Computer voice
UX podcast episode 275.

[Music]

James Royal-Lawson
Hello, I’m James Royal-Lawson.

Per Axbom
And I’m Per Axbom.

James Royal-Lawson
And this is UX podcast. We’re in Stockholm, Sweden. And you’re listening in 200 countries and territories around the world, from Brazil to Greece.

Per Axbom
Almira Osmanovic Thunström, is a doctoral researcher at the institution for neuroscience and physiology at Gothenburg University. And she’s also an organisational developer within the areas of brain computer interfaces, artificial intelligence, social robotics and extended reality at Sahlgrenska University Hospital.

James Royal-Lawson
Back in episode 186, we talked to Boon Sheridan about augmented reality. And at the end of that episode, back in 2018, Boon urged us to go and research about VR therapy. Boon said: The avenues that are open with AR and VR for therapeutic use are amazing. And I don’t think they’re talked about enough. It’s such a good thing.

Per Axbom
So with that in mind, we’ve brought Almira onto the show to provide more insights into the work she’s doing with VR in healthcare, what to look out for, new opportunities, what the most common challenges are, as well as some hopes for future developments in this relatively new tech space.

James Royal-Lawson
Almira can speak no less than seven languages. But in this interview, we keep it to just English. We also though want to warn you that there is sensitive content in this episode, that could be emotionally triggering with references to both suicide and palliative care.

Per Axbom
So I mean, I’ve been following you for for a few years now. And I realised that you seem to be one of these people who just loves picking apart technology. So I imagine that you as a kid, you’re one of those people who went around the house just picking apart stuff. I don’t know if it’s that that’s an accurate description or if that interest came later on in life.

Almira Osmanovic Thunström
That is a very accurate description, I would pick apart my parents phone, my parents remote controls, everything that you can think of, because I was really curious about what was inside. And my dad is an electrician. He does that for a living. So I always thought that that doesn’t look hard, like my if my dad can do it. So I just picked it apart and tried to put it back together again. And sometimes it worked and sometimes it didn’t. And my parents were really, really good with that. So they never discouraged me. They just tried to eventually give me the right tool, so I wouldn’t electrify them.

Per Axbom
Oh, wow, that’s fantastic. That says something about your parents. That’s really interesting. But they don’t get upset that you actually pick apart something and then it’s broken. It’s just wow, you you found you learned something?

Almira Osmanovic Thunström
Yeah,

James Royal-Lawson
I’m getting quite nervous. Just the fact that you’re saying that makes me nervous about the fact that mine started doing that. I don’t know what I’d do, really. But that’s the whole fear of putting back together again, I guess, maybe my ability to fix it?

Almira Osmanovic Thunström
Well, you have to also remember that my parents, when I was a child, we had just fled a war and lost everything. So things were not important to them. Things were just things, I think they came to the conclusion in that stage of their life. So things could be replaced. They had already replaced everything they could replace a remote control.

Per Axbom
That’s really interesting. Wow. So that mindset then brought you sort of where you are today with you. I see you experimenting with stuff in healthcare. And I see you, sometimes I’ve seen posts on LinkedIn where you actually, you have this problem and you go you go scourging in boxes looking for it. It’s old tech that you can use in this experiment because you’re just trying stuff out. And it’s like you’re allowed to do that. .

Almira Osmanovic Thunström
Yeah, and I think it’s why I was hired. Because I had this trouble of becoming hired. 320 people said no, to me, when I was looking for a job, they didn’t even want an interview with me. Because I have a very different skill set. I’m trained in cognitive neuroscience and medicine. But I also did a lot of prototyping and I have a lot of tech skills that aren’t validated anywhere, because I haven’t taken any courses that give me a stamp on it. So my former boss, initially said no to me, actually. But then he out of curiosity went to a link on my CV, and saw prototypes. And he said, If you can scavenge things for fun, why not scavenge things here, and try to save us some money and do something in psychiatry. So I was never given, for the first two years, I wasn’t given any budget, I had no money, I just had to prove that I could do with what I had, which I had been doing all of my life.

