Feb. 25, 2022
Mayo Clinic is developing virtual reality (VR) software to improve neurological evaluations. The innovative approach has the potential to augment telestroke examinations as well as eventually enable at-home monitoring of patients with chronic neurological conditions.
"The transformative capabilities of VR are really exciting," says Stephen W. English Jr., M.D., M.B.A., a neurologist at Mayo Clinic in Jacksonville, Florida. "Mobility is an issue that often makes it difficult for patients to see neurologists in person. We hope this VR tool can be an adjunct that provides objective data for remote treatment decisions."
Mayo Clinic's software is being developed for eventual use with commercially available VR headsets. A pilot project focuses on stroke, taking advantage of Mayo Clinic's extensive telestroke network.
In the initial study, patients treated for stroke at Mayo Clinic's campus in Florida will have three evaluations: a bedside exam, a telestroke evaluation conducted as though the patient were in a remote emergency department, and an evaluation using VR headsets and hand controllers. That VR exam will guide patients through tests of factors such as level of consciousness, ability to answer questions, eye movements, field of vision, arm movements and coordination.
"We want to compare the VR system and the telestroke evaluation to ensure the reliable detection of neurological dysfunction and abnormalities," Dr. English says. "The goal is to validate the VR modality and then expand its use to aid in assessment of other neurological conditions such as multiple sclerosis, Alzheimer's disease and Parkinson's disease."
Dr. English notes that VR headsets are widely available, highly functional and relatively affordable for consumers. "Our long-range goal is to provide headsets and software for patients with chronic diseases to use in their homes," he says. "The patients could do periodic VR tests to catch early signs of progression, monitor treatment response or screen for abnormalities that might prompt a neurological evaluation."
Capturing subtle visual abnormalities
Mayo Clinic is a pioneer in the use of telemedicine for the evaluation of patients with stroke. Telestroke has been well validated as a means of assessing stroke severity. But assessing vision via telestroke video can be a challenge.
"The very rudimentary finger-counting exercises that we do at the bedside to test peripheral vision are suboptimal. The person performing the tests doesn't always understand how to properly administer them," Dr. English says. "The VR headset allows us to quickly test eye movements and visual fields through novel eye-tracking technology and get objective data."
Detecting hemispatial neglect is a particularly important part of visual examinations — not only for suspected stroke but also for diseases such as dementia, traumatic brain injury or malignancy. "Sometimes hemispatial neglect is obvious. But it might be very subtle," Dr. English says. "We're hoping to develop various VR exercises that can capture hemispatial neglect in ways that aren't feasible with telemedicine evaluation." For example, a patient might be shown a horizontal line that fills the field of vision and then be asked to bisect the line. Individuals with hemispatial neglect might cut the line at the 25% mark rather than the 50% mark.
Mayo Clinic is committed to developing new technology that benefits patients. "That's part of Mayo Clinic's culture of innovation," Dr. English says. "We're at the tip of the iceberg in terms of VR's capabilities. In the next five years, we'll have an even greater ability to capture objective data to help improve the remote and home-based care of our patients."
For more information
Refer a patient to Mayo Clinic.