How augmented reality is helping patients stay motivated for physiotherapy

Each day, Annette Bullen dons a pair of augmented reality (AR) glasses that look like Ray-Bans and does about 15 minutes of exercises to help improve the mobility in her neck.

“It’s very hip. My kids call me Maverick,” says the 59-year-old from Caledonia, Ont., referencing Tom Cruise’s character in the Top Gun movies. Bullen was diagnosed with a rare head and neck cancer called mucoepidermoid carcinoma in 2023. Multiple surgeries and radiation treatment left her barely able to move her head and neck and caused problems eating.

Bullen’s physiotherapist introduced her to the Augmented Reality Integrated Sensorimotor Exercise (ARISE) platform. ARISE’s specially designed glasses project virtual objects onto her real-life environment that guide her through physiotherapy exercises and offer real-time feedback on her progress. For example, she tracks a virtual orb as it moves through a virtual spiral, controlling the tracking with her head and neck movements.

Bullen says the exercises have improved her range of motion, and that being able to do them at home rather than in a clinical setting is a big advantage.

“As long as you can connect to Wi-Fi, it will run,” she says. “I’ve visited my parents in Watford, Ont., and I’ve done them there. I visited my son in Durham, Ont., and I even went to Mont-Tremblant [in Quebec] and I could do them there. So there is a great flexibility within that program that keeps me motivated.”

Gamified interventions ‘can be a bit more fun’

ARISE is one of a growing number of wearable AR devices being used in physiotherapy and rehabilitation health care, including mobility, balance and fall prevention for seniors.

Stevie Foglia, founder and CEO of Neuro-Mod Inc., a McMaster University-based health technology company in Hamilton, Ont., began developing ARISE in 2022 to treat chronic neck pain during his PhD.

“We ran a study on older individuals and saw some really nice improvements with mobility, function and pain,” says Dr. Foglia, who runs Neuro-Mod with Dr. Aimee Nelson and Dr. Harsha Shanthanna. The next step was to advance the technology into other applications patients consistently expressed a need for, he says, such as balance and fall prevention.

“You play these gamified-type training interventions that help with your mobility, your posture, centre of balance, things like that.” Patients can view the data themselves to see how they’re progressing and the platform also connects with clinicians so they can monitor their patients’ progress remotely.

Falls are a major risk for older adults, often leading to injury, reduced independence and lower quality of life. According to the Public Health Agency of Canada, falls are the leading cause of injury-related hospitalizations among people aged 65 or older, and the cost of fall-related injuries among this group was estimated to be $5.6-billion in 2018.

“Behind these figures are people who may hesitate to leave home, withdraw from their communities or question whether they can continue living independently,” says Xiru Wang, a neurophysiology PhD student at McMaster who is using the ARISE platform to examine this issue. (Dr. Foglia and Wang are currently recruiting subjects for their study on the use of augmented reality in balance and mobility training.)

Anita Gross, an associate clinical professor in the School of Rehabilitation Sciences at McMaster University, says that loss of motivation can be a major barrier to compliance with prescribed rehabilitation programs.

“That’s something that can be pretty boring to do on a regular basis,” says Gross, who was the physiotherapist who introduced Bullen to ARISE. “But by gamifying the mobility training and giving them target scores to pursue, it can be a bit more fun.”

‘Real innovation’ supporting older adults

Neuroscientist Dr. Allison Sekuler, president and chief scientist for the Centre for Aging and Brain Health Innovation at Baycrest in Toronto, says “this is probably the most exciting time that I’ve lived through” because of how the colliding technologies of AR, VR (virtual reality), AI, robotics and sensors are transforming research and health care.

“You’ve also got an aging population and now we’re starting to see these two areas connecting,” Dr. Sekuler says. “So we’re seeing real innovation supporting older adults.”

Although Dr. Sekuler says she doesn’t favour one technology over another because it depends on its specific use, AR is especially exciting for her. “It’s not separating you from the real world,” she says. “It’s adding more information to the real world that is useful to you, whereas virtual reality is like shutting you off from the real world.”

It’s an issue that Dr. Foglia encountered while developing ARISE. He says he started creating the platform with VR, “but we saw a lot of side effects like nausea and vertigo with the participants being thrown into a full VR space. The AR allowed us to mitigate those effects.”

He notes that participants in his initial study asked to continue the ARISE treatment after the study ended.

“That’s where we realized we need to make this technology more accessible to a larger population, and that’s why we are focusing our efforts, not only on the research side, but also on the side of getting it into physiotherapy clinics, so that a larger population can access the tech.”