Professor John Quarles sits for a photograph in his lab surrounded by students desks, VR equipment, and a mannequin.
John Quarles sits for a photograph in his lab at UTSA surrounded by students desks, VR equipment, and a mannequin. Credit: Scott Ball / San Antonio Report

“Don’t brush too hard.”

Dental hygiene was a risky proposition for John Quarles in 2002, when a rare immune system disorder diminished his blood platelet count, preventing his blood from clotting. Seemingly harmless activities such as brushing his teeth could rupture a blood vessel and cause him to lose even more platelets.

Doctors couldn’t detect what was causing the condition. But after Quarles’ father found a link in Japanese medical journals between the disorder and the presence of harmful stomach bacteria known as H. pylori, the medical team pumped antibiotics into Quarles’ barely existent bloodstream, and he recovered.

That was the first time he almost died.

Just a few years later, at age 22, Quarles received a life-altering diagnosis: He had multiple sclerosis, a condition that tricks the immune system into devouring sensitive nerve coverings, robbing the body of its essential motor functions.

Complications from a treatment for MS caused his immune system to attack his red blood cells. A blood clot hit his spleen, lungs, and kidney; he had a heart attack. After 22 blood transfusions and six weeks in the hospital, he was released.

In the face of life-threatening illness and a debilitating medical condition, however, Quarles has remained industrious. An associate professor of computer science, he was named the University of Texas at San Antonio’s Innovator of the Year in December for the 3D holograms he develops to help train first responders. In addition to his research, Quarles also teaches game development at the university. His health problems do not prevent but, rather, inform his work.

The software he builds at MedCognition, a virtual-reality startup he founded with Dr. Kevin King and several others, is framed by his passion for improving health care, King said.

“He has a medical condition that requires a lot of rehabilitation and medical care,” King said. “What he’s done throughout his career is figure out a better way to provide rehabilitation services for people with various disorders. … As a guy who’s been through the medical environment, he understands how important good clinical decision making is.”

As a frequent patient, Quarles is intimately familiar with the health care system and its flaws. To combat some of those gaps he has programmed virtual- and augmented-reality games for the children who undergo physical therapy at San Antonio’s Children’s Rehabilitation Institute of Teleton USA, or CRIT. He is studying and aiming to develop remedies for cybersickness, when VR causes dizziness, headaches, nausea, or all of the above. And the U.S. Department of Defense awarded Quarles a grant to develop his augmented reality-powered patient holograms for training soldiers and medics in the Army.

Now 36, Quarles has a slight but muscular build – a product of his religious devotion to working out and completing his physical therapy regimens. Mostly subsisting on chicken and vegetables, he observes a strict diet. Good dieting and exercise – he works out about 10 hours a week – can help stave off some of the effects of MS. He sometimes walks with a cane, and he uses a wheelchair on days when it’s especially fatiguing to get around on foot.

With two young daughters – Faith, 3, and Ella, 8 – Quarles can’t chase them around like most dads. But he bonds with his children through playtime and encourages them to be inventive and resourceful, Quarles’ friends and family members say. If they’re playing a game, make it an original one, he might suggest.

After all, his active imagination helped bring to life games like “Shark Punch,” a virtual-reality game he designed to help people with MS have fun while getting needed exercise in a swimming pool. The player, wearing VR goggles, swims away from a great white shark or punches it square in the nose. Fail to evade the shark, though, and you can expect a crunching Jaws-like chomp, complete with sound effects.

Exercising in water is ideal to avoid overheating and balance issues, which make on-land workouts taxing for patients with MS.

Eliza Castillo’s 5-year-old daughter Olivia Borrego got to try underwater VR at CRIT for the first time this month. Olivia started her aquatic therapy without a waterproof VR headset and could barely muster the effort to complete her squats. Strapping the headset on allowed Olivia to metamorphose into a frog catching bugs, her legs submerged in water as she hopped in the pool.

