Breaking boundaries: VR solutions to real problems

Whether it’s treating phobias, rehabilitating patients or raising safety standards, virtual reality has become a terrific tool for overcoming the obstacles posed by the real world.

 

Vr makes it practical to enact scenarios that would be impossible or too expensive to do in real life, reducing hassle for users while also cutting costs and saving time. The pods blast air and physically move in multiple directions to make the Vr experience more immersive. — 123rf.com — Photos: angelin yeoh/the Star

IMAGINE you are flying on a plane when the sky grows dark, the weather becomes increasingly turbulent, the plane starts to shake, and your seat rattles violently.

While it would be distressing for anyone, it could be too much to handle for someone with a fear of flying.

However, putting them in such a situation under the supervision of a specialist may help them overcome their phobias.

Tanjina Ashraf Khan, CEO and founder of Mentcouch, a psychology centre in Kuala Lumpur, calls it exposure therapy and recommends it for those who want to overcome their extreme sense of fear over an object or situation.

She says that as they work with a therapist to learn how to deal with their anxiety, they will be gradually exposed to their phobias.

“What we want to see during the sessions is the person developing less anxiety toward their fears. We start with a scale of one to 10.

“At the beginning, they may rate their anxiety level as nine. When it gets to a six, that is progress,” she shares.

However, she says exposure therapies are difficult to conduct physically. For example, if a client has a fear of snakes or cockroaches, it’s not realistic to bring those elements into the room.

Enacting certain scenarios, such as getting on a plane, could also be costly.

“It could also be unsafe for the client if they suffer from severe panic attacks on the plane. We may have to request an emergency landing,” Mentcouch managing director Justin Kung adds.

This was the impetus for using virtual reality – just by putting on a VR headset, a person can be “transported” to a different place or situation safely.

“Most importantly, we can assure them that they are in control,” Tanjina says.

She explains that clients typically spend up to 30 minutes in VR while being monitored on a computer by a trained therapist.

Kung says: “We can communicate with them by giving visual commands. This way, they can stay immersed in the environment without too much outside interference.”

Mentcouch counsellor Syahirah Husna says: “We will typically take a break for 10 minutes and assess their anxiety level and talk about relaxation techniques such as deep breathing.

“When they are ready to continue, they can practise the techniques they’ve learned in their chosen environment.”

Apart from overcoming phobias, Mentcouch is using VR as part of its therapy for stress relief, in which an individual would be guided through techniques like muscle relaxation in a soothing virtual environment like a beach or forest.

“Some people have trouble concentrating during therapy, as they will be stressed thinking about work or what the traffic will be like when it’s time to go home,” she says, adding that such sessions will help them become more mindful and calm.

Kung agrees, saying, “They feel that with VR, less effort is required to help them relax.”

Raising the bar

Over at Taman Desa in KL, chartered physiotherapist Lian Yunperng is using VR as part of physiotherapy treatments, describing the virtual world as a “form of distraction from pain”.

“We recommend this specifically for people recovering from a stroke or those who may be living with chronic pain.

“They may find it difficult to lift an object due to their condition, so we help them achieve upper-limb movement by practising using VR,” says Lian, who owns and operates Ace Physiotherapy.

Lian starts a session by securing the headset for the patient and adjusting the focus so they can see clearly. Patients are not required to walk and will largely be sitting down.

“I will be guiding them throughout the process as I can view what they are seeing on my smartphone.

“The sensors will track their hands and they will be able to perform movements such as picking up an object like a stone or throwing a ball in the virtual environment,” he says.

They may also be tasked with completing a block puzzle. It starts off with three blocks, with the number of blocks and complexity increasing as the patient progresses.

Each VR session typically lasts about 10 to 15 minutes and after undergoing training for three months, Lian will measure patients’ progress by checking their muscle power.

“For severely debilitated patients, we hope to see improvements, including being able to perform movements such as making a fist, moving their fingers or lifting their wrist,” he says.

Lian first integrated VR as part of his physiotherapy services back in 2019 – while exploring ways to improve his services, he stumbled upon a crowdfunding campaign for a VR headset.

“The product was geared for gaming, but I was inspired by the possibilities and started to look into how I could use VR for rehab,” he says.

