Dr. Skip Rizzo is the Director for Medical Virtual Reality at the USC Institute for Creative Technologies. He also works as a research professor at the USC Davis School of Gerontology, as well as the USC Keck School of Medicine Department of Psychiatry & Behavioral Sciences.
Tell us about your background.
I grew up in Connecticut and moved to New Orleans in 1977 for my Master’s degree in experimental psychology. I went on to pursue my PhD in Clinical Psychology at SUNY-Binghamton in upstate New York. After that, I was ready for a change of scenery – particularly warmer weather – and accepted an internship here in Los Angeles at the Long Beach VA. That was in 1985, and I’ve called this place my home ever since.
What sparked your interest in AR/VR?
I first became interested in the field through my work as a clinical and neuro-psychologist in brain injury rehabilitation. The tools we had available at the time were limited, and I wished there could be something more engaging for my clients to use. In the 90’s, I began learning about the emerging field of computer games and VR and although the technology was still in its early stages, I saw its growing potential for major impact in the future of healthcare.
After 10 years of clinical practice in the brain injury field, I changed directions to pursue a post-doctorate at the Alzheimer’s Disease Research Center of USC in 1995 in order to access the technology and expertise that USC had for advancing technology in the healthcare space. The computer science building happened to be right across the street, which gave me the opportunity to pester and pitch some ideas for clinical VR to some of the computer scientists and engineers that I met there. They were right on board, but again, the limits of the technology available at the time was still a significant barrier. Nevertheless, we pushed the boundaries of what was possible to make the best projects we could within those limits, making improvements as advancements in technology allowed.
Since then, my interest in VR/AR has grown within my scope of practice as well as other aspects of healthcare. For example, I joined Carolee Winstein’s projects in the early 2000’s to promote VR’s use with physical and occupational therapy, which was new territory for someone with a background in psychology. I’ve also been able to delve further into my own area of study with treatments aimed at PTSD, autism, and psychological disorders.
One of the wonderful things about USC is its vibrant community of scientists with a passion for both scientific and real-world applications of the problems we seek to address. The addition of the SMART-VR community has taken those initiatives another step further, offering greater opportunities for innovation and collaboration across a variety of academic fields.
Which of your VR/AR accomplishments are you must excited about?
What makes this a tough question is the form my research often takes to begin with. Instead of building and handing off a finished product for a targeted problem and moving on to something different, most of my projects adopt an evolutionary path. Many times, they end up developing into enduring research programs on their own that grow over the years.
For example, back in 1999 I developed an intervention that involved testing children for ADHD within an immersive Virtual Classroom. Kids were asked to concentrate on and respond to cognitive tasks presented on a VR blackboard while typical classroom distractions appeared realistically in the immersive space. The initial studies produced results that documented the impact of distraction on attention performance within this ecologically relevant environment in children with ADHD. A test publisher took interest in 2002, and a newer model was created that became the basis of over 15 published studies on the topic. Since 2018, I’ve been collaborating with a company to make this technology accessible at a low cost to clinicians that leverages the latest advances in VR technology. So even after 21 years of R&D, this project and its areas of application still remain a work in progress, but in a state where it is now ready for everyday clinical use by clinicians!
Another similar example would be my research with PTSD over the years. It began in 2003 with this concept of delivering evidence-based exposure therapy in VR, which we accomplished by re-creating traumatizing combat-relevant scenarios faced by service members to help them to confront and re-process difficult memories but in a safe context administered by a well-trained clinician. We were then able to expand this technology into the assessment of PTSD, with my vision for the future taking a step further into the prevention of PTSD via resilience training. We aim to expand our military-relevant findings into the civilian population, taking some of our scenarios with medics and survivors of military sexual assault to help civilians with similar past trauma experiences. This is particularly relevant to helping healthcare professionals who are enduring the current stress of the COVID-19 crisis.
Finally, an area of work I’m excited about is the development of artificial intelligence for use in healthcare settings. This is a big focus of my work at the Institute for Creative Technologies, which started as a project with the military back in the late 1990’s called the Mission Rehearsal Exercise. By creating virtual patients that characterize a wide range of diagnoses and personalities, in partnership with my colleague, Dr. Brett Talbot, we’ve used this technology to prepare doctors and social workers for a wide variety of clinical scenarios. We’ve also found great use among people on the autism spectrum, who can benefit from the opportunity to prepare for challenging social situations in VR using Virtual Humans, such as in role-play training for job interviews.
As you can probably tell, this question feels a lot like asking which one of my children I love the most! I was often met with criticism for dividing my focus in so many ways during my early years as a researcher. Yet I believe all of these projects serve to answer the same question, and therefore share the same mission -- “How do people behave and interact with simulation technology and armed with that knowledge, how can we leverage VR to improve clinical care?” Going a step further, where does VR have the potential to provide higher systematic control of stimulus presentations within relevant simulated contexts, improve accessibility and quality of care, better quantify user performance, and promote increased levels of patient engagement? These are key areas for improving the impact and efficacy of rehabilitation as well as for the clinical areas I described above.
At the end of the day, what makes me excited about any project is its potential to scale alongside technological advancements. In such a rapidly-changing field, it’s important that the value of what we create would never become obsolete due to the ever-present advances in technology. Creating with that anticipation of technological change, and the ability to adapt accordingly, is therefore incredibly important if we wish to create meaningful and enduring work without wasting a lot of resources.
