Bournemouth University Digital Therapeutics and Immersive Technologies presentation

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Some of the things I'm going to be talking about  today really relate to the use of of real world   environments. I'm going to be talking about  some applications which I think Anand could   be interested in because one of those is the use  of digital technologies for neuro rehabilitation   using a combination of games and immersive  technologies. I'm going to try and rattle through   this presentation quite quickly because the  beginning part of it is really to do with a bit   of background to digital therapeutics and I wanted  to start by just seeing if I can define digital   therapeutics. When I first became involved with  the international society for digital medicine   I couldn't get my head around why they called it  digital medicine because how can you use digital   as a form of medicine? So I tried to persuade  them to change it to the international society of   digital health which would include diagnostics and  other things but in the six years that I've been   involved with ISDM I now can see quite clearly how  you can use digital technologies for medicine in   the form of therapeutics, so the first part of my  presentation is really to set the scene as to why   digital therapeutics is particularly important  in today's environment. I'm going to be talking   and giving examples of digital therapeutics for  mental health and well-being and also for physical   health and well-being but before that I'm going  to go very quickly through a series of slides   which explain something about the challenges  which go beyond coronavirus to something more   fundamental about life in the 21st and  22nd centuries. So what we've seen over  

the last century or so is a real increase in life  expectancy and this has created its own challenges   because we've got a growing number of people who  are in my age group. I'm 72 so I am in the aging   society already and I'm very conscious of the  fact that there's a smaller and smaller number   of people who are working to provide the income  to be able to support this aging population.   So this is represented in this graph that  shows that from 1945 when we had approximately   40 percent of people working compared to  the retired population to predictions now   going down to about 2.9 of the population.  Now added to that, we all know that we have   quite a number of challenges that you will all be  familiar with - our lifestyle, smoking, obesity,   loneliness, social isolation. The number of  people and the resources available to support   them particularly when they need care - all  of these things go to create a problem with   the sustainability. I'm just showing a picture as  an example of this. This is actually my mum - my   mum she was taken into a hospital unconscious  and in fact when I went to see her, she was in   acute care and the the nurse talked me through  the Liverpool pathway to explain that my mum was   suffering from, or she was exhibiting  what they call chain stoking - a form   of breathing which is - you probably aware is  what people have when they're close to death   so she was trying to prepare me for the worst   and I thought to myself you're actually enjoying  this you know. I got the impression that it wasn't  

