unknown: 46:47

I used to, I used to like that album is the author of it.

Dr. Spencer Baron: 46:53

I was just listening to him the other day, and I go, man, people would hate this guy. Yeah, anyway. Do you even remember the question?

Unknown: 47:12

About clinical conditions? Like psycho pathology?

Dr. Spencer Baron: 47:20

We're talking about the rock guitarist again, are we deliberately not mentioning names? Because it could get too political here?

Dr. Terry Weyman: 47:31

No, timers and dimensions, stuff like that?

Unknown: 47:35

Yeah. Well, look, you know, we're, we only have an hour here. So we've only scratched the surface in a, you know, a couple of the areas. You know, and I try to always talk about the core elements of simulation technology, and let people imagine for themselves, alright, let's look at Alzheimer's, you know, you can, you can, again, put people in these compelling environments and get some measure of their performance, and you do it over time. And, you know, you can maybe did start to detect, is this decline, something we all go through with aging? Is this an abnormal decline? Or is this something that might be an indicator of some kind of dementing process that if you did something, after knowing that information, you might be able to slow the progression, like you're saying, with the brain training, or the activity or learning a new language, whatever it is that people recommend for cognitive stimulation? Well, you know, this is what you know, worlds where every you know, every home has a VR headset, you know, kind of like a toaster. Everyone has when you don't use it every day, but you got one. And now you can do maybe a weekly, quick and dirty fun, check, check the box, you know, cognitive, physical, embodied cognition, test, that's fun, that's not onerous to do. But meanwhile, in the background, it's charting your cognitive change over time. And it gives you that early indicator. And once you have that indicator, just like you've got some specificity, you know, with your your issues with the hearing and, and working memory and so forth, then you get the recommendation. So there's there in lies one application for, you know, you're not going to use VR to cure dementia, but you can definitely spot it. Or you can assess cognitive function in a way that gives you indicators and gives you recommendations for slowing that progression through activity. You know, I've used VR in a study last year for just reminiscence therapy with older adults at UC Air Facility and using spherical video, an application called World Traveler sauna, I think the penumbra system. And basically, you go to cities, you know, famous cities around the world, Paris, London, Rome, stuff like that. And it's a guided tour, and you're actually at the Trevi Fountain, or in the Coliseum, and so on. And that just that activity with a patient or person that is 80 years old, that hadn't been there in 40 years, all of a sudden, they're back there, and they're talking about what they saw when they were there, then, and you're creating experiences, again, that pull up these old memories, that that might be a positive experience around, you know, you know, countering some of the effects of dementia. I know, I tested that program out with my mom who, at the time she did it, she was ADA. And she had been a Roman 44 years. And the flood of memories in the story she told I recorded, it's actually on my YouTube channel. It's just remarkable. And you see it that at whether whether you're testing kids with ADHD at age six, or seven, or you're, you're providing experiences for people in their high 80s or 90s. You know, this is the breadth of the lifespan where if you have a good theoretical model, and you have a router, or maybe you experiment a little bit, but you try to come up with what is going to benefit this person. The one cool thing in that study was that that that program had a feature where an external user could pipe in and pop up in the headset, like the little zoom window in the upper right, so that we tested having a person in a remote location on their computer. And when they connected to the headset, the person wearing the headset could see them and talk to them, and could have an engaged conversation with them about their experience. Meanwhile, the remote user is seeing on their screen exactly what the user is seeing as a turn and look around and see things in person gold, look at that guy over there by the fountain he's about to throw money in, you know, if you throw money in the Trevi Fountain, you know, it means you're going to come back to Rome and all of a sudden this story comes up. But it's no longer a solitary experience. It's a shared experience. So you imagine you have a family member across the country that doesn't get to see their grandmother because they're, you know, the other side of the country, and they're in a nursing home or whatever. And now, they can have a shared experience where it beats the heck out of a phone call, like how are you doing grandma? Oh, it's, I'm in pain. Oh, how was your pain? It sucks. How's the food over there? Horrible. Okay, I'll call you next week. You compare that with an engaged shared experience? can have so good. So so many of these great opportunities, we need another hour because hundreds of these. I

Dr. Spencer Baron: 53:14

got a quick question he touched on I just Just briefly, ADHD. Do you test for that? And or do you? And do you treat that? And just can you please tell? Because I know there's listeners that think their kids have ADHD or they think they have ADHD? Because what the pharmaceutical industry that sells Adderall makes you think,

