Virtual Reality Technology, Machine Learning, Biosensing Converging to Transform Healthcare By Walter Greenleaf The oncoming wave of Virtual Reality and Augmented Reality technology will impact medicine, clinical care, and personal health and wellness. Although entertainment, social connection, and gaming will drive the initial adoption of VR and AR technology, the deepest and most significant impact of the next generation of VR/AR technology will be to enhance clinical care and to improve personal health and wellness. VR and AR technology will also help facilitate the shift of medicine to direct personal care. We know from decades of clinical research that VR/AR technology can provide breakthrough solutions that address the most difficult problems in healthcare - ranging from mood disorders such as Anxiety and Depression to PTSD, Addictions, Autism, Cognitive Aging, Stroke Recovery, and Physical Rehabilitation, to name just a few. VR technology can also improve clinical measurements and assessments by making them more objective and functional, and improve medical training such as surgical skill training and procedure planning by applying simulation-based learning principles. Personal health and wellness will be improved by using VR to promote healthy lifestyles and to reduce stress and anxiety. As the cost of healthcare rises, VR technology can serve as an effective telemedicine platform to reduce costs of care delivery, and improve clinical efficiency.

1. Walter Greenleaf PhD
Virtual Reality Technology, Machine Learning, Biosensing
Converging to Transform Healthcare

2. VR / AR Technology and Healthcare
The Digital Health Revolution
Emerging and Confluent Technologies
Overall Landscape of XR Technologies
Neuroscience – Why XR Has Impact
History of VR - and Why it Matters
Current Status – Where There is Traction
Future Perspective and Predictions – Also, Impact of COVID

3. The Stanford Laboratory for
Brain Health Innovation and
Entrepreneurship
VR-IT
Stanford Virtual Reality
Immersive Technology Clinic
Academic Affiliations

5. Healthcare Crisis:
Aging Populations
0
50
100
150
200
250
300
350
400
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010 2015 2020 2025
Age 85+
Age 75-84
Age 65-74
Age 45-64
Age 5-44
Under Age 5

6. Transforming HealthCare with Technology

7. Joyance
Partners
TAKE
PAUSE
Ellipsis Health

8. Digital Health
Revolution
• Mobile Health / eHealth
• Machine Learning
• Wearable Sensors
• Patient Centered
• Leverages Internet:
social, quantitative, collaborative

9. • Prevention and Wellness
• Objective Assessments
• Functional Training
• Improved Interventions
• Facilitate Adherence
• Distributed Care Delivery
Digital Health technology will significantly impact Medical Care

10. Every Medical Device Reinvented

11. Wearables, Hearables…

12. Digital systems are not just measuring the physical parameters of our health.
New methods are being developed that will allow us to collect and analyze
biomarkers that reflect our cognitive and emotional status.
Here are four examples…
Brain Health BioMarkers - Passive Data from Smart Phones
Voice Analytics as a BioMarker of Depression
Facial expressions in response to a VR Challenge
Cognitive function assessment using AR and smartphone sensors

13. Digital Health Platforms deliver interventions to patients, and
parse data for enhanced analysis and improved protocols

14. Emerging and
Confluent
Technologies

15. 5G connections will surpass one billion by 2023
Single-digit millisecond latencies with Edge Computing
Cloud-Rendered AR and VR content
Real-time Analytics for Machine Learning, Predictive Modeling

16. Machine Learning

17. Digital Twin Paradigm
For Precision Healthcare

18. Sensors Are Evolving, Connecting, Promulgating
Sensors 1.0
Sensors 3.0
Sensors 2.0
Measure and record
Integration with web;
Sharing and accessing data
Passive data gathering;
Aggregation and
meaningful interpretation

19. Ready or not…
The wearable tech, always
on, always online world
On the way - arriving soon.

20. Virtual Humans - Voice Recognition, Emotion Detection- Dynamic Response

21. Virtual Humans For Education, Training, Support
“Smart Avatar” with a virtual voice,
image and mannerisms via AI

23. THE LANDSCAPE
VR + AR + MR = XR
GAINING MOMENTUM
EVOLVING RAPIDLY

24. The Next Computer Platform
Work
Play
Educate
Socialize
Shop
Entertain
Communicate
Etc

25. Now is the time for VR & AR
XR technology is now affordable,
scalable and accessible
Facebook - Oculus
HP - Reverb Sony – PlayStation VR
Microsoft - HoloLens
HTC - Vive Apple -
Varjo HMD - 60 PPD for 20/20 vision resolution