He eventually decided to go with Oculus after testing several products and finding apps that he felt would be suitable for his physiotherapy plan.

“The headset is light and portable. I don’t need cables (it uses a rechargeable battery) or to carry extra equipment such as monitors.

“I can get it ready in 10 minutes by using my phone and not waste my patient’s time,” he says.

Lian is careful not to introduce VR to patients without first assessing their suitability.

“They must not have conditions like epilepsy or severe balance issues. If they feel dizzy while using VR, then the treatment will cease,” he says.

The feedback for incorporating VR as part of the physiotherapy treatment has been encouraging, saysLian, adding that most patients were open to it.

“They get to try something new and there’s a fun element to it,” he says.

Training tech

Fun is the last thing on the minds of workers at the Genting Tunnel East Coast Rail Link (ECRL) construction site in Bentong, Pahang, as they have to be on their toes to stay safe and minimise risks.

“Safety is a priority for everyone. It is compulsory to attend safety training due to the exposure to various types of hazards,” says Datuk Osman Haron, the health, safety and environment director for China Communications Construction ECRL, the main contractor for the ECRL project owned by Malaysia Rail Link (MRL).

To improve and enhance safety awareness levels at the site, the company said it set up a VR Safety Experience Hall to allow its workers to learn about safety in a more immersive environment.

It has two VR safety experiences, the first being a VR pod that simulates the experience of a fast-moving vehicle.

In a demo, the pod simulated a bumpy cart ride with tight turns and steep slopes in a snowy mountain that was made more real by its ability to blast air and physically move in multiple directions.

“There are trainings to simulate car crashes and falling from great heights. The experiences are meant to serve as reminders to workers to always perform safety checks when on site and to equip themselves with the required gear,” Osman adds.

The other VR service gives the worker freedom of movement within a designated area, allowing him or her to pick up tools and operate them in a virtual world. Depending on the chosen scenario – it’s claimed to offer up to 100 options, including one that was inspired by real construction tragedies in China – the dangers they face will be different. 

Workers may find themselves operating a crane, only for the hosting cable to snap and injure others, or drilling in a tunnel while standing on an unsteady platform that would break.

After each experience, a pop-up will show the actions that led to the mishap.

For example, in the first scenario, the cable could have snapped because no prior inspection was conducted to ensure all equipment was in order, and in the second, it could be due to workers not wearing safety harnesses and the scaffolding not being built according to safety standards. “

Typically, workers would have to sit through hour-long briefings on safety and they may not retain all the information due to the static setting.

“By experiencing what could happen if they are not aware of precautionary measures with VR, it will be a more beneficial learning experience,” Osman says.

Untapped uses

Osman admits, however, that VR can’t replace all aspects of safety training, as practical experience is still an important aspect.

For example, workers have to learn how to operate machinery in real life so that they can feel the “weight” and how objects move in certain weather conditions.

“For some aspects of safety training, we try to find ways to combine it with VR, as it has the advantage of helping workers fully visualise situations,” he says.

He adds that VR also helps to remove constraints such as the need to be in various locations and facilities for training.

“We’ve had issues where training could not be conducted because the trainer was not there.

“But with VR, there is no such issue. We can also upgrade the software with new experiences to keep our workers updated with new safety guidelines when they move to a new site,” he says.

Meanwhile, Tanjina says that with VR “moving fast”, she sees the potential of it being used for online sessions with both the therapist and patient appearing as 3D avatars.

What’s crucial now, she says, is to create more awareness about the benefits of VR and other forms of technology in mental health treatment.

“People were not open to technology being used as part of mental health treatment until the pandemic opened opportunities for people to try online therapy.

“The biggest hurdle is helping more people become aware of the benefits of technology in certain aspects,” she says.

Lian agrees, saying that people have to be more open to trying new forms of tech for physiotherapy treatment.

He claims that robotics, such as an exoskeleton, can be incorporated into rehabilitation therapies, and that an Ai-powered device is being developed to assist stroke patients in performing movements.

“I encourage people to think outside the box and not be limited to what they have learned in university.

“Go to expos and conferences to learn about tech advancements in health. I would also advise them to look into the science and research behind it,” he says.