something that she really felt bad about doing  - I got the impression that she almost enjoyed   having to go through this process with me  and the second thing was and I said to her   chain stoking? that's my mum's snoring you know I  know how my mum snores she spent a lot of the day   asleep so I was quite familiar with that anyway  to cut a long story short she was put into, when   they when they stabilized her condition she was  put into an isolation ward and I went to see her   and the consultant came into the room and again  said you know your mother is extremely ill   and I said well when I came in she recognized  me - she opened her eyes and the doctor was   dumbfounded he couldn't believe it so he said  - he went to the bottom of the bed - he said   Mrs Wortley can you hear me? if you can hear  me raise your hand. My mum's hand went went   up and so from there on they went from  a situation where they were really   withdrawing all the support to help her recover  to help her to she did actually go back again into   another another nursing home so these challenges  are related the fact we are living longer and as   I found out with my mum and my my partner's father  we need more medical care as we age a few people   able to support them and society is changing  exponentially and one of the reasons why   COVID is so severe is the fact we've got such  social mobility - social mobility we travel a   lot - I haven't been able to travel for  for two years and it was you know a big   blow to me but the fact that we are able to travel  so much or have been able to travel so much is one   of the reasons why pandemics are not going to be a  rare event they're going to be something which is   with us for a long time so coronavirus - what it's  done is exposed our vulnerability to unsustainable   public services but it's also accelerated the  use of digital technologies for a range of   situation now we have a number of choices I  think when we're trying to deal with tackling the   problems that we have today with medicine and  these choices I would describe as being clinical   cures and we've already seen the effectiveness  of vaccines in the coronavirus situation   but added to that we can also deploy legislation  as the government has done having lockdowns and   rules that prevent us from spreading infection  and the third thing we can do is to accept   some sort of personal responsibility for looking  after our own health and this is where we have a   bit of a dilemma because I think it's a little  bit of a paradox it's almost like having   an angel and a devil sat on our shoulder - on  the one hand we're seeing the fantastic advances   in technology that give us confidence that you  know these things are going to be sorted out   so don't worry about it we will have technology  that will solve the problem and on the other hand   we can see technology as something that gives  us some empowerment on taking responsibility   for our own health and so whether you're familiar  with the locus of control but research shows that   younger people today increasingly  are feeling that they don't   have power over their own future  they feel that technology is actually   making them more dependent on technology and  with that they don't feel they have either the   control or the responsibility over their future  and I think that's a that's a real issue because   we have to take responsibility for our own  health if we're going to make this transition   from cure to prevention that's absolutely vital  to the future of sustainable health care so   how can we influence lifestyle behaviours and  circumstances at an individual level but also at   scale and the way I described it is that we need  to create a kind of ecosystem where we provide   personalized gamified and validated behavioural  change changing people's behaviour - helping   them to live a healthier and more fulfilled  longer lives is critical to the future of our   healthcare services and these in my experience  are the most important factors in trying to   influence that - diet, exercise, hydration,  sleep, mindfulness and stress management,   and a social support network  so a lot of the things that I   work with and a lot of things thatIi use myself in  my own personal health management are related to   these kinds of factors and I'd be happy to share  with you some of the devices and applications   that that I use to manage my own manage my own  health so what we're using technology to do   are first of all to look at things the factors  that influence our personal health management   create benchmarks for ourselves - if we don't know  where we stand in the health spectrum, we can't   possibly be able to measure how we're improving  on that then we need, from a gamification point   of view, to set achievable goals - now in my case  when I started on this road some seven years ago   I gamified my own health and my my achievable goal  was ten thousand steps a day because that was the   mantra of the day so in the last seven years  I've walked at least five miles every day apart   from probably less than one percent of the days so  wherever I am - today I walked down to Bournemouth   beach and I will do my my five miles during the  day and I use my my Fitbit and devices to to to   achieve that so it's very much a personalization  of healthcare not everybody can do ten thousand   steps and not it's not appropriate for everybody  but what you need to do is to identify those   things in your life that you can change and find  the technologies and the methodologies to allow   you to do that and what you finish up creating  i think is what this personalized gamified and   validated health ecosystem so i am particularly  interested in working with Bournemouth i've been   to many international conferences and i know  Bournemouth has a very good reputation already   and so i'm keen to try and leverage  your reputation my contact network and   experience to help bring people and funding and  reputation to your university so now to get to the   kind of meet and the demonstrations of  digital medicine and digital therapeutics   we're talking about life after COVID 19 what  are the kind of things that are going on already   and how do they work well one of the partners  that i that i work with is an Italian   serious games company they they've done almost  20 EU funded projects and their speciality is   gamified health so they have applications for uh  particularly for people with neuro rehabilitation   people recurring from a stroke, Parkinson's  disease etc um and so they have this gamified   environment it's not virtual reality environment  but it uses Microsoft Kinect or equivalent devices   and just got a little