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#19 Digital Research, Training and Improving Patient Outcomes Using Virtual Reality

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Virti Team
July 16, 2020

Description

This week's guest is Dr Brandon Birckhead, MD, who is a project scientist working on VR clinical trials at Cedars-Sinai. He is currently running the Digital Pain Reduction Kit study which is assessing the use of virtual reality therapy in those with musculoskeletal injury. This will be one of the largest randomized control trials within VR pain reduction research. He is also the co-director of the Virtual Medicine Conference along with Dr. Brennan Spiegel the founder of the event. One of the largest immersive technology conferences focused specifically on its use in healthcare.
In VR education, Brandon has collaborated with radiation oncologists at Moffitt Cancer Center to assess its use in medical education. While at the Medical College of Wisconsin he designed a VR breast cancer education program to help patients understand radiation treatment and why it is of use for their cancer. He then designed a pilot study which has garnered 40K of funding from the NCI.
Alex and Brandon discuss how technology can be used to improve patient performance and outcomes in healthcare, how remote tools including immersive technology are essential post-COVID and the importance of remote training and education.


https://www.virtualmedicine.health/
https://twitter.com/bjbirckhead
https://www.linkedin.com/in/brandon-b-b6749a40/


Tweet Virti: @virtimed
Contact Virti: https://virti.com

 

Transcript

Brandon Birckhead:

Hi, Alex. Good to see you. Good to hear you again.

Alex (Host):

The last time we caught up was in sunny Los Angeles at Cedar-Sinai hospital. So I'm already missing being out in Los Angeles, but I mean we connected obviously when we were doing some work at Verti with Cedar-Sinai Medical Center and it'd be great for you just to explain what your role is there and your background and your particular interest in virtual reality.

Brandon Birckhead:

Great. Yeah, so for my intro within Cedars, I'm a product scientist who almost exclusively works on virtual reality clinical trials, particularly virtual reality therapy clinical trials, and helping out other individuals within the institution with their clinical trials or advising those, but mostly focusing in at home-based VR pain reduction, which I'll dig in deeper into one of our topics what that includes. For my background, I went to medical school at Mayo Clinic. Kind of maybe backtracking a bit before that ever since probably undergrad, very interested in sciences, helping people continue to learn. So for me it kind of was an overall interest in technology in healthcare led me to med school.

Brandon Birckhead:

I initially did some training and transitioned into part of radiation oncology residency, but all along the way, ever since 2015 when the Oculus quest kind of really hit the map, I started digging deeper, deeper into VR itself, but then also VR for medical research and help design a few studies while I was a resident and continue to work with groups across the US remotely via online through a committee that I actually met Dr. Brennan Spiegel through this online community group called VRA-RA and through that found an opportunity to then take this on as a full time position and so over the last two and a half years, and pretty much full time working on clinical trials, but then also another area that we've talked about in a little bit is Virtual Medicine Conference. This is another thing that Dr. Brennan Spiegel founded, created, and then has been evolving with the times, particularly with the times of the COVID era that we're in and so we can chat a little bit about that as well and yeah, that's pretty much me in a nutshell.

Alex (Host):

And I always find it fascinating when anyone from, I suppose, what is termed the kind of immersive or VR community talks about their backstory and what really interested them. I mean, my personal journey was obviously... I was a surgeon, but I was also quite a big gamer and I was always fascinated about how you could basically replicate real life as well as making things fun in the education space. Specifically about I guess VR, what was one of the things that really drew you in initially when you saw it?

Brandon Birckhead:

Yeah, that's a fantastic point and it's always... For me, it feels like a lot of people have their first experience is what... Really the first feeling of having that sense of presence being immersed in a virtual world is kind of an Aha! moment. So mine was, we had the Oculus-dev-kit and we pulled up a demo from Oculus. In the demo there was a T-Rex in it at the end of the hall, and I just remember looking at it and thinking, "Wow, that's a really..." They did a great job with this T-Rex and of course, it's... You know, the graphics side of it and the lighting of it, but what was interesting is as the T-Rex is coming down a hallway, my whole objective thought process of how well they did, went from like objectively this is very beautifully done, so "Oh, wow. A T-Rex is about to come at me and like eat me." And so when it comes down to bite, I like... I won't lie. I got into a fetal position because it was my first time ever being this immersed and I even felt a sense of breath on my neck and that even momentary synesthesia, change in senses that I actually manifested that the T-Rex could be breathing on me.