James Royal-Lawson
It’s a fascinating conundrum that when you’re working with innovative situations or innovation, then you haven’t got any track record, because you’re innovating, and you’re being a pioneer. So someone eventually has to take the leap of faith and give you the chance.

Almira Osmanovic Thunström
Yeah, and very few people do. And I understand that because you, when you put money and effort on someone, you want them to have validated skills, but at the same time, you lose a lot of people who might be even more qualified, that don’t have validated skills, but a lot, a lot of knowledge. So the way we see skill sets in workplaces today, I hope really will change. Not just looking at someone’s CV, but looking at someone’s GitHub library or looking at someone’s homepage and their prototypes and thinking, is this person, the right person for our organisation, not just their diploma?

James Royal-Lawson
Right.

Per Axbom
That to me, I’m going to try a really nice segue here. That, to me, is a way of changing perspective. And of helping people see things through the person’s eyes and seeing value in things that you don’t see value in today. And something that can help in doing that. Is VR. VR, is what you seem to be working with most. But give us an example of what I knew. I know you’re working with tonnes of stuff constantly, it seems. But what what are you mostly passionate about? What are you mostly working on?

Almira Osmanovic Thunström
The VR is definitely one of those things that I’m very, very passionate about. Because it’s such an amazing tool, not just a tool for education, it’s a tool for empathy. It’s a tool for treatment strategies in psychiatry, for training in medicine it is such an eye opener, literally, a lot of people, both in terms of what they could learn, and also what they can experience, which is really rare. I mean, in psychosis treatment, in what world will we be able to recreate an auditory and visual hallucination? Precisely as another person sees it so that you can make it tangible for someone with psychosis. That has not been possible before VR. Showing the empathy.

James Royal-Lawson
So thats a situation where you’ve made, you’re making an individual’s condition, a shareable experience through the use of VR. Yeah, precisely. And that then, of course, allows us, I guess, enables understanding and the other people to be more compassionate, empathetic about the world that the person’s having to live with.

Almira Osmanovic Thunström
Yes. And even if you don’t become the slightest, empathetic, after the experience, you will at least objectively know how this person views their hallucination, what type how it acts, why the person acts in relation to it. So you also get a sort of objective version of their behaviour towards this towards this condition that they have.

Per Axbom
So they’re really, I mean, there’s really some amazing work being done in healthcare when it comes to virtual reality. And I don’t think a lot of people are aware of what’s going on. So give us some examples of what what’s been going on for the past 10 years.

Almira Osmanovic Thunström
Well, a lot, thanks to the commercialization of VR headsets. When I started looking into it back in 2012. Then Oculus was just sort of thought idea, Kickstarter. It wasn’t out in the market and the headsets that were on the market were extremely expensive. So you had to have a very rich lab to afford a graphics card if you guys remember that 80,000 crowns, graphics cards now cost 600 crowns. And so when Oculus came, it revolutionised the way we could implement these things in clinics and do research on them. And there’s everything, there isn’t a diagnosis now, where VR hasn’t been tested, clinically a proper clinical trial. And if you look at sort of when we started publishing articles about virtual reality, in psychiatry, and in medicine, it was in the 1960s already. So there was this around 2013, there was this exponential boom, from maybe four or 500 articles to 12, 20, 30,000 articles being published each year about this subject in science, not to speak about all the things we don’t hear that happened in everyday clinics.

Per Axbom
Right. So I saw this video of you on stage, and you were showing another video of you trying on a VR headsets, going through Palliative Care Hospital, where you first struggled to understand who you were, but you were you were deaf. And you understood that you were supposed to help these people pass on. And then you entered it with an elderly person. And then there was this room where you entered and you realise Well, there’s a child here in this hospital bed. And it was so powerful, and it made me start to cry as you started crying, because and that that’s sort of, for me was the ultimate example of, Wow, what a powerful tool, but also what a risk. What I did, there must be so much care put into understanding how people react when they come into these worlds, and how you take care of them, when they are really, really emotionally attached or impacted by by what’s going on.

