It’s undeniable that the Internet has altered our world. Some people use to it to stay in touch with old friends, look up random facts, display personal photos, play games, or, perhaps, all of the above. Now, imagine logging on to adjust to a dramatic life change, using the world wide web not merely for entertainment but to secure your mental and physical wellbeing.
That’s Sandra Winkler’s vision. A faculty researcher and assistant professor of the College of Health Care Sciences’ Occupational Therapy Department, Winkler was recently awarded a three-year grant totaling nearly $1 million from the US. Department of Health & Human Services to continue developing and maintain a Second Life program for veteran amputees.
Using the virtual world program will allow participants to simulate using their missing limbs, while connecting with other amputees nationwide in an interactive, supportive community.
Winkler sees it not just as a supplemental program to aid in amputees’ ongoing recovery, but as a whole new way of thinking about their health care.
“As a therapist, I am limited in what I can teach an amputee because I have both my arms and both my legs. I can’t put on prosthesis and show them,” she said. “And so, with the platform that we’re using, the amputee becomes the teacher. The therapist role changes a little bit, where we really become facilitators in their reintegration into the community.”
The program will also be highly personalized and flexible, encouraging participants to care for themselves.
“We’re not telling them you need to do this, you need to do that. Here’s your prescription, do this, this, this,” she said. “We’re teaching them that this is the research that’s out there but you need to now make your own decisions.”
The program, based on Winkler’s research titled “Dissemination of Amputation and Prosthetic Evidence-based Medicine” will include four “islands” within Second Life. One will be open to the general public, on which Winkler and her research team will build a virtual museum showcasing the history of prosthetics. The other three islands will be open only to research subjects.
“On one of the islands, we’re going to build a virtual home where people with amputations can go in and plan home modifications to a house. It will give them the opportunity to try it out on a virtual house, before they actually implement it in their own house,” said Winkler.
Another island will feature a racetrack, on which participants can ride any car of their desire, modified with hand controls to accommodate their amputations. Winkler said that this will give participants a safe way to practice driving, while showcasing what driving modifications are available in the real world.
The fourth island will be completely underwater, an ocean covered in coral reefs, allowing participants to practice swimming.
Winkler began developing the idea in 2004, when she was invited to the nation’s capital for a meeting between the U.S. Department of Veterans Affairs and the Department of Defense.
“It was kind of a VA/Department of Defense joint idea,” she said. “Originally, we developed it as training for clinicians. And then, at some point, we repackaged so it would be a self-management intervention for amputees.”
In 2000 and beyond, as soldiers began to return home after serving in Iraq, Winkler and her colleagues noticed a distinct difference between young amputees and older ones.
“We realized this was a new cohort of veterans,” she said. “These are young, very in shape, active guys. The amputees that we know at the VA are older and their amputations are due to diabetes. They’re not in good condition. And to try and mix these two groups for one intervention just didn’t work. So we realized we really have to be more innovative in how we treat these guys in therapy.”
Winkler also sought to conquer the problem of distance.
“At that point, there were less than a 100 amputees and scattered all over the United States. So, the only way to bring them all together was by the internet,” she said. “Veterans are very, very loyal to each other and they believe that soldiers take care of soldiers. So, that’s kind of why I went the Internet route. Because we needed to bring these guys together meaningfully.”
Winkler will start by enrolling 96 study participants, likely around May. She anticipates that the participants will come with a wide variety of experiences and backgrounds.
“We’ve opened the study to any and all amputees. It doesn’t matter how old they are. It doesn’t matter race, gender, sex — it just doesn’t matter. It doesn’t matter how long they’ve had their amputations or how recent. They just have to be willing to be in the study,” she said.
In addition to the study participants, Winkler hopes to involve NSU students in the occupational therapy program.
“Our doctoral program at NSU is an online program. And so, I thought, this is a really good way for me to be able to work with them,” she said. “Right now, I’d like to find either an occupational therapy or physical therapy doctoral student who would like to research the benefits of therapy through prosthetic training.”
But students won’t be the only ones to learn from this project. Trying out Second Life has also taught Winkler a lot.
“What I’m learning, and perhaps even just over the past month, is that when you’re working in a virtual world, whether you’re driving a jet ski or going on a sailboat, it changes your balance and it changes your body perception.”
Among other questions, Winkler hopes to explore if Second Life can help decrease phantom limb pain and how it may impact a participant’s fear of falling. Though her research will focus on veteran amputees, she encourages anyone interested in Second Life to check it out, no matter their physical abilities and interests. After all, the program is free.
“People say ‘Well, it’s too hard to learn.’ You have to go out of your comfort zone, but within, I’d say six times on Second Life, you’re pretty good at it,” Winkler said.
She is especially grateful that NSU has supported her endeavors, as other universities may not have done so.
“I want to do some really inventive things that would be difficult at other universities. For example, being able to hire amputee actors and being able to get my webpage up,” she said. “NSU is a really tight community where you can go to the people who you need help from. And they’re excited about what you’re trying to do and they reach out to help. And I think that at a lot of other universities, everyone’s so busy that they don’t really embrace working with their own researchers.”
For more information on Winkler’s study and research, visit virtualhealthadventures.org.