Brandon Birckhead:

That wasn't created CGI generated, that was my mind making that and what I felt was interesting in that moment, although startles are very reflexive. So it's not even necessarily like a deeper thought it is reflexive. It also meant that I felt a certain way and I didn't have maybe total complete control to have that thought. That thought was brought to me in this immersive world and so that thought of an electronic environment, being able to kind of short circuit or create a behavior or an idea, that's what has stuck with me since that day and there's things I've seen at other labs and things that we've looked at that VR could be a way, just from the evolution of the brain and how it was developed, that we can create and give patients kind of a behavioral modification tool that is better than any other medium in some situations and so that is what led to the chase for immersion for therapeutic intent.

Alex (Host):

And for you personally, on the research side had you always been interested in, I suppose the technology side of research, or are you more interested in the medical aspects and the outcomes of what was happening with patients?

Brandon Birckhead:

That's a great question. I think too it's been... I have to admit my own internal driver in the sense that I've always been interested... The outcome that I'm interested in are always clinical outcomes, but I would say that what drives the motivation is the excitement for technology. So even radiation oncology why I loved it was that you could hone in on a piece of technology that had such great outcomes and just continue to evolve and adapt over time and that became a vehicle, amuse or a canvas to create a great outcome for patients. I would say that I'm somewhat technology at least motivated, but always interested in the outcome for the patient. That means I do always have to... What I always do is for any one study, we make sure that we have someone who is kind of an expert and champion for a specific disease or outcome patient population and then I come in or we come in with our group at least with the focus on what can the technology do at this time and who do I know in the field that's doing something related to that, or that could fix that problem and so kind of bringing those two together.

Alex (Host):

I mean, we... Obviously on this podcast, we talk about things in terms of human performance and we've had people with sports backgrounds, obviously medical backgrounds, military backgrounds, lots of different things but one thing where human performance also applies is obviously to patients and performance that is often on things like patient related outcome measures and how they can effectively be managed in hospital and how they can improve their condition and their health. What... Just as a sort of I guess, an initial top level, because we'll dive into a couple of these, what are some of the ways that you've seen virtual reality really have an impact in the patient populations you've been researching?

Brandon Birckhead:

I would say that for patients there's multiple layers to it and I would say, let's say we were talking about a new VR program. In the beginning the first layer of questions that are asked are very much about at the very least did you enjoy it? You know, satisfaction, patient, tolerability, but you know that's a very minor... You know, considering the times around the technology and how well it's being made and developed, tolerability is pretty great, but there is, I would say satisfaction first and overall high satisfaction. For most patients there is some tailoring that is needing to be done over time to tailor product towards a patient's preference, but I would say satisfaction first then the next outcome is... And this is definitely where it gets challenging, is what is that best? And so I worked mostly on pain reduction. What's the best pain outcome to assess?

Brandon Birckhead:

I definitely think pain intensity has been shown enough randomized control trials that we'll probably see on average if you're going to do a randomized study, it's probably going to be... I'll predict about 22% reduction on average and then if it's unrandomized or uncontrolled, sometimes it can be as high as 50% reduction, but probably in the end, it'll end up being with randomized trials probably a 20 to 25% reduction in pain/intensity. The next question is what about the effect on work? I think that most groups are moving towards the impact of VR on people's either psychological components that affect pain. So there are... There's how you feel, but then also does it interfere with things like sleep and actually we've seen a ton of great results just initially I've published yet a lot of great qualitative feedback from patients on effect from improving sleep, which is when you improve sleep, you can also improve patient's life overall, so quality of life via that metrics would probably going to look a lot more towards sleep and then probably the next thing is their outcomes themselves, are they improving? Do they need less?

Brandon Birckhead:

So probably opioids and reducing opioids because of the opioid epidemic. So those types of outcomes, that's always... It's an area of interest. We usually have that as a secondary outcome. It's just, I think it's challenging because how we look at VR, we give it to the patient, they use it when they feel they need to use it. We recommend they use it once a day to kind of ritualize or have a time where they can kind of reset if you will and we think that that's a good way to go about it, but again because we're giving it to the patient in their life. I think that asking about opiates and reducing those it's... Well, there's multiple other factors about how they're using the opiates and then how they're using the VR headset and where they are in their state and their evolution of their pain and also their opiod use.