Almira Osmanovic Thunström
Yeah, it definitely was sort of one of the most emotional experiences I’ve had, it’s really hard crying inside of a VR headset. And I’ve done it so many times. Because things are so impactful there. Because you get to experience things you are not prepared for. Like in there, I learned a lot about myself, I always I’ve worked in geriatrics for a very long time and research on Alzheimer’s and cognitive ageing. So I’ve met a lot of elderly and I’m passionate about elder care about seeing about removing ageism, about researching on topics that are important for the elderly. So when I came there, and I was so willing to take their hand and help them move on, but not the child, I was surprised by myself. Like why was I okay with that? Why didn’t I say no to death? When it asked me to take the hand of the elderly woman and said No, I’m not going to do that to her and her family. It just felt like, Okay, you want me to do that? I’m going to do that, but not for the child there. I refused. So it was like an emotional experience even after, like facing myself like, Oh, you’re one of the people that I don’t like. You should, that’s not how you should think and how you should have acted. So it was extremely interesting. And then I realised like, you say, Per, it’s really scary. What if I put someone in a really bad experience that traumatises them, that’s never going to be good for them.

James Royal-Lawson
When I watched that video, and it’s incredible to see the emotional response to the virtual world, but I started to think about how for decades we’ve been hearing how computer games don’t affect us that impact our behaviour and so on. It’s no it’s not harmful playing games. And yet we’re we we see how you’re using VR to stimulate response you’re using VR to to treat people for emotional conditions and so on. It kind of this is, this is the opposite VR is affecting who you know your emotional response in behaviour.

Almira Osmanovic Thunström
It really is because you are engaging sense you aren’t when you are gaming with just a console in 2D. There’s quite a lot of research. I had a bachelor student look at how we affected like for example, horror into in 3d. And of course it was an effect of the 3d because you’re using your hands in this world. You’re using your body, you’re using a 360 sort of movement and six degrees of freedom. So you are engaged in the world in that, you’re not a silent observer. So it tricks your brain literally, to think that you are not in control. While in a video game, you know, you are in control.

James Royal-Lawson
Yeah, I guess it’s relatively the, the moment you reach in your development, when you become self aware that, you know, from like, was it two or three years old, you can, you know, the difference between something on a screen and something in real life. But with VR, it’s, it’s not the screen versus reality, because you’re so submersed.

Almira Osmanovic Thunström
It is such a strange phenomenon, because I had to learn over time as well, when I let colleagues try that I have to stand next to them, if we’re in experiences that can trick their brain that it’s a height or things that can disrupt their balance, because I was putting people up in a high building, so they could see the height and be a simulator. And some people are like, they would lose all control of their legs and fall on the floor. And I was shocked that it was so instantaneous, and they were shocked that they couldn’t control their brain and their body to think that there was an actual floor underneath them. So I nowadays I stand and I hold people in their hand like ‘I’m here.’ So I can rip off their headset or catch them when they fall. And that was something I wouldn’t have even thought would be that immersive.

James Royal-Lawson
Yeah, I remember the first time I did that, the beam walking VR example it was on the Oculus and you have to walk out the building on the beam. It’s so weird when you fall off and you don’t hit the ground. Because, you know, you’re actually on the ground already. But all you’re stimuli is saying, you’re falling, you’re falling.

Per Axbom
Wow. I mean, but that really puts attention to the fact that you really have to be careful when you conduct these experiments, because they are manipulating perception of reality. So what character so I mean, if you want to get into VR, now what, what types of problems spaces do you want to attack? but also, how do you make sure that you conduct your experiments in a safe way?

