Virtual Reality Used to Combat Isolation and Improve Health
Explore your world through augmented and mixed-reality technology
En español | I’ve been here before. I’m standing on a treeless plain; behind me are massive boulders streaked with moss. A stiff wind rustles tufts of grass, and seabirds wheel overhead against a low gray sky. The flat arctic light tickles some long-buried memory, and I know where I am: Iceland, a place I visited for just a few days more than two decades ago.
But something’s different, starting with the small yapping robot dog running around. It wants to play fetch, so I reach down to pick up a stick and fling it into the grass.
The dog bounds away. I try to follow, but the wires attached to my headset remind me where I really am — in a room, linked to a virtual reality system that’s running a cunning projection of Iceland’s Snaefellsjökull National Park.
This is the experience, at once exhilarating and perplexing, of virtual reality — a computer-generated simulation of a three-dimensional world, with the participant plopped down in the middle. To enter this world, you need gear. First you don an eye-covering headset and headphones that block out the real world and replace it with the sights and sounds of a virtual world. Then, mainly using hand controllers, you can move and engage with the fantasy around you.
Virtual reality, or VR, is a technology that has been promised for decades. Now it’s available to regular consumers via a range of devices that provide a 360-degree simulation that can allow users to fly like Superman, swim with sharks or roam the streets of Rome. Several competing VR headsets are on the market — ranging from just a few bucks, for cardboard View-Master-like goggles that hold a smartphone, to $600 to $700 (not including the PC needed to run the software), for flashier, more enveloping rigs.
Virtual reality has been joined by two closely related technologies — augmented reality and mixed reality. Both involve superimposing simulated objects and information over real scenery; think “Pokémon Go,” where animated creatures appear on your phone’s camera viewfinder. Some tech prognosticators see that model as potentially more useful, since AR and MR don’t require users to be sealed off in self-contained artificial environments.
The development of all three ideas is racing along, fueled by an abiding belief that, soon, ordinary people will crave a new way of seeing the world. Global sales, around $27 billion in 2018, are expected to reach more than $100 billion in 2022. That’s a leap of faith: So far, the most avid VR explorers are video game enthusiasts. But many researchers think that the sense-scrambling power of virtual reality might be even more transformative when used by another audience entirely: older adults. And they won’t just be playing games but traveling the world, sharpening brain function, alleviating pain, even traveling through time itself.
How VR came about
The term “virtual reality” was coined in the 1980s, but visions of an immersive simulated world have been the stuff of science fiction for decades. (See the recent Steven Spielberg film Ready Player One for a modern interpretation.) The military conducted some of the earliest experiments in the 1960s and ’70s. That’s when engineer Tom Furness, searching for ways to help fighter pilots master complicated aircraft controls, began working on what would eventually lead to an amazingly realistic jet simulator: the Super Cockpit. It boasted 3-D computer-generated images projected inside the pilot’s helmet, complete with sound effects. “From day one I knew how powerful it could be,” says Furness, now 75 and recognized as a VR pioneer.
Early attempts at consumer-facing VR didn’t go far. After leaving the military, Furness adapted his Super Cockpit display into a device called Virtual Vision. It was a technical marvel, but it failed to sell, and not only because of its $800 price tag. “People liked it,” says Furness. “But then they said, ‘What do I do with it?’ ”
That, in a nutshell, explains why the first VR boom went bust and why the current one is still so heavy on hype. Initially, the pricey gear was too crude to offer the “full immersion” that would allow users to feel physically present in another place, and there weren’t enough software programs written to take advantage of the concept. The downsides of the technology also started to emerge. Some people reported debilitating motion discomfort and headaches; others were turned off by the experience of being completely isolated within the heavy and uncomfortable headsets, unable to see or hear the world around them.
But virtual reality didn’t go away. Engineers kept refining the technology, which found plenty of military and industrial applications. In 2012, VR took a turn back toward the everyday consumer when an enterprising teenager named Palmer Luckey assembled a VR headset that could use software running on a home PC. He set up a Kickstarter campaign to fund production; barely two years later, Facebook’s Mark Zuckerberg bought his start-up company, Oculus, for more than $2 billion. That reignited an industry-wide race to ramp up consumer-grade VR production, with Facebook, Amazon, Google, Samsung, Microsoft and many smaller players vying to deliver hardware and software. Virtual reality was back, more real than ever.
