Wearables, Robots, VR and AI in Physical Therapy

Physical therapy is about to experience a sea change. The development of advanced physical therapy technology is coinciding with an increase in the demand for care. Even before the pandemic, the United States Bone and Joint Initiative published research showing that musculoskeletal diseases impacted more than half of the adults in the United States. Remote working conditions, extended ICU stays, and Long Covid are increasing that number dramatically. At the same time, we’re seeing the sudden ubiquity of telehealth and health tracking apps in every smartphone, creating the perfect conditions for widespread technological change in the field of physical therapy.

Here, we’ll look at some of the major developments transforming the field, so PTs can prepare for the future.

Some of the emerging PT tech employs next-generation hardware and robotics. Some involve revolutionary AI that works on any device. Some will require a big upfront investment, others an affordable but consistent monthly subscription. Many will require adjusting your practice or learning a new skill set. None will replace the intelligence and emotional care of a dedicated therapist, but from AI and exoskeleton suits to VR and video games, advanced technology is already improving patient outcomes, reducing physical therapist burnout, and making clinics more efficient.

Wearable tech is helping paralyzed people walk and keeping PTs in the loop

From robotic exo suits to electronic sensor skins, wearable technology is helping PTs provide huge improvements in their patients’ mobility, independence, and quality of life.

Exo suits are battery-powered robotics worn over clothing, originally developed for military applications to help soldiers carry heavier loads. Subsequently introduced for training in a therapeutic setting, these have now received FDA approval for home use. The cost of these powerful robotics will generally put personal ownership out of reach for most patients, but the benefits of using these with a therapist as part of a comprehensive treatment plan are making some clinics consider the investment. The support and mobility provided by an exo suit can improve circulation and oxygen intake, reduce pain, and lead to better bowel and bladder function and joint maintenance. And for many patients, the psychological impact of being able to stand and look their loved ones in the eyes again is immeasurable.

Electronic sensor skins might be less dramatic, but for patients who benefit from them, they’re no less revolutionary. This wearable tech looks like fabric, but it’s laced with hundreds of intelligent sensors able to read, analyze, and map body behavior. This helps bridge the communications gap between PTs and patients and can help improve the therapeutic relationship and keep patients dedicated to the work of their recovery.

ReWalk

• ReWalk allows people with spinal cord injuries to stand and walk using motors at the hip and knee, along with subtle gravity sensors that allow the user to “drive” the system with minor changes in their weight distribution.
• In the United States, this is the first exoskeleton to get FDA approval for personal and rehabilitation use.

Ekso Bionics

• Ekso is a gait-training exoskeleton designed for medically supervised use.
• EksoHealth originally focused on helping people with spinal cord injuries who were told they would never walk again take independent steps.
• EksoNR was the first exoskeleton to be approved by the US Food and Drug Administration (FDA) for medical use in the treatment of strokes, brain injuries, and spinal cord injuries.

BioSleeve

• BioSleeve is an ultra-lightweight sleeve with a network of interconnected sensors that capture motion and biometrics in real time.
• BioSleeve connects the integrated sensors to a dashboard via Bluetooth to display a virtual avatar, allowing physical therapists to run through exercises and track data in a clinic or remotely.

Rehab robots are making physical therapy more efficient

Rehab robots are automatically operated machines — from roboticized arms to balance boards and tilt tables — designed to improve movement for people with impaired physical functioning. At their best, they are extensions of the therapist: they allow PTs to help more patients with their exercises than they could before and empower them to offer more data-driven coaching. Rehab robots allow patients to learn an exercise — for example, squeezing a hand or moving individual fingers or toes against a sensor — from a machine that is calibrated to make minute adjustments. A study has shown that patients do more repetitions with the rehab robot, and they enjoy the independence of being able to practice the exercise on their own. And PTs get useful, fine-grained data from each patient’s session with the robot, allowing the PT to use their time and expertise more effectively.

PT clinics that want to use this technology work directly with manufacturers that provide software and training as well as the robots.

Tyromotion

Tyromotion is a major manufacturer of technology-based therapeutic devices, including:

• The Pablo Upper Extremity system for hand, arm, shoulder, and trunk rehabilitation and the Lower Extremity system for gait analysis and training. These are small, lightweight, location-independent, wireless, interactive, and sensor-based robotics focused on rehab for daily living.
• The TYMO Balance Board that’s equipped with measurement systems to assess and train postural control and provide deep data for both patient and therapist.

