Exergames: leveraging the fun of games to support therapy

The idea behind it is simple: rather than doing repetitive exercises – whether it is with a therapist or by yourself – the exercises are a part of digital games that take the players into a virtual world. Patients must perform the exercises in the respective games to achieve a set goal. Examples include being in synch with the right timing, using the optimized dose of strength and effort, and executing the correct movement sequences. The game measures and analyzes these activities based on the respective criteria. Players only get points or reach the next, more challenging difficulty level if they perform the exercises correctly. Reaching subsequent levels means players must successively improve their performance.

Gamification in physiotherapy and rehabilitation is a trend that started a few years ago. Today, there are various types of exergames to foster physical activity. Some use sensors or cameras to detect movements, some consist of software on specifically designed training devices, while others are virtual reality applications: wherever conventional, analog therapy approaches have drawbacks, games can step in and unfold their full potential.

"Games can combine physical and cognitive training. They also provide an opportunity of collecting data, thus allowing therapists to monitor the success of the training remotely without being physically present. This enables athletes to train on their own without dependence on treatment sessions. Games also motivate patients to adhere to training in long-term rehabilitation," says Dr. Eveline Graf of the ZHAW Zurich University of Applied Sciences in our MEDICA-tradefair.com interview. Together with her team, she is exploring the potential of the "ExerCube" during rehabilitation after cruciate ligament injuries. "The ExerCube is a device suited for HIIT or high-intensity interval training that enables users to train in a virtual environment," explains Graf.

The virtual reality aspect gives exergames another edge: while the virtual environment is more engaging and thus more attractive than standard exercises performed in an unchanging physical therapy setting, it is not the only benefit. Virtual reality creates immersion – the illusion of being physically present in the non-physical world of the game –, which can change perception of pain and might reduce inhibitions about certain movements or can make it easier for patients to perform the exercises.

Immersion can also support the actual pain management approach. The "ReliefVR" project at the University Hospital Würzburg is currently exploring this application: patients are advised to perform exercises in a VR setting to help relief chronic back pain as focusing on the virtual environment can theoretically decrease the perception of pain.

The "KORA" project creates a connection between the virtual and the real world by combining playful approaches with a conventional therapeutic device ("KORA" is short for "Kostengünstige aktive Orthese zur Rehabilitation und Analytik von kindlichen Bewegungsstörungen", in English: Cost-effective active orthosis for the rehabilitation and analysis of pediatric movement disorders). The project explores the development of an active orthosis, which – along with an app – is designed to help train movement behavior in a playful way and treat movement disorders in children as a result.

"I hope that the potential of this type of adjunct therapy will be realized. The idea is not to replace conventional treatment but to give children and parents the option of continuing the therapy outside the medical office in a simple and playful manner," says Fabienne Erben in a MEDICA-tradefair.com interview. She created the app at the Munich University of Applied Sciences as part of her bachelor’s thesis. The orthosis measures and records the sequences as children practice the respective movements. Parents and physiotherapists can subsequently access this data to track and assess the child’s progress.

Exergames even offer economic potential: therapists can save time since they do not always have to supervise and direct the exercises thanks to exergames. What’s more, being able to offer different types of modern therapy approaches can make medical practices or hospitals more attractive and raise their public profile.

Regardless of the technology they rely on, exergames are still not as widespread in their role as therapeutic tools. This is mostly owing to the technology they entail. Facilities must buy software and hardware for implementation, unless exergames come in the form of games or applications that are facilitated by the patient's own mobile devices, as is the case with the KORA app. However, once there are lower technical requirements and devices will get smaller and less expensive, even smaller medical practices will be able to afford them. And in doing so, exergames will benefit even more patients in the future.