26. Why use XR?
Uniquely Capable
Extension of existing virtual capabilities
Intuitive “spatial” language
natural interactions streamlines engagement
Deeply Personal
Learning content made meaningful through user’s interaction & feedback
Immersion enhances engagement, retention
Making experiences “personal” drives motivation to learn & keep learning
Highly Functional
Experimenting with systems & concepts to better understand
Applying learned concepts in practice
Can do things are otherwise expensive or impossible
-e.g. due to safety/cost

27. Fully immersed in an environment
Virtual Reality

28. Digital objects and overlays in the real world
Augmented Reality

29. The spectrum between AR & VR:
From blending ourselves with digital environments
to anchoring digital objects in the real world
Mixed Reality

32. 11.3
16.9
27.3
41.5
56.2
68.0
Year 2 Year 3 Year 4 Year 5 Year 6Year 1
Within 3 years, VR will likely be adopted by 30 million users
Within 6 years, XR will likely be adopted by 70 million users

33. XR Technologies
Currently Disrupting
Education & Training
Manufacturing
Maintenance
Product Design
Process Design
Healthcare
Simulation & Modeling

34. • Prevention and Wellness
• Objective Assessments
• Functional Training
• Improved Interventions
• Facilitate Adherence
• Distributed Care Delivery
VR and AR Technology Impacts All Sectors of HealthCare

35. Acute Pain
Addiction
Medicine ADHD
Anxiety
Management
Autism
Spectrum
Disorder
Chronic Pain
Cognitive
Assessments Depression
Disability
Solutions
Emergency
Medicine
Medical
Education
&Training
Ophthalmology
Orthopedics Palliative Care
Patient
Education Phobias PTSD
Physical
Medicine and
Rehabilitation
Preventive
Medicine
Respiratory
Medicine Senior Care Stroke & TBI
Surgical
Procedure
Planning
Surgical Skill
Training
Uncomfortable
Procedure
Mitigation
More Than 200 Emerging Medical VR/AR Companies
Targeting Multiple Clinical Sectors and Specific Indications

36. Significant Investment in XR for HealthCare
The Medical VR / AR Market is projected to be $5.1 B in 2025

37. The Neuroscience of How VR Promotes
Behavior Change
VR can promote behavior change by
taking advantage of the way our brain’s
learning and reward systems function
Activate neuroplastic change via reward systems
Shorten the reward feedback loop –
show progress
Leverage mirror neuron systems
VR systems can:

38. VR is More Effective than Imaginal or In Vivo Exposure Techniques
VR exposure floods the visual thalamus and cortex,
activating both subcortical, threat detection and
response pathways as well as cortical, conscious
pathways
In this manner, VR exposure therapy is more effective
than imaginal exposure therapy - it activates both
exposure/cognitive processes and threat extinction
processes.
In vivo exposure is inconvenient, expensive, time-
consuming, difficult to standardize, difficult to monitor,
and imposable to provide in a graduated or controlled
manner.
Sensory Inputs
Sensory thalamus -> amygdala path -> (non-conscious)
Sensory cortex -> PFCvm -> amygdala path (conscious)
HPA Axis

39. Ability to change attitudes and behavior after “being” one’s future self.
Leveraging Mirror Neurons

40. Addition Mechanisms of Impact
Active Involvement: XR systems provide users with
immersive experiences that maximize cognitive
engagement.
Feedback: learning is reinforced by direct, immediate
and relevant feedback that reinforces the experience
and the lessons learned.
Engaging and Motivating: the dynamic nature of
VR/AR systems provides users with agency and can
provide immediate rewards for progress.
Team Training: Multiuser experiences can provide
and leverage group skill building.
Cost Effective: XR systems extend the reach and
reduce the cost of face-to-face training.
Novels
Theater
Film
Games
AR/VR

41. Wired for Narrative Stories
Research shows that STORY:
• Provides superior retention
(memory and recall)
• Provides improved understanding
• Creates context and relevance
• Creates empathy
• Promotes engagement and participation
• Enhances the creation of meaning and
personal relevance

42. First general purpose
and commercially
available VR
systems.
VR Technology Has Evolved
1987

44. Academic research has indicated that Virtual Reality can effectively treat a
wide variety of clinical problems – ranging from addictions, to stroke, to PTSD

45. • Prevention and Wellness
• Objective Assessments
• Functional Training
• Improved Interventions
• Facilitate Adherence
• Distributed Care Delivery
VR and AR technology will significantly impact Medical Care