Hocoma

Hocoma is a provider of robotics and sensor-based technologies for rehabilitation, including:

• The Erigo table takes the traditional mechanics of tilt-table training for the early stages of rehab for acute patients and improves their safety and outcomes.
• The Armeo arm and hand rehabilitation devices offer robotic support and assistance as needed in patient-initiated gestures, with augmented reality games and success tracking dashboards to improve a patient’s motivation and success.

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VR games are helping PTs and patients think (and thrive) outside the box

Gamification appears throughout PT technology because research has shown that video games improve brain capacity. And VR games offer distinct benefits to the field of physical therapy because virtual reality can challenge the patient's awareness and help restore links between eye movement and vestibular organ function. PTs who are looking for creative ways to inspire patients who otherwise struggle to engage with a therapy program can increasingly look to the world of video games — some designed specifically for physical therapy, others not — to complement a treatment program.

As long as they can be incorporated safely and with the guidance of an experienced PT, video games can make the therapy process a lot more fun. And the psycho-social effects can improve a patient’s self-motivation and emotional well-being, which can make a big impact on overall outcomes. The Nintendo Wii was one of the first classic gaming platforms to be studied by PTs and incorporated into their practice with therapy-focused games like PHYSIO FUN Balance Training. The Wii Balance Board allowed patient and PT to explore movement and analyze results from the board’s sensors while keeping the activities diverse. Next generation games combining VR headsets and sensors will take this potential further. Will you go as far as hacking your own Xbox Adaptive Controller to meet your patients’ needs? Maybe not. But digging into the possibilities to practice physical movement where patients are already spending time — meeting them where they’re at — just might be a game-changer.

Nintendo Switch + Switch Pro

• The hit Switch game Ring Fit Adventure comes with a flexible ring accessory, like a weighted steering wheel, but you don’t need the ring to play many of the other motion-based games for Switch. The Joy-Con controllers are meant to be held, one in each hand, and to sense the players’ movements, making games like Just Dance and Arms into workout games with highly detailed feedback on the players’ gestures.

• The Nintendo Switch Pro, rumored to be released in the next year, will likely be more immersive and take further advantage of the possibilities beyond a heart rate sensor to read players’ physical responses to games.

Corpus VR

• While the game worlds we touched on above are expanding the implementations of virtual reality, technologies developed specifically for therapy offer more direct ways to take advantage of VR’s ability to help with rehabilitation and improve neuroplasticity. In Corpus VR, patients play in game environments where the therapist controls patient-specific settings based on biofeedback. Therapists can assess and support their patients and adjust the exercises in the virtual world in real time.

Neuro Rehab VR

• The patient uses the lightweight Pico Neo 2 virtual reality headset and controls to play fun, immersive games while the therapist analyzes data and makes real-time adjustments from the FDA registered data portal.

AI is driving patient self-motivation, reducing PT burnout, and making clinics more efficient

AI and machine learning are perhaps the most impactful — but invisible — technologies changing the face of physical therapy. AI is unsurpassed at precisely measuring movement and mobility, providing detailed feedback and correction during an activity, and gathering and assessing a huge amount of data from patients’ sessions. AI makes a strong, intelligent bridge for patient and PT communication, which goes a long way toward making clinics more efficient.

SWORD Health

• SWORD Health clients receive a kit that includes sensors and a tablet through which they connect with an AI therapist as well as a human therapist remotely.
• The AI Digital Therapist uses sensor readings to guide patients through their exercise program and offer live feedback.
• SWORD Health is hiring PTs for part-time, remote work all across the country, so while this may not be a solution for enhancing your existing practice, it might help you diversify.

Exer Health

• Exer Health runs on common mobile devices and requires no additional hardware or sensors. This system can be used with any smartphone or tablet with a camera, and it relies on AI rather than the hardware to monitor patients’ movements.
• AI tracks motion through the camera on the patient’s device to precisely measure their form while they do their exercises and offers detailed real-time form corrections.
• Exer AI makes sure the client’s files are maintained with comprehensive and precise data and can do an in-depth analysis of the data to help PTs spot underlying issues.
• Exer AI supports the PT and patient relationship by doing what AI can do best — freeing up time and generating intelligent data — in order to empower PTs to excel in all the aspects of the role that technology can’t replace.

PTs who play will lead the field

All this bleeding-edge tech can feel overwhelming. There are countless new doors being opened for PTs, but here’s the truth: you don’t have to walk through all of them. PTs can build a unique practice, deliver exceptional outcomes, and deepen their relationships with their patients by engaging creatively with the challenges and possibilities provided by emerging tech.

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Play with the technology that appeals to you, and follow what excites you and your clients. PTs teach their patients to be adaptive, so let that approach lead you to new places, and you’ll take the whole field of physical therapy with you into the future.