For children and adolescents with cancer, exercise is a proven way to improve quality of life, cancer-related fatigue, and physical strength. Yet, many young patients struggle to stay active, especially during hospitalizations.
Enter Virtual Reality (VR), an innovative tool that’s bridging the gap between exercise recommendations and real-world challenges.
In this episode, I sit down with experts Mary Hunter, PT, & Dr. Stephanie Hunter, PT, from Stanford Children’s Hospital to discuss how VR is reshaping pediatric oncology rehab.
You’ll hear about VR’s unique benefits—like pain reduction, improved patient engagement, and enhanced endurance—and unpack the latest research, case studies, and practical tips for incorporating VR into your patient care.
If you’re curious about how technology can elevate your practice and your patients’ experiences, this episode is for you!
🎧 Tune in now to discover the future of pediatric cancer rehab.
Mark your calendar for Can Virtual Reality Improve Clinical Reality? VR’s Role in Pediatric Oncology Rehab
Join Mary & Stephanie for their session, Can Virtual Reality Improve Clinical Reality? VR’s Role in Pediatric Oncology Rehab, on Thursday, February 13, 2025 from 11am-1pm.
This session will be available on-demand.
Click here for more information on this amazing session.
More resources on VR in oncology rehab:
Check out the nonprofit InvinciKids.
Check out the Stanford Chariot Program.
About Mary Hunter, PT
Mary Hunter, PT is a pediatric acute care physical therapist at Stanford Medicine – Children’s Health in Palo Alto, CA. She received her Physical Therapy degree from the Medical University of South Carolina and has been in pediatric practice for over 20 years working at Oregon Health and Sciences University, Texas Children’s Hospital, University of California San Francisco, and Stanford Children’s Health. Much of her time has been spent in the pediatric acute care setting, primarily with the oncology/SCT patient population.
Over the last year, she has begun working as part of an interdisciplinary team developing programs to promote the use of Immersive Technology/Virtual Reality in the rehab setting, providing training and ongoing support to hospital staff regarding the use of VR in the rehab setting, and developing and assisting with research focused on the use of VR to increase patient engagement in Physical Therapy with the Stanford Chariot Program at Stanford Children’s Health. Mary enjoys working with patients and their families to empower them to find ways to continue to move, move more, and enjoy moving. She strives to help patients find their own way to exercise and remain active throughout their cancer journey and hopefully bring them some joy (or at least a distraction) to enable families to help their loved ones have an active future living with and beyond cancer. In her free time, Mary enjoys reading, playing Supernatural on her Quest 3 VR headset, spending time with family and friends, and nice long walks with her dog.
Mary can be reached at mahunter@stanfordchildrens.org.
About Dr. Stephanie McGee, PT
Dr. Stephanie McGee, PT, DPT is a pediatric physical therapist at Stanford Medicine Children’s Health. She has received her undergraduate degree from Loyola Marymount University in Health and Human Sciences, and her doctoral degree at Mount Saint Mary’s University. Stephanie has worked in hospital based pediatrics in a primarily outpatient setting at Stanford Children’s Health and Ann & Robert H. Lurie Children’s Hospital of Chicago. She has experience working with pediatric oncology patients both in outpatient and acute care settings. She has also participated in multidisciplinary clinics for chronic pain and chest wall deformities.
Stephanie enjoys working with her patients and their families to empower and encourage each child to reach their potential. She is passionate about spreading optimism and enjoys helping patients focus on what they can accomplish rather than what they are limited by. In her free time, Stephanie enjoys spending time with family and friends, swimming in open water or at a master’s practice, cooking, or hiking with her dog.
She can be reached at stmcgee@stanfordchildrens.org.
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Transcript
Elise Cantu (00:19)
Hey, Onco PT and welcome to this episode of the Onco PT podcast. We are continuing on with our APTA CSM preview sessions. And this next subject is one that I have had my eye on for a while and I’m so thrilled that they have agreed to come on the podcast to talk about this very emerging and frankly, top of mind topic right now within healthcare and especially within cancer rehab.
And so I’m so thrilled to have both of our speakers for this upcoming session called Can Virtual Reality Improve Clinical Reality? VR’s Role in Pediatric Oncology Rehab. What a loaded title, my friends. I cannot wait to get into it. So first of all, I need to introduce Stephanie McGee to the podcast. Stephanie, welcome to the OncoPT podcast.
Mary & Stephanie (00:59)
Thank
Hi, Elise. Thank you so much for having us. We’re so excited to be here.
Elise Cantu (01:14)
And then of course, Mary Hunter. Mary, welcome to the Onco PT podcast.
Mary & Stephanie (01:18)
Hi Elise, we are so excited. Thank you for having us.
Elise Cantu (01:22)
My pleasure, is truly my pleasure to have the both of you on now this topic.
What a, just so many things to get into right off the bat. So first of all, let’s kind of back up why the interest in VR in oncology first, and then we’ll get into the PEDs aspect of it.
Mary & Stephanie (01:44)
Yeah, absolutely. So we found that VR has been excellent specifically for the oncology population. Mary, and we’ll get into a little bit more details on this in a minute, but Mary is employed partially by our rehab department, but partially by a team that’s role within our hospital is to put technology into practice.