Unknown: 53:33

yes, this is one of the biggest diagnostic challenges of last, you know, last 50 years, basically. Because there's a lot of reasons children can have attention impairments. That is that Ritalin or Adderall, whatever, you know, is not the treatment of choice when a kid has an anxiety disorder. And that's why they can't pay attention. Or what if they had, you know, a sports injury? And all of a sudden the teacher saying yeah, he's not paying attention anymore. He must be have ADHD here, go pay, go pay$3,000 for Neuro psych eval, and get your medication, you know. So better assessment of attention processes are key to informing the diagnosis. So you know, and I've kind of built it up in a self serving way one of my applications and that is virtual classroom. And what I can do is I'll send you a paper after this, if you have on your website, you can maybe posted for any of the parents that might have an interest in this. Basically you have a child put on a headset, they're in a virtual classroom, they have you know, teacher instructs them to what the task is, which is essentially you look at the whiteboard at the front of the class, and every time you see the letter A followed by the letter X pop up in a sequence on the board. Once you just hit your mouse button or you hit your controller button. And, okay, simple task, and it's kind of fun. You know, okay, okay, I'm watching all these things go by. Then meanwhile, during the testing, you have a school bus go by the window, you have the teacher go answer the door, you have a kid throw a paper airplane, you have kids fumbling with their cell phone off to the side fidgeting. And so you can systematically present distractions, like they might occur in a real classroom. And measure the performance during the 13 minute test, where they're, you know, for 13 minutes, they forgot to focus on this thing. But meanwhile, you know, there's all these things happening. And you're not only measuring how well they perform on the reaction time, and the vigilance task and all that. But you mentioned your head movement, and you're fidgeting, and the hyperactivity component that often doesn't get a solid measurement, it gets a behavioral rating, but now you're getting it in conjunction with the cognitive data. And so now you have a way that you're getting a more comprehensive evaluation of the components, let's say, and this is an ADHD diagnosis. But it gives you the the, it can tell you that how many times the kid is looking out the window and missing a target, versus how many times they're just staring at it, not moving, looking forward and missing a target. That's a loss of focus error, versus a distractibility error, and how much ambient movement, all of a sudden, you've got all this new data that in combination with the traditional data, the behavioral ratings, maybe some psychometric tests, you get a more comprehensive picture of that kids performance in the real world, by using this proxy for the real world, this virtual classroom. And so, you know, that is the first step. Now, what you do with that, after I say, the kid does get diagnosed over, you know, the parents are loath to want to put their kids on medication, but sometimes it is called for, to keep the child up with developmental milestones of their peers, and so on. But there are other strategies that can be employed to address ADHD, whether it's a Neurofeedback biofeedback type approach, or whether it's just a pure brain training. Like there's a company I think called Achille, that has a computer game, a video game, that's kind of really fun for kids like Super Mario thing, but it has all these cognitive challenges in it. And the idea is to get the kid to play this game rather than a game that's just you know, blood and guts. And this will help him amplify their cognitive ability, whatever the treatment is, you know, you got to have good measurement on the front end. So the paper, I'll send you one, I'll send you one, that's an overview very digestible overview of why this is not but then the second one is a normative data set of about 800. neurotypical kids age six to 13 that show the changes in performance across the age ban on all these different measures, that now we use to make our comparisons, we have norms. So when a kid comes in your office and parents don't know, it's like, well, let's run this 13 minute screener, and you run it, and then you look at how that kid performs relative to the neurotypical sample at that age. Because, you know, a lot of times you'll see scores that don't look that bad for you know, a kid, that's age 13. But then you look at how it compares. And really, they're performing at an age eight or nine year old level, based on the norms. And it's like, Okay, here's an area that we need to think about, you know, the kid, you know, is socially, you know, capable, he gets away with it, you know, maybe maths or perhaps little girls is there who are under diagnosed where if they sit quietly in class, they may be a little slow, but they're, you know, they're being good students, but actually, they're falling under the radar, they may have a significant inattentive impairment that could have long term implications in their cognitive development into adulthood. So, there's, there's so many of these things that the simulation technology approach can help us to get a better, better grasp of.

Dr. Spencer Baron: 59:31

Yeah, I actually, you know, the pharmaceutical industry has been successful in expanding the scope and in need for Adderall and adults. Now that I watch these adults that say, they're on Adderall yet. I could see that, depending on the subject, I see them focus intensely on things and it all it's almost like a choice. But the Adderall gives them a little jazz, you know, and they feel like they need it, but that's a whole nother We're gonna wrap up but you have the perfect character for our, one of our favorite segments of the show. Before we close, we do our rapid fire questions. There's five of them, and they have nothing to do with anything we talked about. I have a feeling he's gonna be good at this. Oh, yeah.

Dr. Terry Weyman: 1:00:23

I liked his face though. He kind of got that.

Unknown: 1:00:28

I'm gonna be 70 a couple of months. I hope you're giving me the older version. Yeah, you're fine.

Dr. Terry Weyman: 1:00:35

You still Easy Rider? Harley look. So I think you're gonna be totally fine.

Dr. Spencer Baron: 1:00:42

And you don't look 70 So let's test your brain. Are you ready? rapidfire question number one. Have you played rugby? Which position did you play? And what is your most memorable moment? From your rugby playing? DayZ?

