3D Virtual Reality Device for Upper Extremity Rehab After Stroke

In this episode of the Better Edge podcast, Mahesh V. Ramachandran, MD, chief medical officer Northwestern Medicine Marianjoy Rehabilitation Hospital, and Dhruvil J. Pandya, MD, health system clinician in the Ken & Ruth Davee Department of Neurology at Northwestern Medicine, discuss their study involving 3D virtual reality devices for upper extremity rehab after stroke. They share clinical implications of their findings, and what these findings could mean for the future use of 3D virtual reality in medicine.
3D Virtual Reality Device for Upper Extremity Rehab After Stroke
Featured Speakers:
Mahesh Ramachandran, MD | Dhruvil Pandya, MD
Dr. Ramachandran is the Chief medical Officer at Marianjoy. He is board certified in both physiatry and internal medicine, and his medical practice addresses the medically complex needs of rehabilitation patients. Dr. Ramachandran completed his medical training at the Chicago Medical School (now Rosalind Franklin University) after receiving his undergraduate degree at the University of Illinois in Urbana-Champaign. He was chief resident during his residency in physical medicine and rehabilitation at Loma Linda University & Medical Center in California. Dr. Ramachandran completed his internal medicine residency at the University of Illinois at Urbana-Champaign in 1998. Dr. Ramachandran's practice style is a reflection of his holistic approach to patient care, as well as his commitment to treating each individual with respect, empathy and compassion. 

Learn more about Dr. Ramachandran 

Dhruvil Pandya, MD is a health system clinician in the Ken & Ruth Department of Neurology at Northwestern Medicine. 

Learn more about Dhruvil Pandya, MD
3D Virtual Reality Device for Upper Extremity Rehab After Stroke

Melanie Cole (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and today, we're exploring D3 virtual reality device for upper extremity rehab after stroke. Joining me in this panel discussion are Dr. Dhruvil Pandya. He's a Vascular Neurologist and Neuro Interventionalist in the Ken and Ruth Department of Neurology at Northwestern Medicine and Dr. Mahesh Ramachandran. He's the Chief Medical Officer at Northwestern Medicine's Marianjoy Rehabilitation Hospital. Doctors, thank you so much for joining us today and Dr. Ramachandran welcome back. And I'd like to start with you. Can you tell us a little bit about the evolution of 3D virtual reality device for upper extremity rehab after stroke and how it has evolved for use in rehab medicine? How does virtual reality help stroke patients?

Mahesh Ramachandran, MD (Guest): Thanks Melanie. Thanks for that introduction. Three D, per se has not been used that much. We've used things like video games and other types of things in the rehab field to help enhance stroke recovery, but not in the way that the 3D reality is working at this time. And so we're really excited about this new technology and how it may be able to enhance upper extremity function after stroke. Certainly we do have 2D methods and ways to measure improvement and so on, this is a brand new technology for us, here at Marianjoy. And I think it can really enhance stroke recovery over overall.

Host: So you were both part of involving that 3D virtual reality device for upper extremity rehab after stroke. I'd like to give you each a chance to tell us about the role that you played. So, Dr. Pandya start, please, if you would and tell us the role you played in this study.

Dhruvil Pandya, MD (Guest): Thank you Melanie again for the introduction So I am the principal investigator for the study that evaluating 3D virtual reality for upper extremity rehabilitation after a stroke. And, what we're looking at with the study is since it's a newer technology for stroke rehabilitation, we want to see how the patients accept this new device and what are the side effects associated with it. So we're doing a trial looking at acceptability and tolerability of the 3D virtual reality for upper extremity rehabilitation after a stroke.

Host: Dr. Ramachandran, you're role in this?

Dr. Ramachandran: So, with Dr. Pandya's expertise, from a neurologic perspective, and in identifying the appropriate patients and the roles, the next step is getting them the type of rehabilitation. And we see the 3D virtual reality technology as an enhancement or as an additive agent to what we were doing before from a rehab perspective.

So, we think that this can add a certain level of improvement to the patient that they didn't have before the 3D technology. So, I'm looking at the rehabilitation aspect of it.

Host: This is so interesting. So, Dr. Pandya tell us a little bit about the objectives of the study and really the model that you used.

Dr. Pandya: Absolutely. We have three specific aims that we're looking at for this study. The first aim is to look at the technology acceptability using a seven-point Likert scale questionnaires. The second aim is to evaluate the safety of the technology by evaluating symptomology questionnaires. And the third aim is to look at the clinical outcomes and we're using the febrile mile assessment to look at the clinical outcomes. The study is taking place at Marianjoy with our research team and occupation therapies as another principal investigator.

And what we're doing is patients coming to Marianjoy for rehabilitation, they're getting their standard of care treatments. If they have upper extremity weakness and they qualify for our inclusion criteria, we are including them in the trial and having them utilize the 3D virtual reality for rehabilitation. After they use this, we're asking them questionnaires to evaluate the acceptability and symptomatology. And at the end of the sessions, when they leave Marianjoy, we're going to be evaluating whether there was any difference in their functional outcomes.

