Madonna uses virtual reality technology for amputation rehabilitation

While the bright colors of the virtual ocean or sounds of an oversized pinball machine may feel like purely fun and games, for patients at Madonna Rehabilitation Hospitals, these activities are part of therapy. A specially curated suite of virtual reality (VR) exercises designed with a rehabilitation focus, known as the REAL? y-Series by Penumbra, uses upper and lower body sensors to allow clinicians to track and customize full body movement and progress in real time.

Clinicians can use the system to address motor skills, cognition, core and balance, functional tasks and wellness to support patient progression. As research emerges on the benefits of VR in rehabilitation, Madonna has begun incorporating it into physical and occupational therapy care plans. For specific patient populations, like amputation survivors, VR is proving to offer both physical and mental benefits.

“I’ve played on my nephew’s virtual reality headset before, and you don’t ever think about it as a healing tool until you’re here in this moment,” Krystal Bogdahn, an amputation survivor who used VR during her inpatient stay at Madonna, said.

Michala Hueber, PT, DPT, Krystal’s physical therapist, is using VR to combat a phenomenon known as phantom limb pain.

“Phantom limb pain occurs after an amputation, so those nerves are severed when they remove the limb and they continue to fire and they’re looking for a muscle to fire into that no longer exists,” Sarah Siegel, PT, DPT, Madonna’s amputee program leader, said. “It gives the patient the sensation that they’re still having pain in that portion of the limb that is no longer there, which can be very frustrating because the patient knows their limb is not there, but they’re still feeling that sensation or pain.”

“VR is essentially mirror therapy just in a different way,” Hueber said. “With mirror therapy, you put a mirror down the midline of a person’s body, and they look at the reflection of their sound limb. In VR, they can see their virtual limb moving, even if the physical limb is not there. Using mirror therapy or the VR can sort of trick the brain like, ‘Hey, I see this intact limb moving. It’s not painful when I move it.’ It is kind of like reverse psychology on that severed nerve and limb.”

For Krystal, seeing a virtual leg less than a month after her below-the-knee amputation brought several different emotions.

“Michala explained that I was going to see legs, and would this be ok with me?” Krystal said. “I appreciated that because it’s still really hard to have a leg removed, and then all of a sudden, here’s a visual representation of your leg, but I was ok with it. I even had fun with it, just kicking out a leg with a cute little shoe on it.”

With sensors on each hand and each knee, Krystal was able to simulate kicking a giant pinball with her feet and swim through the ocean using flippers. The exercise helped to improve her range of motion and strength in her residual limb, which is necessary should she decide to use a prosthetic in the future. Plus, the VR therapy gave her a much-needed a mental break from being in a hospital setting.

“It was exhilarating,” she said. “For me, you don’t think that this is therapy. I’m having fun. I’m at an arcade. That kind of escape I think is very good for mental rehabilitation as much as it is for physical.”

The underwater exercise proved to be Krystal’s favorite.

“I was even thinking about like, having my goggles put on and in a wetsuit,” Krystal said of putting on the VR headset and seeing virtual limbs. “It’s like donning a costume, like you get to be part of the role and it helps you feel like you’re actually there. I was swimming around and getting to see bubbles and fish, and then I got to virtually feed a little sea turtle. I put my hand out with a little leaf and he swam up and just ate. The joy that I felt, it filled my heart and it warmed my soul. I think that’s important for the healing too.”

Madonna therapists say they’re excited by the opportunities VR continues to present within the rehabilitation space. Hueber said she enjoys trying to think outside the box of ways to challenge her patients while making therapy feel like a game. With Krystal, Hueber added weights to her hands and had her sit on an uneven surface while using the VR system to force her to focus on using her core muscles to balance. It also helps to keep therapy sessions feeling fresh and exciting.

“It’s a great new tool in the toolbox,” Siegel said. “For our patients who have a longer length of stay, some of the basic activities can kind of stale to them and to us, so it’s just great to have as many tools as we can to engage them and keep progressing them.”

“I think that mixing up a care plan and having some fun is so important, and I really hope more people get to experience that,” Krystal added.