Brandon Birckhead:

So I think that we'll always assess that, but I don't know if that's a primary outcome at this time and then I think that if you're doing procedural pain, it's just so cute. It's so controlled. I think opioids is definitely highly focused right now and there are studies showing the reduction opioids when using VR for those types of acute situations and that's definitely an area of interest. So I would say those things within the pain reduction world of VR.

Alex (Host):

And I think it's fair to say certainly a lot of the research for this and you know, got to give credit to both of you and Dr. Brennan Spiegel, who you mentioned earlier for really sort of pushing this forward and having a Cedar-Sinai Medical Center as kind of a bastion of virtual reality research both in the patient space and outside. When you, I suppose joined the sort of VR research team, how difficult was it I suppose to persuade people, whether this was research institutions or funders that this was actually something worth testing and looking out on the patient population?

Brandon Birckhead:

That is a great point. That's a great question. So I would say four years ago, before I joined the lab, I was trying to get different hospitals to get interested in it and I was kind of the [inaudible 00:13:00], to get these different hospitals interested. Again, as a resident you're not a very highly ranked person in hierarchy of healthcare. I would say that it was very challenging in the beginnings 2015, 2016. I think that in those days, what I knew of from this lab is that a lot of the research is more so industries funded. So you know, different industry partners, such as Samsung whatnot, interested in getting results on their type of equipment. We had Samsung Gear VR for a long period of time for the majority of patients that we treated.

Brandon Birckhead:

I think in those days was mostly industry and even the FDA back then, I remember calling them and asking them about if we... Will this be FDA regulated? And first time I called they said, "Are you talking about video games?" [crosstalk 00:13:46], when I was on the call with them. The second time I called it was about a year later and this was three years ago and they said, "Well, yeah. We'll look into that. Yeah, we'll probably look into that, but it is still an entertainment device, you know?" And then... So I would say the last two years there have been a shift. So the first NIH sponsored VR clinical trial that was randomized large R-01 level was the... R-01 level grant happened in 2000... End of 2018 and definitely 2019 and then we've gotten this grant in 2019 for backpack, which is lower back pain and that would be also one of the largest for government funding. So there's lots of government NIH interests.

Brandon Birckhead:

There's NCI, National Cancer Institute, National Institutes of Health, both these are US government agencies. We have lots more interest from the government funding side, which is always great, but those are going to be a long [inaudible 00:14:46], studies that you need to answer some of the hardest questions and so it's not just industry funding anymore and then post COVID if you're home-based VR, there is a ton of interest in having something to use to help support the patients who aren't going to be coming out, who are afraid to come out from their home that needs some type of outlet, need support and we need to increase remote care in all ways possible from all different technologies and so I think that there's a ton of interest there. I do feel from people that were mostly on inpatient units.

Brandon Birckhead:

I just think for the time being it's going to be hard for them to restart their studies, but then also to get funding, but there is definitely an even higher increase than what I've seen naturally for the last few years. Of course, the FDA has a mixed reality panel and they're interested in focusing in on virtual reality now. So it's been a great last four years of progress, particularly in the last two years, particularly in the last year. So I think it's overall just a lot of natural developments and evolutions with the funding side of things.

Alex (Host):

Well, I was going to say you know, from my perspective as sort of I guess, an outsider to some of the deeper patient research you are doing, it was amazing just seeing the accomplishment of getting the FDA panel together and making it sort of an important thing that they were talking about because I mean, I guess for anyone listening, who is not from a medical background or not from a research background is very challenging dealing with some of these organizations where the regulatory and they look at compliance and you've got to do firstly, a lot of research, but secondly a lot of almost like lobbying behind the scenes just to get people understanding the benefits of... and you know, yourself and Brennan have done a fantastic job with that and I think it is really, really going to benefit patients certainly in the long term if not already.

Brandon Birckhead:

Definitely, definitely. There's also interesting billable codes. So Dr. Brennan Spiegel has gone and spoken with panels from CMS related to... This would be a billable code for a physician to provide a consult. So for us, we would go see patients or we are called from our colleagues at Cedars to go see if VR would be a use for them. These are a lot of patients that have no options for pain reduction and need to have some type of non-drug base intervention and so just like any consult, those can last up to 45 minutes to an hour and so you know a billable code for that would be quite helpful. So they're already thinking about that even before an FDA approved kind of program is out, even though we know that there's definitely startups that are going that route with FDA approval for their product and so those will probably come in tandem and so I do feel good that once something's FDA approved it, that the reimbursement codes probably will come kind of a full set of re... You know, a full set or... You know, both the consult holding and the code for the product itself will probably come in tandem within some time period after that. So we'll see. I mean, it's very exciting.

