Dr Peter Sturgess

Please tell us about a day in the life as Director of Rehabilitation Medicine Prince of Wales Hospital

Every day is a little different which keeps it interesting! Usually, I start the day with a large cappuccino from my favourite coffee shop and then check and respond to urgent emails. I’m usually at my desk at 7.30am to review my calendar, respond to emails and review patients' electronic medical records before starting ward rounds or clinic at 8.30am. I’ve got meetings to attend on most days, these can range from family meetings, medical administration to research, which keeps the days varied.

I supervise a number of students and trainees and try to catch up with them for coffee a few times per week. Sadly, lunch is usually spent at my desk working! On Fridays I try to keep free for research at NeuRA, where I’m researching surface spinal cord stimulation and the effects it has on blood pressure and heart rate in persons with quadriplegia. I pick up my daughter from daycare in the afternoons some days, so leave early to navigate Sydney traffic! The evenings are spent with my wonderful family and dog, and I try my best to avoid work.

What sparked the idea of using VR in stroke rehabilitation?

I’m not the first to think of Virtual Reality (VR) for stroke rehab, but what’s unique about my focus is whether patients and caregivers can use the technology without clinician involvement. The idea came about as clinicians have less and less time to spend with patients, with increasing administrative work. In hospital, patients often have a lot of time in their day not doing rehab, and I wondered whether these gaps could be filled with VR games. VR allows someone to experience something new, not possible in the “real world” and has the potential to motivate people. Games can be fun, and allow patients to move their body and improve recovery from stroke. In this case, we’re interested in improving and increasing movements of the stroke-affected arm, creating an additional opportunity for neuroplastic changes (improving recovery after stroke).

How does "Whack-a-Wombat" help patients with their recovery?

The original “Whack-a-Wombat” was developed by Prof Juno Kim from the UNSW School of Optometry and Vision Sciences. His original game was produced for people who have vertigo and are able to stand and walk. When a person wears the VR headset, wombats appear anywhere in the virtual world, and they move the controller (which looks like a boxing glove in the virtual world), to “whack” the wombat and it disappears.

The idea was to adapt this game was to create an environment for “wombat whacking” that a patient could use whilst sitting upright in their hospital bed. Specifically it needed to be done so any patient could use it, so it had to be simplified and made as safe as possible. We also needed to get rid of the remotes, as many patients with stroke can’t use their hands effectively. Simo Jurisic, from IHealthE is a software engineer/programmer/guru who made it happen. He altered the view to only include a limited area where wombats would appear, and the new game can recognise the patient’s hands without the need for remotes. Most importantly, it can start simply by putting the headset on and wearing it.

We’re now in the process of recruiting participants and caregivers to experience this technology. After they’ve tried it, we will interview them to see what factors make this type of technology work, and what can be improved. Alongside this project we have UNSW students who are doing honours projects looking into developing additional stroke-specific VR games.

How does VR address some common challenges in stroke rehab?

For stroke recovery, the more you practice the better chance of recovery. This is the main principle of neuroplasticity. An analogy someone once said to me was, “if you want to get better at playing the piano, practice the piano”. In other words, repetitive movements doing specific tasks can lead to improvements in those tasks or similar. A challenge in stroke rehab is getting enough time to dedicate to therapy (time with their therapists e.g. physio, occupational therapists etc). Therapists only work during business hours, and nurses are often busy. This leads to time many hours not doing rehab, which I see as an opportunity. Some people also require an additional motivating factor to attend therapy, as this is voluntary and not forced upon patients. VR has the potential to address both these areas. If patients can use the technology on their own, it has the potential to reach many people around the world who aren’t able to attend rehab services.

How can other clinicians learn more about using VR in their work?

VR is readily available for gaming and getting cheaper with more competition from different gaming companies. Its use is expanding into clinical care for simulation, training and therapy. The potential is endless. A great start to see where VR is being used by clinicians in Sydney is join Sydney VR