Israeli virtual reality game helps dozens of new war amputees reduce phantom pain
Start-up 6Degrees says their immersive approach cuts phantom pain faster than current treatments; amputees do physical therapy on their own in an over-stressed healthcare system
Reporter at The Times of Israel
An Israeli medical start-up company has designed immersive virtual reality games to enable dozens of new war amputees to have independent physical therapy sessions while decreasing their phantom pain — and their dependence on pain medications.
As of the beginning of September, there are currently 68 soldiers who are newly registered war amputees, according to a spokesperson for the Health Ministry, which monitors the number of injured soldiers who need prosthetic fittings.
The Defense Ministry Rehabilitation Department said that 10,056 soldiers have been wounded since the war began on October 7, when thousands of Hamas-led terrorists stormed southern Israel to kill nearly 1,200 people and take 251 hostages.
Of those injured soldiers, some 37 percent, or 3,720, have suffered physical trauma to their limbs.
The sudden increase in the wounded has put a strain on the healthcare system, said Aryeh Katz, 41, co-founder of the company, 6Degrees. He and his wife, Miri Berger, developed AI immersive virtual reality games for amputees to participate in “mirror therapy,” where they can see and control a virtual leg or legs, on their own.
Clinical trials at Sheba Medical Center and veterans’ hospitals in the United States have shown that the company’s MyMove games can reduce pain faster than current treatments.
Berger, an industrial designer, developed the 6Degrees system and designed the user experience, while Katz, an electrical engineer, constructed the hardware and programmed the algorithms that power it. The company received a grant from the Israel Innovation Authority and Arc Innovation at Sheba, where the company ran a successful pilot trial. They are now waiting for approval from the Health Ministry to make the system available to patients countrywide.
They say their technology will allow patients to do physical therapy independently, both in the hospital and later at home. The AI system is connected to the hospital data center so that staff can use the feedback to chart their progress and level of pain.
Berger said that 80% of all amputees have phantom limb pain. Clinical trials show that 88% of the patients who used the gaming system reported decreased pain. Some reported pain reduction immediately after the first session, while 29% said the pain relief lasted 6 months after their last session. This allows the patients to reduce their use of pain medications to help them function better as they try to reintegrate into society.
In the Sheba Medical Center rehab room
On a recent morning, Berger and Katz, who walks with a cane, arrived at the busy orthopedic rehabilitation room in Sheba Medical Center. The hospital has already treated about 55 amputees; there are now 19 soldier amputees in the orthopedic ward.
The couple was giving away two MyMove systems, free of charge, to recent amputees as part of a fundraising campaign. Katz said they have received requests from Israeli hospitals for 120 systems, which include a VR Oculus, headset, and connective data bands.
Katz was injured in an army drill while a paratrooper in 2002, with severe nerve damage in his feet. He suffers from Complex Regional Pain Syndrome, or CRPS, a persistent pain condition that can affect a limb after an injury.
“I live with pain, and I know how much pain can influence your day-to-day,” Katz said. He also struggled with the way pain medications decreased his ability to concentrate.
I live with pain, and I know how much pain can influence your day-to-day
“It’s one of the things that stuck with us,” he said, and a reason they developed the MyMove system because they saw “what people were going through.”
Katz spends most of his time barefoot; if he has to wear shoes, he wears them without socks, keeping them untied and loose because of his foot pain.
He bent down near Tamir, 27, whose last name has been withheld, to help him put the system’s bands on his legs, setting up the system.
Tamir told this Times of Israel reporter that he had been injured three weeks before in Rafah, Gaza Strip. He recounted that he and fellow soldiers had gone “deep” into an area to find Hamas-built tunnels. They saw terrorists, and 40 minutes later, when they were in a room, “an RPG hit from a direction we didn’t expect,” wounding three other soldiers. Tamir knew his ankle was “destroyed” in the blast, but as the unit commander, he was the one who called for medical assistance.
In a wheelchair, his left leg bandaged and extended, Tamir watched a former soldier, whose leg was amputated due to war wounds several months ago, walk confidently into the room, outfitted with a prosthetic leg, wearing a pair of athletic shoes.
Tamir said he would stay in the hospital for a total of six weeks, waiting to be fitted for his prosthetic leg.
Katz helped Tamir put on the Virtual Reality Oculus. Before playing, Tamir replied to questions concerning how much pain he was in, and whether he had increased or decreased his pain medications.