Alex (Host):

And just I guess to emphasize the point especially on pain reduction and pain relief and one thing you sort of mentioned was obviously the opioid problem and epidemic and I think just for again anyone listening, who might not be necessarily aware of that, that is a huge problem globally. I think one of the stats I've got written down is the thinking in 2018, around about 70% of around six 68,000 deaths involved an opioid in the United States and it's just because the medication itself is addictive and because it's often the only relief that people have for chronic pain and it also gets prescribed in the acute setting as well, which people then potentially go on to continue to use when they're starting to get better. It's a massive sort of cost category and mortality risk and so anything really that can be done to reduce the need to prescribe opioids is going to have a massive, massive impact on patients globally.

Brandon Birckhead:

Absolutely, absolutely. And there's a lot of ways I've seen VR be used to help with that. So I would say pain reduction in what we do, the goal of that is if it shows continual use in multiple areas of clinical settings, the use of a non-opiate pain reduction can be used as a tool to help maybe decrease the total supply of opiates. So the people that end up addicted to opiates may not always be the people that are using the opiates. You know, sometimes it's grandma's opioids and somebody's having some at the house or it can be the person that has the opiates and just has so many after so long that they go into a cycle of starting to have some symptoms of addiction. So I would say, pain reduction VR is for decrease in the overall supply in the population. Now that's decreasing in general because there is a lot of focus on this from the provider side.

Brandon Birckhead:

So they're not prescribing often or the transition patients to a pain specialist to help with that type of tapering process or management process and then I would say the biggest thing that actually I've seen from studies is also education. So in your area of education... You know, a lot of studies have been shown that this wasn't with VR, but just educating patients deeply about all the side effects and all the complications that can have actually some of the biggest impacts on randomized studies for patients to decrease their own use of opiates and safer turn of opioids they don't use and then for the patients we already have, because there's a huge... There's millions of patients that are already addicted. You know, what do we do for them? I have some colleagues in psychiatry and psychology that are doing work with VR, and it's amazing. It's like the... One of them that I'm really excited about is... A friend of mine is starting a company to help patients anonymously using VR chats. Social VR platform where people can come in and completely anonymously because there's such a stigma with getting rehab, getting help.

Brandon Birckhead:

You can do it from your home, in your own and in the safety of your home as soon as you're feeling that you would like to make a change. That's a huge benefit for those patients. So I think that... I think there's a lot of hope and a lot of help that can be done with VR and I really do hope definitely by the time we get closer later on in our career that we've gotten past this pandemic of opiates, which has caused a real... So much pain in this country and around the world.

Alex (Host):

And going back to what you mentioned a little bit earlier around the COVID pandemic, the... And we've spoken about this in the past, but the ability to deliver therapy or education kind of remotely to patients, especially in the current times is incredibly important. For anyone who might not know about our space, how virtual reality can help both deliver home-based educational home-based therapy. Could you speak a little bit about that?

Brandon Birckhead:

Yeah, absolutely. So the use of VR at home is fantastic. Really anything in home because that's the beauty of a patient's life you know. This is something that Dr. Brennan Spiegel has talked about in a lot of his lectures. You know, more than 99%... 99% of our life is spent outside in the home and so making sure that we can help people in their home, whether we are in COVID or not is definitely an area of interest and it does have its own set of challenges, but the great thing about the home is that... What VR could do in the home is that... Reason why the home is challenging is that you have your whole life going with you when you're at home, when you're inside the office you are there for that dedicated time and there's a lot of help that can be done in that moment, but when we get back home, there's all types of things, family job, in this case a pandemic. There's all types of stresses out there.

Brandon Birckhead:

So integrating something with your life. Now we're talking about life and integrating something with your life. Something like the smartphone, which is integrated seamlessly now given all the things that can do for you. So I would say the thing with VR is it creates such a novel experience for people, and it provides such a way to garner someone's attention, even in a chaotic home or home with lots of things going on that might take away so much for bandwidth. When you put the headset on that can help you focus in on something, let's say it's educational module, or even an immersive distraction therapy or immersive education, but use therapeutic content that even if you have a busy home, you can gain that support. You know, if you were to do a video-video visit with a provider as you have four kids running around you that can somewhat get interrupted.

