1	From e-Health to p-Health The emergence of a presence-based health Giuseppe Riva, Ph.D. http://www.cybertherapy.info
2	Goals of this Presentation Outline the actual trends in the use of Virtual Reality in health care Identifying applicative areas Identify a possible future scenario - the emergence of p-health – based on Immersive Virtual Technologies and Ambient Intelligence Understanding how this scenario can influence future health care provisions Identify a tentative roadmap
3	What is p-health? Is a shared immersive e-therapy in which the presence, simulation, and experience components are key factors of the therapeutic process.
4	VR is the basic p-health tool Since the development of methods of electronic communication clinicians have been using information and communication technologies in health care. However, the possible impact of virtual reality (VR) on health care is even higher than the one offered by the new communication technologies In fact, VR is at the same time a technology, a communication interface and an experience.
5	VR Technology VR is usually described as a collection of technological devices: a computer capable of interactive 3D visualization, a head-mounted display and data gloves, equipped with one or more position trackers. The trackers sense the position and orientation of the user and report that information to the computer that updates (in real time) the images for display.
6	Immersive Tools (1)
7	Immersive Tools (2)
8	PC based VR For many years one of the main obstacles to the development of VR applications was the price of the equipment: a typical VR system required a costly Silicon Graphic workstation in the range of 250000 US$. The significant advances in PC hardware that have been made over the last five years, are transforming PC-based VR into a reality. A simple immersive VR system now may cost less than 6000 US$.
9	Mobile/PDA based VR N-gage from Nokia: 330 Euro Symbian OS Bluetooth and GPRS Graphic Power similar to a Playstation 1, MP3, MJPEG Zodiac from Tapwave: 350 Euro Palm OS Bluetooth and Wi-FI VGA output Graphic Power similar to a Playstation 1, MP3, MJPEG
10	VR: Beyond the technology There are two visions of VR: Simulation technology: a collection of technologies that allow people to interact efficiently with 3D models in real time using their natural senses and skills Communicative interface: a advanced form of human-computer interface that allows the user to interact with and become immersed in a computer-generated environment in a naturalistic fashion In synthesis: a synthetic experience providing the feeling of “presence”
11	Presence as neuropsychological process Presence is the key characteristic of VR, differentiating it from other media. It is “sense of being there” , or the “feeling of being in a world that exists outside of the self” can be described as a selection mechanism that helps the self in organizing the streams of sensory data: by differentiating between internal and external states. Self versus non-self Self versus present external world Self relative to present external world
12	VR in Health Care The concept of presence clarifies the possible role of VR in medicine: a communication interface based on interactive 3D visualization, able to collect and integrate different inputs and data sets in a single real-like experience. It is up to the health care provider to decide if the VR application will be more focused on the integration of different data sets or on the realism of the virtual experience.
13	VR in Health Care 1989: First VR company (VPL Research) founded 1991: Virtuality Game System 1993: Suggested the use of VR in psychological treatment 1993: Suggested the use of VR in surgical simulation 1995: First research papers on VR in neuro-psychological assessment and treatment 1996: Completed Visible Human (male) 2003: more than 1000 papers in MedLine
14	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 inside them. 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
15	VR applications in Medicine Surgical simulation and planning Surgeons know well that in training there is no alternative to hands-on practice => 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.
16	VR applications in Medicine Neuropsychological assessment and rehabilitation 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 world. 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 personal efficacy.
17	Actual weakness of VR “Perceived” and Actual Costs “Perceived” and Actual Complexity Platform Compatibility Wires!: The Interface Challenge Display Hardware Side Effects Front End Flexibility Back End Data Extraction, Management, Analysis, Visualization
18	The issues to solve No Moore’s Law Operating in the area of HMDs and other quality peripherals Need Cost/Benefit Proofs! Aftereffects Lawsuit Potential Ethical Challenges The Perception that VR Tools will eliminate the need for the Therapist Limited Awareness/Unrealistic Expectations
19	From VR to p-Health
20	Advantages of p-Health
21	From VR to IVT
22	Immersive Virtual Telepresence
23	IVT in Health Care
24	ITV in Telemedicine
25	Ambient Intelligence (1) Ambient Intelligence (AmI), a new paradigm in information technology, in which people are empowered through a digital environment that is : aware of their presence, sensitive, adaptive, and responsive to their needs, habits, gestures and emotions. It is a direct extension of concept of ubiquitous computing: a pervasive and unobtrusive intelligence in the environment supporting the activities and interactions of the users.
26	Ambient Intelligence (2)
27	AmI in Health Care AmI integrates different complementary areas: health care information provision, administrative and clinical data collection, therapy and assessment provision. In particular, new and emerging technologies will provide personalized, intelligent, assistive technology that can promote recovery and sustain independence and quality of life.
28	How to apply p-health vision in health care? Provision of therapeutical contents using 3G portable phones; Advanced telemedicine settings based on mobile mixed reality; Biofeedback like VR: interaction based on biosensors’ data; Integration of patients data in wide networks for behavior analysis and better therapy planning.
29	Advantages of VR (1)
30	Advantages of VR (2)
31	p-health killer apps (1) REHABILITATION Through its capacity to allow the creation and control of dynamic 3-dimensional, remote, ecologically valid stimulus environments within which behavioral responding can be recorded and measured, p-health offers clinical assessment and rehabilitation options that are not available with traditional methods. Possible clinical areas: memory, motor abilities, executive functions and spatial representation.
32	p-health killer apps (2) EATING PATHOLOGIES Through its capacity to modify the perceptual/cognitive bodily distortions, a major reason patients want to lose weight . support the empowerment process. VR has the right features to support empowerment process, since it is a special, sheltered setting where patients can start to explore and act without feeling threatened p-health offers new options that are not available with traditional methods. Possible clinical areas: anorexia, obesity, binge eating disorders, bulimia - Addictions (smoking, drug, etc.)
33	p-health killer apps (3) PHOBIAS p-health through its simulation and mobility power has: the potential to precisely control what is presented; the ability to tailor treatment environments to the needs of each individual; the ability to expose the client to a range of conditions that would be impractical or unsafe in the real world; the ability to improve confidentiality by substituting for group treatment or in vivo desensitization. Possible clinical areas: panic disorders, generic phobias (fear of driving, flying, etc.)
34	What we need…
35	p-health supporting issues Processing Power/Graphics/Video Integration Integration with mobile communication Academic and Professional Acceptance Well-Matched VR Rehab/Clinical apps also have widespread intuitive appeal to the public: phobias, eating disorders, Alzheimer, etc. Close Knit VR Community Gaming and Entertainment Industry Drivers Integration with Imaging and Psychophysiological Approaches TeleRehabilitation Virtual Humans
36	The US challenge In 2002 different US government institutions funded research in this area to the amount of 26 million US$ (Source: DARPA bulletin, 2003). In the same year the European institutions funded research in this field with less that 6 million Euros (estimated from CORDIS database, 2003): less than 1/4 of the US effort. Up to now, Europe has matched the reduced funds with the creativity of its researchers. According to the leading scientific databases the European researchers have the highest number of published papers in this area on peer-reviewed journals (Sources: MedLine, Science Citation Index, PsycLit, Nov. 2003, Keyword “Virtual Reality”).
37	The p-health research community
38	Roadmap to p-Health