immersive internet australia:focus on health 2011

8/7/2019 Immersive Internet Australia:Focus on Health 2011

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Focus on Health 2011

Mandy Salomon Swinburne University of Technology

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Immers ive In te rne t Aus t ra l i a : Focus on Hea l th 2011

AUTHOR, MANDY SALOMON IS A SENIOR RESEARCHER, SWINBURNEUNIVERSITY OF TECHNOLOGY AND THE SMART SERVICES COOPERATIVE

RESEARCH CENTRE, MELBOURNE, AUSTRALIA

[email protected]

This is an extract from Immersive Internet Australia, available athttp://digitaldownunder.org

A tour of Londons Imperial College virtual hospital in Second Life, 2009


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Contents

The Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1!

Virtual Hospitals..........................................................................................8 !

Continuing Medical Education..................................................................10 !

Games 4 Health .........................................................................................12 !

Money for research?..................................................................................13 !

REFERENCES ................................................................................................ ........................15 !


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The Australian Productivity Commission has released several reports since 2005,emphasising the primary role that digital systems must play in the quest to overhaul

healthcare infrastructures (Banks, 2008). Indeed, globally, governments are seeking toimprove unwieldy and outdated information systems, limited resources and cost blowoutsthrough better use of technology.

Medicine and patient care, by their very nature, are fields that attract innovators, so it is notsurprising that the dual drivers, need and the innovative spirit, have resulted in some of themost adventurous and committed uses of immersive technology.

Better resourcing of health specialists in remote regions, establishing a social network amongst chronic care patients, pain therapy for children using calming and meditative virtualspaces are amongst the motivations, and a growing body of peer-reviewed studies supportingthe clinical and resources value-proposition (Virtual Ability, 2010).

In Second Life , where users themselves can create content, virtual clinics, community supportand outreach groups are proliferating (Norris, 2009). Amongst the many services arerehabilitation tasks for stroke victims, cognitive exercises for people with brain injuries,behavioural modelling programs for people with autism, and social opportunities for peoplein need of chronic care or with disabilities (Beard et al, 2009).

Cigna Vielifes Healthy Eating pilot study In Second Life.


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An environmental scan undertaken by the author in 2009-10, noted early adopters and theways they were using immersive technologies. From this, a number of categories werecreated ( table 1 ).

TABLE 1: Virtual worlds incorporated into public and private health strategies

Health Servicesin Virtual Worlds

Example Platform Organisation URL

Public HealthCampaigns

Info Bus and livechat with nurse todiscuss HPV(Cervical Cancer)immunisation

HABBO NHS (UK)

Virtual Clinicsand groups

Clinical support for war veterans

SL Univ. San Diego(US)

Library ResourceHealth Info Island -library for medicaltexts

SL National Library

of Medicine (US)

Patientmonitoring andrecords

Healthcare Island:secure integratedcentre for patientshealth record

SL IBM (India)

ClinicalScenarios

Learning protocolsf or medicaldevices

SL Imperial College,London

Allied HealthTraining

Emergencyresponse e.g.resuscitation

OLIVE http://www.saic.com/products/simulation/olive/

Remotespecialists

Behaviouraltherapy.(Professor Greenleaf)

OLIVE Greenleaf Medical

Patientrehabilitation

DreamIsland customised for stroke patients

SL

CarersSophias Garden: extended familysupport

Tele-place

Private family(user-createdworld)

CommunitySupport Groups

AARecoveryJourney for peoplewith substanceabuse

SL http://slurl.com/ Second Life/ETSU/27/108/26

Data CollectionQuant/Qual

SL

US Centre for Disease Control/Univ Illinios,Chicago

Prototyping andco-design

Polyclinics SL NHS (UK) http://secondhealth.wordpress.com/


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The value of virtual worlds in enabling people who identify as disabled to participate andsocialise in ways they cannot do in the atomic world has been noted by researchers JohnNorris, (2009); Denise Wood (2010) and the Virtual Ability NGO (2010). One of the mostprominent advocates is the British disabilityactivist, Simon Stevens, whose avatar isSimon Walsh. Stevens has cerebral palsy.He established Wheelies, a wheel chair community, offering peer-to-peer support inSecond Life. People meet on his resort island,the home of Wheelies nightclub (right), where avatars can dance, with or withouttheir wheelchairs. Other parts of the islandhave gardens, a swimming pool and trainingcentre (Stevens, 2010).