Almira Osmanovic Thunström
There are a lot of difficulties, for example, occupation is still a problem when you’re working with with VR and AR, you can walk through things still, which makes it feel less real. You have disadvantages when it comes to moving around, because you can bump into things. And it’s not really designed for people with functional variations. So I don’t say disability because we all have disability. But we have additional variations. And someone who is in a wheelchair is still far from included when it comes to, it’s becoming better, but when when worlds and games and treatments are designed, they often to think standing or sitting and not people in wheelchairs. The coloration of the worlds often don’t take into account colorblindness. There’s quite a lot of these small aspects that you have to think of when you work in healthcare that you might not think of when you work in commercial, gaming. But most games come from commercial enterprises.

So we have to sort of build ourselves or adapt quite a lot to make sure that it’s inclusive and accessible to all of our patients when we work. And how we make it safe is that we do a lot, a lot of screening to see which aspects of our needs does this fulfill. And we also work with companies startups that work in the VR/AR scene. And from the start when we learned that they’re building something we ask you, do you want some free labour? Do you want us there as your research and development midsection because we want to use your products in the future but there are there are some things that you are doing that we are not happy with. Could we work together to improve them? To make it more accessible. So that’s how we build it.

Per Axbom
That’s wonderful. It’s too bad it has to be free when you want to make something accessible as usual. But

Almira Osmanovic Thunström
Yeah, well, it’s never actually free. We give them our work time. But we also gain a lot back because we do research on these things. And we are a University Hospital. So we, we gain from collaborating, we make them make better products, they make us publish more.

Per Axbom
Right? Yeah, no, I meant that they actually get free labour. But you’re right, that it benefits the end users in the end, and that you come with the insights that make available this technology to more people.

James Royal-Lawson
Wondering though with the, with now with so much talk of meta metaverses, and when we have, or Facebook already own the Oculus, and are really trying to make the move into the metaverse in the VR Worlds. How can we ensure that the, I suppose the medical side or the human side of VR, is I’m gonna say winner. I mean, that’s not the right word to use. But I don’t want I don’t want what you work with to be drowned in maybe privacy concerns and manipulation and an overreach from companies that are as large as Facebook. Is there anything we can do to make sure we end up on the right side for this for the good of humanity!

Almira Osmanovic Thunström
That is one of the biggest problems we’ve had is because the commercialised headsets, the cheapest most available highly functioning one for us has been Oculus Quest that has required us to have a Facebook account. And that does not work. And they have started thinking about Facebook Enterprise, but still that is patient data ending up in their possession. So we have been looking at other alternatives and use other alternatives. But it’s still sort of a privacy issue, because most of these things come from companies that have and do and use data for their own purposes and for third parties. And Oculus was our biggest headache two years ago, especially when they announced that they wanted to move more towards each headset being connected to an account. So we made some fake accounts. But they get blocked easily because they’re smart, they know that this is a this is someone trying to get around system. So my personal account has been logged into most of the headsets, which means that I’m giving up my privacy for everyone else’s privacy. And that’s not optimal either. So that’s a huge concern that we have, and why I’m hoping that future generations ‘Physineers’ physician engineers will start building hardware as well, that can be marked as medical equipment when it comes to virtual reality. So that we can also not only have software, but hardware that we are in control of when it comes to cybersecurity.

James Royal-Lawson
I mean, this must be one of the few but it feels like one of the few situations where the medical equipment hasn’t kind of come first that you that you like you say that it isn’t actually marked as medical equipment and tagged as medical equipment. This is commercial equipment that’s coming in to your world via that way, which is quite unusual it feels.

Almira Osmanovic Thunström
It is really unusual and poses a lot of problems because I empty my bank account for almost every month, because I have to buy the equipment for the hospital because it’s really hard to get hold of the traditional ways of getting it to the hospital.

James Royal-Lawson
Oh of course

Almira Osmanovic Thunström
And it’s also, Yeah, that all kinds of equipment that has to do with VR/AR whether it’s about HTC Vive or what it’s Oculus, or what it’s a Pico, Neo VR or anything, I have to order it and pay up front and then be reimbursed which is really hard for my economy, but it’s what I have to do. So another aspect of my privacy being shut down for the sake of this working because it’s not tagged as medical equipment does the hospital does not have a routine for it. And plus safety issues. For example, to test it, Is it safe for psychiatric patients who are suicidal? I had to hang myself from an Oculus Go, to test which weight it breaks on to know if it’s safe to give to a patient in inpatient care.