Osman adds that, in addition to VR, the company is relying on technology such as drones to monitor remote areas that are difficult to access by humans.

“We are closely following the development of technology in various fields to see how it can be implemented.

“Technology is very much an important aspect of what we do,” he says. 

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A stressed brain; Top 4 Most Common Causes of Your Headache

With the increased stress of being in the midst of a pandemic, people might be acting out more than they usually do.


FOR months, the nation has been assaulted by an invisible enemy that has the upper hand.

The stress of the Covid-19 pandemic has many wondering, how is this affecting the mental health of the populace?

At their best, Americans are feeling distracted, forgetful, disorganised and helpless.

At their worst, there are highly publicised incidents of deniers who have screaming meltdowns in stores when they are told to wear face masks.

Yale University professor of neuroscience and psychology Dr Amy Arnsten says that all psychiatric disorders have a neurobiological basis.

In short, it isn’t psychological weakness, it’s a prefrontal cortex overloaded with chemicals.



“If you understand the neurology behind it, you feel forgiveness for yourself.



“It’s self-freeing. It allows you to be better,” she says.

“There is no difference between a mental health issue and a neurological issue.”

She has created a YouTube video that teaches how “arousal chemicals” released in times of uncontrollable anxiety inhibit a person’s insight, reasoning, empathy, conscience, patience, judgment, and control of emotions, thoughts and actions.

Speaking over the phone from her home in Bethany, Connecticut, Prof Arnsten answers some questions on the topic:

Are people acting in ways that reflect the change in their brains?

You really see this in some places.

Connecticut is doing so well. It’s really a “prefrontal” state.

A simple way of saying that is that they are being thoughtful.

You see (US) states where there’s been poor leadership and people are encouraged to be reactive rather than thoughtful; where so many people are dying; (and) where people say, just go out and party, don’t wear a mask, just do what you want to do, don’t be thoughtful about consequences.

They want the right to act like that even though it kills others.

Can you give some behavioural examples?

The prefrontal cortex controls wisdom and judgment.

When it goes “offline”, control goes to our primitive brain circuits. We can get angry very easily. We can say things that we later regret to people we love. Anger can get the best of us. Rather than being thoughtful, you yell at a store clerk and throw groceries in his face.

Is this change in brain chemicals from stress ever useful?

A: Yes. It can orchestrate a response in an unconscious, primitive way that could save your life.

For example, if what is stressing you is that you are suddenly being cut off on the highway.

You stop thinking about your plans for going to a party on Saturday night and slam on the brakes really fast.

But if the stressor is an invisible virus, losing your prefrontal function is extraordinarily unhelpful and more dangerous.

Why does the stress from the pandemic feel uncontrollable?

This has been studied in families.

If a child feels a parent is in control, even though something terrible is happening, the kid is OK.

Part of what is so stressful right now is the feeling that there’s no parent in the room taking charge of this pandemic, so we’re all at the mercy of this random destruction.

... Our current government makes us feel out of control, and that is the exact thing that increases the stress response and impairs our prefrontal function.

That’s an uncontrollable stress.

Q: Can long-term uncontrollable stress cause permanent neurological change?

A: Yes. With chronic stress, along with the chemical changes, there are also architectural changes where you lose the connections between brain cells and the prefrontal cortex.

Research on young rats indicates that with sufficient time spent being nonstressed, connections grow back. We didn’t see that in old rats. Resilience seems to be age dependent, but maybe we need to wait longer.

How can people control their stress and reduce these chemicals in the brain?

Exercise if you can. Get that oxygen.

Eat healthy.

Get plenty of sleep.

Those things truly matter. The prefrontal cortex is the Goldilocks of the brain. It likes to have everything just right.

It’s also good to help other people. It makes you feel better yourself.

Listen to your favourite music. Give yourself experiences of beauty.

... So often people don’t think to give these things to themselves.

Try to be your own cheerleader.

Stress can create changes in the brain that inhibits our judgement, empathy, reasoning and self-control. — TNS

Are there wrong ways to control stress?

I think a very natural thing to do, but that ends up being counterproductive, is abusing substances.

Alcohol makes you feel better for a little bit, but in the long run, it makes you feel worse.