We very quickly found, Mary very quickly found that oncology was the perfect setting for VR. We’ll get into it a little bit in more detail, but the great things about VR is for this population, the size and space requirements, that’s a big one. The immersive features of it and kind of its impact on psychology, that’s a big one. One that’s not as frequently talked about is the
cardio component to it and how well that it can help, know, Mary always says, moderate intensity, moderate intensity exercise. And there’s really so much more, but it’s been such a great medium. think we’re very lucky to work at a place that has this technology and so accessible and readily available. And we’re just excited to share what we found.
I absolutely second that. I have been working in oncology, mostly in the acute care setting, for over 15 years. And one of the biggest things that I’ve always had struggled with is that aerobic exercise component. If you’re admitted to the hospital, you’re on isolation precautions, you’re in a room, you’re a teenage boy in a room for two months, sometimes longer, you’ve got an IV poll, I have an exercise bike, or videos.
And those were just not working for maybe the first couple of weeks. But after that, they’re like, come on. A dad of a patient said, you should try VR. I said, don’t do video games. He said, no, seriously, you should try VR. So I bought a headset for my niece for Christmas. My brother and I took it outside and started playing on the patio. And I was like, now I get it. I was working hard. My niece was working hard. I was like, this is that component that I haven’t been getting. And so I
took it to, I took my headset to work and started putting into practice. I cleared it with the head of the aunt department and they said, sure, whatever. Can you wipe it? I said, yes. Took it in the room and that was the big thing, right? Can you wipe it down? I like, you got that. I took it in the rooms and I put it on these kids’ heads and they’re getting up out of bed and they’re smiling and their parents are like, my goodness, they haven’t been smiling in weeks. They’re working out, they are sweating, they are getting tired. And I’m like, can you take a break? Let’s sit down. One more.
Elise Cantu (04:18)
Nuh-hah!
Mary & Stephanie (04:38)
One more game. And I was hooked. So I was fortunate enough to get a position at Stanford and get to work with this amazing, the Chariot team there that supports the use of immersive technology. said, here you go, see what you can do with this. And I met Stephanie, said, hey, can you help me figure this out? And so we’ve been working and…
Elise Cantu (04:42)
night.
Mary & Stephanie (05:07)
you know, trying different things out for a couple of years now. And we thought Stephanie said, we have to tell other people about this. I did because I wasn’t a believer at first, to be honest. The first time I was introduced to VR in a rehab setting, not at this current job, but at a previous job where I think, you know, some big sales pitch came in over lunch and they let us play with it. And
All of our reactions, I’m primarily outpatient is my background, Mary’s primarily inpatient is her background. And especially for the outpatient physical therapist, all of our feedback was, okay, this is really cool. We could see our patients really liking this, but what is it gonna do? If we can’t send it home with them, if we can’t use it consistently, like is it just a gimmick? And so that’s kind of my first exposure to VR.
Elise Cantu (05:41)
Mm.
Right.
Mary & Stephanie (06:03)
I was like, this is really interesting. This is really cool. I see uses for it, but I’m not sold. And then it wasn’t until I met Mary and then started working at Stanford that, and we had unlimited access to it. I mean, they have, it’s really, really lucky how much, and how much access we have to the headsets that we use. And that’s when I started really interjecting it with my out, I’m sorry, using it with my outpatients.
Elise Cantu (06:08)
Mm-hmm.
Mm-hmm.
Mary & Stephanie (06:31)
and started to realize, okay, so this is actually really helping this patient. This is helping them get past whatever barrier is in their way. This is helping them not be so fearful of movement. And this is helping show their families that they actually can move a little bit. And so there’s carryover to be had, which is something that I found really important that I initially thought was lacking.
Elise Cantu (06:57)
Mm-hmm.
Mary & Stephanie (06:57)
And yeah, I just
want more people to learn how well it can really work if you are using it the right way. And that’s the one thing that Stephanie talks about these companies that would come in and show these headsets. And one of the things, latest APTA magazine, the article about VR, it has these really expensive models that these companies are bringing in, but we use off the shelf like MetaQuest two old school headsets and we’re having amazing results. And that is something that is actually accessible.
Elise Cantu (07:05)
Mm-hmm.
Mary & Stephanie (07:25)
to a larger audience than these fancy ones. And if you practice with it and play with it, you can find plenty of programs that do anything you want them to do without having to spend all this extra money. And again, it can be something accessible for these families. Yeah, exactly.
Elise Cantu (07:38)
Mm-hmm.
I really appreciate that y’all brought up first and foremost. think one of the initial, even just my brain before we started talking about this was like, what are kind of the safety around using this from patient to patient? But it is nice to hear like, you can wipe these down, these can be very clean, you can use these in practice with even very immunocompromised patients. But I really appreciate, we hear about a lot of different tools and technology in PT, which is amazing. But a lot of times I feel like we get a little hyped up.
Mary & Stephanie (07:59)
Yes.