Host: Tell us about patient selection, Dr. Ramachandran. Dr. Pandya just briefly touched on that. What qualifies a patient for this study?

Dr. Ramachandran: It's a fairly, rigorous process. First of all, the patient should have had a stroke. And they should have upper extremity dysfunction. As you may know, there are many different types of strokes. Some strokes can only affect speech and some strokes can only affect the ability to walk. And then certainly there are strokes that affect upper extremity dysfunction, as well as all of the above. So, it's important that we select patients that have upper extremity dysfunction, as part of the study, because that's what we're testing for. Some strokes, cause what's called an aphasia.

And aphasia is when the patient doesn't quite comprehend instructions or language. those patients will be typically excluded from the study. Because we want those patients, because there are certain instructions to be involved with this study. And so the patients should not have a severe aphasia. And so they can actively participate, follow instructions in the study. And then if the patient should be able to be measured with regards to improvement. And so that the occupational therapist and the rest of the team should be able to easily measure improvement or lack thereof, on the study, based on a constant objective testing. So, these are three of the main criteria that are required to be included in this study.

Host: This is such an interesting study and I hope you'll both come back on and tell us as it continues, and the findings that you get. Dr. Pandya tell us a little bit about this collaboration between rehabilitation and the neurosciences. And also while you're telling us that, as traditional methods for rehab of upper limb issues in stroke patients have been provided in standard of care, physical and occupational therapists. How do you see this helping them and those clinicians in their aim to help stroke patients?

Dr. Pandya: As I always say, stroke is a team effort. After a stroke, significantly, the patients are impacted not just from physically, mentally, but also mentally, emotionally, socially, and financially. So, the collaboration is an important part of this trial, but moving forward, how we can provide a holistic approach for patients with stroke and utilizing technology as it evolves to have the best outcome possible? As you may be aware, stroke is the number one leading cause of disability. And even with the advancement of the technologies that had, there are significant number of patients whose quality of life is impacted by stroke. So, this collaboration came about after I joined Northwestern and I met Dr. Rama where both of us have a passion of treating patients with the stroke and providing the holistic approach to give them the best outcome possible. And at the same time, we were learning about the 3D virtual reality where we were able to put the team together quickly and start the trial.

But due to COVID, this was delayed in starting it recently. I think what this does is adds another tool in our toolbox. The more tools we have, the better outcomes we can have. From what we understand about the 3D virtual reality, this makes fun for patients to participate. It gives them motivation to participate in a therapy, and it's also makes it fun for the therapist. So, it creates a collaborative relationship between the therapist and the patient. And our hope is that this will result into a better outcome.

Dr. Ramachandran: Just to add to Dr. Pandya with regards to therapists, sometimes, therapy gets quite monotonous for the patients. You're doing similar exercises every single day and the same type of thing. And after a while, after a few days, the same type of exercises get a little bit monotonous, but very important for recovery. And so as Dr. Pandya said, adding this other creative type of technology, doing something a little bit different, a little bit more fun, really enhances and motivates the patient to continue to do therapy in a slightly different manner. So, it doesn't become as monotonous toward the end.

Host: What a great point you made Dr. Ramachandran and I'd like to give you each a chance for a final thought and Dr. Pandya to start with you, what would you like referring physicians to know about getting their patients involved in your study on 3D virtual reality device for upper extremity rehab after stroke?

Dr. Pandya: What I want the physicians to know is that at Northwestern and Marianjoy Hospital, we have a holistic approach for treatment of a stroke. We're always looking for innovative technology to improve outcomes for our patients. And I think there is a collaboration that occurs from a clinical as well as the rehabilitation team. And we work very closely together for the best outcomes. I think the patients that really qualify for the study as Dr. Ramachandran mentioned the inclusion criteria, where they would have to have a stroke, they would have to have upper extremity weakness and be able to participate in the 3D virtual reality therapy

Host: and Dr. Ramachandran, last word to you. What are your predictions for the future? The use of 3D virtual reality in medicine in general and what your findings could mean for the future use of these type of technology?

Dr. Ramachandran: I think medicine overall, technology and artificial intelligence are all going to be major parts of medicine moving forward. My gut feeling is that these types of technologies are not going to replace existing practices, but hopefully enhance existing practices. So, having physicians use the technology to help enhance and help improve outcomes for their patients is what I see in the future.

There's just so much technology involved and learning that's exciting. It's certainly an exciting field, but at the same time, we want to make sure and that's one of the reasons for the study is that we are practicing with evidence-based medicine, that we're using technology that certainly helps the patient, doesn't harm the patient and doing more studies like this will help prove this technology is effective. But I see more and more of these studies being done. This is a first step. The stroke team is really excited about this study. As Dr. Pandya said, this is adding one more item in their arsenal and armamentarium of trying to get stroke patients as functional as possible.

Host: Certainly is. What an interesting interview. Thank you both so much for joining us today. And to refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/rehab to get connected with one of our providers. That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. For updates on the latest medical advancements and breakthroughs, please follow us on your social channels. I'm Melanie Cole. Thanks so much for joining us today.