Virtually Endless

Gabby* wasn't sure about the headset. Gaming wasn't her thing. Her cerebral palsy left her without the hand dexterity to use a controller well, which could quickly turn a fun thing frustrating.

The Extended Reality team had a solution for that.

"Some of our virtual reality headsets have controls that work by movement instead of buttons," says Joe Albietz, MD, Medical Director of Child Life. "They can just use their arms and shoulders, and she just went to town. Her dad leaned over like, 'I've never seen her do that before.'"

Gabby's physical therapist had been trying for months to get her to do a movement that required her to reach with her hands and raise her head. It would improve her dexterity and range of motion. Gabby had more or less given up on it. By happenstance, though, the game required that exact movement - and Gabby was going for it.

It was a lightbulb moment for Gabby. For the Extended Reality team, it opened a potential new door. But it was far from the first door they'd seen a game open.

How virtual reality applies to healthcare

"We're already using virtual and extended reality technologies as a tool for procedural support," says pediatric anesthesiologist James Thomas, MD. "Basically as anxiety reduction or distraction during mild to moderately painful procedures."

For example, some cancer patients need a procedure called a lumbar puncture, where medicine is injected into the spinal fluid. It's moderately painful. Most adults get it awake, but because it can be distressing for children, patients at Children's Colorado almost always get it asleep.

But going under anesthesia isn't easy. Patients fast for eight hours beforehand, and the anesthesia requires more prep time and staff than the lumbar puncture itself. With the recovery time afterward, a 20-minute procedure can eat up a whole day.

Using virtual reality as a calming distraction, several patients are now getting lumbar punctures awake. Every one of them has been enthusiastic about it so far.

Augmented reality as best of both worlds

In the Burn and Trauma Center, child life specialists are using augmented reality to help patients get through painful dressing changes.

"Instead of completely immersing the patient in virtual reality, augmented reality overlays some game or visual image over the environment," says child life specialist Jenny Staab, CCLS. "They can still see the dressing being changed, but while they're interacting with a robot coming out of a wall or something. So they can still develop some mastery over that experience because they're still present."

The possibilities are virtually endless. Extended reality, or XR, serves as distraction during anxiety-inducing procedures like needle sticks or mask inductions before surgery. It will soon help prepare kids for potentially unnerving ones, like MRI (and help them hold still for it, too). It helps kids stuck in hospital rooms get out and explore, even when they can't.

Harnessing the power of gaming players

Through tech-intensive offerings like Seacrest Studios, Children's Colorado's in-house radio and TV channel, innovators like Child Life Director Carla Oliver and studio manager Chris Coleman have long cultivated partnerships with industry players. One important partner: Child's Play, a charity specifically dedicated to bringing gaming tech into pediatric hospitals.

"We actually get access to a lot of headsets or gaming technology that isn't even on the market," says Staab. "It's exciting, but the reality was that a lot of us didn't know how to use it."

"So we started looking at our resources," says Dr. Albietz. "What would it take to use this well?"

That line of inquiry led to a new request for Child's Play.

"We told them we needed a full-time position," Oliver recalls. "They said, 'Well, write a grant. We'll see what happens.' In the end they gave us everything we asked for, and the next year they funded two more positions - a medical director and a research coordinator."

Hospital gaming and technology specialists

The first grant led to Abe Homer, one of about eight full-time, dedicated hospital Gaming and Technology Specialists in the world.

"I basically play video games with kids for a living," he says. "It's pretty cool."

That entails a good chunk of time spent partnering with child life specialists to support kids through procedures using XR. And slowly, he's training the child life team to apply it themselves, expanding it to a wider segment of patients, and broader applications.

He also works with game developers and industry partners to adapt games for hospital use. Already, games with specific medical applications are rolling out.

For example, says Dr. Thomas, "If you've ever been in virtual reality, you know it's oriented on a horizontal axis. If I lay down, now I'm just looking at the ceiling of a virtual reality experience. So we've been working with one company to make games where, if a patient has to bend over or lie on their side, we can just push a button and reorient. And we've seen that that works - the mind can just automatically adapt to experiencing it that way."

Virtual reality beyond the hospital

A few months ago, a robot learned how to make a duct tape wallet in the atrium with its mom. Then it caught a book at Judson's Club, a regular patient-led show at Seacrest Studios. Then it went back up to its room.

The robot was in fact operated by 8-year-old Maliq*. While he lacked the mobility to leave his room, thanks to one of Children's Colorado's three robots and a virtual reality headset, he still got to get out and explore.

Virtual reality will one day help many kids like Maliq learn and play, even within the confines of a hospital bed. For many more, the tech will come to them. Homer is setting up traveling spaces called "maker carts" at several Children's Colorado locations across the state to train the next generation of developers: his patients.

"A lot of kids here wouldn't have any way to access this kind of technology," he says. "We're getting this holographic display thing that hasn't even started shipping, where you can do a 3D design on a computer, then see it as a 3D holograph, then bounce it from there to a 3D printer and actually make it.

"These spaces are designed to help patients learn how to do that kind of stuff and build the confidence to say, 'Hey, I can be an engineer, I can be a game developer.' That's inspiring beyond their experience here at the hospital, and we're bringing it to them. I don't know of any other children's hospitals doing that."

"We could use this to put a kid in a classroom, with their own class," says Dr. Thomas. "The other students might see them as a hologram, and they're right there hearing the lesson. We could let potential patients do a virtual hospital tour. We could let kids in the hospital tour somewhere else. A kid could tour the Grand Canyon with sibling while they're here. You know, it's like, 'What was your hospital experience like?' 'Well, I got poked, I got prodded, I had to breathe into a mask, and then me and my brother got to tour the Grand Canyon.'"

"It's funny," adds Homer. "After a minute, you really forget this stuff isn't 'real.' You're there. And you remember it that way."

"It's crazy," says Dr. Thomas. "It changes the whole hospital experience."

* Names and medical details changed to protect patient privacy.