Elise Cantu (08:14)
on some of the tech and then it doesn’t really get used in practice. So the fact that this is an ongoing thing that is being not only used in practice, but we’re also seeing some really good results from this with our patients, I think really lends a lot of credibility and the momentum behind, like this is not, like VR is here to stay.
Mary & Stephanie (08:39)
Absolutely.
Elise Cantu (08:40)
It’s not
going anywhere. My dad, who is retired in his 60s, loves his VR headset. I mean, like, and it’s not, you know, like young to old. There are some people who are really, really into it. And it’s really about kind of what Stephanie was saying, like, how do we actually use this in practice? And so I am curious, like, what are y’all doing when, you know, VR, it’s such an umbrella term, like, what does that look like?
Mary & Stephanie (08:48)
Love that. Yeah.
Elise Cantu (09:09)
in practice.
Mary & Stephanie (09:11)
Yeah, that’s such a great question. And I guess we should start at the very basics for people who might not be exposed to VR at all. So VR is virtual reality. might have seen them in commercials. I feel like it’s all over the place now, you know, with the MetaQuest headsets coming out really consistently. And there’s a wide variety of different headsets, but basically you’re putting on a headset. It’s fairly lightweight. Do you know how much they weigh?
Elise Cantu (09:19)
Mm-hmm. Mm-hmm.
Mary & Stephanie (09:40)
These are fairly lightweight and we’re able to have a variety of ages and strength levels put the headsets on without issue. And they are looking at the screen and it’s completely immersive. So when you are wearing the VR headset, you feel like you are in whatever that manufactured environment is. I was talking about my favorite game, which is the climb, which is a rock climbing game. I’m afraid of heights.
Elise Cantu (09:42)
Mm-hmm.
Nice.
Mary & Stephanie (10:09)
I don’t know why this works for me, but this game, you are climbing up a mountain. And if you look behind you, you see these gorgeous jaw dropping views of, you know, the desert or the ocean or whatever it might be that you’re climbing by. And you really do feel like you’re there.
you know, that is pretty insane to feel. So with the headset, so it’s immersive. And then you also have two hands. Very lightweight controllers. Yeah, lightweight controllers. Two lightweight controllers in your hand. And most games will have some sort of component of controller use where you are.
Elise Cantu (10:44)
Mm-hmm. Mm-hmm.
Mary & Stephanie (10:53)
reaching for different things. You might be smashing boxes that are coming your way in like a Beat Saber game. Like I mentioned earlier, you might be climbing up a rock face using your hands to get up to the next level. There are some games where you’re working in a kitchen and flipping burgers and things like that. Surprisingly popular, let me tell you. So popular.
Elise Cantu (11:00)
Mm-hmm.
Mary & Stephanie (11:18)
But really the cool thing about VR is that the possibilities are endless and there are some really cool games out there that get people of all ages really engaged. That’s what I use. Well, I use it primarily in the acute care setting and there’s two different ways that I utilize this the most often. feel like the first is like post-op mobility or just deconditioned patients who don’t want to move or fearful of movement, having pain.
The Chariot program that I work with was started by anesthesiologists using immersive technology for pain control to decrease the use of opioids in the medical setting. And it’s hard to explain until you actually see it when you see a post-op post-heart transplant, you know, huge incisions, drains, anxious about moving. You put this headset on and they’re in like Stephanie was saying, this immersive world and they forget what they are. And I’ve had little kiddos post-heart transplant
Elise Cantu (11:50)
Yeah.
Mary & Stephanie (12:13)
huge incision, nothing we would do. Like we would bring balls and they just, couldn’t get them to come up right. The cooking game, you put that on, they’re like, I have to grab this spice. I have to, they’re reaching up here, their posture. my goodness. It’s so much better. And you don’t have to do anything. And their parents are sitting there like, I didn’t know they could do this. And you do get the carrier too. We, you know, you continue to use it. So that is one way we use it. It’s just.
Elise Cantu (12:36)
my gosh.
Mary & Stephanie (12:41)
general post-op mobility. I just want you to move. I just want you to sit upright. And then the other way that I’m actually currently doing research on and showing what I always thought was true, but you have to have data and numbers. I know, I know. But is that modern intensity aerobic exercise. And I love that Andrew Chongaway he, like several people in the Rehab Community Conference really stress that whole look, they’re moving, but are they doing it at a high enough intensity? And what we’re finding is that
Elise Cantu (12:46)
Mm-hmm.
Yes.
Mary & Stephanie (13:12)
Believe it or not, standing up using these, just using these controllers and moving your arms, you get to that moderate intensity level of aerobic exercise. And they usually do it for longer. And so I will use it frequently in a patient’s room. Several games where you just get in there, there’s Creed where you’re boxing with the Palo Creed, but some people really love, there’s different ones with different music. So they have songs that you like and I can get them.
Elise Cantu (13:23)
Yeah!
Mary & Stephanie (13:37)
in there doing that, getting up to that level, approaching those ACSM guidelines, For the 150 minutes of moderate intensity spread throughout the week. It’s been another tool. It doesn’t work for everybody, but it’s a wonderful tool to have in your toolbox to help you meet that goal. The resistance training, I can get a few squats, it doesn’t really… You got to work on that too. But if I can get that in… If I can get one thing done, I mean, it’s…
Elise Cantu (13:45)
Right. Right.