Brandon Birckhead:

So I think that what's unique about VR is that it can be asynchronous if... Although that's harder on the technology. So it doesn't have to be with the provider if you have something that's a supportive tool, educational package, or therapeutic package all to itself, and then it can be remote and done at any time and also in isolation, even within a room, you are now in your own world in the headset. So I think that those things make it advantageous. The challenges are still present and I think anyone who has done at home studies knows that the on-boarding process is harder in the sense that you are now distanced.

Brandon Birckhead:

You are not next to that patient helping them with that on-boarding process, but truthfully if people have had experiences, which actually in the LA area, a large portion population has heard of VR, even larger portion of population, even elderly populations have used smartphones to a significant degree and I think once they get so comfortable with smartphones... Any population which is pretty comfortable with smartphones is pretty comfortable with... Can be pretty comfortable with VR. So I think as long as we keep improving our on-boarding process, I think that at home use is a win. We just have to continue to innovate and continue to improve our implementation process and the science of implementation of technology at home and we'll continue to try to improve patients' lives in more impactful way or with multiple touch points with less friction.

Alex (Host):

And that ability of a virtual reality headset to really transport anybody, whether it's a patient or whether it's an employee or anybody into a completely different environment. That's one of the things that I find really, really interesting because when it's deployed for things like, whether it's pain relief or especially things like mental health and mindfulness, or anxiety or depression types of virtual reality coaching, that's where as you say, whether you are at home and you are a patient who can no longer go outside because of COVID or maybe even without the current pandemic, you are just stuck in at home because of poor mobility.

Alex (Host):

You could potentially put a headset on and be transported to anywhere in the world and there's a bunch of companies doing that to help people in isolated environments and equally actually for the workforce, especially the healthcare workforce, there's a lot of work being done around effectively using headsets a little bit like Google use their sleep pods, such that employees can grab a quick sort of 10, 15 minutes of mindfulness or relaxation, but in what would normally be a reason to kind of like busy or in accessible area of their work environment. So that always fascinates me how you can... And you know, Dr. Brennan Spiegel talks about this a lot, how you've actually trick your mind into bypassing a lot of your I suppose, sensory pathways and parts of your nervous system when you convince your brain that you are completely somewhere else or engaged in something in VR.

Brandon Birckhead:

Absolutely. And I think that that's a very thing about it, and I think that's what's... What's interesting with what you do with education makes sense from a lot of the research that's out there, how this can be used to garner one's attention, and that's so key for learning anything. I think the problem with society right now is that we're... Like you said, we both had to turn our notifications off or turn them down during this meeting to try to keep that bandwidth and our world is starved for bandwidth because of how much notifications we get and so I think VR is a great tool right now, I guess, until we get maybe into an augmented reality world and then we have messages flying into our periphery, but until then it's used as a very... You know, for lots of knowledge in a short period of time, and that can happen.

Brandon Birckhead:

Relatively easily patients have contraction of time when you're immersed. You don't know how long they're actually in there and you can garner a fair amount when done right with high quality... Video with high quality content and so... So yeah, I'm curious, I don't know if your guests can ask you questions, but a question to you post COVID with learning on the job training to get ready for this COVID era and all the equipment that needs to be taught with that. Could you talk a little bit about, how did you ramp up for this type of ability and the success you've had with getting this out there to providers during this era and how is it different from maybe in your past product? I know you've had a lot of success of course pre COVID, but how have you been able to help out some many?

Alex (Host):

Yeah and definitely well, thank you for asking me a question and putting me on the spot. So yeah. I mean, I think it's been very interesting because one of the aspects that we always talked about pre COVID with the purpose of our company Verti was how do you scale experiential on the job training and learning? And for me obviously, when I was training, it was always difficult actually to access repeatable on demand experiential learning environments and when I was doing surgery that might be getting access to a particular surgeon or trainer and learning from them because it can be quite serendipitous any type of on the job training, such that if you go into any work environment, doesn't have to be healthcare, but on one day of the week or one time or one geographical location, you might receive a very, very different learning or training experience than someone else who has your exact same intelligence, exact same demographic, whatever and that just led to sort of inequity of access basically to quality learning and also the process was defacto pretty slow because... And again, I apologize using surgery, that's what my background was in.

