VR and Rehabilitation: Dr Ram Hariharan and Dr Abayomi Salawu explore the future of patient care

Dr Abayomi Salawu is a neuro-rehabilitation consultant at Hull University Teaching Hospital NHS Trust who is pioneering the use of virtual reality (VR) in rehabilitation. Dr Ram Hariharan is a consultant in spinal injuries at the Princess Royal Spinal Injuries and Rehabilitation Centre in Sheffield and the chair of the UK SCI Research Network.

Dr Hariharan and Dr Salawu got together at the recent BSPRM BASCIS Joint Annual Scientific Conference in Sheffield to discuss the remarkable ways in which VR is transforming patient care, particularly for those recovering from traumatic brain injuries and stroke. Dr Salawu's innovative approach creates a virtual environment where patients can safely practice rehabilitation exercises, aiding their recovery and fostering self-reliance. And VR is impacting the rehabilitation landscape beyond physical recovery. We hear how this technology can train patients in other important aspects of self-care, such as bladder and bowel management. Dr Salawu also explains the emerging use of VR in delivering specialised psychological therapies, such as eye movement desensitisation and reprocessing (EMDR) for managing post-traumatic stress disorder (PTSD) symptoms. 

The insights from this conversation illuminate the transformative power of VR in rehabilitation and its potential to revolutionise patient care. 

The opinions of our host and guests are their own; ISCoS does not endorse any individual viewpoints, given products or companies.

If you enjoyed this podcast, please rate, review and subscribe with the podcast provider of your choice.

This show is brought to you by ISCoS - you can follow us on Twitter and LinkedIn

The SCI Care: What really Matters podcast aims to provide valuable insights and the most up-to-date information for those providing care to people with spinal cord injury (SCI) worldwide. The vision of the International Spinal Cord Society (ISCoS) is to "facilitate healthy and inclusive lives for people with spinal cord injury or dysfunction globally".

Partnership and collaboration are key to achieving this vision. Our episodes include expert guests, persons with lived experience and representatives from the industry supporting SCI care.

We invite you to:

ISCoS 2024 will take place in Antwerp, Belgium 22 - 25 September 2024

Contact us directly with any questions or comments at iscos@associationsltd.co.uk

Transcript

Speaker 1: 0:00

Hello, we are excited to be here at the BASCAS BSRM 2023 meeting in July 2023. It is a dream come true because, after the COVID, this is the first time we are coming together face to face and also, more importantly, this is perhaps the first time that the two big areas of rehabilitation are coming together the spinal injuries that holds the guttman meeting every year, and the previous BSRM, which is now the BSPRM, has come together for holding a conference. My name is Dr Ram Hariharan. I'm a consultant at the Sheffield Spinal Injury Center and I'm here with my consultant colleague, dr Yomi Salawu, who is a neuro-rehab consultant working in Hull. So I'll let you introduce yourself, dr Salawu.

Speaker 2: 0:44

Thank you, Ram. I'm Abhayami Salawu. I'm a consultant in rehabilitation medicine. I'm based at all university teaching hospitals and I work mainly at Castle Hill Hospital, but I also cover all real.

Speaker 1: 0:56

That's really nice and thanks for finding time to do this short interview. I was really fascinated by your involvement in virtual reality and I know that you really brought it on very well at the Rehabilitation Center. Congratulations on setting up an exclusive rehabilitation center in Hull and your introduced virtual reality, and this is primarily for patients with head injury, and I just wanted to hear your experience with that, please.

Speaker 2: 1:21

Thank you very much. Yes, we've been doing different things with virtual reality. The real purpose or the main goal is to basically increase the opportunity for patients for self-directed rehabilitation. We all know we don't have enough, we're never going to get enough therapies to deliver everything we want to deliver. So any opportunity that we can enhance and support the patient for self-practice and we know self-practice is the ultimate goal in rehabilitation it enhances recovery. It does a lot more in terms of getting people better.