Mary & Stephanie (14:05)
It’s like I said, it’s a lovely tool and they’re smiling when they’re done and their parents are like, my gosh This is one less thing I have to argue about because I have to tell them to take their meds have to tell them to the Wipe down Tell them to that so I can say I used to have to argue you have to get up and exercise and now I can say put this on so
Elise Cantu (14:15)
Yeah.
How fun is that?
you know, I literally, this is not a joke. It’s not a bit I prepared for this interview. So I adjunct teach at a local university and today, right before I came here, I was teaching and one of my students made the comment, she’s participating in a VR study that they’re doing in the grad department. And she made the comment, she says, yeah, I didn’t think I was working that hard. And then I took off the headset and then I was sweating and my heart was beating fast. And I thought, I actually was working really hard. And what?
Mary & Stephanie (14:50)
It’s true.
Elise Cantu (14:52)
a great way to distract from the often unpleasant, sometimes sensations associated with exercise, especially if you have a patient or a client who’s not really into exercise or is maybe like you all have been talking about, very deconditioned. What a great way to distract from that and still get those moving minutes in in a really fun and engaging way.
Mary & Stephanie (15:20)
One of the crazy things I realized is that we had to start using this Actiograph to get better data on how much they’re moving because their RPE would be lower than it was with other exercise like the stationary bike, but they were working out harder. So it’s like they’re having so much fun, they don’t realize that they’re actually getting a decent workout, which is pretty cool. It’s a really, really common reaction to using VR, especially these more active games that us PTs kind of cherry pick for our patients.
Elise Cantu (15:33)
Yeah!
Mary & Stephanie (15:50)
is insane to see. They’re like, yeah, like just like Mary said, when they pull off the headset or just like you said, when they pull off the headset, they’re sweating and they’ve got no idea. They had no clue that that was, you know, how hard they were working, but there they are.
Elise Cantu (16:07)
Okay, Mary Stephanie, have to ask, how do you find the new games to try out? Like, do y’all have a headset at home that you’re like trying out the new games before you bring them in?
Mary & Stephanie (16:16)
You have to. You have to try them. You really do. And I feel like I didn’t quite appreciate this until Mary sent me home with one for like a couple of weeks at a time. And the other thing that was really helpful was to not only practice them yourself and get proficient in them, but have your family members try them and be proficient in teaching other people how to use them and knowing kind of what you’re looking for. It makes a
Elise Cantu (16:42)
smart. Yeah.
Mary & Stephanie (16:43)
big
difference. And in terms of games, I mean, because there’s so many coming out, so many new ones coming out all the time. Honestly, sometimes patients tell us about them. feel like we have requests sometimes. then Mary also has a lot of people asking or looking into these different things. I have summer interns and I’ll tell them, I need you to play these games and tell me because I’ll have these young kids coming in. like, yeah, I need a squat.
Elise Cantu (16:51)
Mm-hmm.
Mary & Stephanie (17:13)
I need trunk rotation, I need reaching overhead, and find me some guys who can tell me what they are. Stephanie’s right, though, about helping people understand how to play the… Teaching somebody else to do it is really helpful. One barrier I found, or one perceived barrier, I guess I would say, is some of my coworkers say, I can’t teach them how to… I don’t know how to use this. I can’t teach them how to use this. Well, you go in, if they’re over 10, you give that to the child. I say, they’re probably gonna do it.
Elise Cantu (17:16)
Yeah.
my God, they’ll teach you.
Mary & Stephanie (17:42)
They figure it out. It’s crazy. Maybe a mom can’t figure it out sometimes, but sometimes they can. Like your dad, but most of my patients just, yeah, no problem. They’re in there changing this profile, so I’m like, nevermind.
Elise Cantu (17:51)
absolutely.
Yeah, yeah, and you don’t have to grow up with technology to appreciate this. Again, my dad is retired in his 60s and he loves, I think he has a meta quest. I think that’s what we got him. His favorites right now are Beat Saber. And then there’s also a roller coaster one where you ride the roller coaster that he really enjoys also. So.
Mary & Stephanie (18:08)
Yes.
Ooh!
Elise Cantu (18:22)
There’s a lot out there and it’s not just for the really, really young, know, people of all ages can appreciate this. I do appreciate there’s a little bit of vestibular challenge with the roller coaster one. You know, if you’re looking for some more inspiration on maybe your balance impaired patients out there, which unfortunately we know is very common in oncology. Now we’ve talked a bit, you know, we’ve talked around it. We’ve talked about, yes, this is really valid. It’s very useful in oncology.
When it comes to pediatrics, what do you think are some of the special challenges in pediatrics that are being met or solved by integrating VR into clinical practice?