video to  show you an idea of how it works so you can see the patient is just using  the hand to navigate around the maze   so it tracks motion and it deploys it  in a game environment and this can help   not just with physical rehabilitation  but also with cognitive rehabilitation   by uh giving people challenges so for example with  dementia sufferers uh they have a typical kitchen   environment where people have to pick coloured  cans off the shelf and put them on the table so   they're exercising their body but they're also  exercising their mind as well so there's a range   of different kind of applications that they work  with so that's Rehability as a project and i know   that the company behind them are always  interested in collaboration with university   so that the information that is collected from  Rehability goes to a physiotherapist dashboard   so the physiotherapist can remotely manage  the patient so the patient can be at home   do these exercises in front of their own  television and the data is captured by the the   system and the physiotherapist can adjust  the exercises in the games and the complexity   according to how the patient is doing but  at least it gives them an ability to manage   patients remotely without the patient having to  travel to a dedicated rehab adaptation facility   now this is something that i've been using myself  you can see me with my Oculus quest headset on   there and i'm using a little um a desktop bike  which you can put on the floor and you can cycle   with or you can put on a table as i'm doing here  and you can do exercises and what i've been using   it is with um a software via virtual reality  software application called VZFIT which allows   you to carry out exercises and you can choose your  virtual environment so it is about creating and   sharing virtual rides so this is a little video  i've made showing myself with the oculus quest so i'll start the exercise and you can see  uh i chose the environment and this is a us   environment and i'm busy excitedly through a  virtual environment but because it works with um   with google earth google maps i  could cycle from this building   into Bournemouth station or wherever i want  i can create my own customized environment   is i found myself a little bit disoriented  because the way that Google Earth captures   images and you perhaps can see this is that  as you're driving along it has incremental   steps and that can make you feel a little bit  dizzy and sick so there are limitations to it   but there are other applications to work on a  mobile phone and Holofitt is one example of that   this is something which i think has a lot of  impair potential and i i would love to work with   with you on a funded project to evaluate its  potential i call it 360 and 360 living memorials   and it's about capturing the memories of  older people and recording um family events   so the a it can help the person with their  with their memory and stimulate their   cognitive ability but also from a family  point of view when that person passes away   they can have the same experience of  being in the room with that person so   what you see on the screen here um is my partner's  late father he died in October 96 years old   and there's a VR video with his girlfriend  she's 92 and they've been together for   eight eight years and sadly because of both  of their conditions we had to separate them   because we couldn't look after both of them so  Eric stayed with us and his partner went to live   near her family but i took the opportunity to  record some uh vr videos and i created a kind   of harry potter environment using uh real world  images and i i just like to just show you a quick   video here's Eric and this is actually taken  from the application so this is our living room   and you can see talking pictures unless you  family tree displays when you go over this   and as you roll over you get these pictures of  the family when when it's developed fully uh if   you click on someone in the family um you will get  their memories so here's Eric and his girlfriend   and if i click on that they're talking about when  they first met on a Saga holiday and this is in a   VR environment you can see me standing there  talking to them and so this is available for   their family and above the fireplace there are  these talking videos of my my wife my partner's   sisters and if you click on a picture frame uh  you get Eric telling about talking about his   his early life so i i think there's many  different applications and i i love doing   the lunch time to show you some of those  applications the other thing i would like   to to show you is has anyone heard of Alcove  VR no i think it's a wonderful application   particularly for uh for families and dementia  patients in fact the environment was created to   be able to build your own personalized space  so what you get is an apartment like this   that you can invite other people to  so other people wearing oculus quest   can actually join you in your apartment you can  watch videos together you can listen to music   together you can go on tours around the world  and you can personalize your environment with   your own pictures so if i go into the next slide  this is actually captured from my oculus quest   jags about a bit so i i've uploaded some of  my own virtual reality videos um so i love   steam trains but i also love drones and this is a  360 degree drone photograph shot in Kuala Lumpur   at night so i turned it into a still  image and within this alcove environment   you get the virtual reality experience of  actually flying through uh Kuala Lumpur   so uh getting very quickly towards the end of my  my presentation now um when we're talking about   these digital therapeutics for older people  solutions are already available for both   physical and mental health and these solutions  can do with some research and validation   and lots more solutions will will come along  and if i'm trying to sell myself i have a lot of   contacts who are working in this space so i would  love to engage them with you to create win-win   situations that will bring funding and projects  into you but it's important that the solution must   be plug and play for older people particularly  one of the disadvantages of the Oculus quest is   that it's not a plug-and-play environment  what i had to do with uh with Eric was to   basically to load the the the VR  experience and put the headset on   on him to watch it um and because he's not  familiar with the controllers i had to cast   the the video onto the television set so i could  see what he saw and i could control it for him.

2022-01-31

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