How a suburban hospital uses VR for stroke rehab

David Gerfen puts on a headset and finds himself in a food truck tasked with making a cheese and tomato sandwich to order.

Transported into another virtual environment, Gerfen has to use one hand to fend off a blue ball that’s being shot at him across a green field like a throwing machine.

Gerfen, 80, is not an avid gamer. He is a stroke survivor who dons virtual reality goggles during his therapy sessions at Northwestern Medicine Marianjoy Rehabilitation Hospital in Wheaton.

“This is one of our newer games,” said occupational therapist Nicholas Giovannetti, directing Gerfen to move his weaker right arm. “Alright, you got it. Reach forward. Perfect.”

Virtual reality has a significant presence in healthcare. Some hospitals offer immersive virtual reality experiences to soothe and distract patients in pain or to escape a chemo appointment. Virtual reality has become a navigation tool, allowing brain surgeons to plan procedures and get a three-dimensional view of tumors.

Marianjoy is researching a virtual reality system as part of a rehabilitation program for adult stroke victims. Physicians see the potential for VR to help patients stay motivated in an intensive therapy plan.

“We hope that with this new type of technology, patients will be more interested in a therapy because it’s different,” said Dr. Mahesh Ramachandran, the hospital’s Chief Medical Officer and specialist in stroke rehabilitation. “It’s a little more exciting and fun than doing a monotonous type of routine exercise.”

David Gerfen from Elmhurst (right) is equipped with a head-mounted display. Occupational therapist Nicholas Giovannetti ensures the device fits properly and is comfortable for the patient.
-Paul Valade | Staff Photographer

How VR works

Sharon Schmidt suffered a debilitating stroke last December while clearing away Christmas decorations outside her home in Glendale Heights.

“I couldn’t do anything with my left leg, I couldn’t do anything with my left arm and left hand, and it was difficult for me to speak,” said Schmidt.

Schmidt, 74, was introduced to recreational virtual reality by her grandchildren. When her Marianjoy therapist suggested putting on VR gear, Schmidt was willing to give her a shot.

“Anything that helps you get back to where you were after a stroke — I’m all for it,” Schmidt said.

The rehabilitation clinic equips patients with a penumbra virtual reality system. Patients wear safety goggles and six sensors placed around both hands and down their waist, across their elbows and down their back so their virtual avatar matches their movements in real life.

Gerfen remained seated while his therapist guided and monitored his virtual exercises using a handheld tablet. Some activities are designed to practice hand-eye coordination, reaction time and motor control, the company said.

“We work on the balance while sitting,” said Giovannetti and asked for the right posture. “We’re working on his right arm in particular, reaching, working on coordination and also the ability to follow directions.”

Marianjoy tests virtual reality in a study led by Ramachandran and Dr. Dhruvil Pandya, a neurologist at Northwestern Medicine Central DuPage Hospital in Winfield.

First, they assess how well patients tolerate the virtual reality device. Therapists check for signs of motion sickness, dizziness, or nausea. The study is also limited to up to 20 patients who have upper body weakness due to stroke.

Doctors hope to publish their findings, but when and where will depend on study completion and results.

“Everyone we’ve actually tested has given us positive feedback,” Pandya said. “The next step is to examine the clinical results. Does this, along with traditional rehab therapy, improve outcomes?”

Researchers have described virtual reality as an adjunct — not a replacement — to standard therapy. The approximately 20 Marianjoy patients complete six sessions – 30 minutes of virtual reality followed by half an hour of conventional therapy per session – over a period of two weeks.

“We call them activities very specifically so they can feel like games at times,” said Gina Barry, executive vice president of Penumbra, a company that provides a virtual reality system to Marianjoy.
-Paul Valade | Staff Photographer

“Incredible Features”

Penumbra isn’t a tech company, but getting into virtual reality therapy was a logical next step.

The healthcare company is known for manufacturing catheters, which are used to remove a blood clot and restore blood flow to the brain of a stroke patient. Penumbra built the REAL system with Sixense Enterprises, a virtual reality developer acquired last year.

“VR offers some incredible capabilities,” said Gita Barry, Executive Vice President and General Manager of Immersive Health Care at Penumbra. “And we’re seeing that make a significant or real difference in the patient and therapist experience because therapists have a whole new way of engaging their patients.”

Therapists gradually increase the level of difficulty to allow patients to work towards more advanced activities in virtual environments.

“VR immerses you in the experience,” says Barry, an Arlington Heights graduate student from Buffalo Grove High School. “At least it just makes you happy because you’re having fun playing a game.”

The system records a patient’s progress, how much time is spent in these activities, and range of motion in the shoulders, elbows, forearms, and wrist. A “game of hide-and-seek” with animated penguins is intended to train the patient’s cervical spine.

“This distraction factor comes from getting more out of my therapy experience by engaging with the activity and not thinking about the pain,” Barry said.

The company also points to a 2019 meta-analysis of previous studies that suggested virtual reality “could apply principles relevant to neuroplasticity,” the brain’s ability to form new neural pathways around damaged areas.

dr Mahesh Ramachandran, left, Chief Medical Officer at Northwestern Medicine Marianjoy Rehabilitation Hospital, and Dr. Central DuPage Hospital neurologist Dhruvil Pandya, right, watches Elmhurst resident David Gerfen as he navigates a virtual reality environment.
-Paul Valade | Staff Photographer

What Patients Say

Giovannetti adjusts the flying blue ball’s speed and trajectory, and Gerfen seems to react intuitively. He stretches out his arm to punch it away.

His “seat balance has gotten better,” said Giovannetti. “He’s really stable there.” Gerfen’s wife Gerri agreed: “It helps him get a little more coordinated.”

Schmidt has evolved from a walker to a cane. She cheers for her grandchildren at football and baseball games. She can climb stairs independently.

But nearly a year ago, completing a simple virtual task was a challenge.

“It wasn’t easy to put these birds in their nests,” Schmidt said.

But she was looking forward to her virtual reality sessions.

“I would recommend it to anyone having a stroke.”