Mary & Stephanie (19:00)
Yeah, I think there’s a lot of things that we could say in this category. But the ones that come first to mind would definitely be that motivation piece, right? I think that it’s so high. And this actually applies to all ages, but it’s so highly motivating. know, we are all used to.
that response to knocking on a patient’s door and saying, hey, I’m here for physical therapy. And they just give you this look. Sometimes having this, you know, the VR in hand or asking, hey, are you interested in doing VR? It gives you a little bit of a different response. Not always, not always, you know, it’s never going to be a perfect solution, but not always. I also really love it. Like, like you mentioned,
balance impairment that’s a huge component to it. That’s something that we can really get challenged, especially with like the different reaching activities that you could do. I also think that it solves a space issue a lot. So for our people who are admitted for stem cell transplants or really anytime that they’re admitted with contact precaution or isolation precautions.
Elise Cantu (19:59)
Mm-hmm.
Yeah.
Mm-hmm.
Mary & Stephanie (20:18)
it can really help give you another option when it’s a situation where you don’t have a lot of options. know, if you can’t leave the room, you can’t leave the room. But we’ve had a lot of patients like admitted in the hospital for months at a time, unable to leave their room. And there’s a, the wander game. There’s a wander game. It’s basically your dad would like this. Yeah. It’s a cool one. You’re basically dropped in Google street view.
Elise Cantu (20:24)
Mm-hmm.
Absolutely.
Mary & Stephanie (20:48)
Okay. Anywhere on the planet. Anywhere on the planet. So I know you were telling me a patient that we shared, an inpatient and outpatient was using this with her mom and they were, you know, going to their house or going to a place that they’d gone on vacation before. it’s just… Seriously, that’s what my dad is in an assisted living facility and they’re in their eighties and I took this and I had it in the lobby and I had several, you know, several older people. That’s what they wanted to do.
They went to go to, said, can you put my address? You can’t find mine. They would tell me their address and I would be able to put it in. And so, that’s, that’s one of the amazing, just one of the many wonderful things. And I don’t really know. You would initially think like the pediatric aspect. I’ve worked some with adults. I don’t know that there’s anything specific that I could really say that doesn’t carry over to adults because at UCSF, would float over to the adult side sometimes that I’ve had these on patients.
Elise Cantu (21:42)
Yeah.
Mary & Stephanie (21:47)
grown men and I would say they would be having a lot of complications after surgery, major surgeries. And I would say, can we just try this? And they would love it. And the parents love it. I use it a lot with the caregivers. You have a caregiver, you walk in, they’re in this room for like two or three months at a time with their child. They’re stressed out. They can’t exercise. They’re like, don’t you have a gym? I need to work out. And I would, bring this into moms and dads. I’ve had dads who like did this fishing game. Like his daughter was in the hospital for two months. He’s like, I fished every pond on this game.
much good stress relief for him at night after his daughter went to sleep. had one moment she was like, they were getting frustrating bad news. And she was like, I just need to punch something. And I said here, and she was able to do the boxing game. And she would ask every time she would come in, she goes, can you have that boxing game, please? That was a moment that I didn’t expect. I didn’t expect that part to be so amazing.
Elise Cantu (22:22)
Wow.
That is so sweet! And again!
Well, and
both of y’all have, you know, both of y’all have spoken to the immersive experience, you know, like, yes, we understand VR is immersive, but what a great way to kind of escape a little bit from kind of those four walls, if we’re talking acute care inpatient here, that those patients have seen, you know, those four walls for days, weeks, potentially months at a time. What a great opportunity, even within that very small, isolating space to kind of just get away from it all for a little bit. I mean.
Mary & Stephanie (22:47)
Thank you.
Elise Cantu (23:16)
Talk about just like, and again, Stephanie, you mentioned this previously, the psychological benefits, which I’m curious to talk more about too.
Mary & Stephanie (23:24)
Yeah, I think when it comes to psychological benefits, mean, they can, there’s a lot of different directions we can go with psychological benefits. That escape is a big one. There’s also some really interesting research out there. Mary hit on this earlier, people exercise, and you actually hit on this too, Elise, but people exercise for longer when, depending on their environment, right?
There was a study that we read that kind of talked about, you know, people were able to do a specific exercise longer if they were in immersive VR in a stadium with people cheering them on versus less long at a relaxing beach where you’re not that motivated to stay going. it’s just the way our, we all know our environment affects us so profoundly.
so this is a way to really manufacture the environment for the patients, right? Give them a good environment, to really help change things up and help, increase their motivation. and, and yeah, allow for better exercise, longer exercise. There’s also, a lot of research on its effects on pain. It’s crazy. Yeah. There’s a fascinating. Yeah. Yeah.
Elise Cantu (24:26)
Yeah, yeah.
Mary & Stephanie (24:48)
And we work a lot with like the meditation. And that can be a big component of the oncology patient population too. You have a lot of issues with pain. And we have wonderful meditation, we also have relaxing games, meditation activities, or puzzles, or you know, what calms me down may not calm someone else down. And that’s the wonderful thing about this is, that didn’t work for me, okay, I have other options. Right here, you just flick on to the other one. So, the Chariot Program has done a lot of research into like well-being.
and trying to find what can instill or improve that sense of wellbeing in patients and caregivers. mean, so the options are, they’re endless.