So I had to test that what weight does it break if I hang myself, because that’s something that a commercial entity does not have to think about. It’s not in their job description to see is this safe for a suicidal patient? While it’s my primary mission to make sure it’s safe, if it had been a technical device that is made for the hospital or a medical device, it would have had in its specification to have that as a safety issue having cardboards in certain ways and length of the of the straps, so they couldn’t be used. But it’s not. So I’ve had to go from the start sort of looking at what the medical directory of things that are registered there and see, what does it require for it to be safe? Just because I don’t want any catastrophes happening while it’s being used. So that’s a huge problem!

James Royal-Lawson
Self regulating, you’re having to do the you’re having to do the whole approval regulatory process yourself. For these things.

Almira Osmanovic Thunström
Yes.

Per Axbom
That’s mind blowing.

James Royal-Lawson
Really.

Per Axbom
Again, it’s like you’re, it’s again, with you picking apart that remote control as a child, you’re actually now you’re picking apart the system, and finding ways around bureaucracy. And that is really, really fantastic. I’m so impressed.

Almira Osmanovic Thunström
Well, it’s not, it’s not easy. It’s many, many times, I’ve thought, is it worth it? Is this worth it because tomorrow, I’m going to have to redo all of this again, when the next headset comes, because the next Headset comes very quickly. So but I see when it’s in the hands of a patient, how much it means to them. So it’s sort of okay, that you’re not doing this for nothing. And one day someone might listen to you and make this a part of medical equipment.

Per Axbom
Wow. So the outcome makes it worth it. Definitely. Thank you so much Almira, its been, fantastic.

[Music]

There’s so so much to unpack for me in this interview. And it’s, I mean, I love this when we go into an interview and don’t really know, all the things we’re going to talk about. And one of the things was just a thing with children picking things apart. Which makes you think, well, how would I react in that situation with my children? I’m not sure I would be as understanding.

James Royal-Lawson
No, and I said that in the interview it straightaway made me feel anxious. The thought of, you know, my kids pulling stuff apart on and, and that was that’s one of the best, or nicest privilege-checks someone has ever done to me was her response to me and, you know. Makes you have another perspective on things when you you hear someone say, Well, you know, we fled a war, war torn country and left everything behind. So yeah, pulling stuff apart, what the hell doesn’t matter. And, you know, realise how privileged you are to have all these things and be so precious of them that you don’t want your kids to pull them apart. Because you’re worried about the time and cost of replacing them.

Per Axbom
Yeah, exactly. Which made me reflect so much on the people around her, who have supported her way of doing things. So first her parents and then the person who hired her, I mean, she’s obviously struggled and met so many obstacles and dead ends but when she finally has someone, believe in her who gives her the freedom to act and do things in her way, she works wonders. And she’s taking on her own. A lot of huge leaps forward in scientific understanding of the benefits and dangers of VR when it comes to wellbeing. It’s really, really impressive.

James Royal-Lawson
Yeah. And I think this, Yeah, I think the therapy, thats opened up. The possibilities are really, really impressive that the, the speed of treatment and effectiveness of treatments, using VR seems to be really quite powerful.

Per Axbom
Right? And that power is also making me feel a bit worried and concerned about the fact that Amira is doing all these experiments and tests in a research environment, where she’s taking care of the patients and following ethical codes and worth. And the other aspect is that in a commercial world, we’re just throwing out this technology. And Almira’s work is showing us how powerful it is in affecting people, I especially I caught on to how when people put on this for the first time, they essentially fall down straightaway because they are so immersed in it within seconds. That is hugely powerful.