Olivia was born with hypotonia, or floppy baby syndrome, a congenital condition marked by decreased muscle tone. She can walk with leg braces, but long distances fatigue her. In the four years Olivia has been coming to CRIT, however, she has built up muscle she lacked as a baby, said Castillo, who credits the virtual- and augmented-reality games Olivia has used in physical and occupational therapy.

“She forgets this is a struggle” when she puts on the VR headset loaded with games Quarles developed, Castillo said. “She forgets this is exercise. When she’s immersed in that VR world she forgets she’s in a world of disability and limitation. When she was a frog … she was somewhere else.”

Olivia, 5, tests out the VR simulation during the therapy session.
Olivia, 5, tests out the VR simulation during a water therapy session at CRIT with physical therapist Kelly. Credit: Scott Ball / San Antonio Report

An emergency room doctor, King co-founded MedCognition with an eye on improving simulated medical scenarios. Mannequins that paramedics and other emergency medical professionals use for training have evolved with advancements in technology and are effective at mimicking the sensory experience of treating a critically ill patient. But the dummies, in the trainees’ minds, are still just dummies.

That’s where MedCognition’s augmented reality-powered holograms come in. The virtual patient is projected into the room when the trainee puts on a set of AR-enabling goggles, Microsoft’s Hololens. The holograms can cough, seize, or writhe in pain, and their vital signs are reflected in the complementary mobile app.

“They develop an emotional reaction to it,” King said of the trainees. “Again, that is exactly what we’re hoping to elicit because that’s what it’s like to take care of a real patient. … It really triggers that almost instinctual response to want to help another human.”

The trainees forget it’s a mannequin they’re treating.

Quarles said he owes his creativity and inventiveness to a lifelong passion for video games, science fiction, and computing.

His father, now 80 and retired from his professor role at Texas Christian University, remembers playing Zork, a text-based puzzle game on the computer with a very young John. C.A. Quarles, his wife Sonja, daughter Jennifer, and John played video games on the Commodore 64 as a family. The early 1980s 8-bit home computer features an early version of “Game Maker,” an engine for creating your own two-dimensional computer games that John remembers behaving wonkily. He built a Spiderman-themed game on it once, but it was incomplete.

“We certainly played a lot of video games together,” said C.A., who as an experimental physicist did a lot of coding and computer programming.

His son was a fan of comic books and Teenage Mutant Ninja Turtles. Testing the limits of science motivates Quarles’ work, bending the fiction in sci-fi toward reality. He remembers wanting to build Data, the android character from Star Trek: Next Generation. Iron Man’s augmented reality-designed face and holographic arms might not be too far off from his own creations.

Jennifer Quarles, who is 44, also has MS. She was diagnosed about eight years before her brother, which is perhaps a reason the condition hasn’t slowed his drive to innovate but has propelled it. Having an older sister who’s gone through some of the same progressions of the illness helped him feel prepared to take on MS.

“I have to very much prioritize the things that are essential,” John Quarles said. “On an everyday basis I think about, ‘Should I do this? Let’s see, could I die from not doing this? Yes, I could die from not doing this, so I’m going to do it.’”

Jesus Castillo helps his daughter Karina jump into the air during the simulation.
Jesus Castillo helps his daughter Karina who is diagnosed with MS jump into the air during the simulation. Credit: Scott Ball / San Antonio Report

Transcending human limitations is a thread that weaves through much of Quarles’ work. His sister joked that he would eagerly sign up to become a bionic man – like the character in the popular television show of the 1970s – if it were possible. But there’s a point at which the lines between escapism and reality blur, and Quarles’ VR games are blurring that line.

“For just a minute, you forget that you’re at physical therapy and you’re trying to get better and you’re working on something related to an injury,” said Jennifer Quarles. “Just for a minute, you’re kind of taken away from that.”

JJ Velasquez

JJ Velasquez

JJ Velasquez is a columnist at the San Antonio Report. A former reporter and editor at the SA Report, he currently works as a project manager for New York City-based Advance Local.