How Virtual Reality and the Metaverse are Changing Rehab

A patient with balance issues standing on a bosu ball while hitting a playful puffer fish between two dapper penguins.

Another sitting and holding a weighted ball while kicking the pinball controls with his feet.

Stand on one foot while following a path on a beach; make a ham and cheese sandwich in a food cart; playing tarot cards.

This may all sound strange going to physical therapy – but that’s the future of rehab, made possible by virtual reality (VR) tools.

“Patients are really engaged in virtual reality,” said Nora Foster, Doctor of Physical Therapy, physical therapist and executive director of NorthBound Health. “The immersive VR experience motivates and challenges patients to get the most out of their rehabilitation therapy.”

Medical device company Penumbra hopes to further enable this capability – and help improve patient outcomes – with today’s release of the world’s first hands-free, full-body, untethered VR rehabilitation platform.

Penumbra’s REAL System y-Series is the only platform to use upper and lower body sensors that allow clinicians to track full body movement and progress in real time, Penumbra CEO explained , Adam Elsesser.

“The whole body was the next big step,” said “It’s the one thing in our area that people wanted to be able to work with patients on the rest of the body, not just the upper part, the whole body. This opens the window to help many more people.

Penumbra’s REAL System y series, which leverages virtual reality, now features improved hardware and sensor technology, including lower-body sensors. Comprising a helmet and five sensors, the technology can now address upper and lower limbs with a full-body avatar, Elsesser said.

It is currently used in clinics and hospitals across the United States for patients undergoing physical, occupational and speech therapy, Elsesser explained. It helps treat upper body impairments caused by stroke and other conditions, trunk and balance, cognition, functional uses, training activities of daily living (groceries, personal care ) and cognitive stimulation.

The REAL System y-Series is intended for use with a therapist guiding patients’ movements, Elsesser said; they can visualize on a tablet what the patient sees in virtual reality. Clinicians can then customize exercises and activities to challenge, motivate and engage patients, while tracking movement and progress in real time.

But, Elsesser was quick to point out that it’s “not just a game we’re repurposing. It is very particularly focused on health. The experiences and activities carried out in VR are designed with very serious clinicians.

Also, while the Metaverse is undoubtedly one of the hottest topics in tech – if not the free world – right now, he pointed out that the product is called “Real System” for a reason.

People using avatars in the metaverse environment are emerging to attend unique virtual events not possible in the real world, wear virtual clothes, buy virtual goods, and have experiences they would otherwise never be exposed to, that’s great. , he said – but in this case, the virtual world is being used to help people get back into the real world.

“We don’t want people to live in a fake world,” Elsesser said. We are a healthcare company, we want people to get better and get back to their daily lives. It happens to be a particularly well-suited tool for this.

Overcoming rehabilitation challenges

The prevailing feeling is that the need for innovative rehabilitation therapy has never been greater. For example, in a YouGov survey of more than 100 US-based physical therapists, 80% of respondents said the field had changed only moderately or not at all over the past decade.

Similarly, nearly 75% say patient compliance is the biggest challenge in physiotherapy today, and more than half believe virtual reality can help improve this.

And, while the majority of physiotherapists (65%) would be keen to use technologies like virtual reality in their practice, only 39% believe that decision makers in their hospitals and clinics are likely to invest in such technologies.

Foster and others agree that two of the biggest challenges in rehabilitation are maintaining patient motivation and lack of commitment.

Virtual reality can help with that in a number of ways, Foster said. For example, patients struggling with pain are often reluctant to move and challenge themselves. But, when that patient turns on the VR system, they move in a way they haven’t before (or haven’t in a long time).

From a mental health perspective, during this time, a patient with a spinal cord injury or brain injury often cannot physically do things or go places, which is understandably frustrating. Virtual reality allows them to forget about those circumstances for a while, Foster said.

“Having access to this specialized equipment, I am able to engage and motivate my patients with fun and enjoyable activities,” said Foster, who has used the REAL System for a range of injuries and conditions.

She specifically mentioned one patient who found typical rehabilitation activities difficult and eventually dropped out of therapy altogether. But when the therapists showed him REAL and the various activities, “he felt really involved, which led him to participate in therapy again,” she said. In fact, “he loves it”.

And, as patients progress, settings can be adjusted to keep them engaged, Elsesser said. Therapists have data in a way that is difficult to measure and see by simply observing someone.

Using virtual reality also increases therapist satisfaction, he pointed out. “They like to see their patients be more engaged.”

Game roots

As Elsesser explained, he and Arani Bose founded Penumbra in 2004, initially focused on stroke patients. The company is best known for its interventional technology for blood clots causing strokes. “At the time, it was quite advanced technology,” Elsesser said.

The company has since moved on to technologies addressing conditions in other parts of the body, and began its journey into VR technologies just five years ago (and rather by chance). In 2017, Elsesser said, he was asked to demonstrate SixSense gaming technology.

He was reluctant at first, he said, but he went anyway and described being in the middle of a game standing atop a castle wall and thwarting attackers. Suddenly, two other players shouted over the noise of the game that he had to close his eyes.

He did not do it. “I wanted to see what I wasn’t supposed to see,” he said.

It turns out that a headset glitch has turned the floor of the VR castle into a glowing white nothingness. As he explained, even though he intellectually knew it wasn’t real, he still had a physical reaction.

The health care benefits have become very clear, he said, comparing virtual reality’s ability to fool people to neuroplasticity (when the brain rewires itself based on internal and external stimuli).

“It was a great journey to get here,” Elsesser said of today’s post. “We’re just looking forward to hearing the individual stories that patients are going to be able to share, telling us how they’re feeling better, getting better, getting back to a more normal life.”