Unknown: 1:00:57

Oh, aside from the social element in the party Yeah, I had a I have a memory I replay in my mind where I tackled a guy in the tri zone that and it saved the game and took the ball away from him. And I relive that probably once a week. That's awesome. That's

Dr. Spencer Baron: 1:01:19

a good answer. Question number two, can you share about a particular memorable motorcycle road trip you've taken? And what made it so special? Oh,

Unknown: 1:01:31

that's an easy one. I did a trip from from where I was going to school in Binghamton for my graduate work down to New Orleans to finish my master's thesis one summer, and I took my motorcycle down to the Skyline Drive and Blue Ridge Parkway. And, you know, it was great. It was beautiful. And then I met a girl and you know, up in the top of Skyline Drive, and it just made what could have been you know, one day 90 mile tour until like a three day hangout and really enjoy the whole time so that was back in my wild used before I got married. Right I was great one.

Dr. Spencer Baron: 1:02:14

Question number three. I'm gonna love the answer to this music. Music seems to be a big part of your life. What's on your playlist right now? Which songs or artists can always lift your spirits other than Ted Nugent?

Unknown: 1:02:30

Oh, Ted Nugent. Now aside from luxury Senator the mind back from when I was in high school. But oh, man, I listened to music all the time. You know, from old school stuff to things like there's a band called porcupine tree Steven Wilson. Heavy Metal band called O path. I listened to them quite a bit. What I listened today when I was doing my morning swim. I owe him ambient music Harold Budd. You know, it's good, good kind of work and chill music. You're feeling it but you're not being distracted by it.

Dr. Spencer Baron: 1:03:12

I like it.

Dr. Terry Weyman: 1:03:13

I like to download that one.

Unknown: 1:03:16

Again, one playlist.

Dr. Spencer Baron: 1:03:17

I would love to hear question number four. Rugby and motorcycle riding both require a strong sense of adventure and risk. What is your next big physical challenge or adventure you're planning to undertake?

Unknown: 1:03:36

Oh boy. It's hard to I mean, I think I'll ride forever. I used to when I was younger. My friends would say if you had to, like when you were 30 If you had to give up one rugby or motorcycle riding. I hate to admit it but I would have said rugby because I knew I could ride my motorcycle off until my 90s and that is that has been the case where it's I can't play rugby every day. I can ride my motorcycle every day. I'm gonna do it right after this. This thing I have to drive into work on it. But you know, I think the next big thing would be to age me so much is getting an RV and touring the country and going all places I haven't been and just taking off and still been able to work from the RV you know, but to be able to travel around I think that's

Dr. Terry Weyman: 1:04:32

one you'll like to skip. I sold my 40 foot RV and I got a van and I've been touring all over in a van I've been doing the van life and it is We'll talk when we hook up to talk. I got some I got some ideas for question

Dr. Spencer Baron: 1:04:49

number five. When not immersed in technology or sports. Do you enjoy cooking or have a favorite cuisine and what is the best dish you can cook so

Unknown: 1:05:00

Oh boy, I make a really good New Orleans barbecue shrimp kind of a thing when I was going to school there, I learned that one. And is this style where you're broil the heck out of it not too much to make it dry. But you leave the shells on. And you actually eat the shells with it. You take the tail, and the shell is all crisp and crunched and all that. And garlic and soy sauce and butter in it. And you just oh, that sounds fancy. That's when so if you guys ever come to my house for gathering, we'll I'll make that for you. You're

Dr. Terry Weyman: 1:05:40

only a couple of like, less than an hour from me. So you know Spencer? Sorry, but I'm gonna be hanging out with skip.

Dr. Spencer Baron: 1:05:47

I'm looking forward to hearing your last answer. I might book a round trip from Florida to California. Yeah, good teach stripped

Dr. Terry Weyman: 1:05:55

again here not as buddy Terry.

Dr. Spencer Baron: 1:05:58

food in general, right. Skip, this has been a fantastic show, man. I really, really appreciate your knowledge base your, your ability. And by the way, you have a great radio voice. Isn't it great to listen. So really appreciate it. Thank you.

Unknown: 1:06:16

Thank you for all

Dr. Spencer Baron: 1:06:17

thank you for partnering such valuable information that's really cutting edge in the world of VR and healthcare.

Unknown: 1:06:23

Well, I enjoyed talking with you guys. You know, I mean, this isn't this isn't like work or nothing. This is this is just a bunch of guys talking about cool stuff.

Dr. Terry Weyman: 1:06:33

And I can totally see a future another show because there's so much stuff that we can we can ask and and it's so nice to have an expert in a field that we can just chat with and help other people. So thanks. Sorry, knowledge. Thanks for your fun. Thanks for everything, man.

Dr. Spencer Baron: 1:06:49

Yeah, thanks.

Unknown: 1:06:51

All right, is that well, thank you so much.

Dr. Spencer Baron: 1:06:56

Thank you for listening to today's episode of The cracking backs podcast. We hope you enjoyed it. Make sure you follow us on Instagram at cracking backs podcast. catch new episodes every Monday. See you next time.