2023-09-25 09:17:59
by Ruggiero Corcella
From surgery to neuromuscular rehabilitation to the treatment of anxiety, phobias and stress, the new frontier of medicine promises to revolutionize the very concept of therapy. Without hiding shadows and dangers
When we talk about the metaverse, the most immediate image evoked is that of the classic geeky kid intent on playing with a particular visor lowered over his face and maybe even a pair of hand-tracking controllers waved in the air.
What is the metaverse
But what is the metaverse? It is difficult to define it: We immediately enter into a divisive and heated discussion – explains Professor Salvatore Maria Aglioti, neuroscientist coordinator of the Neuroscience and society research line at the Center for Life Nano & Neuro-Science of the Italian Institute of Technology in Rome – because someone claims that there is not one metaverse but many while for others the metaverse includes them all. Basically an “other” world generated by the computer where we, using special devices, can go with our “virtual” body (an avatar, ed.) and carry out operations of various kinds: from commercial ones to social interactions.
What are the applications in medicine
Even up to therapies in medicine, where the applications of the metaverse are beginning to take their first steps. Recent research by Boston Consulting predicts that this technology will be increasingly used in the healthcare sector and describes the fields in which it is already present: surgery; diagnostic imaging; neurological and neuromuscular rehabilitation; Physiotherapy; pain therapy; treatment of anxieties, phobias and post traumatic stress; medical training. In the United States, as of September 1, 2023, the Food and Drug Administration had examined and authorized the marketing of around fifty devices for the metaverse in various sectors of medicine and estimates that applications will continue to increase.
How to enter the metaverse
How do you enter the metaverse, then? Through a mobile device, such as a smartphone, with the use of a PC equipped with a webcam or other sensors, with vision, listening and manipulation devices that add multimedia information to the normally perceived reality. In its creation, the metaverse is not a homogeneous technological world – explains Professor Andrea Gaggioli, professor of General Psychology at the Catholic University of Milan -. instead, a panorama of possible experiences that are enabled by different platforms and technologies that are sometimes very different from each other, in terms of immersion, that is, in their ability to make us protagonists, to “isolate” us within that world.
We also have a heterogeneity of virtual technologies. Because the classic virtual reality (VR), where you are completely immersed in the artificially created world, is flanked by the so-called augmented reality (AR) where digital objects are superimposed on physical spaces and mixed reality (XR, extended reality or mixed reality) which a bit of an intermediate version between virtual reality and augmented reality. In mixed reality there is a perfect overlap of virtual and real, so I can physically touch a table, for that table appears to me under different virtual guises, that chair appears to me in a different way because I observe it through a viewer that allows you to superimpose a virtual object to a real one, adds Professor Gaggioli.
What type of preparation is needed
Yes, but how can we rely on virtual therapies and why should we ever try, since it is already difficult in the real world? A premise must be made: the patient does not cure himself with the metaverse – points out Elena Giovanna Bignami, full professor of Anesthesia and Resuscitation at the University of Parma; Artificial Intelligence expert of the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (Siiarti) —. Instead, he benefits from the fact that the doctor or even he himself has trained (the former) with a method, or become familiar (the latter) with a procedure or an environment. In short, a sort of training that will lead the patient to be both less stressed in the possible traumatic experience and more compliant with the prescriptions and/or to avoid making mistakes.
Telemedicine and virtual visits in hospital and at home
The general public has already had a first taste of the potential of virtual care during the Covid pandemic. Telemedicine in its various forms (remote consultation, transmission of vital parameters), after all, can fully fall within the applications of the metaverse in the healthcare field. And not only. In Milan, the Humane Technology Lab of the Catholic University (directed by Professor Giuseppe Riva) used VR in the Covid Feel Good project, a self-help protocol to overcome the psychological distress generated by the Coronavirus.
In the recent document drawn up by the European Citizens’ Panel on Virtual Worlds of the European Commission it is stated that virtual worlds will help with faster and more accurate diagnoses and therapeutic treatments. The Maria Middelares, a cutting-edge healthcare facility located in Ghent (Belgium), is proof of this: the virtual hospital project it has launched allows pregnant women to carry out a virtual inspection of the maternity ward, to plan the various phases of their subsequent hospital visit and thus reduce the fear of giving birth.
An avatar to help children walk
As regards the pediatric population – says Luigi Piccinini, head of the Functional Rehabilitation Unit at Irccs Medea in Bosisio Parini (Lecco) – virtual reality and metaverse technologies can certainly have a greater attractive capacity than standard treatments. The child’s adherence to therapies and motivation would certainly be increased. Furthermore, if the possible involvement of the mirror neuron system (nerve cells in the brain that “activate” when they see someone else making a gesture, ed.) in the reactivation of silent brain areas was demonstrated, this rehabilitation approach would have unique implications.
Recruitment has just started at Medea for a clinical trial on the use of the metaverse in exergaming (exercise and gaming), i.e. physical exercises aimed at rehabilitation treatment to be carried out in a video game environment. We know – says Piccinini – that at a certain age children and young people with disabilities are little motivated to continue classic rehabilitation treatments, which last for years due to the chronicity of the underlying pathology. Virtual reality, on the other hand, allows you to have objectives to achieve from a motor, cognitive and neuropsychological point of view in a pseudo-playful environment, therefore more fun and captivating. An activity that will necessarily have to be integrated into the individual rehabilitation project.
I study
The study, which sees the collaboration of the Polytechnic of Milan, will involve 10 children aged 6 to 14 with spastic, unilateral and bilateral cerebral palsy. If the child has a motor problem, so for example he is unable to grasp an object correctly or is unable to walk with a correct motor pattern, we create an avatar for him, a sort of “virtual twin” with which he can carry out a series of exercises. The child sees himself performing that function in the right way and, consequently, should learn to grasp more correctly and walk with a more physiological pattern, says Piccinini.
Plasticity of the brain
At the basis of exergaming, there is the mechanism of neuronal plasticity. Plasticity is the central nervous system’s ability to readjust and create more physiological circuits if these have been damaged following a brain injury. Therefore, by presenting the child with an activity performed by his avatar in the closest possible physiological way, we try to recreate neuronal circuits that can reinforce this correct movement, adds Piccinini.
The same mechanism includes other clinical applications. Several studies have demonstrated, for example, how repeated and systematic exposure to virtual environments of a certain type can help relieve both acute and chronic pain. But, in fact, we are only at the beginning. Metaverse therapy still has to overcome a series of obstacles, starting from the regulatory framework: in Italy it does not yet exist, unlike other European countries, such as Germany, France, and Belgium. Thus virtual treatments cannot be reimbursed by the Health Service.
The conference
The metaverse and its applications in the field of rehabilitation will be discussed on 6 and 7 October, in Bosisio Parini (Lecco). On the occasion of World Childhood Cerebral Palsy Day, which is celebrated on October 6,
Irccs Medea – La Nostra Famiglia Association and Milan Polytechnic organize the Sport, disability & metaverse conference (open to all) in which we will talk about integration and inclusion of children and young people with disabilities (in particular, with infantile cerebral palsy) in the world of sport.
September 25, 2023 (modified September 25, 2023 | 09:14)
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