In any event we must not give false hopes

After training or video games, virtual reality is investing another domain: health. The growing number of medical conferences devoted to this technology is a good indicator of this trend. The last took place yesterday at the festival Laval Virtual, under the direction of Evelyne Klinger, responsible for the entity Handicaps and technological innovations of Arts et Métiers ParisTech. "Immersion in an artificial world allows some patients to address disability in a progressive manner, to better overcome," she explains. So far, the effectiveness of virtual therapies must be demonstrated by clinical studies, where the research current.

Started in the United States as early as the 1990s, the further work focuses on the treatment of phobias (fear of flying, the vacuum, the crowd...). The principle is the following: patients, equipped with a head mounted display, wandering in virtual worlds to relive a traumatic situation, in a gradual manner. The arachnophobes are, for example, exposed to increasingly larger spiders. The Agoraphobic are immersed in more and more popular cities... If the image perceived by the brain is virtual, felt anguish, it is real. In all cases, the goal is to realize that anxiety can be controlled, first step to desensitization.

Such sessions are now performed at hôpital Pitié-Salpêtrière in the psychiatric ward of Professor Roland Jouvent. "These therapies are at least as effective that exposure in vivo, but they are also several benefits, he says." They allow greater immersion of the patient safely, in controlled sessions. They are also more practical, since just a few minutes to simulate a flight or a sensation of dizziness at the top of the Eiffel Tower. "Other interest: the variety of artificial worlds allows to adapt more finely to disorders of patients. Some American laboratories thus recreate war environments to treat soldiers revenusd' Iraq and suffering from post-traumatic stress disorder.

Beyond psychological disorders, these worlds designed from scratch interested cognitive rehabilitation, to treat victims of brain injuries. After stroke or head injury, these patients do know often organize, neither in time nor in space. They are then unable to perform simple operations as a meal or shopping. By enabling them to replay these daily scenes, virtual reality techniques are useful for therapists to refine their diagnosis.

The VAP-S project for its part uses a virtual supermarket for clinical collaborations with CHU de Bordeaux and the University of Haifa in Israel. Patients, equipped with gloves simulating the sensation of touch, are invited to their races. "We play on various parameters, such as the provision of products, to better understand the difficulties of patients, explains Evelyne Klinger, responsible for the project." It is then based on these observations to develop strategies to compensate for the impairment, such as lists of races shown for those who fail more to associate words and images. "Touch, sound or Visual signals can also be sent to the participant to accelerate learning. A hospital clinical, ongoing research project, must show the transfer of the acquis, the laboratory in the real world.

Motor rehabilitation is also a promising field of application. It established here the playful aspect of virtual reality for pushing the participants to do physical exercise. "It's more interesting to ride a bicycle on a country road, even artificial, as in a sports hall," provides Daniel Mestre, Director of the Center for virtual reality of the Mediterranean (CRVM). He currently pilot project to the effort of sedentary people. Behavioral and physiological analyses are performed participants pedalling with a screen broadcasting the crossed landscape. Return force, device placed under the wheel back, simulating the slopes.

"We are trying to develop scenarios that encourage the effort, without pushing patients to exceed their limits, which would be dangerous to their health," said Daniel Mestre. These "serious games" must also strengthen the motivation in the long term, to consider to use in the treatment of obese people. "Rehabilitation protocols are known, the problem is that people overweight too quickly abandon their physical exercise", says Daniel Mestre.

Can we expect to see such devices invade our hospitals In the United States, virtual clinics specialized in the treatment of phobias have been the day, as the Virtual Reality Medical Center, located in San Diego, California. But in France, their adoption takes more time. Our medical system seems not yet particularly applicant and financing are still rare. Finally, "industry are very cautious, said Evelyne Klinger. "The introduction of these tools in re-education institutions implies that companies to manufacture, market and after-sales service". Some go all the same, such as Dassault Systèmes (see below) or Medimex, which markets Armeo, arm hinged to achieve driving rehabilitation exercises in a virtual reality environment. He is currently the subject of a clinical study.

The release of the game consoles like the Wii or the Kinnect, with the young but also older people in retirement homes, should contribute to the acceptance of virtual therapies. But they require certain precautions. The port of the HMD can for example cause malaise (motion sickness), close the sickness. Of confusion between real and virtual world has also been observed. "In any event, we must not give false hopes." These therapies will not replace the doctor, observed Daniel Mestre. They will intervene only as a complement to conventional treatments.