The virtual approach to diabetic neuropathy
Virtual reality and biofeedback may hold key
Virtual reality, until very recently the kingdom of video game buffs and the sci-fi fringe, has become the stuff of solid scientific research.
Paired with biofeedback, a 70s tool of the meditation and mantra crowd, virtual reality may soon provide diabetics with a means of eliminating the crippling effects of neuropathy and perhaps preventing the amputations so often coupled with the disease.
Researchers at Eastern Virginia Medical School in Norfolk are conducting preliminary studies aimed at teaching patients to prevent nerve damage by helping them visualize blood vessels feeding the nerves and to focus on relaxing to help improve circulation.
A team led by Aaron Vinik, MD, director of research at Strelitz Diabetes Institutes at Eastern Virginia, devised a series of tests to study blood flow to the nerves. "We used laser doppler techniques, which we applied to skin at different parts of the body to measure blood flow," he says. "Through a series of provocative tests, we have shown that diabetics have this as one of the earliest abnormalities. In fact, they have the decreased blood flow long before you can see other evidence of nerve damage."
Vinik and his team used a variety of tests such as heating and cooling parts of the body, mental arithmetic, and "everything that will try and activate the nervous system that will change the diameter of blood vessels and alter the flow."
He notes that diabetics respond poorly to all the provocateur’s maneuvers. "I’ve always said if you want somebody to rob a bank and pass a lie detector test, use a diabetic. Basically what you are measuring with lie detector tests are changes in skin resistance and sweating and blood vessel reactivity, and [diabetics] don’t have that."
The research soared to the stratosphere when Vinik hooked up with NASA researcher and virtual reality inventor, Alan Pope, PhD, who had modeled how blood vessels react. "We said it would be very nice if we could actually get a model where we could see blood vessels in real time. So they went back and built a computer and software that does that," Vinik says.
The first effort was like a 50-year-old cartoon. "The blood vessel looked like a tube, and we said to them, No, that’s not what it looks like in reality,’" he says. "So we re-drew the tube to show them the arteries and capillaries, so they modeled them like that."
Now a subject wearing the headgear and an input cuff on the finger can "get inside the blood vessels. You don’t just look at them from outside, but it’s a model, so you can come right inside the model and you can walk around inside your blood vessels if you wish. Our studies on diabetics so far show that lot of the change was functional; it wasn’t structural," Vinik says. "The vessels weren’t permanently damaged; they were just overreactors. So we think that we ought to be able to train people to stop their vessels from being overreactors and we could then reduce the likelihood of developing ulcers and so forth."
Virtual reality may be slightly removed from the medical mainstream, but highly respected researchers like Vinik and many other colleagues are traveling the virtual road for answers to some age-old questions.
One of those travelers is David Warner, MD, PhD, a perceptual psychologist and founder of the Institute for Interventional Informatics at Syracuse (NY) University, whose work on a variety of fronts — including using virtual reality for paraplegics and for children with attention deficit disorder — has gained national attention.
"Virtual reality is an extra-strength placebo," he explains. "Sure this works. We’ve seen it all over the place. This is great for anything involving the autonomic nervous system. Eventually, we could create nerve entrainment through virtual reality."
Warner, Vinik, and their colleagues stop short of saying that diabetics could cure their own neuropathy through virtual reality and biofeedback. "If diabetics can unintentionally shut off circulation to an area of the body where it shouldn’t be shut off, like to the extremities, patients can also restore the circulation," Warner says. "Eventually, they’ll also be able to do it without virtual reality; that’s just a tool to help them."
"In some future time, probably within our life span, we can learn to turn the pancreas back on," he concludes.
For more information, contact: Aaron Vinik, MD, Director of Research at Strelitz Diabetes Institutes, Eastern Virginia Medical School, Norfolk. Telephone: (757) 446-5910. David Warner, MD, PhD, Institute for Interventional Informatics at Syracuse (NY) University. Telephone: (800) 950-0849. E-mail: [email protected].
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