The current gear is much improved. At the high end, headsets made by Oculus, HTC and Samsung are relatively comfortable and big enough to accommodate prescription eyeglasses; the best ones have additional focusing features to aid near- or farsighted users. Even the low-spec modern VR — lightweight goggles with a smartphone stuck inside, such as Samsung’s Gear and Google’s Daydream — is pretty impressive, says author and futurist Alex Soojung-Kim Pang. “Five years ago it would have required a $10,000 headset to do what they do.” But the question that’s always haunted VR still lingers: What, exactly, are we supposed to do in this brave new world?
The first and still dominant answer is, play games until your head hurts. I spent several hours inside a VR gaming room dubbed the Holodeck, rigged up inside the offices of Mindgrub, a software developer and creative consulting company in Baltimore, trying out a range of games for the HTC Vive system, which allows players to experience “room scale” VR.
You can walk (carefully) around while tethered via cables to a very hardworking PC nearby. A pair of controllers function as your hands. The games themselves can be astonishingly “real” — I shot flaming arrows, piloted a starship and roamed around a wizard’s castle. It was cool. But despite the unfamiliar interface and the much improved graphics, it wasn’t exactly paradigm-shifting; anyone who grew up with an Atari in the living room or fed quarters into a Pac-Man machine will feel fundamentally at home with this generation of VR. Gaming in VR is also somewhat physically draining. After 30 minutes or so, I had a headache and a host of strange mild pains from repeatedly miming archery with my digital bow.
So virtual reality remains more parlor trick than disruptor, useful for arcade-like experiences and VR-based thrill rides, such as those that theme parks are now rolling out. And there’s a lot of interest in developing VR as a platform for more grownup entertainment, the kind that might support a whole new way of telling stories. Hollywood’s dream factory wants to create immersive and interactive films that unfold all around you and seem to be really happening. Some of the most impressive VR-based experiences use the technology for a very different end: to make journalism. The New York Times’ VR app, for example, allows viewers to experience the brutal conditions of Syrian refugees.
But a handful of entrepreneurs want to exploit VR’s uncanny ability to evoke reality for more therapeutic purposes, with potentially far-reaching consequences for older adults.
VR for assisted living, isolation
A troupe of MIT grad students and technology entrepreneurs in 2015 launched a company called Rendever, which offers VR programming for adults in assisted living as well as for others who are suffering from social isolation and depression. Cofounder and CEO Kyle Rand recalls how his grandmother, a former nurse and college professor, swiftly faded into dementia after transitioning into a memory-care facility.
“She fell into that classic social-isolation trap and just spent a lot of time in her room watching TV,” says Rand, who at the time was studying biomedical engineering and neuroscience in college. The potential of VR technology seemed to provide a compelling alternative: “When I tried it, I realized that this was part of the solution. You can put this on and go anywhere.”
Rendever began by testing VR programming aimed at older people at assisted living facilities in the Boston area; now the company’s products are being used in facilities in 30 states. The idea is that VR technology can provide a window to activities and experiences that would be unattainable in real life — from simple travel destinations to powerful scenes from the user’s past. And it isn’t used just to distract residents; Rand emphasizes that group experiences in VR are a “platform for community building.”
He recalls a former Air Force pilot struggling with social isolation after moving into assisted living; he was shown a VR simulation of an aircraft in flight. “All of a sudden he was sitting in a pilot seat again,” Rand says, “and the stories started bubbling out of him."
Virtual travel experiences are already one of the top nongaming draws of the technology. You can stroll the streets of distant cities and get at least a vaguely satisfying simulation of what real travelers experience. Once this feature is honed, it’s not hard to see how liberating VR could be for less mobile or disabled people. The elderly mountaineer with the bad knees might finally conquer K2; the homebound nature lover could spend an hour in the woods.
And when social features are introduced, people can share these virtual experiences with friends and family. In the future, real-time VR might allow the homebound to enjoy vacations that seamlessly blend the real and the digital. “The ultimate thing will be when you can go on a trip with your family,” marvels Furness. Say you want your mom in Ohio to join you on a stroll in Paris. If you have a small 360-degree camera livestreaming your experience, she can plug into your reality and see and hear everything.
Similarly, cameras set up in the home could allow virtual visits from distant friends or family members anytime. “What this is,” Furness explains, “is a way of moving minds. It’s a transportation system for the senses.”
Other therapeutic uses are emerging. Physician Sonya Kim runs a program called Aloha VR at One Caring Team near San Francisco. Aloha VR customizes virtual reality experiences to reconnect older clients to life. “We find out what their past passion has been, then pick programs that fit their interest level,” says Kim. “Every patient is different. We tailor it to their cognitive level and their mobility issues.”