Brandon Birckhead:

For sure. Yeah.

Alex (Host):

You know the old adage was, it's an apprenticeship type model of trainings, such that you go and work with a master surgeon and you get your hours and hours and hours of repeated competence in and then you're deemed to be kind of proficient if you've done X number of operations or something like that and because of sort of working time adjustments both in the US for residents and even more so in Europe where they reduced the working time down to 48 hours, it meant that they tried to switch everything over to a much more kind of data-driven competence and capabilities sort of assessments.

Alex (Host):

So my just really basic idea when we were first thinking about solving this big problem was how do you just transport people into these environments on demand? And then the followup to that was also how'd you get unique data and it kind of goes back to what we were talking about earlier, which was how do you basically trick someone's brain such that they perform what they would do in the real world, or be it in a virtual kind of assessment environment? Because the problem with things like E-learning or video based learning, or even face to face learning, particularly fitting role play and the actors are pretty bad as I'm sure [crosstalk 00:01:58] training.

Alex (Host):

You know, a lot of that you've got to suspend your disbelief and you don't always get the kind of best data and then with stuff like haptics and spatial tracking of where people's hand movements are and things like that, or where the eyes are looking, you can pull out data that's just unique really to sort of virtual training and so I guess fast forward to what happened with COVID when everything suddenly became impossible to do face to face training, partly because a lot of staff were being advised that they were no longer essential or that they shouldn't go into the simulation centers or do face to face training, but there was still a huge demand because you were having members of staff particularly in health care, who needed to learn new skills, like how to put on protective equipment or how to do other things.

Alex (Host):

So I suppose a little bit for us like telemedicine, we were seeing what we were really advocating and we were having success with previously suddenly comes to the front of people's minds across a number of different industries, how do you train people remotely? And for us we do virtual reality, but we also... Our system also works across augmented reality on mobile and desktop. So we were quite uniquely positioned to then actually look at the problems facing some of these big organizations with their remote training, and then see how we could basically quickly up-skill them and work with them to solve some of their problems and so yeah, for us we thought we had really help where then it was great that we were able to do so and continue to be able to do so.

Alex (Host):

One thing I was just going to actually ask you in a similar vein is going right to the top of the conversation. Obviously your main interest is research. Now we're doing research kind of all over the place and a lot of ours has been sort of shut down or postponed until like later on this year or next year. I was just wondering if you could sort of give a little bit of insight into what you've seen happen there and equally how you think virtual reality and sort of remote capabilities can help deliver research in these types of environments.

Brandon Birckhead:

Yeah. So I guess... So how it can be done virtually is that essentially the tips I've given people is to probably for one get really comfortable with FedEx and learn how you're going to implement your technology or deliver your technology literally to the patient. Figure out what onboarding tools you're going to use. I think the Zoom call is great, but it's actually something we haven't implemented yet. We've mostly been doing phone calls and phone calls have worked well for us, but usually your first phone call could be up to an hour. Sometimes it's little as 30 minutes and that could be even maybe less, a little less, maybe 25 minutes for your consent phone call and then another 25, 30 to 45 minutes for your onboarding call with the actual device once it's at the patient's home. So I think it's a couple of phone calls or couple of Zoom calls and I think providing those patients with as many different types of tools to help them understand the device quickly. So videos that are sent to them via email or pamphlets, or combination of the two. Anything and everything that might fit for them so they're prepared for once that box gets to their home.

Brandon Birckhead:

I think that the use of web based survey tools is key. So patient [inaudible 00:35:17], comes... All the different programs... I've definitely had some frustrations with patient [inaudible 00:35:23], outcome survey programs. I just think that... You know, we all... Most of the academics use red tap. It works, it's customizable, but it definitely has its limitations, but it is what most academics use. There's a lot of other ones that work. You can also do wearable data to collect data, particularly if you're interested in wearable activities such as our case [inaudible 00:35:45], and then just physical activity, but I would say, let's say if I was to go... Because I know for education, many times that's done in the same center just the assessment part of it and so some centers and all of the places in the healthcare world are kind of going to a lower point of use or just focusing most of their use in clinical use.

Brandon Birckhead:

So if I was to do a remote education study, I would bring those same skill sets over in a sense that I would probably figure out the list of all the students. They would get headsets to their home. They would do all their surveys and assessments via their home computers, which they already have. You know, we don't have to worry about cleaning those down and then the big tip I would have for researchers is just have enough headsets for everyone to kind of cover in the sense that... You know, people keep asking about what's the COVID cleaning process?