The same thing goes for drugs. And the same thing goes for eating a lot of fattening foods, afterwards you hate yourself and then eat more.

It’s the same old same old as before the pandemic, but now it’s often intensified, because there you are home alone with your refrigerator. – The Hartford Courant/Tribune News Service

Top 4 Most Common Causes of Your Headache

“A bad headache can destroy all plans for the day.” 

These are few common type of headache:

1. Cervicogenic Headache

• Commonly having one sided headache from the back of the head until forehead and eyes, it will involve with shoulder pain and soreness too.
• It will last for one hour or several weeks
• Moderate to severe intensity

2. Migraine

• One sided headache involving eyes and head mostly with gradual onset.
• It will last for 4-72 hours
• Moderate to severe intensity of headache

3. Tension Headache

• Most common headache which involve bilateral side during the attacks.
• It will last half an hour to several hours
• Mild to high intensity
• Normally can be resolved by OTC medication or Panadols.

4. Cluster Headache

• Intense and explosive headache which involve at one side eye area more.
• It can last for 3 hours or sometimes weeks follow by remission period for months or years.
• High intensity of pain

5. Sinus Headache

• Headache that involve forehead, eyes, eyebrows, cheek and ear due to inflammation of the sinus.
• It will last days to weeks (resolved faster if treated)
• Mild to moderate intensity

Pain pattern of cervicogenic headache

Work from home has become a lifestyle recently due to Covid-19, work at home will need to use computer or other electronic devices for longer period. Will this become one of the causes of your headache?
Check out the video below, it might give you an answer for your current headache !!

https://youtu.be/_IHvYvCUhF4

Article by LAI YU FENG
Physiotherapist of Your Physio Ampang

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Exercises for Stroke Patients

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Attacking the brain

Stroke kills more women than men each year but there are preventive steps you can take to minimise your risks.

 

Attacking the brain

Stroke kills more women than men each year but there are preventive steps you can take to minimise your risks.

IN Malaysia, strokes are the third leading cause of death for women, following heart attacks and pneumonia.

For some unknown reasons, many women choose not to join a post-stroke rehabilitation programme.

It is more deadly to women than breast cancer, and if it doesn’t kill you, can leave you with permanent disabilities.

A stroke is sometimes known as a “brain attack.”

It occurs when blood flow to a part of the brain is blocked by a blood clot or plaque, and brain cells begin to die.

Here are some facts about how strokes affect women differently from men:

> More women have strokes later in life.

> After age 85, stroke affects many more women than men.

> It is twice as common for women between 20 and 39 to have a stroke compared to men of the same age.

> Having a history of problems during pregnancy like gestational diabetes or preeclampsia.

> Using hormonal birth control while smoking.

> Being on menopausal hormone therapy during or after menopause.

> Experiencing migraines with aura, atrial fibrillation (irregular heartbeat), and diabetes.

Many strokes are preventable and treatable.

By knowing your risk factors and making healthy changes, you can minimise your risks of experiencing a stroke.

Three types of stroke

Ischemic stroke is the result of blockage of blood flow to the brain. This is the most common type of stroke, and it happens most often when a person has a blood clot or atherosclerosis, a condition when an artery is clogged with plaque

Hemorrhagic stroke, caused by bleeding into the brain.

This type of stroke happens when a blood vessel in the brain bursts, and blood bleeds into the brain.

An aneurysm, which is a thin or weak spot in an artery that can burst, is responsible for this type of stroke.

Mini-stroke, also called a transient ischemic attack or TIA, can happen when, briefly, less blood than normal flows to the brain.

TIA usually lasts only a few minutes or up to several hours. Many people aren’t even aware that they had a stroke.

Stroke affects different parts of the brain, and depending on which part, you may experience problems with speech, movement, balance, vision or memory.

Division of brain

The brain is divided into four main parts: right hemisphere; left hemisphere; the cerebellum; which controls balance and coordination; and the brain stem, which controls all of our body’s functions that we don’t think about, such as heart rate, blood pressure, sweating and digestion.

A stroke can happen in different parts of the brain.

In the right half of the brain, a stroke can cause:

> Mobility issues on the left side of your body.

> Problems with misjudging distances. This can cause falls, or inability to guide your hands to pick something up.