Virtual Ability Inc, a not-for-profitcorporation based in Colorado, conductsresearch and patient support programs inSecond Life . The consortium coordinates adiverse range special-needs initiatives; one is a partnership with the Telemedicine AdvancedTechnology Research Center (TATRC) and the U.S. Army Medical Research and MaterialCommand (USAMRMC). Together, they have established the Amputee Virtual EnvironmentSupport Space (AVESS), designed to assist U.S. war veterans adapt to the considerablechallenges of their injuries. Given the numbers of affected soldiers returning from Iraq,military authorities are constrained in the kind of care they feel is needed (Virtual Ability,2010). It is hoped AVESS will not only fill the gap, but also enhance existing rehabilitationservices by enabling veterans to establish friendships, play games, watch films, and socialisewith their families inworld, as well as provide remote counselling and monitoring services.The current proof-of-concept is being undertaken via Second Life Enterprise, with a view toestablishing a private space behind the US military firewall (Virtual Ability, 2009).

Unfortunately, initiatives in the disability area are hampered by the limitations of virtualworld interfaces themselves, which are not designed for people with sight impairment or those who lack dexterity. The release of motion-sensor games consoles, Nintendos Wii andSonys Playstation Move, along with the hands-free console Xbox Kinect (formerly known asNatal ), demonstrate yet again that leads in the immersive Internet are strongly driven byinnovation within the games industry. However, Australian researcher, Dr Denise Wood of the University of South Australia, is making inroads within the virtual world itself. Wood isworking on range of assistive technologies that enable people with disabilities to orientate andwork within virtual environments. She undertook ethnographic research, spending time onSecond Lifes Wheelie Island ( Metaverse Journal , 2010) in order to observe the fundamentalproblems. As a result, she is collaborating with a dispersed global team to create AccessGlobe, an enhanced accessibility open source viewer and a Web 2.0-enabled interface tovirtual worlds. Its features include an audio notification system to assist the visually impaired

and alternatives to a mouse-driven interface. Another solution is Max the virtual guide dog,


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whose object sensors equip him to lead sight-impaired users avatars around immersiveenvironments (Wood D, 2010).

Max, tguide dog to the visually impaired. Typing an avatar name or location withaBraille interface, alerts Max to lead his user there. Image by iggyo, at

There is mounting evidence that people find degrees of liberation in virtual worlds, as theyare not constrained by what cognitive scientist Andy Clark (2005), calls our biological skinbags, finding purpose and agency in digitally generated environments that otherwise theymay not have. The experience of cerebral palsy-afflicted residents in a care centre in the USdemonstrates this. They have jointly created an avatar Wild Cunningham who socialises,rides waves and climbs mountains in the Second Life . Their caregivers report that theparticipants, free of their wheelchairs and disease, experience a level of social acceptance notpossible in the physical world. This has resulted in improved self-confidence and a sense of empowerment: and that participants express their creativity and humour in ways notpreviously available to them (CBS, 2008).

Flying with a disability: a Cerebral Palsy group with their avatar Wild Cunningham whichenables them to experience activities not feasible in the real world.


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TABLE 2: Health, healing and support in Second Life

Second Life Disability Resources Second Life Disability Resources

AA in SL , Hosp. And Inst. Group (professionalcommunity)

Friends Fighting Cancer

ADHD Research Friends of Bill W. (Alcoholics Anonymous)Agoraphobia Support Headquarters Friends of Lois W. (Alcoholics Anonymous)

AICR (Association for International Cancer Research) Health Info Island + iVinnie Center + SL Health andWellness Center + Japanese Herb Garden + Consumer Health Library + SL Medical Library + SL HealthInformation Outreach Research Lab

AIDS and HIV Help La Ligue contre le cancer

AIDS and HIV Support Live2Give support group for cerebralpalsy

Alcoholics Manic-Depression

Alcoholics Anonymous MDSLA support group for muscular dystropy, ALS, and

other myopathiesAll About Cancer Mind Blinder's club for those with autism spectrum

disorders

ALS Accessibility Center. Providing education andresources to all on issues related to disabilities and howSL can enrich a person's life.

Mobility Impaired in Second Life

American Sign Language usersAnxiety http://www.anxietyaustralia.com.au

MS Society

The Arthritis Society (founded in Spain) affiliated with theArthritis Foundation

MS Support GroupMultiple Sclerosis Help and Support

Asperger Awareness Multiplicity multiple personality disorder support group

Aspies for Freedom National Institutes of Health

Autism Awareness/support for parents and caregivers N.D. Research and Support Committee support group for neurological disorders

Autism Research Nexus Foundation The Counselling Center annex, Boncarus (73, 41, 82)Making an appt is easy. Check the calendar at http://www.slcounseling.org/avalonbirke.htm. Look for "AVAILABLE" times. Then send an IM to Avalon Birkewith the day/time you'd like.