Brandon Birckhead:

We have added additional layers for cleaning equipment, but the biggest thing for me is, yes, you wipe it down with Sani wipes like you maybe did before. If you had a wipe down type of procedure with something that could sterilize the device or sanitize the device and then we would also do UV. We have UV machine specifically for VR, but then above and beyond that is the correspondence that we... There's a publication that has come out and a few have come out since then on how long does COVID stay on any substance or material and most are averaging kind of logarithmically the loss of that virus within about five days. So for us, we have enough VR headsets that I can be certain that any one of our headsets has been in our office are cleaned and prepped for over a week and so I think that that's probably a good idea for any type of research that's in the COVID era, just to keep everyone at ease. That this might be the only person using this device ever, or the only person using this device and then providing them the full description of how it was cleaned.

Brandon Birckhead:

So I think it can definitely be done and it can even be done for educators because anyone in any part of the training has to sleep and go home. So if they need to do some of their education at home instead of the same center, it seems natural that there is some decentralization there just as there's some... You know, moving [inaudible 00:37:53], home for the patient, there's moving things at home for the providers as well as they are training.

Alex (Host):

And with I guess, your research knowledge and seeing virtual reality develop, where do you think things are going to go next? What are you sort of most excited to see from the technology side of things?

Brandon Birckhead:

Oh yeah. So I do feel... I remember... Some of the viewers may know this, some of the viewers don't, but so Oculus is one of the big providers of VR. At least consumer based VR. There's... Pico has definitely been a bigger one for industry and enterprise as of now also HTC Vive and the other ones, but... So Oculus recently stopped with their Three degrees of freedom headset. So the Oculus Go. And there've been focusing much more on Six degrees of freedom. So I think six degrees of freedom headsets has a lot of interesting areas for therapy in the sense that... So the difference between three degrees and six degrees is essentially that with six degrees I can move around the computer that this headset has, understands my environment where it is in space and so you can move with it, but along with that you also can feel embodied, you can have an avatar and I think in the future, I'm very excited and have been for years now, the idea of having an avatar.

Brandon Birckhead:

There's so much psychological impact benefit to that level of immersion from a mental health standpoint and the different programs that can be created for that embodied therapy will be a whole new level of potency, a whole new level of different kinds of indications that will be used for that. I think that six degree freedoms also comes with... Because there's tracking, you can have your hands. Use your hands instead of remote. I think remotes have worked. I think the challenge with remotes have been that some people... Literally it's like batteries. There's some practical issues with remotes that I have had with our patients and I'm interested to kind of go from that, just have a headset then feeling natural to use hands at some point.

Brandon Birckhead:

So I think some intuitive streamlining of the product and making it more intuitive for patients I'm excited for. I think I'm excited for also the new types of higher potency programs can be created when you have a six-DoF headset and maybe some other peripherals that'll be needed in the future and so yeah. Definitely an exciting time has move towards six-DoF and then even more interesting is these new headsets that are glasses and having it be that easy because I've had patients that... You know, the weight of the device, particularly if we talk about the Oculus Quest, it does have some weight to it. It doesn't have a counterbalance.

Brandon Birckhead:

Picos do have some counterbalances because they changed the battery to the back and that's been quite helpful for patients cause they... We have neck problems, they have way more neck pain than we do if we're talking about a chronic pain patient. So I think the weight distribution, the intuitive controls and inputs with hand and six-DoF. I think the future looks very bright for an increase again in the amount of uses that VR can have, and then the amount of patients that can feel comfortable with the device.

Alex (Host):

And I mean, you've obviously done a huge, huge amount to further virtual reality and immersive technology as a whole in the healthcare sector. I think one of the most impressive things that you've been involved with has been again with Dr. Brennan Spiegel setting up V-Med, which is probably one of the most well known conferences and events for virtual reality in health care. Unfortunately was delayed or [crosstalk 00:41:45], but then this year because of COVID, but it'd be great just getting your input on how you managed to kind of build that community and how that sort of helped further things.

