Walter Greenleaf PhD

Information about Digital Medicine and, more specifically- Virtual Reality and Augmented Reality Technology in Healthcare

I am a neuroscientist and digital medicine expert. My passion is to explore and develop new ways to apply technology to address difficult problems in healthcare.
My academic positions:

Distinguished Visiting Scholar - Stanford University's MediaX Program

Visiting Scholar - Stanford University Virtual Human Interaction Lab

Director of Technology Strategy - The National Mental Health Innovation Center

In addition to my academic work, I strive to move VR/AR technology forward by serving as a technology and neuroscience advisor to medical product companies, investment groups, and accelerator / incubator programs

Overview - VR and AR Technology for Medicine

Founded on decades of research

Founded on decades of research
Virtual Reality (VR) and Augmented Reality (AR) technologies have been used for more than three decades to support medical training, improve clinical interventions, and to promote health and wellness. VR and AR (Immersive) Clinical Systems have been designed, developed, and validated primarily at university research centers, and as a result, there is an impressive body of published research literature demonstrating the principal efficacy and therapeutic value of VR and AR-based tools in medicine, providing the proper context for further advances.
Until recently, the cost of immersive technology has been a barrier to acceptance outside of the university environment. Now, however, the reduced cost and increased availability of virtual reality technology have made clinical VR practical for everyday use. As a result, VR and AR technology has migrated from the university and surgical training centers to other sectors of medicine, including neurology, psychiatry, clinical psychology, optical, physical and cognitive rehabilitation, and palliative medicine among other sectors.

A broad impact on healthcare

All aspects of health and wellness are being impacted by the application of this next wave of technology – in addition to clinical skill training and as a way to evaluate patients in a more natural/objective manner. VR and AR technology is being used in the fields of psychiatry and clinical psychology and the field of physical medicine and rehabilitation.
In psychiatry and clinical psychology VR technology is currently being used to treat Post Traumatic Stress Disorder (PTSD), provide social skills training to those on the autism spectrum, provoke cue reactivity and teach refusal skills for substance abuse therapy, to treat phobias and anxiety disorders, and to address cognitive impairments – to provide just a few examples. In physical medicine and rehabilitation, VR technology is being for stroke rehabilitation and traumatic brain injury recovery, physical and occupational therapy, and to provide disability support solutions. These systems have been shown to be effective in increasing treatment efficacy, reducing treatment time, promoting adherence to clinical protocols, and reducing healthcare costs.

Six major areas of impact

VR technology provides meaningful improvements in five key areas of healthcare:
• Prevention – Promoting Health and Wellness Habits
• Improved Clinical Training
• Objective and Accurate Assessments
• Improved Clinical Interventions
• Improved Adherence
• Distributed Care Delivery / Telemedicine

Leveraging training and gaming paradigms

VR technology made its first inroads into widespread use through the computer game industry and the military, where it was used in flight simulation and other training scenarios. Applications in medicine shortly followed, with VR seeing increasing use as a medical teaching tool, for planning and conducting surgical procedures (including remote surgery), and for interactive diagnostic imaging. In the realm of behavioral medicine, VR has now seen several years of successful use in the treatment of PTSD, phobias, and as a way to mitigate pain and discomfort.

Prevention – Promoting Health / Wellness

VR technology is being successfully used to address sub-clinical healthcare issues such as stress management, emotional regulation skills, and to help with nicotine, alcohol and other addictions. The use of VR avatars has been shown to promote the transfer of healthy behaviors from the virtual world to the real world. For example, VR users have been found to increase their physical activity after observing the positive effects of exercise on their avatar.

Improved Training

VR technology is being used to improve all aspects of medical training: clinical skill training, surgical skill training, interpersonal skill training, use of equipment and tools, team training - e.g., emergency department and surgical teams, and to teach empathy and improved understanding for patients and their experiences. It is possible to train in a VR environment for rare and unexpected events. VR training sessions can be recorded and replayed for review and quantitative analysis and integrated into learning management systems. Instructors can participate in training sessions to provide instructions, encouragement, and intervention remotely and even asynchronously. In virtual environments every element in a scenario can be tightly controlled, enabling near-perfect replication of environments between participants, studies, laboratories, and time points.

Objective and Accurate Assessments

In virtual environments, every element in a scenario can be tightly controlled, enabling near-perfect replication of environments between participants, studies, laboratories, and time points. Standard assessment scenarios allow for more objective and realistic assessments that are far superior to self- reports. The use of VR for assessments falls into two broad categories: Physical assessments and cognitive/behavioral assessments.
Physical assessments
The use of VR motion tracking technology combined with standard challenges facilitates the objective assessment of function for physical medicine. The assessments used for stroke, TBI, and musculoskeletal injury rehabilitation all benefit by more accurate and functional measurements enabled by VR technology. VR also provides improved assessments for the evaluation activities of daily living skills, disability assessment, ergonomic evaluation, and for the design for disability adaptations and prosthetics.
Cognitive/behavioral assessments
Standard assessments rely predominantly on individual self- report and therefore are inherently subjective, rudimentary (low-resolution), subject to reporting bias, and are difficult to compare between individuals. Furthermore — since human cognitive states strongly reflect interpersonal interaction /dynamics and context — standard assessments based on individual self-report lack the proper context for the measurement of dynamic cognitive states. VR technology enables the creation of controllable, interactive scenarios in which the patient, represented as an avatar, can respond to specific challenges similar to those they would encounter in the real world. Through the use of standardized and age- appropriate cognitive and emotional challenges in a computer-generated environment, Virtual Reality environments provide the capability to efficiently evoke and quantitatively score cognitive state and behavior in a reproducible, objective, standardized, dynamic, accurate, and culturally / contextually correct manner

Improved Interventions

Virtual Reality (VR) and Augmented Reality (AR) environments provide the capability to effectively evoke an emotional response and cognitive states in a reproducible, objective, standardized, dynamic, and culturally / contextually correct manner. The ability to reliably evoke a cognitive and emotional state provides the appropriate context to teach emotional and mood regulation skills, utilizing the protocols of CBT, ABMT, MBCT, and other evidence-based interventions that have been shown to be clinically effective. Patients can be taught cognitive and behavioral skills and practice them in real-time while being exposed to realistic cues - an approach that is believed to improve the generalization of therapeutic gains into the real world.

Promoting Adherence

Patients can be taught disease management skills and practice them in real-time while being exposed to realistic cues - an approach that has been shown to enhance generalization of therapeutic gains into the real world. The heightened sense of experience and game-like features of VR training help motivate patients and engage them more fully in the treatment process. VR training scenarios and exercises can be tailored to fit the patient's skill level, and rapidly modified to generate more or less challenging tasks. VR can be used to produce health maintenance protocols and exercises targeted to the specific needs of individual patients, using scenarios relevant to the patient's real-life daily activities and healthcare situation.


Distributed Care Delivery / Telemedicine

By leveraging the fact that a computer- generated environment enables VR facilitated assessments and treatments, portable VR technology can be deployed as the foundation for a telemedicine program. Standalone VR systems can be used to extend the reach of the clinician, provide healthcare access to underserved populations, support managed home recovery, enhance chronic disease management and protocol adherence, and facilitate for aging in place.
The possibility for the clinician and the client to physically remain in their respective locations while meeting in the virtual space for therapeutic interventions can transform the current focus of clinic-based care by shifting the center of care to the patient's location, no matter where that may be.
Moreover, the portable nature of VR technology provides the opportunity for therapeutic interventions to be provided early - the emphasis can be placed on prevention or early intervention before disorders become severe and chronic.