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Professeur R. BONIVER
Professeur à l’Université de LIEGE
Virtual Reality is a new technology that modifies
the way individuals interact with computers. It
consists of a set of computer aid technologies
that, when combined, provide an interface to a
computer-generated world. Particularly it
provides such a convincing interface that the
user believes he is actually in a three
dimensional environment and so he may
navigate and interact with this virtual world in
real time.
VR in Health Care
 1989: First VR company (VPL Research)
 1991: Virtuality Game System
 1993: Suggested the use of VR in
psychological treatment
 1993: Suggested the use of VR in surgical
 1995: First research papers on VR in neuro-
psychological assessment and treatment
 1996: Completed Visible Human (male)
 2003: more than 1000 papers in MedLine
VR applications in Medicine
Medical Education
 Through 3-D visualization of massive volumes
of information and databases, clinicians and
students can understand important
physiological principles or basic anatomy ⇒
For instance, VR can be used to explore the
organs by « flying » around, behind, or even
 A significant step towards the creation of VR
anatomy textbooks was the acquisition of the
Visible Human male and female data made in
August of 1991 by the University of Colorado
School of Medicine
VR applications in Medicine
Surgical simulation and planning
 Surgeons know well that in training there is no
alternative to hands-on pratctice ⇒ since early
1990s different research teams has been trying
to develop VE simulators.
 Another application is the planning of surgical
and neuro-surgical procedures. It usually relies
on the studies of series of two dimensional
Magnetic Resonance and/or Computer
Tomography images, which have to be mentally
integrated by surgeons into a three-dimensional
concept ⇒ A VR-based system can incorporate
different scanning modalities in a 3D view.
VR applications in Medicine
Neuropsychological assessment and
 VR is a highly flexible tool, providing a large
amount of controlled stimuli and,
simultaneously, monitoring the possible
responses generated by the user of the virtual
 The patient can manage successfully the
problematic situation or rehabilitation task:
The patient is more likely not only to gain
an awareness of his/her need to do
something to change.
But also to experience a greater sense of
The interest and perspectives of this
technology according to Mechanic
Cybernetic Synergetic point of view are:
B. Improvement of Spatial Knowledge that is:
spatial orientation and spatial exploration
C. Simulation of potentially dangerous
D. Training postural control in an artificial
The Spatial Knowledge is organized in three
2. Memorizing the main landmarks
3. Integration of these landmarks inside pathways
or sensory motor sequences
4. Processing of a panoramic landscape
representation in which are both landmarks and
pathways between them.
The Vestibular system is involved in the Spatial
Knowledge not only to assure postural control and
visual stabilization but also to establish the
directional context and to calculate the best paths
that join together the memorized places on the
basis of visual landmarks.
The knowledge of an unknown environment is
easier if it is possible an active exploration rather
then a mere observation of the places on a paper.
Many authors, in experimental controlled
conditions, have stated that also virtual
environment and virtual navigation are able to
improve spatial orientation.
Thanks to Virtual Reality ability in manipulating the
perception of spatial features of visual input it is
possible to develop exercises for equilibrium
control training in static and dynamic conditions.
For instance Jaffe in 1998 proposed a program
intended to prevent elderly falls based on the
evaluation of postural control and on equilibrium
training using virtual obstacles and simulating
potentially dangerous situations.
According to the same scientific assumption
Alpini D. and co-workers have recently proposed
the use of virtual environment, with increasing
complexity regarding directional and topographic
information, where is possible to navigate by
means of the active control of own gravity center.
This system has been designed both for
diagnostic use and for therapeutic training and
is essentially composed by the integration of
tree different hardware subsystems: an
« immersive » Virtual Reality server, a digital
Craniocorpography and a Stabilometric
The signals from the Stabilometric platform in
standing position are used to control the
movement inside the virtual environment.
Furthermore the Craniocorpography allows the
monitoring of head and shoulders displacement
strategy during hip displacements directed to
modify the barycentre projection in function of
visual-acoustic virtual stimuli.
The combination of these instruments improves
the sensory-motor learning on the basis of
feedback as in classic vestibular rehabilitation
protocols. With the system based on Virtual Reality
it is possible a better integration of cognitive
factors used to enhance a more conscious
equilibrium control.
Virtual Reality Limits and Perspectives
It is important to emphasize that nowadays the
most powerful and faster computers aren’t
able to recreate exactly all the natural and real
environments. Therefore, Virtual Reality users
have to experience a lot of adaptations.
The main problems that may arose are:
 mismatch between motor perception
produced by visual virtual environment and
the one due to vestibular or proprioceptive
subsystems (visual-inertial mismatch)
 intra-vestibular mismatch between
semicircular canal and otolithic inputs.
In these cases oscillopsia and
« cybersickness » may develop: symptoms are
the same or « motor sickness » or « sea
sickness ».
Some considerations are necessary:
– cybersickness indicates that the
compensation ability is exceed
– generally an adaptation to the new situation
takes place to limit symptoms
– a memory of this adaptation persists in the
In conclusion Virtual Reality limits may be an
interesting means of studying vestibular
compensation in normal and pathological