An intensive care unit patient's recovery is not just physical; the mental aspect is vital. What happens to the brain while the body heals?
Dr. Dmitriy Golovyan, an IU School of Medicine Pulmonary and Critical Care fellow, treats patients by providing life support so that they can recover from their illness. Patients may spend days or weeks laying in hospital beds, many in significant discomfort or pain.
"Most of them are in restraints so they don't pull off any of the life-support equipment," said Golovyan, who also works with the Regenstrief Institute through the Division of Pulmonary, Critical Care, Allergy and Occupational Medicine.
Many intensive care unit survivors will experience years of ongoing cognitive decline, depression, and anxiety, collectively called post-intensive care syndrome. Golovyan has been drawn to the field of post-intensive care syndrome treatment. Studying patients' brains when they are in -- or fresh out of -- intensive care is a concept only a decade old, but like many medical fields, technology is helping change and improve treatments.
Description of the following video:
"Virtual reality brain care therapy for intensive care unit patients demonstration" video on https://youtu.be/pSnLN73w5Y8
[Wen Krogg speaks: Right, at this particular time you're gonna hear a voice that talks about you're in the ICU. And during your stay, you're gonna be able to enjoy some rest and relaxation. In a few minutes the walls are going to disappear, and you'll find yourself outside and the tram will start.]
[Words appear: IUPUI Presents]
[Video: A close-up of the virtual reality program on a laptop.]
[Krogg speaks: When this is actually for the patient, they have a system called Ratchet, because they won't be able to turn their head like Albert's turning his head. So, they'll be using the joystick, which they don't have to have a lot of motion for. But they can press it either left or right, and it'll turn them a specific degree so that they can see around them if they wish.
Tell me if I take you too fast. The whole tram ride is approximately eight minutes long, and it's gonna take you through wooded areas. At the very end, there will be waterfalls. When you get to the end of the tram ride, you will be directed to tell the conductor, who is me, whether you want to go to the statue garden or the beach, or if you'd like to take the train ride again.
But what is kind of cool is, nobody's doing this yet. Would you like to go to the statue garden, or would you like to go to the beach?]
[Albert William speaks: The beach.]
[Krogg speaks: The beach it is.]
[Words appear: IUPUI Fulfilling the Promise, iupui.edu]
[End of transcript]
Over a cup of coffee, Golovyan and Wen Krogg, a media arts and science graduate student, decided to explore ideas for providing life-support for the minds of critically ill patients. Combining Krogg’s experience in creating hyper-realistic virtual reality environments with Golovyan’s understanding of the needs of critically ill patients, they teamed up to create the first virtual reality brain care therapy for intensive care unit patients.
“The virtual reality goggles are like the IV” Golovyan said. “The content that Wen created is the therapy. Luckily, we have the resources at IU School of Informatics, School of Medicine and at Regenstrief Institute to test this therapy to determine if its effective for our patients.”
The program, which will be showcased at the School of Informatics and Computing capstone event, works with the UITS Advanced Visualization Laboratory'scy.PIPES to bring physical sensations to the experience.
The capstone event will take place from 4 to 7 p.m. Friday, April 27, inside the Informatics and Communications Technology Complex.
The goal of Krogg's thesis project is to "reduce pain, anxiety and delirium in critically ill patients." Utilizing her 3-D modeling, photogrammetry and Unity game engineering talents, Krogg's program starts in the hospital room but takes the patient outside via virtual reality tram. A fan kicks on to represent wind. A heat lamp is activated to replicate the sun. Birds and soft music pipe in through the headphones.
The program works with very limited head and trigger movement because some intensive care patients might not have use of their neck or hands.
Krogg hopes that this virtual reality journey could ease the patient's mental recovery from a traumatic experience quicker.
"There are so many things that media arts and science students can do besides just making models and levels for gaming and film," Krogg explained. "One of the things I wanted to do was to be able to help people."
When Krogg was only 8 years old, her father suffered a life-threatening brain injury after a motorcycle crash.
"He was either going to die or become a vegetable, according to the doctors," Krogg said. "He spent many days in the ICU. He had wonderful physicians, and it was actually a miracle: His brain cells started to regenerate at a rapid speed.
Krogg's father defied the odds, but the work wasn't done just because he was released from the hospital. It was years before he was close to where he was before the crash.
Spring 2018 Capstone
The School of Informatics and Computing's capstone events come at the end of every semester to showcase the final projects of graduating seniors and graduate students. Friday's edition will host 146 presentations from 204 students within the first four floors of the Informatics and Communications Technology Complex.
"The capstone allows students to show off what they've done for the past four years or so," said Albert William, a lecturer in media arts and science. "It's great to see how students innovate. A lot of them do things that step outside of what we teach in the classroom. It allows students to do something that's really game-changing."
Krogg hopes the new software will be considered a therapeutic option, for hospital and home.
"Patients who are out of the ICU are called ICU survivors," Krogg said. "There's a lot of cognitive impairment that happens after an ICU visit. This will be designed to stimulate cognitive functions. The relaxation will also help them deal with some of their stress."
More VR, less drugs?
Golovyan is excited about Krogg's work. After a recent demonstration in which he strapped on the virtual reality headset for himself, the doctor said Krogg's work could be the future of intensive care therapy.
"Many ICU patients have to stare at ceiling tiles for days on end," Golovyan said. "VR improves pain. It improves anxiety; it's been shown to do that. It may decrease the dosages of the medications that we give patients in order to tolerate the discomforts of life support.
"This can replace ceiling tiles with sculpture gardens and beaches, and even scenes reminiscent of their own homes.” Dr. Golovyan says. “None of this would be possible without Wen, and the incredible support that she has had from her department, and from Regenstrief Institute."