Virtual reality is spicing up physical therapy with games for balance, posture, and more

• VR can enhance physical therapy by providing dynamic activities tailored to a patient.
• The VR-rehabilitation market is projected to grow over the next several years.
• This article is part of "Trends in Healthcare," a series about the innovations and industry leaders shaping patient care.

Genevieve Lewis, a 66-year-old stroke survivor, struggled with weakness on the left side of her body that caused her foot to drag as she walked. Feeling unsteady made her wary of getting on and off escalators. But she said virtual-reality physical therapy helped her overcome this fear by improving her mobility.

"VR exercises have made me stronger and have helped with my coordination," Lewis said. "And it's fun to use."

Virtual reality is becoming a valuable part of rehabilitation plans for people with neurologic conditions such as stroke or spinal-cord injury and musculoskeletal conditions such as osteoarthritis, sprains, and strains. The technology can engage patients and facilitate activities designed to improve their balance and coordination and relieve pain.

VR is a part of the Academy of Neurologic Physical Therapy's clinical-practice guidelines for treating people who've had a stroke, and the American Physical Therapy Association encourages providers to use evidence-based VR treatment plans.

The VR physical-therapy industry also appears poised for growth. Virtue Market Research estimated that the global market for VR for rehabilitation was valued at $135 million in 2022 and that it may reach $371 million by 2030.

VR can enhance physical-therapy plans

Lewis' physical therapist, Gregory Thielman, recommended "Beat Saber," a rhythm game played on an Oculus VR headset, to complement her physical-therapy plan.

The game is being used as part of a clinical trial exploring circuit training and high-intensity interval training for people who have had strokes. To play, participants move their arms to slash through incoming virtual blocks on the beat of the music.

"'Beat Saber' encourages patients to balance, perform repetitive activities, and enter a high-intensity exercise zone, which helps pump blood throughout the brain," said Thielman, a stroke-rehabilitation specialist and a professor of physical therapy at Saint Joseph's University in Philadelphia.

Thielman told Business Insider that navigating VR could aid rehabilitation by stimulating the mind and the body. Repeating movements and improving blood flow can enhance neuroplasticity, or the brain's ability to reorganize itself by forming new neural connections. "Once brain activity improves, patients can better move their arms or legs," Thielman said.

Mark Havran, the national physical-therapy program manager at the Veterans Health Administration, said VR physical therapy could also help people manage conditions such as Parkinson's disease or chronic pain as well as improve their balance, gait, and strength to prevent falls and return to daily activities.

Individualized physical therapy plans keep patients engaged

David McAdon, a physical-therapist assistant and alternative-modalities specialist at the VA Central Iowa Health Care System, said basic upper and lower extremity table exercises and some balance activities could be boring at times, leading patients to stop attending treatment sessions.

VR platforms can liven up the experience by offering immersive activities, such as playing pinball, making a sandwich, and playing the xylophone.

McAdon uses a device called the REAL-y Series, made by Penumbra, to personalize a program consisting of seated or standing exercises for the full body, upper body, or lower extremities.


"The activities are gamified and engage patients, which helps with compliance," he said. "Veterans want to come back to their appointments."

A growing market and evolving technology

Havran anticipates that VR headsets will become smaller and more affordable in the coming years and that they'll integrate more with the health-tracking apps that pair with Fitbits or smartphones.

Havran said VR devices could also end up helping with initial assessments of a patient's movements, posture, and functional deficits. With the oversight of a physical therapist, "this assessment could be done anywhere, helping with health equity and accessibility," he said. "For example, people in rural areas won't have to drive to a PT office for care."

As patients improve their strength and mobility with VR in the physical-therapy clinic, they may want to pursue VR wellness programs at home. "My hope is that VR helps people pursue a whole lifestyle change," Havran said.