46. • Clinical Skill Training
• Surgical Skill Training
• Interpersonal Skill Training
• Use of Equipment and Tools
• Team Training - eg: Emergency
Department, Surgical Team
• Emergency Response Training
and Rehearsal
• Facilitate Empathy
Medical Training

47. Surgical Procedure Training

48. Anatomy and Physiology Training
• Response to the acute shortage of human
cadavers
• Allows for repetitive training and self-study
• More detailed examination of micro-
features of organs, tissue etc.
• Integration of text, video and other media
to further enhance learning

49. Virtual Patients for Clinical Skill Training

50. Preparation and Training for Difficult Situations

51. • Prevention and Wellness
• Objective Assessments
• Functional Training
• Improved Interventions
• Facilitate Adherence
• Distributed Care Delivery
VR and AR technology will significantly impact Medical Care

52. • Medical Image Review
• Neuropsychological
Assessments
• Activities of Daily Living
Assessments
• Physical Medicine – OT / PT
• Behavioral Medicine –
psychology, psychiatry
DIAGNOSTIC ASSESSMENTS

53. Standardized Environments for Neurocognitive Evaluation
New Approaches for Cognitive Assessment
Migrates traditional paper
and subjective evaluations
to a more sophisticated
level.
Provides robust
assessments that can
challenge cognitive skills in
a more natural,
standardized, objective and
reproducible manner.

55. BioMarkers - Cognitive and Emotional State
Collecting and analyzing psychophysiological responses in VR

56. Standardized Environments for Neurocognitive Evaluation
New Approaches for Cognitive Assessment

57. We use brain circuit biotypes to connect
brain imaging with VR
Neuroimaging measures
1. Scan brain at rest
2. Emotion regulation task
3. Cognitive control task
Virtual Reality:
1. Relaxing scene
2. Emotion regulation task
3. Cognitive control game

58. • Prevention and Wellness
• Objective Assessments
• Functional Training
• Improved Interventions
• Facilitate Adherence
• Distributed Care Delivery
VR and AR technology will significantly impact Medical Care

59. Some Examples – VR and AR in Use Today

60. Preoperative Planning & Image Guided Surgery

61. Stroke and Traumatic Brain Injury
Physical / Occupational Therapy
New Approaches to Physical Medicine & Rehabilitation

62. New Approaches to Mental Health

63. VR for Pain Distraction
Clinical Research and Validation
Interactive virtual environments significantly
reduce pain from as much as 44% during the
most painful procedures
(ex: burn wound treatment)
Diverts patient attention away from perceiving and feeling
pain; (selective attention theory)
Decreases pain-related brain-activity
Reduces need for anesthesia, opioid medication
No pharmacological side effects

64. PTSD, Phobias, Anxiety Disorders
• Exposure-based treatments can be conducted in the safety and comfort of an office setting
• Effective tools for treating a variety of clinical problems, in particular anxiety and addictive
disorders
• Fully immersive environments, with include the use of a head mounted display, 3D sound, tactile
stimulation via shaking platform, and olfactory stimulus are used for PTSD therapy

65. RISK AVOIDANCE TRAINING
Refusal skill training, Situational Confidence

66. ! Generalized Anxiety Disorder
! Phobias
! Obsessive Compulsive Disorder
! Anger Management
! Eating Disorders
! Schizophrenia
Virtual environments are used clinically to treat several
important mental and behavioral health problems

67. • Social Anxiety Disorder
• Depression
• Chronic Pain
• Mild Cognitive Impairment
• Autism Spectrum Disorder
• ADHD
Virtual environments are used clinically to treat several
important mental and behavioral health problems

68. Virtual Hospital Tours Used To Relieve Pre-procedure Anxiety

69. Senior Care

70. Multiple Programs - One Platform
DTx Programs
BALANCE Foundation
Mindfulness Relax Regulate
Chronic Pain
Acute
Pain Relief
Addiction
General Wellness Programs
Stress
+
Rx Adherence
+ Efficacy
Anxiety /
Depression
Acute + Chronic
Pain
Cloud-based System
Dynamic
Experience
Biometrics Service Social VR Engine*Analytics
Permissions &
Security

71. • Improve Cognitive Function
• Promote Exercise & Weight Management
• Stress Management
• Mood and Resilience
HEALTH AND WELLNESS
• Disability Solutions
• Addressing Isolation
• Grief Counseling

