Virtual exercises, real motivation: how a suburban hospital uses virtual reality for stroke rehabilitation

Virtual exercises, real motivation: how a suburban hospital uses virtual reality for stroke rehabilitation

David Gerfen dons a helmet and finds himself in a food truck, tasked with making a cheese and tomato sandwich to order.

Transported to another virtual environment, Gerfen must use one hand to deflect a blue ball thrown at him like a pitching machine across a green field.

Gerfen, 80, is not an avid player. He is a stroke survivor who wears virtual reality glasses during his therapy sessions at Northwestern Medicine Marianjoy Rehabilitation Hospital in Wheaton.

“It’s one of our newest games,” occupational therapist Nicholas Giovannetti said, asking Gerfen to move his weaker right arm. “Okay, you got it. Move on. Perfect.”

Virtual reality has a significant presence in healthcare. Some hospitals offer immersive virtual reality experiences to soothe and distract suffering patients or as a way to escape a chemo appointment. Virtual reality has become a navigational tool, allowing brain surgeons to map out procedures and get a three-dimensional view of tumors.

Marianjoy explores a virtual reality system as part of a rehabilitation program for adult stroke victims. Doctors see the potential of virtual reality to help patients stay motivated in an intensive therapy regimen.

“We hope that with this new kind of technology, patients will be more interested in therapy because it’s different,” said Dr Mahesh Ramachandran, the hospital’s chief medical officer and stroke rehabilitation specialist. . “It’s a bit more exciting and fun, rather than doing a monotonous type of routine exercise.”


Elmhurst resident David Gerfen, right, is fitted with a head-mounted display. Occupational therapist Nicholas Giovannetti makes sure the device fits well and is comfortable for the patient.
– Paul Valade | Staff Photographer

How Virtual Reality Works

Sharon Schmidt suffered a debilitating stroke last December while she was putting away Christmas decorations outside her Glendale Heights home.

“I couldn’t do anything with my left leg, I couldn’t do anything with my left arm or my left hand, and I had trouble speaking,” Schmidt said.

Schmidt, 74, was previously introduced to recreational virtual reality by her grandchildren. When her therapist Marianjoy suggested she put on some virtual reality gear, Schmidt was willing to give it a shot.

“Anything that can help you get back to where you were after a stroke – I totally agree,” Schmidt said.

The rehabilitation hospital equips patients with a Penumbra virtual reality system. Patients wear glasses and six sensors placed around the hands and waist, above the elbows and on the back, so that their virtual avatar matches their movements in real life.

Gerfen remained seated while his therapist guided and monitored his virtual exercises with a portable tablet. Some activities are designed to practice hand-eye coordination, reaction time and motor control, the company says.

“We’re working on seated balance,” Giovannetti said, encouraging good posture. “We are working specifically on his right arm, his extension, his coordination and also his ability to follow instructions.”

Marianjoy is testing virtual reality in a study led by Ramachandran and Dr. Dhruvil Pandya, a neurologist at Northwestern Medicine Central DuPage Hospital in Winfield.

First, they assess how well patients tolerate the virtual reality device. Therapists check for signs of motion sickness, dizziness or nausea. The study is also limited to a maximum of 20 patients with upper body weakness resulting from stroke.

The doctors hope to publish their findings, but when and where will depend on the completion of the study and the results.

“Everyone we tested gave us positive feedback,” Pandya said. “The next step is to look at clinical outcomes, if this, along with traditional rehabilitation therapy, does it improve outcomes?”

The researchers described virtual reality as a complement – not a replacement – to standard therapy. Marianjoy’s 20 patients will undergo six sessions – 30 minutes of virtual reality followed by half an hour of conventional therapy per session – over the course of two weeks.


“We very specifically call them activities so they can sometimes feel like games,” said Gina Barry, executive vice president of Penumbra, a company that offers a virtual reality system to Marianjoy.
– Paul Valade | Staff Photographer

“Incredible Features”

Penumbra isn’t a tech company, but venturing into virtual reality therapy was a logical next step.

The healthcare company is known for making catheters used to remove a blood clot and restore blood flow to a stroke patient’s brain. Penumbra built the REAL system with Sixense Enterprises, a virtual reality developer acquired last year.

“Virtual reality offers incredible capabilities,” said Gita Barry, executive vice president and general manager of immersive healthcare at Penumbra. “And we’re seeing that making a significant or real difference to patients, as well as the therapist experience, because therapists have a whole new way to engage their patients.”

Therapists gradually increase the level of difficulty as patients work toward more advanced activities in virtual environments.

“What virtual reality does is it immerses you in the experience,” said Barry, an Arlington Heights native and Buffalo Grove High School alumnus. “At the bare minimum, it just makes you happy because you’re having fun playing a game.”

The system tracks a patient’s progress, how much time is spent on these activities, and the range of motion of the shoulders, elbow, forearms, and wrist. A hide-and-seek game with animated penguins is designed to exercise a patient’s cervical range of motion.

“That distraction factor comes from me enjoying my therapy experience more, because I’m so engaged in the activity and not thinking about the pain,” Barry said.

The company also points to a 2019 meta-analysis of previous studies suggesting that virtual reality “could apply principles relevant to neuroplasticity,” the brain’s ability to form new neural pathways around damaged areas.


Dr. Mahesh Ramachandran, left, chief medical officer at Northwestern Medicine Marianjoy Rehabilitation Hospital, and Dr. Dhruvil Pandya, neurologist at Central DuPage Hospital, right, watch Elmhurst resident David Gerfen navigate a reality environment Virtual.

Dr. Mahesh Ramachandran, left, chief medical officer at Northwestern Medicine Marianjoy Rehabilitation Hospital, and Dr. Dhruvil Pandya, neurologist at Central DuPage Hospital, right, watch Elmhurst resident David Gerfen navigate a reality environment Virtual.
– Paul Valade | Staff Photographer

What patients say

Giovannetti adjusts the speed and trajectory of the flying blue ball, and Gerfen seems to respond intuitively. He reaches out to push him away.

“His sitting balance has improved,” Giovannetti said. “He’s really stable right there.” Gerfen’s wife, Gerri, agreed: “It helps him become a bit more coordinated.”

Schmidt went from a walker to a cane. She cheers on her grandchildren at football and baseball games. She can climb the stairs on her own.

But nearly a year ago, it was a challenge to complete a simple virtual task.

“It was not easy getting these birds into their nests,” Schmidt said.

But she looked forward to her virtual reality sessions.

“I would recommend it to anyone who has a stroke.”


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