BAVIEC (Blind and Visually Impaired EducationalCenter)

Obsessive Ambulatory Disorder

BEF (Cystic Fibrosis) Positive Mental HealthBipolar Support Prostate Cancer Research

Foundation http://www.malecare.com/

Breast Cancer Awareness Prostate Cancer Support

British Sign Language Users - BSL Psychosis and Depression Support

Cancer Co-Op Self Injury Support

CF University (Cystic Fibrosis) Shock Proof (Stroke Survivors)

The Circle of Support (anxiety, depression, and other mental illnesses)

SL Cancer Research UK

Crohn's and Colitis Support SL Foundation for Diabetic Children

Dementia Interests (mainly for carers) SL Relay for Life- Furs for A Cure


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Second Life Disability Resources Second Life Disability Resources

Depression 24/7 Helpline SL Support for HIV/AIDS SL' s Cancer Caregivers

Depression and other disorders SLCSS Social Anxiety Support Groupshttp://www.socialanxietysup

port.com/

Depression Italy Successful Sobriety

Depression Support Group Survivors of TBI (Traumatic Brain Injury)

Diabetes Type 1 Community United Spinal Motorsports

Disability Guerillas (activists) Virtual Hallucinations (schizophrenia)

Disability Support Workers International Wheelies @ Second Ability (193, 115, 27) disability-themed nightclub

Endometriosis support Youth Cancer (UK)

Fibromyalgia Support Friends

Source: Virtual Ability


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Imperial College Medical School and Virtual Hospital for training:Source: hvxsilverstream on Flickr (Second Health, London, 2009)

2. In another example of prototyping, Palomar West Central Hospital, San Diego,California is under construction and due to open its doors in 2011. Ahead of thephysical opening, it opened its virtual doors in Second Life for people to explore thelayout and facilities ahead of time (Cisco, 2008). Within the virtual environment,

many proposed high-tech services are modelled, including smart environments thatadapt to patient preferences and a wireless mesh network throughout the hospital andgrounds. Avatars entering the virtual hospital are given RFID tags to wear, as theywould as patients in the actual hospital, and can enter the private rooms and interactwith the rooms customisable features.

Palomar West Central Hospital partnered with Cisco to build its prototype in Second Life.Left: construction of the real hospital as it looked in March, 2010Right: the virtual version opened to the public in 2008.


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Screen shot from a machinima describing Palomar Wests imaging technology;;

Continuing Medical Education

A study conducted by Boston University in 2010, placed 14 primary care physicians in anhour-long, highly interactive event in Second Life on the topic of Type 2-Diabetes.

Participants completed surveys to measure their confidence in the application, their performance on test cases, and to assess the learning value.


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Boston University/U.N. -W.H.O.Trial in Second Life

The post-survey findings were reported in the Journal of Medical Internet Research (Wiecha,J. et al, 2010). Of the 12 participants who completed the survey, all agreed that the experiencein Second Life was an effective method of medical education, that the virtual world approachto CME was superior to other methods of online CME, that they would enrol in another suchevent in SL, and that they would recommend that their colleagues participate in a SL CMEcourse. Only 17% (2 of 12) disagreed with the statement that this potential Second Life method of CME is superior to face-to-face CME.

The summary of the findings included:! Fits busy schedules, no travel component, tasks can be done in the comfort of own

home.

! Positive and engaging experience, superior to other methods of online CME

! Some respondents preferred it to dealing face-to-face (F2F) contact with their instructor

! Positive impact on learner and their sense of self-efficacy

! Suggested a positive impact on clinical competence

! An added sense of presence

! An added sense of real life application (the use of mock patients and role play

! Advantage of using backchat via instant messaging for logistical, technical and casualenquiries (Dr > Dr; Dr > Instructor)


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! Boston University Study: The Diabetes Learning Module, using The Second Life Platform

A growing number of pilot studies indicate social worlds have a place in Continuing MedicalEducation (CME), although a study undertaken by nursing colleges in New Zealand and theU.S. (Honey, M.L.L. et al, 2009), in which Second Life was used to create a simulation for haemorrhage management, found a number of obstacles. These included students requiring

preliminary orientation training before the simulation exercise could begin, indicating that theuser interface was not intuitive enough. It also noted that creating the clinic and props wastime intensive, and that technological glitches were likely to occur. However there wasstrong approval of the interactive elements. Comments such as, was weird and fun; seemedreal; We had to think and act quickly and taught me about responding and thinking on myfeet indicate that respondents were strongly engaged.

