The Air Force’s Telehealth Virtual Reality System

Blogger Margaret Emory with Systems Analyst Krista L. Septer and Telehealth's VR System
The Air Force Medical Service participated in Air Force Week 2012 in New York City from Aug. 19-21.  The medical portion, “Air Force Medicine: 21st Century Care for Hometown Heroes,” featured three state-of-the-art deployment medicine programs that demonstrated the continuum of care provided to our troops, from cutting-edge trauma training for deploying medical staff, to aeromedical evacuation critical “care in the air,” to treatment and support for recovery of body and mind.

As Editor of Brain World Magazine, I was especially interested in the Virtual Reality-Afghanistan system to treat PTSD and other mental ailments.  The Virtual Reality system is an interactive VR-based application developed to aid in the assessment and treatment of service members returning from Iraq and Afghanistan who are diagnosed with anxiety disorders, such as Post Traumatic Stress Disorder (PTSD). The Virtual Iraq/Afghanistan application uses VR as a promising alternative to traditional imaginal exposure therapy in which patients suffering from such anxiety disorders are led by clinicians to imagine their traumatic experiences in an incremental, stepwise fashion. Just as an aircraft simulator can teach a pilot how to operate efficiently under extreme weather conditions, VR simulations can be used by a clinician to help patients cope with and overcome their trauma.

Air Force Lt. Col. Antonio Eppolito, M.D., Chief of Telehealth greeted me with the question, “Are you familiar with exposure therapy?” I said I thought so. He went on to explain that it’s what a psychologist typically does when treating a patient with PTSD. When exposure therapy is taken to the next logical level which immerses a patient in a virtual reality then you have virtual reality exposure therapy. While the treatment occurs in a safe, controlled clinical environment with a clinician standing by, the virtual reality simulation immerses the patient so fully they don’t have to draw on their imagination as has historically been done on the psychiatrist’s couch. The therapist uses the usual techniques of biofeedback, relaxation techniques, whatever they would do to talk them down when the patient becomes stimulated. The virtual environment enhances the experience. It was primarily created to treat wounded warriors for PTSD and TBI but it has other applications beyond–treating phobias, addictions, role playing scenarios such as anger management therapy, fear of speaking, fear of heights.

Col. Eppolito explained that what keeps you safe in the theater environment can render you incapable in the civilian environment. For example, let’s say you’re trained to never slow down at a roadside box or bag because it could be an explosive. So in that instance, you will move to the other side of the road, or speed up. This behavior is not practical in the civilian environment where you might come out in the morning and everyone has their garbage out for pick up in your neighborhood. Those garbage bags look like the roadside boxes you were trained to avoid. You panic and become disfunctional. When exposed during the session and in a panic state the therapist talks you down. VR Simulation customizes the virtual reality per individual case and because a patient is put through it over and over they become desensitized to the trauma. Repeated exposure helps desensitization. And if you practice enough in therapy when it happens for real you draw on your therapy training. There are also homework sessions.

VR Simulation is currently in 10 Air Force Military Treatment Facilities at the largest populations at need, 9 in the U.S. and one overseas. It has been in existence for two years and while it is not for everyone, it is particularly successful with a certain pool of candidates.

Then it was my turn to demo the equipment. I put on the goggles, adjusted the lenses so I could see comfortably. I donned the earphones. Unfortunately they were without the scent machine so no smell of burning flesh or diesel fuels this time. That was a disappointment because I hear that olfactory emissions are very powerful triggers. Systems analyst Krista Septer (pictured above) offered me the model gun with the toggle switch…this is apparently very popular as so much of the war theatre occurs while walking. I opted for the standard gamepad controller and started driving my humvee down the village street in the midst of gunfire, blasts, cars exploding. Avatar meets Armageddon. It was quite an experience. It is one of the reasons I don’t like going to the movies…they are just too real. But I could see how effective this could be in transporting patients quickly to the scene of their terror.

I found out from Telehealth Program Manager Bart Delphin that “tele” means movement of electrons to support technology…in this case, with telehealth, the technology delivering health care. According to Bart, “We have minimized funding, reduced manning but our field is growing so we have leveraged technology.”

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