Brandon Birckhead:

Yeah. It's been fantastic and all hats off and really impressed with what Dr.Brennan Spiegel was able to do. I remember when I first met him, I thought this was all just professionally done the first year with some outside event management system, but it's all done entirely with his research team and it's really through his kind of execution that it turns out to be one of the highest quality conferences I've ever seen and just the energy of it every year, feeling that energy in that room. You know, you get the feeling like this has happened. You know we're so early... We are early adopters in the cycle at which something's going to go mainstream is long and it will take time and there are several steps along the way for something to hit a mainstream society and yet we have these moments where we really can see a bit into the future about where things could go at getting screwed together, seeing how much work the whole world is putting into this technology, this field of therapeutic, but also immersive education and I think that each year what I've been impressed with is how much each year I see startups improve, make headway, reach more hospitals.

Brandon Birckhead:

So there's been a natural evolution each year and we did have to... You know, not doing in person conferences. This year we're really not sure maybe next year, next March if that will be a time for in person. So because of that, this year it's been a series of webinars, sponsored by one of our startup for each of the webinars and it'll be focused on different topics. Well, the great thing about vMed is that we really try our best to broaden out all the potential uses. All the way from schizophrenia to obesity, to depression, to anxiety, to pain, to education of multitude of different provider and sub specialties. It's quite varied and broad and so we'd like the webinar series to also reflect that and it can, and it will and so we've just had our first one that was on pain reduction and at home studies, as we've talked about in this podcast, but then also we were able to find through our colleague Kate Donovan, we had another colleague, Dr. Cogburn from Columbia, who does VR research for... Related to racism and that was fascinating.

Brandon Birckhead:

Absolutely fascinating some of the work that's going on there and, could be a real help and boost for implicit bias, but also for obvious external biases as well, and really helping people fill into someone else's shoe and have that empathy and path of view and lots of great things I learned just from our first webinar and we really much look forward to having future webinars on a multitude topics education, pediatrics, physical therapy, you name it and so that's what we'll probably be doing throughout the year over a couple of months at a time and then we look forward to the day when we can do conferences again, but we definitely know that that may not be next year, and I'm not sure when it will be specifically, but definitely when we can, we'd love to get the community together and by then, who knows what we'll be able to announce coming out of regulatory agencies or yeah. From different groups, about the health and state of the industry of this field.

Alex (Host):

And just to wrap things up, I mean, every week on the podcast we ask our guests to give a hero in human performance that they find amazing. Do you have any specific examples either from what you're doing about virtual reality or can be from any field you like?

Brandon Birckhead:

Any field? I think that those working in areas that relate to COVID-19, I think I very much commend those that are doing that because I think that there's so much going on and it's so hard to keep up and so I think that... You know, I'm really supportive of all the doctors that are working in that area. Within VR, I would say there's so many that are working hard to try to help out people get through this struggle and so it's hard to really pick. I guess I would say human performance you know... You know even Dr. Brennan Spiegel, he's a marathon runner, he does COVID related research and his VR research.

Brandon Birckhead:

I honestly, I don't know how to keep up with it all, but I definitely think that he... It's an incredibly commendable all that he can do and all that he does in a given day, but also throughout the year and I'm not a marathon runner, so I will have to give it to him on that, and he's boxer as well, but... So maybe I'll put him down as the hero and... But again, all the people that work on COVID related issues is just... I commend them. That's just a wave of infill they're having to keep up with and the millions of lives they're trying to help. My hats off to them.

Alex (Host):

Yeah. I second both of those choices. Both really, really great examples and obviously there's the vMed website, but where can people get hold of you on socials or follow the webinars as they are delivered?

Brandon Birckhead:

Absolutely. So my Twitter handle and my LinkedIn account is both... Let me just get my profile up, I believe it's a BJ and then Birckhead, so that's B-I-R-C-K-H-E-A-D. So BJ Birckhead, B-I-R-C-K-H-E-A-D. They just have to look me up and find me on Twitter or LinkedIn and I'll be happy to reach out and see if there's something we can collaborate on or help out. Yeah. Love to.

Alex (Host):

Awesome. Well, it's been an absolute pleasure catching up and chatting, and I think I'm equally very excited as to what certainly the VR research department at Cedars-Sinai Medical Center can do over the next six to nine months before hopefully we get the next vMed conference in person [crosstalk 00:48:29], exactly what you guys have been cooking up.

Brandon Birckhead:

Absolutely. And I'm interested also with the Virti, with what you guys have going on for education. I'm very interested to see about those results. Yeah, it seems exciting.

 

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