Games 4 Health

PULSE is a serious games platform for learning complex medical practices and technicalknowledge: diagnoses of illnesses, ER services and complex surgical procedures. Throughimmersion in virtual environments, medical students are put into complex situations such asunderstanding how a patients medical history impacts on their response to drug treatments.Based on game technology, variables are programmed into role-playing and instructionmodules to better prepare students for un-expected situations and anomalies (Breakaway,2010).


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Pulse is a virtual learning environment for health care professionals. Research funding has comefrom the U.S. Department of Navys Office of Naval Research, in partnership with Texas A&MUniversity World

Money for research?

Whilst the use of virtual environments for clinical purposes, for education and training andfor patient outreach is establishing, there is one area that is less recognised but that warrantscloser attention: virtual worlds can be used to create revenue. Leads are coming from all over

the web, wherever virtual goods are transacted. The worlds biggest social network itdescribes itself as a life platform - is Chinas QQ , recording 568.6 million registered users

Snapshot from 2008s Relay for Life, in which 1700 avatars wenton a walkathon and raised $(US). 215,000

The track was themed Quest For a Cure and wascreated by more than 75 volunteers. Avatars were treated tovirtual scenes from action and adventure stories.Participants `encountered opportunities along the way tohave fun while donating money - lighting virtual luminaries,

and participating in events such as musical performances,sky diving, roller coaster rides, and treasure hunts.

http://www.cancer.org/docroot/GI/content/GI_1_8_Second_Life_


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in March 2010 (TenCent, 2010). Morgan Stanley reports that money spent customisingavatars and purchasing game items in 2009 amounted to $(US)1.4bn revenue for its parentcompany TenCent, up 94% on the previous year (Morgan Stanley, 2010). If medical researchgroups could form sponsor partnerships with such companies, might they not learn how todirect some of the explosive consumer interest their way? This is an area for deeper investigation; certainly establishing a virtual presence would be one way to start.

Another early signal for fundraising comes from The American Cancer Society. Its renownfundraiser Relay for Life attracts participants from around the world, many who have usedthe Societys online resources in Second Life, or who attend the many cancer communitydiscussion groups held at its virtual precinct. Relay for Life was first held as a Second Life event in 2004, with 99 avatars having raised $(US) 2,000. The following year, $(US) 5,000was raised. By 2008, 2230 avatars had secured $(US) 218,000 via their sponsored activitiesinside the world. Donated funds as of 2010, total $(US) 655,500 ( Secondlife 2010).

Screen shot from the American Cancer Foundations Relay for Life, 2009.


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The authors avatar ponders the resources on Health Info Island in Second Life, 2009.

REFERENCES

Banks, G. 2008, Health Costs and Policy in an Aging Australia, ProductivityCommission, Health Policy Oration 2008, Menzies Centre for Health Policy. Paper presentedat the John Curtin School of Medical Research, ANU, Canberra, 26 June, retrieved March2009,

Beard, L., Wilson, K., Morra, Keelan,J., 2009, A survey of health-related activities onSecond Life Journal for Medical Internet Research . 2009 May 22;11(2):e17, retrievedSeptember 2009,< http://www.ncbi.nlm.nih.gov/pubmed/19632971>

Breakaway, 2010 Serious Games for Healthcare markets, retrieved March, 2010

Carvel, J. 2008, New NHS polyclinics will damage patient care, warns think tank TheGuardian , retrieved March 2009,

Cisco, 2008. Cisco Helps Palomar Pomerado Health Open 'Hospital of the Future'Three Years Ahead of Schedule - In Second Life, (media release), retrieved September 2008,

Clark, A. 2004, Natural-Born Cyborgs: Minds, Technologies, and the Future of HumanIntelligence, Oxford University Press.


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Norris, J. R. 2009, The Growth and Direction of Healthcare Support Groups in VirtualWorlds, Journal of Virtual Worlds Research Vol2, No 2: 3D Virtual Worlds for Health and Healthcare., retrieved October 2009,

Second Life 2010, Relay for Second Life, retrieved August, 2010

Stevens, S. 2010 The Wheelies Story, blog, retrieved May 2010,

TenCent 2010, retrieved May 2010,

Virtual Ability, 2010, Medical Benefits, retrieved January 2010

Wiecha, J., Heyden, R., Sternthal, E., Merialdi, M., 2010,Learning in a Virtual World: Experience With Using Second Life for Medical EducationJ Med Internet Res 2010;12(1):e1, retrieved April 2010

Wood, D. 2010, Communicating in virtual worlds through an Accessible Web 2.0Solution. Telecommunications Journal of Australia , 60 (2): pp. 19.1 to 19.16. DOI:10.2104/tja10019.

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