The Neuroscience and Four Use Cases
For the past few years, we have been watching, and working to facilitate, the evolution of virtual reality (VR) in healthcare. We even built a Learning Hub on the IKONA Health website where we collect and curate peer-reviewed basic science research. In that time, we have witnessed the expansion of VR across healthcare as the number of use cases and success stories seemingly grow by the month, day, and experience.
In this report, we discuss the neuroscience behind VR and show that VR is effective because it broadly engages multiple learning and performance systems in the brain in synchrony. We then discuss four specific uses cases in healthcare where we see VR providing the greatest good.
Patient and healthcare provider education and training: medical procedure and device training, hospital familiarization, and empathy building.
Senior care and caregiver support: education and training around cognitive, emotional and physical changes with normal aging and dementia, empathy building.
Mental health, therapy, and addiction: PTSD, depression, substance abuse and addiction.
Pain management: alternatives to opioids or during painful medical procedures like venipuncture, or cancer treatment rehabilitation
We will end with a few closing remarks on what we consider to be very promising and plausible future directions based on what we have learned and experienced along the way.
Let’s begin with the question driving our collective curiosity.
Why is VR Effective? It’s All in the Neuroscience
“Learning is an experience. Everything else is just information.”
This quote from Albert Einstein is supported by the neuroscience of learning and performance, and is the primary reason why VR is so effective in healthcare. As we explain below, all four use cases outlined above require broad based engagement of learning and performance systems in the brain. Education and training in healthcare — whether for patients, professionals, seniors or their caregivers, to give just four examples — are specifically about “learning”. Much of mental health and therapy is about the “unlearning” of destructive behaviors, such as drug use, or the “unlearning” of perseverative behaviors like rumination. Even pain management is about “learning” to redirect one’s attention from something painful to something enjoyable.
As outlined in Figures 1 and 2 below, the human brain is comprised of at least four distinct learning systems. As Einstein so eloquently stated, experience is at the heart of learning (and performance).
Four Learning Systems
The experiential system has evolved to represent the sensory aspects of an experience, whether visual, auditory, tactile or olfactory (Figure 1). Every experience is unique, adds rich context to the learning and is immersive. The critical brain regions associated with experiential learning are the occipital lobes (sight), temporal lobes (sound), and parietal lobes (touch/smell). In other words, the experiential regions cover a vast expanse, neuroscientifically speaking. Experiential learning might represent the sights, sounds, smells and tactile aspects associated with a hospital, emergency room, or post-acute care facility. It also might represent the sights, sounds, smells and tactile aspects of a war zone, the street corner where an addict normally gets their “fix”, or the facility where a patient receives chemotherapy. At its core, experiential learning provides the context and scaffolding that grounds and contextualizes learning.
Figure 1.The Experiential and Cognitive Learning Systems
Figure 2. The Emotional and Behavioral Learning Systems
The cognitive system is the information system (Figure 1). It processes and stores knowledge and facts using working memory and attention. Critically, these are limited resources and form a bottleneck that slows learning with more information coming in and available to the learner. This system encompasses the prefrontal cortex and hippocampus. This is the “everything else” aspect of learning that Einstein alluded to. Unfortunately, this system is slow to develop, not reaching maturity until an individual is in their mid-20s, and it begins to decline in middle age. In addition, processing in this system is adversely affected by anxiety, stress and pressure. The cognitive system processes the information you see in most traditional media: in an anatomy and physiology textbook; in onboarding and training manuals for new direct care hires; in a senior’s list of medications; in a breakdown of the pros and cons of dialysis modalities; in the definition of empathy; and in the list of symptoms of alcohol abuse, PTSD or depression. Despite the processing limitations, developmental changes, and susceptibility to stress and anxiety in this system, much of our traditional training relies almost exclusively on this system. This explains why so much training is ineffective and time-consuming.
The behavioral system in the brain has evolved to learn motor skills (Figure 2). This is an amazing system and one that builds the “muscle memory” needed to achieve goals. The detailed processing characteristics of this system are fascinating but beyond the scope of this report. Suffice it to say that the critical brain structure for behavioral learning is the striatum, and processing in the striatum is optimized when behavior is interactive and is followed in real-time (literally within milliseconds) by corrective feedback. Behaviors that are rewarded in real-time are more likely to occur again, and behaviors that are punished in real-time are less likely to occur again. This system links rich experiential contexts (represented by the experiential learning system) with the appropriate behavioral responses. It is one thing to know “what” to do (cognitive information), but it is completely different (and mediated by different systems in the brain) to know “how” to do it (behavior). For example, you might want to train a nurse to care and maintain a central line, a surgeon to perform heart surgery, a senior care worker to “show” empathy verbally and non-verbally and to see the signs of sundowning, an addict not to “use”, a veteran not to get anxious in situations that remind them of combat, or cancer survivor to use relaxation and mindfulness techniques as alternatives to manage pain.
The emotional learning system in the brain has evolved to provide rich motivational and emotional context and to train situational awareness (Figure 2). Situational awareness is about nuance, but nuance that is vital to success. Whereas one can have all of the facts and figures available, and can have a strong behavioral repertoire, in the end one has to extract the appropriate information and engage the appropriate behavior in each distinct situation. One needs to know what to do, and when. The critical brain regions are the amygdala and other limbic structures. Emotional learning and situational awareness are critically important in healthcare. Healthcare workers must know how to respond quickly and accurately under high stress conditions, and when time is of the essence. The frontline senior care worker must know how to diffuse a contentious situation, at the same time knowing how to show sincere empathy toward a senior who is sundowning. Mental health professionals must have a deep and intimate understanding of a broad range of mental health conditions (e.g., addiction, PTSD, depression, and anxiety) and at the same time know how to “read” a situation and do the right thing.
Although each of the four learning systems in the brain are distinct, they all reside within the same brain with massive, dependent interconnections. In nearly all healthcare situations information needs to be stored and retained (cognitive), motor skills must be perfected (behavior), situational awareness must be strong (emotional), and all of these must be present within the relevant work context (experiential). In other words, ideally all four learning and performance systems in the brain should be activated in synchrony.
This is the power of virtual reality in healthcare — one experience at a time.