She has found VR to be particularly effective for patients with dementia; it seems to treat anxiety, depression and other symptoms of social isolation: “[Patients] are calmer, are sleeping better and in a better mood. We’re not curing dementia. But patients are happy.”
VR can even, sort of, move through time. In tests, the Rendever team showed older subjects VR simulations, based on Google Street View photos, of former homes and childhood neighborhoods — places they may not have seen in decades. For many, the experience is almost too powerful. “If you can take someone back to a place that’s meaningful to them, the emotions that come back to them are extremely profound,” says Reed Hayes, a cofounder of Rendever.
Along the way, the Rendever team learned that VR has a key advantage over other kinds of technology: It’s easier to use. “There’s a stereotype that seniors and technology don’t mix, but really, that just means the tech is poorly designed,” says Rand. “All they have to do is put the headset on and they’re immediately having the experience.”
Hayes agrees. “It’s not putting a laptop in front of an older person and saying, ‘Now you can go Google things,’ ” he says. “It’s, ‘Put this on and transport yourself to another world.’ ”
Medical uses for VR
Back in the 1990s, Tom Furness was surprised to learn that the biggest market for his Virtual Vision was dentists, who would have patients put on the goggles during procedures. He had stumbled onto something important: virtual reality’s potential as a pain reliever.
That led to experiments with VR among burn victims and children with leukemia undergoing painful treatments. A program called SnowWorld was developed at the University of Washington in 1996, specifically for severe-burn patients. The illusion of being transported to an icy scene was so powerful, it could overcome even the intense pain of wound care.
More recently, virtual reality has been used to treat post-traumatic stress among military veterans and to relieve chronic pain via immersion into meditative environments. Walter Greenleaf, a behavioral neuroscientist at Stanford University’s Virtual Human Interaction Lab, is a pioneer in these innovative therapeutic uses. He helped to develop VR systems to aid people with phobias, drug addictions and depression. He believes it is healing that will prove to be VR’s métier.
“Entertainment and gaming are going to drive the price down, but what’s going to really make a difference is wellness and health,” he says.
Stroke patients who need to relearn how to use their limbs in recovery could work with a virtual therapist to help guide their movements and “slow down the speed of the world,” Greenleaf notes, allowing them to practice physical gestures at half-speed.
The same principle could help people with autism model facial expressions and practice interpersonal interactions in an artificial setting. There’s also some good evidence that VR therapy can address cognitive issues in older people, delivering to us the long-promised “brain game” that brings on lasting, meaningful improvements in executive function.
Other applications of VR focus on injury recovery. The technology’s ability to fool the senses and make the body feel what isn’t there can help train those with prostheses to use artificial limbs, rewiring neural pathways for object sensing. Eventually virtual and mixed reality could be exploited to dramatically improve medical treatment.
Some of the most startling VR applications beyond health involve what’s called the Proteus effect — the emergence of an emotional bond between the user and his or her computer-generated avatar. In one famous study, young subjects were digitally aged in VR, which encouraged them to make better financial decisions: Inhabiting the skin of their future selves made the concept of saving money for retirement emotionally meaningful.
Like Furness, Greenleaf has lived through several of the hype cycles that have accompanied VR’s development. “You can’t believe how exciting it is for me,” he says, seeing it on the cusp of mainstream adoption. But he also voices some cautionary notes.
“We’re fooling the brain’s visual system with VR,” he says. “Some of the long-term health effects we just don’t know.” There are also ethical concerns. One technology writer suggested using VR on prisoners, essentially confining them in a “rehabilitative” 24/7 virtual experience in lieu of offering human interactions.
The potential for abuse of virtual reality could spark moral and public health outcries. “It’s like we’re splitting the atom,” Furness observes. “We’ve unleashed an enormous power. When you go into an immersive VR world, you never forget it.”
Sensitive to potentially coercive or subversive uses, Furness has founded the Virtual World Society, to bring together “people who want to embrace the good side of virtual reality, to be the consciences of VR” and provide a type of Good Housekeeping seal of approval for content. “The people who first developed this technology are in a position now to be able to guide it and use it responsibly,” Furness says. “As the old guy who’s sort of the touchstone, my mantra is, ‘We have to understand what VR does, not what it is.’ ”
But Greenleaf hopes that VR will become a communication platform superior to email, social media and other tools. “I think typing and texting put more barriers between people. I view this as a reversal of that — VR allows people to be with one another,” he says. “If the right people come and make use of this technology, amazing things could happen. I guess we’ll find out. It’s coming. It’s coming really fast.”
David Dudley, a former AARP features editor, is the executive editor at Atlantic Media's CityLab.