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Ulster University spinout is using gamification for new approach to stroke rehabilitation therapy

The eXRt virtual physiotherapy platform uses games to increase the amount of time patients spend on their physiotherapy programmes

Ulster University spinout eXRt Intelligence Healthcare is using gamification to take a new approach to stroke rehabilitation therapy. According to NHS statistics, patients in the UK only complete an average of two of the 45 minutes of physiotherapy prescribed by the healthcare system. This translates into longer recovery times for patients resulting in longer NHS waiting lists.

The eXRt virtual physiotherapy platform, which utilises a virtual reality headset, uses fun custom-designed games to increase the amount of time patients spend on their physiotherapy programmes. The platform is available 24 hours a day and physiotherapists can log in to monitor patient progress. Trials have taken place with UK healthcare providers and have recorded patients increasing their average time spent on physio by 24 minutes.

EXRt co-founder and CEO Dr Dominic Holmes has a personal interest in the area. “My undergraduate degree at Ulster University was in computer science and games development. My granny had a stroke and that drew me towards doing a PhD in rehabilitation technologies. It was very hard to see her suffer and I asked myself if I could use my computer science skills to help in some way.”

His PhD project investigated how gaming, virtual reality (VR) and immersive technologies could be used to engage stroke survivors and other patients with their physiotherapy programmes.


“One of the biggest reasons why patients discontinue physiotherapy programmes is that they are not 100 per cent suited to them,” he says. “The programmes can be boring or even painful. We use artificial intelligence (AI) to adapt the programmes to make sure they suit the patients’ abilities and skill levels. That helps them to keep doing it and the game element engages with them to make it fun.”

After completing his PhD Holmes was asked to participate in an EU Horizon 2020 research programme project which would look at bringing the technology to a point where it could be commercialised and launched on the market. “I was the lead developer on the project. We received £2 million from Horizon over three phases. We got some really good results from the project, and we decided that we should act on them. I established the company with my co-founder Dr Darryl Charles in late 2019.”

Not much happened until late 2021 due to a lack of finance. “That’s when we started to work on it. With support from Innovation Ulster support we got on the ICURe programme.”

ICURe is a programme of commercialisation support for teams of academic researchers from within Ulster University who wish to explore the commercial potential of their research.

“It’s all about market discovery and market validation,” says Holmes. “We spent four or five months talking to CEOs of NHS trusts and private healthcare providers. As a result we got a user trial with a healthcare provider.”

The outcomes of that trial were strongly positive, and with funding of £300,000 from Innovate UK, Holmes continued with product development. “The initial product was a big heavy table with a large laptop. It wasn’t scalable, and it was too expensive. We wanted to make it much more accessible and mobile for patients. We did that work over the past few years.”

The result is a lightweight VR headset which connects wirelessly to a smartphone, tablet or other device. The use of immersive technology means that users do not have to look at a screen during a physiotherapy session. “It is designed to be as usable as possible in both clinical and at-home settings,” says Holmes. “They can use the mobile app to live stream the physiotherapy session to the therapist as well. This saves on travel for both the patient and the therapist.”

It also allows the therapist to ensure that the patient is carrying out the programme properly. “It could be two weeks before a physiotherapist sees the patient again after first seeing them in hospital. They have no way of knowing what they have been doing during that period and there is no guarantee that the patients remember the programme properly.”

The games element is critically important. “The games award points for levels of performance and users can even join in with other patients to compete with them. This brings in a fun element and enables people to be more accountable for their therapy. It makes it more likely that they will stay engaged with the therapy.”

The next stage will see the company bring the technology to market. “We have got some funding from InvestNI and we will go for round one investment in the next few months. We are hoping to have the product on the market by the end of the year.”