How virtual reality and the metaverse are changing rehabilitation

How virtual reality and the metaverse are changing rehabilitation

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

Another sits and holds a weighted ball while kicking his feet at the pinball controls.

Standing on one foot while following a footpath on the beach; make a ham and cheese sandwich in a food truck; play tarot cards.

This may all seem strange to undergo physical therapy – but this is the future of rehabilitation made possible by virtual reality (VR) tools.

“Patients are really engaging with virtual reality,” said Nora Foster, MD, physical therapist and chief executive officer 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 first hands-free, untethered full-body VR rehabilitation platform.

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

“The whole body was the big next step,” said, “It’s the only thing that people in our field have wished for, so they could work with patients on the rest of the body, not just the upper body but the whole body. It opens the window to helping so many more people.”

Penumbra’s REAL System y-series, which leverages VR, now features upgraded hardware and sensor technology – particularly sensors for the lower body. The technology consists of a headset and five sensors, and can now target both the upper and lower extremities with a full-body avatar, Elsesser said.

It’s currently being used in clinics and hospitals across the US for patients undergoing physical, occupational and speech therapy, Elsesser explained. It helps address upper body impairments from stroke and other conditions, trunk and balance, cognition, functional applications, activities of daily life training (grocery shopping, self-care), and cognitive stimulation.

The REAL y-Series System is intended to be used with a therapist guiding patients’ movements, Elsesser said; You can see 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 “this isn’t just a game that we’re repurposing. It is particularly health-oriented. The experiences and activities carried out in VR have been developed with very serious clinicians.”

While the Metaverse is undoubtedly one of the hottest topics in tech right now – if not in the free world – he stressed that the product is called the Real System for a reason.

People using avatars in the emerging Metaverse environment to attend unique virtual events not possible in the real world, wear virtual clothing, purchase virtual goods, and have experiences they would never otherwise be exposed to is all nice and fine, he said – but in this case, the virtual world is being used to help people get back to the real world.

“We don’t want people to live in the wrong world,” Elsesser said. We are a healthcare company and we want people to get better and get back to their daily lives. This is simply a tool that is particularly well suited for this.”

Overcome rehab challenges

The prevailing opinion 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 has changed little or not at all over the past decade.

Similarly, nearly 75% say patient compliance is the number one challenge in physical therapy today, and more than half believe VR can help improve this.

And while the majority of physical therapists (65%) would like to use technology like VR in their practice, only 39% believe their hospital and clinic decision-makers are likely to invest in such technology.

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

VR can help with this in a number of ways, Foster said. For example, patients struggling with pain are reluctant to move and challenge themselves. But when this patient uses the VR system, they move in a way they’ve never done before (or haven’t in a long time).

From a mental health perspective, on the other hand, a patient with a spinal cord injury or a brain injury often cannot physically do things or go places — which is understandably frustrating. VR allows them to forget those circumstances for a while, Foster said.

“Having access to this specialty equipment allows me to engage and motivate my patients with activities that are fun and enjoyable,” said Foster, who has used the REAL System for a range of injuries and conditions.

She specifically pointed out one patient who found typical rehab activities difficult and eventually gave up therapy altogether. But when therapists showed him REAL and the various activities, “he felt really involved, which led to him getting back into therapy,” she said. In fact, “he just loves it.”

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

The use of VR also increases therapist satisfaction, he emphasized. “They love to see their patients become more engaged.”

gaming roots

As Elsesser explained, he and Arani Bose founded Penumbra in 2004, initially with a focus on stroke patients. The company is best known for its interventional technology for blood clots that cause strokes. “It was pretty crazy technology back then,” Elsesser said.

Since then, the company has moved into technologies that address conditions in other parts of the body, only starting its journey into VR technologies five years ago (and rather by accident). In 2017, Elsesser said he was invited to demonstrate SixSense gaming technology.

Hesitant at first, he said, but went anyway, describing standing in the middle of a game, standing on a castle wall and thwarting attackers. Suddenly, over the noise of the game, two other players yelled for him 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 caused the VR castle floor to turn into a brilliant white nothingness. As he explained, although he knew intellectually it wasn’t real, he still had a physical reaction.

The healthcare benefits became very apparent, he said, comparing VR’s ability to fool people to neuroplasticity (when the brain rewires itself based on internal and external stimuli).

“It’s been a great journey coming here,” Elsesser said of today’s release. “We can’t wait to hear the individual stories patients can share, tell us how they’re getting better, how they’re getting better, and how they’re getting back to a more normal life.”

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