Rehabilitation after sports injury: Gamification of exercises in the ExerCube

Returning to a sport after injury can be demanding and arduous as athletes often need to undergo lengthy rehabilitation. Yet even after they have physically recovered from their injury, some may experience mental issues that can make it difficult to return to play and competition. Exercises that combine physical and mental training and challenges in a game setting can be an effective solution.

In this MEDICA-tradefair.com interview, Dr. Eveline Graf talks about the "ExerUP!" research project, explains how the ExerCube by Sphery combines physical and cognitive exercises and describes the possible evolution of exergames and gamification in physiotherapy and rehabilitation.

Dr. Graf, what is the objective of the "ExerUP!" project?

Dr. Eveline Graf: We combine the ExerCube by Sphery – a product for fitness and exergaming – with rehabilitation. The ExerCube is a device suited for HIIT or high-intensity interval training that enables users to train in a virtual environment. As part of this study, we explore the potential of the ExerCube to facilitate sports rehabilitation after cruciate ligament injuries and look at future exergame developments that ensure a safe and effective use in rehabilitation settings.

How does the ExerCube work?

Graf: The ExerCube is actually shaped like an open cube with three walls, which serve as projection screens for the physically immersive exergame setting. The current "Sphery Racer" game takes players on a track. As they speed along the track, players pass various gates where they must perform specific exercises. These are typical fitness exercises, such as burpees, lunges, jumps, or punches. Users wear motion tracking systems on their hands and feet, which track the player’s body position and determine whether the movement was performed correctly.

ExerCube training is physically demanding, but also adds a cognitive layer since exercise timing is an important aspect. If the players complete the exercises with the right timing, the game will speed up – or slow down if the person cannot keep up. It adapts to the player's individual fitness and gaming skills.

Thanks to this cognitive component, the ExerCube bridges a gap in rehabilitation. Physiotherapy takes place in a highly controlled environment. Meanwhile, sports can be an unpredictable setting with uncontrollable variables and distractions: your own and the opposing team, handling sports equipment and dealing with stimuli from light, noise, and the audience during competitions. These days, we can physically prepare athletes to return to play following injuries, but these distractions present major mental obstacles that can hold them back.

Why does the project focus on cruciate ligament injuries?

Graf: They are one of the most common knee injuries in many sports that have a major effect on athletes. ExerCube training emphasizes leg exercises, making this a very sensible choice. Shoulder injuries would be a conceivable topic for a follow-up project.

Do you see the ExerCube primarily as a measure in sports rehabilitation at the professional level?

Graf: We do not want to limit our efforts to just competitive sports. Obviously, the rate and quality of rehabilitation is higher for competitive athletes, and they also benefit from having a staff of professionals at their disposal to address their recovery needs. However, enthusiastic amateur athletes who want to return to play and need a combination of physical and cognitive challenges can also benefit from the ExerCube.

What is the current stage of project development?

Graf: As part of our first work package, we analyzed movement sequences, meaning we identified the movement patterns of users during training with the ExerCube. We are now assessing them to identify the movement patterns of both healthy athletes and those who completed rehabilitation after suffering a cruciate ligament injury. Our goal is to identify movement patterns that should still be avoided during the rehabilitation process.

At the same time, we are interviewing patients and physiotherapists to build a catalog of user requirements for this type of tool. This will determine the further development of the ExerCube – meaning the development of new, more rehabilitation-specific game scenarios.

How important are exergames for physiotherapy and rehabilitation at this juncture?

Graf: While exergames are presently still in a marginal acceptability range, a growing number of devices provide this option. I think there is huge potential since the games can combine physical and cognitive training. They also provide an opportunity of collecting training 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, engage, and increase patients' adherence to their training if long-term rehabilitation is necessary. Recovering from cruciate ligament injuries in the knee can take six to nine months.

Exergame applications are also improving from a technical perspective and are getting smaller and less expensive, ensuring more medical practices can afford them. This will help promote the widespread use of exergames in the future.