72. Ability to change attitudes and behavior after “being” one’s future self.
Have a Dialog With your Future Self

73. Portable Telemedicine Platform

74. XR Technology
Trends Impacting The Future

75. XR - A Key Component
Combination Therapy - Digital Health Platform
XR system designed to
enhance medication
efficacy
Medication with
clinical benefit
Prescribed
combination product
with enhanced
efficacy
=+

76. Digital Health Platforms deliver interventions to patients, and parse data for
enhanced analysis and improved protocols

77. A data stream for physicians to manage patients between visits
Includes specific
Rx compliance
tracking capabilities
Focus on issues
disease worsening,
new symptoms
Includes Alerts to
Care Team and
integrates at POC
Sensor Tech PatientApp Wearables
PATIENTS
PhysicianApp
PHYSICIAN
Office Visit Office Visit
Injection
issue
GI issue Relapse?Sleep issues Tingling,
weakness
Actionable, avoid
events, costs, ROI
path to payment

78. Pediatric Resuscitation Training
The CHLA residency program
and hospital use VR as part of a
required curriculum for interns -
required prior to setting foot in
the emergency department.

79. Acute Pain
Addiction
Medicine ADHD
Anxiety
Management
Autism
Spectrum
Disorder
Chronic Pain
Cognitive
Assessments Depression
Disability
Solutions
Emergency
Medicine
Medical
Education
&Training
Ophthalmology
Orthopedics Palliative Care
Patient
Education Phobias PTSD
Physical
Medicine and
Rehabilitation
Preventive
Medicine
Respiratory
Medicine Senior Care Stroke & TBI
Surgical
Procedure
Planning
Surgical Skill
Training
Uncomfortable
Procedure
Mitigation
Considerable Activity

80. Acute Pain
Addiction
Medicine ADHD
Anxiety
Management
Autism
Spectrum
Disorder
Chronic Pain
Cognitive
Assessments Depression
Disability
Solutions
Emergency
Medicine
Medical
Education
&Training
Ophthalmology
Orthopedics Palliative Care
Patient
Education Phobias PTSD
Physical
Medicine and
Rehabilitation
Preventive
Medicine
Respiratory
Medicine Senior Care Stroke & TBI
Surgical
Procedure
Planning
Surgical Skill
Training
Uncomfortable
Procedure
Mitigation
Relatively Underdeveloped – Significant Opportunities

81. Improved Assessments and Diagnostics
Addressing Isolation and Loneliness
Acute and Chronic Pain
Depression and Anxiety Disorders
Physical and NeuroRehabilitation
Design for Disabilities
Post-Discharge Follow-up
Staff Training: not just procedures, but empathy
Digital Therapeutics for Senior Care

82. The Impact of Covid-19 on XR Markets
Education
Training
Manufacturing
Maintenance
Product Design
Process Design
Healthcare
Simulation & Modeling
Location Based Entertainment
Gaming

83. Covid-19 - The Impact on XR Technologies and Applications
XR Systems are poised to dramatically impact several vertical markets
Regulatory and conceptual barriers are dropping
The need to address Covid-19 is accelerating the process
Investments and deployments are continuing
Remote work and Telemedicine is gaining acceptance
Increased focus on Mental Healthcare
Migration from LBE to Healthcare
Of course, provisions for disinfection are critical

84. Kills 99.99% of viruses, bacteria and fungi, supported by
independent lab testing
❖ Utilizes medical grade UV-C light in an LED, eliminating
the need for heat, moisture or toxins in the
decontamination process
❖ Multi-functionality can include storage, locking,
charging and credit card access capabilities
❖ Can be used for any size hardware or products
including HMDs, production/broadcaster headsets,
earphones, tablets and cell phones
❖ Can be used for other products used on the face, such
as sunglasses and eyewear.
❖ 100% Made in the USA—No supply chain constraints or
dependencies.

85. In Summary

86. Current technologies and concepts are
founded on more than 30 years of research
and development
Recent changes in cost and access make
VR/AR technology affordable
VR and AR Technology Impacts All Sectors of HealthCare
After years of study and use by early adopters –
validated systems are poised to move to the mainstream
On the horizon - enhanced, ubiquitous, informative and integrated
VR/AR systems are currently used for -
prevention, evaluation, treatment, and chronic disease
management

87. International Virtual Reality Health Association
IVRHA.org

88. Walter Greenleaf PhD
Virtual Reality Technology, Machine Learning, Biosensing
Converging to Transform Healthcare