> Short-term memory loss. You may be able to remember events from 10 years ago, but may forget the directions to your regular grocery store.

> Misjudgement of abilities to do things and unusual behaviour such as leaving your house without getting fully dressed.

In the left half of the brain, a stroke can cause:

> Mobility issues on the right side of your body.

> Difficulty completing everyday tasks quickly.

> Trouble speaking or understanding others.

> Memory problems, or a tough time learning new things.

In the cerebellum, a stroke can cause:

> Dizziness, nausea (feeling sick to your stomach), and vomiting.

> Stiffness and tightness in the upper body that can cause spasms or jerky movements.

> Balance problems.

> Eye problems, such as blurry or double vision.

In the brain stem, strokes are most harmful.

Impulses that start in the brain must travel through the brain stem on their way to the arms and legs, so individuals that suffer a stroke in the brain stem may also develop paralysis.

Beware of these symptoms

Some women are more at risk because of certain health problems, family health history, age and habits. These are called risk factors.

There are certain risk factors that cannot be changed, such as age, race or ethnicity, or family history. The only thing that you can do is to control other stroke risk factors, such as high blood pressure, diabetes, smoking and unhealthy eating.

Common symptoms of stroke include:

> Trouble seeing in one or both eyes.

> Severe headache with no known cause.

> Trouble walking, dizziness, or loss of balance or coordination.

> Numbness or weakness of face, arm, or leg, especially on only one side of the body.

> Confusion or trouble speaking or understanding.

Recovering from stroke

The process of recovery can take a lot of time and depends on many factors, like the type of stroke you had, the area of your brain affected, and the amount of brain injury.

Recovery begins once you are medically stable, and this is within a day of suffering the stroke.

Your next steps will involve changes in everyday habits, medicines and rehabilitation.

In some cases, surgeries may be needed to lower the risk of another stroke.

The first step is to learn about your condition and what you should do during recovery.

Your doctor, nurses and physical therapist can answer questions you may have about about the treatment and rehabilitation.

The next critical step is to take steps to prevent another stroke from happening.

Stroke patients are always at a higher risk of having another down the road, so you need to:

> Identify and control your personal risk factors.

> Be consistent with your treatment plan. It is designed to help you recover from your stroke and prevent a recurrence.

> Continue taking medications even if you feel better. Discuss with your doctor before making changes. Also, determine the rehabilitation services you will need.

For unclear reasons, many women do not join a post-stroke rehabilitation programme.

After a stroke, you will often recover some function in the first few months. This is part of the body’s natural healing process.

But women who do go to stroke rehabilitation reap the following benefits:

> Regain as much independence as possible.

> Relearn skills and abilities that were damaged or lost.

> Learn to cope with any remaining limitations.

Setting a goal

Settling a goal can motivate you to measure your progress - TNS

Another important step is to set goals for your recovery.

You need to set realistic and measurable goals for recovery in every area of your life that has been affected.

Stroke recovery may be fast in the first few months, but it may slow down eventually.>>

When you set goals, it can motivate you to maintain progress.

Create a timeline for achieving long-term goals.

Take a multi-step approach for each goal and celebrate the short term wins when you gain them. And finally, don’t give up! The aftermath of a stroke can make patients feel powerless.

Part of your recovery is determining how to live as independently as possible.

Be reasonable with yourself, and be prepared to face challenges as you adapt to the differences in how your body works.

The road to stroke recovery may not be easy, but by focusing on celebrating your progress at every step, you can reach your goals.

Ensure you also have adequate nutrition and nutritional supplements to expedite the healing and recovery process.

Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

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Read more:

How to recognise signs of a stroke, and what to do ...

Remember "FAST": “Face” (does the face look uneven?), “Arms” (is one arm weak or numb?), “Speech” (does the speech sound strange?), and "Time" (4.5 hours before brain damage). If you notice these signs of a stroke, get the person to a hospital as quickly as possible. — Filepi

Boosting your brain function as you age

Brain Attack (Stroke) - UCLA Neurosurgery, Los Angeles, CA

www.uclahealth.org › neurosurgery › brain-attack

Brain Attack: Stroke or Brain Attack is a disease that involves the blood vessels that supply blood to the brain - UCLA.

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