VR+PT

How virtual reality helps Mary Greeley patients with balance issues and other conditions.

After being seriously injured in a car accident in March 2022, Stan Peterson suffered vertigo so severe he was hospitalized twice at Mary Greeley.

He ultimately ended up at Mary Greeley Rehab & Wellness, where he was able to address his severe balance issues with the aid of a surprising therapy tool that is often associated with video games: virtual reality (VR).

Lisa Haggas, a physical therapist who specializes in balance and vestibular therapy, had seen Peterson earlier in his treatment, and on a subsequent visit she sensed a significant decline in his balance. She opted to evaluate him using a VR device called a Virtualis. Using a Virtualis Sensory Organization Test, she was able to quantify how much decline Peterson had experienced.

“I was surprised to find that he was not only showing deficit in his vestibular system, but all three balance systems—visual, somatosensory, and vestibular. In fact, he performed below age and gender norms in all parts of the tests and his composite score was very low,” she said. “This made me rethink my treatment approach. Stan improved at what was probably a faster rate than if we hadn’t been able to use this technology to assess him. We got Stan better faster, saving time and resources. When I retested Stan before discharging him, he scored above age and gender norms in all parts of the test and had improved his composite score from 18 to 82 percent.”

Peterson said his injuries made him “a totally different man. I was unable to function as a person.” The therapy program Haggas put together with information gathered from the Virtualis device changed that.

“I was struggling for months and then Lisa recommended virtual reality. I was naturally nervous at first, but then I had the opportunity to use the Virtualis and I experienced a miracle,” Peterson said. “I highly recommend it to anyone who is having these issues to get on that machine. It changed my life.”

SWITCH TO VR

For years, Rehab & Wellness used a Balance Master, which was a state-of-the-art therapy tool once used by astronauts. Suitable for basic testing, it had a platform with forward and backward movement surrounded by three walls. The Balance Master was becoming obsolete, however, so Rehab & Wellness switched to the Virtualis in 2022.

“Virtual reality is the best new thing,” said Haggas. “We have so much more flexibility to look at things in a more three-dimensional environment. As a clinician, it’s really helpful to test with this system because it helps me identify more quickly what I need to focus on in a patient’s therapy session.”

VIRTUAL WORLD

Before putting the VR headset on the patient, Haggas explains everything that is going to happen. There is a bar that goes around the platform that the patient can hold onto if necessary. Haggas is right there, as well, providing another level of safety. After the patient is on the platform, they put on the VR visor, which has already been adjusted to fit them.

When the device is activated, the patient sees a virtual world.

“If we’re doing the most common balance test site, they would see a room with four walls. They can look down, and they’ll see a floor. They look up, they see a glass ceiling,” she said.

She’s seeing what the patient is seeing, but on a computer screen. This allows her to make adjustments as needed. Since the first time can be a disorienting experience for some, Haggas encourages patients to take breaks if they need to.

“The important part is talking them through and reassuring them that we’re right here even though they can’t see us. We talk through what they’re doing and a lot of tactile,” she said.

The Virtualis platform can provide the sensation of standing on a firm surface or on a surface that has movement, like being on a beach.

“I can control the variable of the floor as well as how much that will move. We can change the activity of the floor, too. Does it move with them or does it move them and they have to react to it?” she said.

The device can be used to see how well a patient’s ability is to use their inner ear for balance or help a patient find their sense of center or sense of vertical again.

“It also gives me the ability to look at other tests that I couldn’t do with the Balance Master system,” she said. “Some people aren’t even aware of where center is or where their head is moving. They don’t know where center is anymore, and we can do testing and training to address that and track their progress.”

Phyllis Rodgers suffers from a vestibular condition that impacts her balance. She sought treatment because, like many older adults, she was afraid of falling. She was referred to Mary Greeley Rehab & Wellness by the Iowa Ear Center. Haggas suggested a session on the Virtualis, which contributed significantly to Rodgers’ treatment.

“Lisa could evaluate me going up and down, and it showed exactly where I had trouble because as soon as I went to a certain point, then I had to reach for things,” she said. “You couldn’t tell that if I hadn’t been in virtual reality because as soon as I got to one angle, then it told me exactly what I had to do. It’s valuable for Lisa, and she knows what exercise I need to do.”

While the system provides extensive data about how a patient responds to various situations, it’s still up to the clinician to do all the interpretation.

“It makes it a lot easier for the clinician to do that because it’s a lot less subjective. We have actual numbers to look at to say, ‘Oh, this is where the problem is,’ as opposed to subjectively having to go, ‘Well, that looked like that was hard, and that looked like that was harder, so maybe we’ll try this next,’” she said.

After the initial testing, the patient’s data is displayed on a computer screen that Haggas will use to “develop a program for not only here in the clinic, but also for what they can be working on safely at home. I like having the home component so that they are working on some lower-level challenges that will help them get better, and then that allows me more time in the clinic to do the more challenging things.”

