Few people associate hospitals with anything resembling joy or creativity. The inherent grimness of places like the Shock Trauma Center at the University of Maryland — perhaps the least fun destination in downtown Baltimore — made the happy scene inside a windowless office at the pioneering trauma hospital even more special.
Inside, Joshua Basile beamed as he offered his first impressions of a new virtual reality (VR) platform. His audience included Dr. Sarah Murthi of Shock Trauma and interns Nastia Garachtchenko and Marco Cortes from the Maryland Institute College of Art’s (MICA) Game Lab, which organizes internship opportunities and programming around video game technology. The trio spent the past few months developing virtual reality experiences for people with severe spinal cord injuriesespecially early on in their treatment, to deal with physical and emotional trauma through immersion in another world.
“In all honesty, I forgot I was quadriplegic, because every single thing that I saw in the room before went to another reality," Basile said. “I’m in a whole new world, and for the first time, I’m in a world that I can actually control without asking a caregiver to move this, move that."
A different life-changing experience brought Basile to Shock Trauma in 2004. He was boogie boarding during a family vacation at Delaware’s Bethany Beach when a wave threw him headfirst into the ocean floor. The force broke his fifth cervical vertebra and rendered him immobile.
“I heard a loud crack, and I was paralyzed,” Basile recalled. “I couldn’t move anything below my shoulders ... I was face-down in the water, unable to scream for help. Luckily, my friends saw me floating, and they pulled me to shore. It was the start to a new life."
The one-time varsity tennis player was medevaced to a nearby hospital, then to Shock Trauma, where he said he lived for five weeks while adjusting to his new life with quadriplegia. But Basile’s story isn’t one of a promising rise tragically cut short; he channeled his experiences into advocating for others with spinal cord injuries. He launched Determined2Heal, an organization dedicated to supporting people with paralysis within a year of his own injury. He earned a law degree from the David A. Clarke School of Law in 2013.
Today, the 34-year-old represents the catastrophically injured as a trial attorney in Washington D.C. and speaks about his life and work all over the country. Through all of this work, he carries a deep understanding of spinal cord injuries’ physical and psychological tolls. He recalled times in the hospital when he, physically unable to vocalize his immense fear or loneliness, pushed his chin under his neck brace and forced the ventilator that helped him breathe out of his neck — all just so he could experience human connection when the nurses inevitably came.
“You quickly find yourself becoming, to a degree, mentally paralyzed, because it’s so much to take in,” he explained while seated in his electronic wheelchair as a caregiver sat nearby. “It’s so much to try and absorb, and you need any excuse or any way just to get away from what you’re seeing with your own two eyes.”
According to the National Spinal Cord Injury Statistical Center, an estimated 17,730 new spinal cord injuries arise every year. Basile, like the others who developed the games, believes that virtual reality can offer another way to heal.
Basile first met Dr. Murthi through the Trauma Survivors Network support community at Shock Trauma. On top of her clinical responsibilities in Shock Trauma, Murthi is an associate professor of surgery at UMD’s medical school and the co-director of the Maryland Blended Reality Centera multidisciplinary institution focused on the intersection between emerging visual technologies and medical issues. These various hats allow Murthi to research problems her patients with spinal cord injuries encounter, including their lack of treatment options during hospitalization.
“They are in the hospital for long stretches of time — six weeks, three months — and they’re fully intact — they just can’t move. They’re dealing with this new, devastating injury,” she said. “We have, really, no tools to help with the suffering or pain outside of these powerful drugs that have a host of really significant complications, including addiction.”
Murthi launched the Maryland Blended Reality Center with $2.4 million from MPower, a partnership between the University of Maryland’s College Park and Baltimore campuses to support innovative research and opportunities, in 2017. She had been in touch with MICA Game Lab’s director, Jason Corace, since around that time, when the Game Lab was also new. For Corace, the partnership provides access to otherwise difficult-to-obtain resources. Both Corace and Murthi noted that medical funding often involves rigorous standards for approval and reporting that can draw out the research and development process — great for adults in medical graduate programs, but prohibitive for undergraduate students.
“We’re an art and design school — we don’t have a massive research infrastructure,” Corace said. “We look for more projects that are a year at [longest for our students], or even shorter in terms of a summer or spring-into-summer kind of time frame.”
Students working with the Game Lab also get to apply game design skills to non-gaming environments. Cortes, the MICA intern, said that the novelty and ease of entry to virtual reality made signing onto the Shock Trauma project (with Corace’s facilitation) very appealing.
“What I think is most exciting about VR is that it’s still really accessible for first-time players,” said Garachtchenko, another intern. “People who usually aren’t into video games, because they have trouble holding controllers or keeping in mind the button combinations you need to play more complex games, in VR, you’re standing and looking around, and picking up objects.”
At Shock Trauma, the young developers entered the room with smiles on their faces as Basile and Murthi discussed the testing. Over the prior summer, the team worked closely with Basile.
“These whole three months were just us struggling, worrying that it wasn’t going to be fun, and our real big ‘Eureka!’ moment was in seeing Josh play it," Garachtchenko said.
The games take players through activities, such as gardening and archery, that would otherwise be impossible for many people with spinal cord injuries. But more important than the game’s content is the way that people with little to no hand mobility can actually play them. Basile’s input led the developers to make the game playable with a quadstick, an orally-operated joystick that Basile also uses in professional settings.
“I did everything with just my mouth and breath,” he said. “It might not seem like a lot to an able-bodied person, but to have that 100% independence for myself ... the little things are really big in the world of paralysis.”
The team plans to resume beta testing in the new year, and hopes to incorporate more social elements to the games. For instance, similar to contemporary video games that allow players to speak with one another across geographic barriers, people could share the experience with families and friends. This would enhance the social experiences that new spinal cord injury patients lose when they cannot speak, even as loved ones stand by their hospital beds, and bring that human connection into an often lonely healing process.
Murthi sees the potential for VR to enter the medical mainstream as another treatment option, especially in the age of opioid addiction as a public health issue.Researchers at Inova Mount Vernon Hospital, Cedars-Sinai Medical Center, Boston Children’s Hospital and other medical facilities across the country have also explored VR’s patient care uses in recent years.
“I hope that this really sparks a lot more game designers to get interested in how they can use this to help people having those worst days,” Garachtchenko said.
In the meantime, the project already has the support of someone whose opinion matters to his community.
“You think it’s close to being something [a patient] could use?” Murthi asked in the office.
“No," Basile replied. “It’s there.”