Virtual exercises, real motivation: How a suburban hospital uses VR for stroke rehab

David Gerfen slips on a headset and finds himself in a food truck, tasked with assembling a cheese-and-tomato sandwich to order.

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

Gerfen, 80, isn't an avid gamer. He's a stroke survivor donning virtual reality goggles during his therapy sessions at Northwestern Medicine Marianjoy Rehabilitation Hospital in Wheaton.

"This is one of our newer games," said occupational therapist Nicholas Giovannetti, instructing Gerfen to move his weaker right arm. "All right, you got it. Reach forward. Perfect."

Virtual reality has a significant presence in health care. Some hospitals offer immersive virtual reality experiences to soothe and distract patients in pain or as a means of escape from a chemo appointment. Virtual reality has become a navigational tool, allowing brain surgeons to plot out procedures and get a three-dimensional look at tumors.

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

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

How VR works

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

"I could not do anything with my left leg, could not do anything with my left arm or my left hand, and I had a hard time speaking," Schmidt said.

Schmidt, 74, was already introduced to recreational virtual reality by her grandkids. When her Marianjoy therapist suggested she put on VR gear, Schmidt was willing to give it a chance.

"Anything to help you get back to where you were after having a stroke - I'm all for it," Schmidt said.

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

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

"We're working on sitting balance," said Giovannetti, encouraging proper posture. "We're working on, specifically, his right arm, reaching, working on coordination and also the ability to follow directions."

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

First, they're evaluating how well patients tolerate the virtual reality device. Therapists check for signs of motion sickness, vertigo or nausea. The study is also limited to up to 20 patients who have upper-body weakness resulting from a stroke.

The doctors hope to publish their findings, but when and where will depend on the study being completed and what the results are.

"Everyone that we have actually tested has given us positive feedback," Pandya said. "The next step is to look at clinical outcomes, whether this, along with the traditional rehab therapy, does it improve outcomes?"

Researchers have described virtual reality as a supplement - not a replacement - to standard therapy. The 20 or so Marianjoy patients will complete six sessions - 30 minutes of virtual reality followed by a half-hour of conventional therapy per session - over the course of two weeks.

'Incredible features'

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

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

"VR offers some incredible features," said Gita Barry, executive vice president and general manager of immersive health care at Penumbra. "And we see that making a significant difference or real difference in patients, as well as the therapist experience because the therapists are having a whole new way to engage their patients."

Therapists gradually ramp up the difficulty level so patients work toward more advanced activities in virtual settings.

"What VR does is it immerses you in the experience," said Barry, an Arlington Heights native and Buffalo Grove High School alum. "At the bare minimum, it just makes you happy because you're having fun playing a game."

The system charts a patient's progress, how much time is spent in those activities and the range of motion in 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 'I'm getting more out of my therapy experience, because I'm so engaged in the activity, and I'm not thinking about the pain,'" Barry said.

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

What patients say

Giovannetti adjusts the speed and trajectory of the flying blue ball, and Gerfen seems to respond intuitively. He stretches out his arm to bat it away.

His "sitting balance has gotten better," Giovannetti said. "He's really stable right there." Gerfen's wife, Gerri, agreed: "It's helping him get a little bit more coordinated."

Schmidt has progressed from using a walker to a cane. She cheers on her grandkids at football and baseball games. She can climb stairs on her own.

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

"It wasn't easy to put those birds into their nests," Schmidt said.

But she looked forward to her virtual reality sessions.

"I would recommend it to anybody who has a stroke."