After a few weeks of clinic and at-home therapy, the patient can get back on the Virtualis and measure their progress. This data can be helpful when a patient is seeking insurance coverage for ongoing therapy.

APPLICATIONS

While Haggas uses the Virtualis primarily to help patients with balance issues, it has a variety of opportunities for both assessment and treatment for a range of conditions, including orthopedic and neurological.

“I’ve worked with concussion patients who don’t have a sense of vertical anymore and worked on finding vertical again,” she said. “I’ve also had a stroke patient who had a very difficult time finding the ability to weight-shift to one side or the other.”

There are future plans to use the VR for mirror therapy for amputees or stroke victims who have a diminished use of an upper or lower limb. Mirror therapy is where you use the reflection of a functioning limb in a mirror to give the illusion of two functioning limbs. This can sort of reprogram your brain, and a patient can experience some carryover of function to that nonfunctioning limb. It’s like a bit of an optical illusion.

Virtual reality with the Virtualis allows us to do mirror therapy with the upper and lower limbs.

“Let’s say the left hand is impaired. The patient is wearing the headset and we have their hands on a table. When they look, all of the motion that they’re seeing in their left hand is actually coming from their right hand. So, anything the right hand is doing is being reflected to the left hand,” she said. “They get that carryover by seeing both functioning hands. They do get enough carryover that you will see recovery at some level in that side, if that is a therapy that works for them.

There also are assessment and treatment programs on the Virtualis that can be used for occupational and speech therapy as well. Mary Greeley therapists received training with this new technology and are able to use it to work with patients on cognition—including attention, memory, orientation, and problem solving—and hemineglect, including visual neglect.

OLDER PATIENTS

Many of Haggas’ older patients have embraced the new technology. A patient’s family members sometimes come to watch and take pictures to share later with friends and family, she said.

“There’s a wide array of responses, but the one I get the most is, ‘Oh yeah, my grandkid does that,’” she said. “There’s a bit of excitement because they get to connect with this younger generation just doing their therapy.”

Rodgers found that her family was interested in the treatment.

“I talked to my sisters about it. They thought it was really cool,” said Rodgers. “And my kids. And they were really, really interested in what we did. And I thought it was really neat when the floor went out from under me and that I went up and down. And my son-in-law is a big video gamer, and he asked me a lot of questions about it.”

The Pros of Anti-Gravity

How a Mary Greeley Rehab & Wellness therapy tool gets injured runners and others back on track.

Prior to her injury, Brynn Wilson had never heard of the AlterG. 

After her injury, it quickly became her best running partner.

The AlterG is an antigravity treadmill offered at Mary Greeley Rehab & Wellness. It has helped many people, including a lot of young runners, overcome serious injuries more quickly than they might have without it. The advanced therapy tool has applications for all ages and a variety of injuries, whether they come from athletic endeavors or slipping on the ice.

“Without the AlterG you might be in a boot and not weight-bear run or walk at all for twelve weeks,” said Anne Hilleman, Mary Greeley Rehab & Wellness physical therapist and a triathlete. “Now we can start at seven or eight weeks.”

Wilson is a sophomore at Ballard High School and a member of the school’s track and cross-country teams. 

“Running has become really important, especially when I made varsity,” she said. “I love the feeling when you’ve finished, knowing the hard work has paid off. It is really amazing.”

In September 2021, she was about halfway through a cross-country event at the University of Minnesota when her right foot started to hurt. She finished the race but was in a lot of pain. A few days later she saw Hilleman, who sent her to Dr. Sarah Bancroft, McFarland Clinic sports medicine specialist. Bancroft ordered an MRI, which revealed that Wilson was on the verge of a stress fracture. 

Wilson had to boot-up, effectively sidelining her running. While she couldn’t compete, she’d still go to meets to support her team.

“It was hard to watch, knowing that I could have been running,” she said.

Hilleman started her on a therapy program, which involved specific foot strengthening exercises and weight-bearing exercises such as hopping and jumping, as well as counseling on nutrition needed to maintain calories. She also incorporated the AlterG into Wilson’s program. 

“Anne was a blast to work with,” Wilson said. “She was motivating and encouraging through the whole process.”

To use the AlterG, the patient gets into a pair of shorts made of wetsuit-like material and then zips themselves into a cockpit. The device fills with air to calibrate the patient’s weight. This allows Hilleman to “take off” specific amounts of weight from the patient. Then the patient will work on walking or a return-to-run program at a lower weight and slowly add weight back on based on what the injury can tolerate.

“With a patient who has a stress fracture, I want them to get to where they can walk pain free on the AlterG, and then we can move on to the running phase of rehab,” Hilleman said. “It’s all about gradually increasing weight bearing and running time.”

After several weeks of therapy, Wilson was able to strengthen her injured foot, while keeping up her training to a certain level, thanks to the AlterG. She’s back to her athletic pursuits and already beat her cross-country times from her freshman year. Even better, this year the Ballard cross-country team came in second at the state tournament.