Speaker 2: 1:56

So we're trying to look at what things patients can do safely, because if you're going to leave people in the room, you need to be able to do things in a safe environment. So if it's a virtual environment, you're not going to knock anything physically down, you're not going to show the potential for injuries very low. And we do know there is evidence of things done in the virtual world translated into real world environment. A very prominent example and I probably believe your last holiday you probably flew in a plane. Okay, not your pilot, I'm under a percent sure would have trained in a flight simulator at some point or the other. So we know this is well used in training and education, and rehab is just the next step in training and education. We're training our patients to be autonomous, to be self-reliant, and this is what VR brings in addition to the traditional rehab model that we do. And, yes, we're using it mostly in majority of traumatic brain injury, stroke patients and stuff like that.

Speaker 2: 3:05

I actually think spinal cord injury is a bigger potential. Why? Because most spinal cord injury patients do not have the cognitive component so they can initiate, they can do a lot of all these things, so you pretty much only need to set them up and off they will be able to go. They can do a lot of self directed activity using this device. If you see me, I actually think it's the biggest potential that is yet to be found.

Speaker 1: 3:35

So thank you for that, yomi. That's really fascinating and I like the analogy that you used for training pilots, because we don't think twice about their training and we just confidently get on to the flight and we are very confident that we'll reach the other end. And if we have the same confidence for people with disabilities, that's a great step and well done on using it. On your patients head injuries and I totally agree that people with spinal cord injuries do not have the cognitive impact, but what they need is they have an impact in different ways. Exactly, their life has completely changed and they need something to support them, and we all know that there is not enough psychological support and there's not enough that we can give them during the phase of rehabilitation. So currently, how are you using it? Is it provided only as an inpatient or do they also take it home to use it in the long term?

Speaker 2: 4:27

Well, both actually, the ones we have on our unit are mainly for the inpatients. So we do have patients who have actually bought their own headset and they're taking some of the apps we've created and they're using it in their own home environment. There was one of our patients who was featured on one of the local TV stations who actually used this, especially during the pandemic, when the patient was discharged home because at that time everybody was still working remotely. So these patients actually had a headset which they took home with the app and they were able to practice in their own home environment. So he did improve. Well, I wouldn't say that's the only reason why the patient improved, but he did contribute significantly in terms of him being able to do activities on his own.

Speaker 2: 5:16

And, yes, we talked about the training and education component of using virtual reality. Another component is actually mood regulation, emotional sleep, and part of what's on our app that one we created helps with that emotional regulation, mood adjustment and so on. And you can also assess people. This is one beautiful aspect of VR. You can do it before and after assessment so you can rate the mood. They use the VR headset calming zone and then after they can rate themselves on a like scale how well it has worked. So the potential to give you feedback is quite enormous and earlier this year the company has come out with a VR headset that delivers EMDR, which is a specialized aspect of psychology therapy.

Speaker 2: 6:12

This is the rapid eye movement technique that they use for managing people with post-traumatic stress disorder and, let's face it, an acute spinal cord injury for a lot of patients is massive stress and people do develop symptoms of PTSD. So those are the kinds of things and I think I have no doubt in my mind that this will not only revolutionize, it will also help many of our patients. And if it's also for spinal injuries, one of the things you also do is in terms of training people. Bladder management, bowel management all these can be delivered and if you use a head-mounted display, you can focus attention, no distraction. So the content you deliver. Actually, a patient can go back to it multiple times oh, how do I manage? Oh, I forgot now to do self-intermittent catheterization. You can click on that and you can watch an avatar, or you can practice as an avatar on self-intermittent catheterization.

Speaker 1: 7:14

Thank you, Yomi. That's really fascinating that you've highlighted some of the areas that can actually be relevant and applicable for spinal cord injuries. I'm sure we can have more conversations and we'll probably take more input from you as we move on to having our international meeting coming later this year and perhaps get some contacts to maybe use some of these companies to come and demonstrate the use of that in our conferences. But thank you very much for your time and I really appreciate it.