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In talking with physical therapists, researchers say VR exercise games can enhance physical rehabilitation in key ways, but the technology has room for improvement.
If you’ve ever suffered an injury, then you know physical therapy is a vital part of the recovery process. You also know it can be repetitive and monotonous, but it doesn’t have to be.
Researchers from Northeastern University recently worked with physical therapists to see whether virtual reality fitness games, or exergames, are a viable alternative to traditional rehabilitation practices. In talking with practicing physical therapists, they found that VR exergames have the capacity to help with a patient’s physical and mental recovery –– but they also need some work.
The goal of their study, which stemmed from an ongoing collaboration with Massachusetts General Hospital’s design lab, Oasis, was to learn how VR can practically assist physical therapists in their work, not just offer a shiny new toy that has no clear use.
“We’re not just making things to make things. We really want to make a change,” says Casper Harteveld, a professor of game design at Northeastern. “This paper was the starting point to say if you want to create innovation –– actual innovation, not just invention –– then we need to think about what we can create within the space of physical therapy to make sure that that can actually be anchored and integrated into the actual practice.”
That’s why their research focused on talking with practicing physical therapists after giving them access to a cutting-edge VR exergame, “Supernatural VR.” The therapists played through the game and provided concrete feedback about what does and does not work about the technology and how it could be integrated better into their practice.
“It becomes clear that there are a lot of contextual aspects and considerations that need to be made in terms of making sure that such a technology would actually be integrated,” Harteveld says. “You’ve got issues like insurance, but you’ve also got the fact that a physical therapist is dealing with five, six clients at the same time. Would you put all five or six in a VR headset? … Are you sending people home with a VR headset?”
“Supernatural VR” is one of a growing number of VR games that has become increasingly popular, especially after the COVID-19 pandemic. It offers four different modes: flow, boxing, stretch and meditation. The study focused on flow because it incorporates a lot of traditional workout movements, like lunges, squats and side steps, and exercise principles.
Players select a mode and then pick a song from a list of popular licensed tracks. Pre-recorded audio from professional trainers walks the player through the movements they’ll need to make to complete a song, which involves striking and dodging targets using specific movements, similar to a game like “Dance Dance Revolution” or another popular VR game, “Beat Saber.”
The researchers heard mostly optimism from the physical therapists involved in the study. A few of them called exergames a form of “accidental exercise” or “subconscious activity” that is great “for people who may not actually like going to the gym,” says Chin Huen Maria Chiu, the Ph.D. researcher at Northeastern who led the project.
“The immersive element essentially takes the player out of whatever mental state, whatever physical state, they are in and projects them into a whole new dimension where their ability may exceed that of what they expect,” Chiu says.
A game like “Supernatural VR” also comes with accessibility features that make it easy for people with disabilities or limited mobility to tailor the experience, to a certain extent. Players can modify the settings to focus on just upper body movements or eliminate certain movements that are outside their range of movement, like knee strikes, from the workout.
VR exergames don’t only have the capacity to help with a patient’s physical recovery. They also have the potential to assist with the mental health journey that is often forgotten in rehabilitation. Exergames can help increase a person’s motivation to exercise, but Chiu says they also help people perceive themselves and their physical limitations in new ways.
“As soon as you remove someone from their real environment, there’s a lot of changes to brain chemistry,” Chiu says. “There’s a very big disconnect currently where there’s really just no discussion of someone’s mental state as they’re going through a physical rehabilitation journey. That’s something that we hope is addressable, to a certain extent, with immersive technologies.”
However, physical therapists also noted that VR exergames have some very significant limitations.
The biggest challenge is that most commercial VR exergames are designed to be general purpose, not the kind of tailor-made experience that a physical therapist needs to create to tackle a patient’s specific needs. There is also a lack of real-time feedback that patients need to make sure they are exercising safely and in ways that are complementary to their rehabilitation. It’s why, at least for now, this technology is best used in tandem with a trained professional, Chiu says.
“If you’re doing something that is likely to hurt you rather than help you, that’s what physical therapists are there for,” Chiu says. “That’s why as much as technology is advancing and developing, you can’t get away from having a real-live human there with you in some capacity in order to help form correct, in order to help monitor progress.”