He was then immersed in a soccer game where he could see and control a virtual leg which was now kicking the ball, using his virtual ankle, heel, or leg muscles.
“Goal!” Tamir called out excitedly, adding, “Magniv,” in Hebrew, or cool.
During the game, the system collected valuable feedback on how he engaged his muscles and his range of motion and speed. The data was immediately accessible to hospital staff, including physical therapists and caretakers, who chart his progress.
Moving whatever is left of the limb is important for blood flow, Katz said. The games help motor and cognitive skills, and patients can compare their scores. Katz said they hope to develop a multi-player system for people to play simultaneously. He added that he makes sure to test the games on himself; he finds they have decreased pain from his injuries.
“The tingling in my leg stopped,” Tamir said after he finished playing.
“The fact that he’s using the leg during the game will send signals to his brain that the leg is doing what it is supposed to do,” Katz explained. “That will decrease the pain.”
Two hundred kinds of pain
“There are about 200 different definitions for pain,” Katz said.
“It could be tickling, you know, like ants, or somebody is stabbing you,” he said.
Phantom pain for a phantom limb is another strange kind of pain.
Berger said she could explain the phenomenon of phantom pain in “layman’s terms.”
“Let’s say someone whispers to you, ‘move,’ and you don’t move,” said Berger. “The person says, ‘move’ louder, but you still don’t move. Now they are yelling, ‘Move! move!’ Well, the brain, which doesn’t know the limb is no longer there, is telling an amputee to move it, and when it doesn’t move, the brain sends out painful signals.”
The brain, which doesn’t know the limb is no longer there, is telling an amputee to move it, and when it doesn’t move, the brain sends out painful signals
This experience of pain or discomfort in a missing limb is known as “phantom pain.”
However, when patients do exercises as if they are moving their non-existent limbs, the brain is fooled and sends less painful signals.
“Amputees are treated with over-the-counter pain medication, morphine, or opioids, depending on the intensity of the pain,” Katz said. “But painkillers affect your concentration. One of the goals of MyMove is to reduce pain and thereby reduce the amount of pain medication.”
Mirror therapy
The MyMove system works on a protocol known as mirror therapy, invented in the 1990s by Dr. V. S. Ramachandran, a University of California, San Diego neuroscientist and professor, to reduce phantom pain.
Ramachandran hypothesized that using a mirror would trick the brain into thinking the phantom limb was moving, therefore allowing it to relax. To retrain the brain, he invented mirror therapy.
Today, amputees work in front of a mirror and create the illusion that the missing limb is still present, thereby lessening pain.
At the rehab center, physical therapists guided soldiers with missing limbs and other injuries as they did exercises in front of a long mirror. They all talked, encouraging one another.
“The number of patients needing care is overwhelming,” Katz said, looking around the crowded rehab room. Instead of waiting for a physical therapist, patients can use the game on their own.
Katz said that people usually quit traditional mirror therapy because “it’s boring.”
Their system, which includes a simulated soccer game and a music program where people feel as if they are dancing, allows amputees to do the mirror therapy exercises remotely, without a physical therapist, and “without the need of a giant mirror.”
Immersive Room for rehabilitation
Last month, the hospital opened an immersive room for rehabilitation to help a wide variety of patients.
The room has a special sound system, projectors, and sensors that create a four-dimensional experience to aid rehabilitation, and several patients can be in the room at the same time.
Maya Ehrlich, a rehabilitation psychologist and the innovation coordinator at Sheba’s Integrated Rehabilitation Hospital, showed the many uses of the room. The technology comes from a British educational company; Sheba staff has revamped it for rehabilitative uses.
With the touch of a button, she made a verdant scene suddenly spring all around, and patients could make flowers blossom by moving their arms correctly.
Another program was designed to help patients become familiar with their new physical limitations so that they can better adapt to their homes after they leave the hospital. There’s a living room, a bedroom, and a bathroom; after Ehrlich pressed the right button on the wall, the toilet noisily flushed.
People who have suffered traumatic brain injury can use a program that enables them to enter a supermarket or clothing store, shop for various items, and ring up sales. One program whisks people away to Thailand or to visit a museum exhibit on Van Gogh.
The room is available as part of the various treatments for patients at the hospital.
Back in the orthopedic rehab room, Berger said that she and Katz hope their technology will help people “stick with their treatment.”
“We want to be part of their recovery support system,” she said. “Dealing with pain is a lifelong process.”