James Royal-Lawson
I mean, you do when it’s you you straightaway, you can feel dizzy, you can, you can be confused by the fact that you fall but don’t crash at the bottom or whatever, when you don’t bump into things that come towards you, or you walk towards rather, it’s, you realise when you using VR about how you, the self conscious you understand it’s not a real world. Because you’ve put a headset on there’s a there’s a physical aspect to get in the world that I suppose you are very much aware, this isn’t your real reality. But yet, there is stuff going on in your head at another level, which doesn’t understand this isn’t the real world, your balance is thrown off, you kind of you know, your, well, the fact that you can do therapy, or people can do therapy with this kind of equipment tells you that stuff goes on at a deeper level in your brain when you’re submersed in VR, that is closer to reality.

Per Axbom
Right. So I’m figuring we need more of the type of research that Amira is doing. Before we like set this technology free. And say that, well, this is safe to use for everybody.

James Royal-Lawson
But it already is already out there. I mean, this is the paradox that what’s enabling her to do so much research now is the as you said, the cheapness and quality of the VR headsets that are available now as consumer items are have come on so much. I mean, it’s such a leap forward in the last few years of what’s available, the power of the things that are available. So yeah, now there’s more, there’s more VR hours being spent per day on the planet than any time ever before. And we don’t know the full effect of that like we alluded to in the we talked about in the interview, but the research has gone on for 30 plus years about effective gaming, how many hours gaming and the social effects or the behavioural aspects of gaming and children. And that’s been a very contentious thing for decades. This is another thing, another aspect of this of gaming. And, and clearly we can’t argue there’s no, there’s no effects of VR gaming, when we’re using VR to as a therapeutical, medical tool.

Per Axbom
To create effects. Yeah.

James Royal-Lawson
So this, it’s, you know, it’s a non-argument that it does affect. So the question is, how much? And in what ways and how, how do we make sure we don’t end up causing the wrong effects? Or, or subconsciously affecting people, unconciously I mean.

Per Axbom
And that sounds actually watch how she’s doing her work, when when she’s contacting these companies and asking, look, can we be some free workers on your team? That is the way forward currently, at least, for ensuring that it’s not harming as much as it could? Because they actually do that type of testing for the companies?

James Royal-Lawson
Yeah.

Per Axbom
After developing it.

James Royal-Lawson
I mean, I do feel uneasy, though, about, you know, at the moment, the the biggest manufacturer of VR headsets is Oculus, which is Facebook.

Per Axbom
Yeah.

James Royal-Lawson
And we have Facebook then as both the manufacturer and gatekeeper of what is effectively unregulated medical equipment.

Per Axbom
Right.

James Royal-Lawson
And that sounds quite scary. But I don’t want to lose, I don’t want to lose out on this thing, because there’s clearly some really, really good benefits from it.

Per Axbom
So let’s hope somebody listens to this show and actually takes Almira up on her challenge to make some of this hardware. Not connected to privacy, sensitive accounts.

James Royal-Lawson
Yeah, I mean, yeah, just the whole thing. She mentioned about having like, Enterprise versions with the fact that you can’t buy VR headsets as a medical piece of equipment, which is kind of crazy. I guess. Someone should be jumping on that chance.

Per Axbom
Exactly. So I think I already know what you have picked as the suggested episode for listening to next, because you quoted dune in our intro. Yeah, it

James Royal-Lawson
seems to make complete sense that we should do now is golf and listen to episode 196, which was when we talked about augmented reality. With Boon Sheridan back in 2018. We touched on there a lot of the useful ways in which augmented reality can be applied. And I said at the intro Boon encouraged us to look into the wonderful things that can be done with VR, which hopefully we’ve done a bit today.

Per Axbom
And if you’d like to contribute to funding or producing UX podcast then visit UX podcast.com/support. Remember to keep moving.

James Royal-Lawson
See you on the other side?

[Music]

Right, I went on a VR rollercoaster ride while eating an apple.

Per Axbom
Okay, a VR roller coaster ride while eating an apple.

James Royal-Lawson
Yeah, it shook me to the core.

Per Axbom
It’s just so bad.