Elise Cantu (25:30)
in your session at CSM, are y’all going over kind of like the, the how to bring this in or, know, suggestions on how to bring this into your facility? Because, I mean, I’m a private practice owner. I only have to convince myself, but I’m like, I think I need this in my clinic right now. Like I have a patient right now I’m thinking of who has really, really significant lymphedema and lifting her arm is very challenging for her. And I’m wondering if this could be, I have other patients of course who would benefit.
Mary & Stephanie (25:46)
you
you.
Elise Cantu (26:00)
but I’m wondering if this could be a good tool to kind of take her out, like a little bit of distraction and incorporate a little more motion. the wheels are already turning over here for me, y’all.
Mary & Stephanie (26:10)
And you have
contact people who would love to help you. Yeah, we would love to help you with that. Yes, absolutely. I think that would be a super great modality for your patient. And in terms of, we talk a lot about, you know, access and, you know, it is really, I think the MetaQuest 2 is, is it close to like $200, $300? It’s under $300 now. Under $300. And that’s what we primarily use. I think they’re upgrading to the Quest 3.
Elise Cantu (26:33)
Nice.
Mary & Stephanie (26:37)
which the benefit to that one is that they have, they’re starting to use augmented reality, which is where you see the environment that you are in and then virtual things will kind of come into your own space. And that’s nice, especially for people who are nervous about putting the headset on and not being able to see everything. And so I’ll start with some people with that just because they can see around them. And then they get comfortable like, bring it on. I can take some more. Okay. Yeah.
Elise Cantu (26:56)
Good point. Good point.
Mary & Stephanie (27:06)
But the access thing is, it’s interesting, but I was listening to the PT Pintcast who, to Jimmy, they were talking about, know, okay, if you’re spending, if you were trying to like expand programs, they’re not like tens units and having a model where you had a PT providing this tens unit for free, and then you build for patient for PT services. I, Stephanie and I are constantly talking about how to make this more widespread and available to more people.
and how to scale this up because we got lucky. There was a Starlight program that donated a lot of headsets to us for us to utilize initially. And that’s, like I said, that’s something that we’ve never had to actually work with as far as like getting access to these and convincing your providers. But again, something that we would love to continue to discuss with the broader physical therapy community because again,
Elise Cantu (27:40)
Wow.
Yeah.
Mary & Stephanie (27:59)
compared to like the penumbra, like some of these other things that are like $10,000, like just prohibitively expensive. No, this is, it’s out of business now. They’re not, But I mean, that’s what some physical therapists may think when they hear a VR, because they were going around doing these in-services, like an outpatient clinic saying, look here, this is a model that it had things to go under your hands and it had multiple sensors, which is lovely, but is it scalable? You know, we feel like these…
Elise Cantu (28:23)
Mm.
Totally.
Mary & Stephanie (28:28)
$200
headsets. This is something that could be scalable compared to other equipment that you’re buying in your facility. But that is something that we’re still working the kinks out on. And we will be perfectly honest with people like we don’t, we’re not really sure how this could work, but I believe that it could work. Yeah, absolutely. And yeah, one of the big things that Mary’s talking about when we’re saying we’re trained of
Elise Cantu (28:47)
Mm-hmm. Mm-hmm.
Mary & Stephanie (28:54)
figure things out and work out the kinks with a lot of these donated headsets. We’ve tried to start to loan them out to patients to see if that helps with carryover. And it’s gone well so far. They’ve all come back. That was one of our biggest. They’re coming to the oncology clinic. So it’s like, know where to find you. Yeah. But trying to see is there a world in which we can allow our.
Elise Cantu (29:11)
That’s good. That’s good.
Mary & Stephanie (29:21)
patients to take these home for a couple of weeks, just like we do with TheraVans. hope that they are doing it consistently at home and seeing how that goes. also have the capability to track- track. So can tell if they’re doing it. Yeah. So remote therapeutic monitoring billing for that. I want to talk to Andrew more because he mentions using remote therapeutic monitoring with his stem cell patients. I started an email. didn’t fit in. But just to see how other-
Other clinicians are using RTM and how they’re monitoring because there’s a platform that we can tell when you put the headset on, when you took it off, what game you did, how long you did it. You’re getting that data. We’re working out the kinks. Like Mary said, it’s not perfect, that it’s not going to be a model that works for everybody, but we have a dream that we can have this big VR library that we can loan out to any …
Elise Cantu (30:15)
I love that.
Mary & Stephanie (30:17)
child with cancer who’s interested to be able to give them something to practice at home with for a little bit and make some positive change in their willingness to participate in exercise. It’s a dream, it’s still a dream, but I mean, it’s getting more and more affordable, more and more accessible, very user friendly, easy to figure out. So it might not be a world that’s too far off, but it’s…
Elise Cantu (30:33)
I love it.
Mm-mm.
Mary & Stephanie (30:45)
a thought that we’ve
had is, know, how can we scale this? How can we make it usable for everyone? Because it can be such a powerful tool. With the right patient.
Elise Cantu (30:53)
Right.