Is there anything on the horizon of VR and health that you're especially looking forward to?
The technology is finally catching up with the Clinical VR vision that emerged back in the 90’s, and there are many incredible things to look forward to in the near future. It’s finally possible to produce interventions and assessments in high fidelity, at an affordable cost, and in an approachable and usable format for both patients and clinicians alike.
One big step in this direction is the development of stand-alone headsets like the Oculus Quest, which do not require the use of a tethered wire and computer to function. All the computer processing is done on the headset device. This increase in accessibility alone is a tremendous leap forward in terms of potential for use. Clinicians can easily keep them on hand, demonstrate their use to patients, and issue a unit for home treatments. In addition, 5G technology will soon allow clinicians to stream VR content from an extensive cloud-based library, making it easy to choose relevant scenarios for a wide variety of client/patient needs.
Of course, these advancements do not come without some amount of controversy. COVID-19 has made huge strides in the public acceptance of telehealth, which it turn will make the adoption of VR more likely to occur in the near future. The biggest issue is likely to surround the role of artificial intelligence in all of this. Our aim is to develop AI to provide decision support or embody it in the form of a Virtual Human support agent or guide. We should be very cautious about work that aims to use AI as a replacement for live expert-delivered care. Much more research is needed before AI could be leveraged beyond support applications. One such example in development at ICT is called the “Battle Buddy,” which features a virtual human assistant designed to appear on a mobile device to engage service members in health and wellness activities. When you add in connectivity with wearable sensors like a Fitbit or Apple Watch, it is possible for the Virtual Human guide to sense information about the quality of your sleep or monitor your activity or heart rate, and use that data to drive the software to prompt users to engage in self-care activities such as tactical breathing and mindfulness, to name just a few.
Supervision from an expert will always be necessary to develop quality treatment plans and monitor patient progress. That being said, there are aspects of technology that humans simply cannot compete with. For instance, AI’s ability to gather and synthesize information and look for patterns can draw highly personalized insights about a patient’s health and habits. This provides an advantage that a practitioner would have a hard time competing against, especially given the limited time demands that practitioners experience with in-person appointments. This all means that special attention will be needed to understand the boundaries that will need to be drawn between technology and in-person care, especially as the presence of AI increases in everyday life.
All of this may sound like something from a science-fiction movie, but these scenarios are already on their way to becoming a reality for us. As complicated as some of the inevitable questions concerning ethics, privacy, and proper use may be, I’m excited for the intellectual challenge they present to us as researchers and developers. We’ll be faced with important considerations related to who we are as human beings, what our strengths and weaknesses are, and how such gaps can be bridged as technology continues to advance.
What advice would you give to those who wish to follow a similar path?
You have to do it because you love it, not for the goal of financial success. In a way, the field of VR and AR is like the Siren’s song of our days – a beautiful tune calling out to many along this path with the possibility of shipwreck if one is not careful to consider all the challenges along the way. Be aware of the time, energy, and resources it takes to bring an idea from prototype to market, as well as all the clinical trials required beforehand. That being said, having a genuine passion will give you the motivation and patience you’ll need to navigate whatever difficulties come your way.
Take plenty of time to consider which development path is right for you, as well. This typically involves getting started in either the start-up world or academia. You’ll need a lot of endurance for the long road of academia, as well as the persistence required to continually secure funding along the way. As for the start-up route, you’ll need a strong business mindset coupled with a personality of grit to keep your edge in a competitive market.
Finally, do plenty of research on both existing and emerging topics of study. Although VR’s commercial availability has been something of a recent development, many ideas I hear from newcomers have been the subject of research experiments for quite some time. You don’t want to put a lot of time into something that only re-invents the wheel, unless you see some unique way to make that wheel much better. An approach that I think is helpful is to have an eye for finding the pain points for advancing mental health and the rehabilitation process. That requires a good awareness of what current practice or “care as usual” involves in the real world. Then see if there is a thoughtful way to address those challenges in the virtual world. Changing a patient’s mental state is not an easy task, and physical rehabilitation is fraught with emotional challenges and frustration along the way. Seek to make those valleys easier for patients to cross, and you’ve got an excellent path forward for improving clinical efficacy and impact.
Anything you are passionate about, aside from AR/VR?
I enjoy keeping an active lifestyle, primarily right now during the COVID shutdown, by swimming every day. I was a rugby player for a long time, and still play the occasional game a few times a year. I enjoy riding motorcycles as well, having started when I was sixteen. That makes 2020 the 50th year of continuous riding experience under my belt!
Exploring art is also something I love to do, with photography being my favorite discipline. I’ve always enjoyed using traditional methods of photo development, but I’d like to get caught up with the latest digital software sometime as well. I’ve also worked with crafting homemade beer and ink drawing in the past, which I’d like to resume when time allows. I’m always engaging with music as well, whether that means finding new music to listen to, going to concerts whenever possible, or playing musical instruments (badly) on my own.
I have a wonderful family life with my wife, dog, and mother, whom I was recently able to move here from Connecticut to live with us. Finally, although it’s technically my line of work, coming up with new ideas in the field of Clinical VR is just as much my hobby as it is my vocation.