Plucking virtual flower petals: rehabilitation after the IC

Intensive care (IC) medicine is getting better at keeping seriously ill people alive, but recovery after admission to the IC unit often takes months or even years. PhD student Lise Beumeler is researching which patients would benefit from an IC rehabilitation track and what such a track should look like. Together with the company 8D-games, she is researching how gaming, more specifically ‘serious gaming’, can help with this.

Lise Beumeler is someone who enjoys looking through the swinging doors at the hospital department, who works together with other disciplines, and who often gains surprising insights. She embraces collaborating with industry, too, because: ‘The different energy and expertise always ensure outcomes that I would never have reached alone – we simply need one another!’ Beumeler studied Biomedical Sciences at the UG and now finds herself in the final phase of her PhD programme: conducting an innovative health care study at the UG/Campus Fryslân and the Medical Centre Leeuwarden (MCL). In her research, Beumeler maps out the long-term symptoms experienced by former IC patients and what can be done to promote the recovery of these individuals.

Frightening times

‘The symptoms may be physical or mental,’ explains Beumeler. ‘Physical symptoms are often the result of muscle deterioration, which occurs lightning-fast during IC admission and involves a very long recovery period. Even lifting a cup of coffee can be too difficult for these patients.’ But IC admission also has a significant mental impact: ‘Many patients experience their days in the IC unit as a frightening time. Thereafter, they are often bothered by sleeping problems, nightmares, and depressive feelings.’ The consequences are especially significant for so-called long stayers: patients who spend longer than two days in the IC unit. Over half of these patients still experience symptoms a year later, resulting in them having a lower quality of life than before IC admission.’

Attention for aftercare after IC admission was not self-evident for a long time. But this is changing, partly because of the coronavirus pandemic. Ever more hospitals, just like the MCL, are implementing an aftercare clinic, but how this care should ideally take shape and how it could best be offered are not yet foregone conclusions. Together with her two supervisors, MCL intensivist Christiaan Boerma and UMCG professor Gerjan Navis, Beumeler is experimenting with possible solutions regarding rehabilitation, diet, and movement, in close collaboration with healthcare professionals including dieticians, physiotherapists, IC nurses, and intensivists.

For example, Beumeler has developed an aftercare brochure, has organized tours of the IC with the aftercare clinic team, and is investigating ways in which patients can be encouraged to do their exercises in a responsible and appealing manner.

Leeuwarden company

Inspiration to tackle the latter problem sprouted when Beumeler got talking with Johan van der Meulen, technical director of 8D-games, during a networking meeting. This company, from Leeuwarden, makes ‘serious games’ for sectors including healthcare, education, and government. ‘I already knew about the ice-skating game that 8D-games had developed for the UMCG in 2016, in which elderly people could train their balance,’ says Beumeler, ‘and I was curious whether Johan also had ideas for helping part of my target group with their exercises, which are often experienced as being painful, difficult, and frustrating, and are therefore not very popular.’

He did indeed have ideas, and a meeting in the hospital with Beumeler and her colleagues from the aftercare clinic soon followed. ‘In the meeting, I told them about my ideas and showed them the games that we had already developed and that, to me, seemed to be suitable for their target group,’ Van der Meulen reflects. ‘Because many patients are bedridden or chair-bound, the possibilities are limited, but with the help of a Virtual Reality headset, you can give patients the illusion that they are throwing paper planes through a room, for example. For the patients for whom such arm movements would be too much, I brought a game with me in which you can pluck flower petals from a screen using a sensor.’

Fantastic VR headset

After hearing from professionals, it was the IC patients’ turn to try their hand at the selected games. ‘It was really fantastic to see how these folks, mostly in their 70s, couldn’t keep their hands off the VR headset,’ chuckles Van der Meulen. ‘You would expect pure panic, but that was underestimating them: once they knew how to use the device, it worked really well. It was important, though, that the patients were helped in this, which unfortunately took a lot of time. If you want an innovation to be included in a health care track, then it must not take even more time from the staff, as they simply do not have it to spare. We haven’t yet figured out how we will arrange this.’

Beumeler is pleasantly surprised to see that the test subjects not only found enjoyed the exercises more when playing a serious game, but also moved better and for longer. ‘I saw a great curiosity and eagerness among them to have a go with the games. During the games, they were also a lot less aware of their symptoms, meaning that they moved much more freely. Pain has a very clear psychological aspect: you might dismiss certain exercises or tense up during them out of fear of worsening the pain. Shifting the focus offers clear possibilities. In this case, the name “serious games” is therefore misguiding – they actually make the exercises less serious; they take the sting out of them!’

Health care innovations

Beumeler, the aftercare team, and the test subjects are all so enthusiastic about Van der Meulen’s ideas that 8D-games has been tasked with developing a serious game for hand and arm movements, funded by the MCL innovation budget. The first prototypes are expected to be able to be tested in the coming spring. Van der Meulen can already reveal a glimpse of what to expect: ‘Both the VR headset and the plucking of flower petals will return in this game.’

Whether the serious game will actually be implemented in the hospital depends on a great many factors: ‘The medical landscape is very complex. Politicians and healthcare insurers play an enormous role in whether or not health care innovations are implemented,’ explains Van der Meulen. ‘The objective of this whole procedure is, first and foremost, research,’ adds Beumeler. ‘We want to discover what the value of this technology is and, in this way, pave the way for future applications in practice, which we are hopeful will come!’ ‘Other hospitals have already shown plenty of interest, in any case,’ concludes Van der Meulen.

CV

Lise Beumeler (1992) obtained her MSc in Biomedical Sciences in Groningen in 2015. Hereafter, she worked as a researcher at the Slaapcentrum voor psychiatrie (Sleep Centre for Psychiatry) of the Municipal Mental Health Care Service (GGZ) in Drenthe, and then at the Centrum Integrale Psychiatrie (Integral Psychiatry Centre) of Lentis. Since 2018, she has been a PhD student at the UG/Campus Fryslân and the Medical Center Leeuwarden, where she is researching the recovery of patients after IC admission