Again, I don’t think it’s a matter of if it’s it’s a when situation, especially with how, I mean, you know, just even over the past 20, 30 years, know, technology is accelerating so crazily and we can either, you know, and I mentioned this off air before we started the interview, we can either be on the sidelines and watch it go by, or we can lean into it and really leverage it because I mean, I foresee, this is my prediction. People are going to have VR.
Mary & Stephanie (31:01)
to win.
Elise Cantu (31:26)
in their home as a norm. Maybe not everybody in the next 10, 20 years, but I think most people are going to have some form of VR. And so if we can kind of get ahead of it and then just continue to adapt as VR grows into, whatever it’s going to be in 10, 20 years, I don’t even know, if it makes it so that a few more patients are going to be engaged and active and participating in exercise and participating closer to that.
you know, like we’ve talked about that recommended 150 minutes of moderate intensity, you know, aerobic exercise every week. Man, that’s what we’re working for here. And we know, you know, and this was something, you know, Mary, we’ve alluded to Andrew Chongaway’s presentation at the Cancer Rehab Community Conference 2024. He talked about how dismal the stats are on how many patients with cancer are actually achieving that level of exercise. This is yet another tool that we are seeing work.
that is becoming more accessible. Now, again, like, you know, not everybody has two to $300 to drop right now, but how can we maybe make this, you know, start to work in our facilities with a few patients at a time and maybe just kind of expand the creativity on how are we dosing exercise, how are we prescribing exercise so that our patients will actually participate in it? And I think this is a great component, you know, answer to that.
Mary & Stephanie (32:51)
Absolutely. And one thing, speaking of the utilization and scaling it, Nicole Stout her presentation, I absolutely love that too, and talking about the disparities. And I’ve met several physicians from other hospitals who are trying to start similar clinics. And that’s the one thing that these physicians and I both agree on. We talk about how this, you have patients who are in these rural areas who don’t have access to PT at all.
Elise Cantu (33:03)
my gosh.
Mary & Stephanie (33:17)
Right? And it’s like, can remodeled to you. can dose it. I can say, try this. this is an impairment. I can check in with you. And it’s, that’s, that’s one of the big exciting things that I feel like, okay, we, that’s why whenever I get tired and think, I don’t want to have to turn, try and, know, write it, do more research and do this. I’m like, this could actually make a difference in that area. You know, you could, and Stephanie and I talk about this too. We’re like, we don’t want to make money. We just want to make, figure out a way.
Elise Cantu (33:41)
Yes.
Mary & Stephanie (33:47)
to get this into the hands of more patients out there in all these areas. Because we know, like Lynn Tanner also talks about these disparities, how people are not getting access. They’re not getting outpatient PT. They’re not getting the balance. Stephanie was an outpatient PT. Her wait list was always just so long.
Elise Cantu (34:01)
No.
Yes.
And Stephanie, I know you’re a great PT, but like we don’t need to be having these months, like in my area, months long wait list for patients to get in to be seen. Like that’s unacceptable. Unacceptable.
Mary & Stephanie (34:12)
Yeah.
Yeah, exactly.
And it really is something that could help, you know, not replace PT, but it could be a supplement to help spread it out even more. You know, if they’re able to check in with you in person monthly, and they were previously a person that wasn’t very motivated to exercise, so they kind of needed that accountability. Yeah, what if we sent you home with a headset?
Elise Cantu (34:42)
Right?
Mary & Stephanie (34:43)
and we check that you were doing it, and if you’re not doing it, we kind of send you a little nudge, hey, what’s going on? And improve their compliance from there. I think those are all things that are well within reasonable possibility. It’s just a matter of when and how is this all gonna shake out.
Elise Cantu (35:06)
Absolutely. And if you’re listening to this right now and you’re a little weirded out by the idea of nudges like this, we’re already using software like HEP software that does the same thing. So like that’s a non-issue for me because again, like it’s already being used and what a great way to build that accountability. I know I personally need to be accountable to somebody external to myself.
What a great way to be realistic with ourselves as humans and make that happen for our patients and clients.
Mary & Stephanie (35:38)
Well, we all have the watches, right? And I share with Stephanie and have other friends and it’s like, man, they got their circles and I have mine, our closes. She closes her so fast. Hers are crazy. But just, that’s kind of nudge you’re talking about or how like, even you just, even if you’re not seeing a patient in the acute care setting, you walk in, you open the door, you’re like, it’s four o’clock, you’re still in the bed. That’s a nudge, I feel like, you know, right? You’re just looking at them like, yeah. Yeah. And we know it’s a nudge. Right?
Elise Cantu (35:48)
Yep. Yep.
Now, what is one thing that attendees will take away from your session at CSM?
Mary & Stephanie (36:15)
I hope that attendees open their minds to the possibility of using VR in practice. And I hope the everyday PT becomes more open to the idea of using it in practice. Because like I said, when I was first exposed to it, I was like, okay, this is cool for someone else, right? Like, that’s gonna be great for someone else to do. Like, yeah, I could see it really working with that patient, but we don’t have that. So, well. And I think…
I really hope that people can visualize themselves trying to use it, thinking of a patient in mind and thinking of, you know, just being more open to the possibility of this as a helpful tool. You know, it’s never going to be the one and only answer. Nothing is, but we found it to be such a tremendously helpful tool. You know, kind of helps break down a lot of the barriers that we face in the world of
physical therapy in general, but definitely in the oncology world as well. And I hope that people take that away from the session.
Elise Cantu (37:18)
Yeah.
Mary & Stephanie (37:22)
Absolutely agree and we’ll just you know, we’re just trying to come up with a couple of good we have many patient stories But just a couple of good case stories that people would say Now I get it that makes sense. Maybe I could try this. So exactly
Elise Cantu (37:37)
I love that. And that’s what these conferences are about. Like you go and you get these nuggets, these little pearls from each of the sessions. And that’s what we’re really wanting to take away from this conference is, you know what?
They’re doing that over there. That looks really cool. I think that’s gonna work for my patients. I wanna try that. Amazing, amazing. When is your session at CSM?
Mary & Stephanie (37:55)
Mm-hmm.
Our session is the first day, it’s Thursday the 13th, I know, at 11 a.m. And so we are very excited. We also would like to plug our colleagues. There’s two more physical therapists who are working with us from Stanford, they’re amazing. Their section is, or they’re working with the chronic pain as their main focus. So they will be speaking at
three o’clock on the same day. It’s called pain games and it’s for the pediatric section. And then we also have set up a lab session at 5pm the same day that you can find in the CSM programming where the four of us will be taking headsets and allowing participants to try it out for themselves and see what they think.
Elise Cantu (38:39)
I love that.
obsessed with that first of all, like, what a great way. I mean, there’s so much that you have to fit into your session. What a great way to continue that conversation. And I mean, people are always looking for stuff to do at CSM. Good job. Good job, y’all outstanding work. And then is your session going to be available on demand?
Mary & Stephanie (39:04)
Yeah.
Thank you.
I believe it is. Yes, I think we said yes.
Elise Cantu (39:28)
We’ll confirm and we’ll put the final answer in the show notes. Don’t worry.
Mary & Stephanie (39:32)
Thank you.
We definitely checked that box. We checked the box.
Elise Cantu (39:37)
That sounds right, right? That sounds right. I love it. So if you missed it, their session, Can Virtual Reality Improve Clinical Reality? VR’s role in pediatric oncology rehab is taking place on that very first day. So Thursday the 13th at 11 to 1 PM.
Mary & Stephanie (39:38)
Yeah.
Elise Cantu (39:55)
that is located in the oncology section. So if you are looking through the app, looking at conference scheduling, you will find that under the oncology section. And then as they mentioned, I will also link to their colleagues who are doing the pediatric pain specific section also in the show notes as well. So you can find that. Stephanie, Mary, thank you so, so much for coming on the podcast today. This was such a lovely and very educational, informative experience.
Is there anything that you would like to leave the listeners with before we sign off for today?
Mary & Stephanie (40:29)
You know, the other thing that we should mention is a lot. If you do have access to VR already, there is a nonprofit started by Stanford’s charity team, the one Mary works for called InvinciKids. And if you join that nonprofit, you can have access to a lot of the games that they’ve developed, as well as that tracking software that we were talking about earlier.
And so they’re a really awesome nonprofit. Like us, they just want to see it out there. They just want to see all this stuff be used. And it’s a really great program and you can look into that too. Absolutely. Yeah. The Stanford Chariot Program is just an amazing group of people. Like I we’re doing research into immersive technology VR and we developed these games and somebody at the university was saying, we’re going to sell these. And Tom, our director said,
Elise Cantu (41:13)
Definitely.
Mary & Stephanie (41:27)
No, we’re not, we’re giving them all away. And so he and Sam, I believe, the, helped start the InvinciKids. It’s an umbrella organization over all of our programming. So we definitely are, you know, trying to make this accessible to as many people on the planet. We go all over, our headsets are all over the world. So we try to provide this and enable patients and clinicians everywhere to utilize these programs. So.
InvinciKids is amazing. The Stanford Chariot program, could also hopefully put a link in the show notes for them. Amazingly supportive of crazy wonderful group of people that I’m very lucky to get to hang out with.
Elise Cantu (41:54)
That is so lovely.
Love that.
That is so lovely. We will definitely be putting both of those also in the show notes so you can get access to that. Especially I’m thinking like, hmm, if I get a VR headset, where can I find all these games? And this seems like a great place to start. So I love that so much. Stephanie and Mary, thank you so, so much for joining us today on the podcast. I am so excited for your session. I can’t wait to hear all about it.
Mary & Stephanie (42:19)
It’s done now.
Elise Cantu (42:31)
And hopefully get to see you in that after hours demo time. So I will definitely, as soon as I hear, you know, where that’s taking place, I will also link that in the show notes as well. So that way people can hopefully find you and check that out too and see what all this hype about VR is, especially in oncology. So thank you. Thank you so much for joining me today. I really, really appreciate your time and I can’t wait to meet y’all at CSM.
Mary & Stephanie (42:34)
Thank you.
I know, can’t wait to meet in person. Elise, thank you so much for having us. This has been a blast.