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Changing the game for stroke survivors

How gamified physiotherapy is combining with AI to bring new options in rehab



Having been in the planning for two decades, eXRt Intelligent Healthcare has brought new and cutting-edge options to the market for stroke rehabilitation, bringing gamified physiotherapy together with AI to create better insight into remote rehab than ever before

NR Times meets CEO Dominic Holmes to learn more about the difference it is set to make to stroke survivors in their ongoing recovery


“The research behind this dates back 20 years – we were waiting for the hardware technology to catch up.”

For many years, researchers at Ulster University have investigated stroke rehabilitation and the potential of digital, game-based technology in supporting recovery. But while the research was there, it is only more recently that the required hardware technology has entered the marketplace. 

Through the launch of ReNeuro by eXRt Intelligent Healthcare, which brings together the latest cutting-edge gaming development with now readily-available wireless VR headset technology, the game is being changed for stroke survivors.

With its range of in-house developed games, all geared around rehab, and the use of artificial intelligence (AI) to determine whether rehabilitation is effective in more detail than ever before, ReNeuro has already demonstrated its efficacy with a patient trial, showing the potential of remote rehab in times prior to the pandemic – before it had become widely known or accepted within healthcare. 

Now making inroads into the NHS and other healthcare providers, with plans for global expansion thereafter, eXRt is helping to up the ante for stroke rehabilitation, while increasing the options in home-based therapy. 

“We believe we have a role within the care pathway, which is going to make the transition from clinical to home rehabilitation a lot easier, and rehab at home a lot better to engage with. We think this brings something very new for patients, and for the NHS and healthcare,” says CEO Dr Dominic Holmes.

From the initial research from Ulster, including being the focus of Dr Holmes’ PhD, it was established that gaming as a form of rehabilitation could hold significant potential for improving patient rehabilitation – but how to achieve that with the technology of the day was another challenge. 

“Back then, the technology was clunky, heavy, it wasn’t suitable for patients. But we managed to get a lot of good data research, so we knew what we wanted to do. When technology started to catch up, that’s when we could really move forward,” says Dr Holmes. 

“We were starting to realise that the problems for patients were two-fold. Firstly, they weren’t getting enough physiotherapy, NHS departments were overstretched even before COVID, and it has become worse over the years. But also, that some patients weren’t engaging enough. 

“Gaming has become one of the biggest entertainment industries, so we thought, why not engage people in that way? By using gaming, we can let them have fun while doing their physiotherapy.”

Through Dr Holmes’ research, he recognised the crucial role AI could play in this domain – something which is now helping eXRt to really push boundaries in stroke rehab today. 

“Using AI, we monitor, track movement behaviour. Image processing will track movements in their hands, down to their fine finger movements. We track that data and perform analysis on it,” says Dr Holmes. 

“By doing this, we then have the ability to adapt each game to suit each individual person motor skills, which is really important when they’re doing it at home. If you’re playing an off the shelf game remotely but are having problems and finding it difficult, at some point, you’re not going to be able to play. 

“But through AI, we could see the difficulties and switch and change things a little bit automatically, so we can overcome those difficulties and make it so you can continue to rehab successfully.

“You’ll find in physiotherapy that some exercises may be painful for patients, or they might not be doing it correctly. But through AI, we can see that and make the changes to their rehab to improve this.”

From these findings, eXRt was born, bringing together the expertise of Dr Holmes in research and healthcare technology development with that of Dr Darryl Charles in AI and gaming development. Together, they led the creation of a new business with the ambition of redefining rehab for people recovering from stroke. 

Embarking on a study which concluded in March 2020 – only days before the UK went into lockdown – the potential eXRt held was clear. 

“We wanted to assess how effective this could be used in patients’ homes, could they use it themselves without any major interventions from a physiotherapist or technical support team, that was at the root of everything,” says Dr Holmes. 

“The results were fantastic. We saw we were able to give participants an extra 26 minutes of physiotherapy per day, and after six months, we saw a 50 percent reported an increase in improvements to Quality of life such as their mood, mobility and self-care.”

eXRt was formally launched in October 2021 as an Ulster University spinout company, with its suite of stroke rehabilitation games ready to be used on VR headsets both in clinical and at-home settings. 

Guided by the University’s dedicated Research and Innovation team at Ulster, eXRt founders were given support in harnessing their extensive research into a valuable service for patients at home and beyond.

“These improvements continue, we’re constantly adding to it on the strength of further feedback from a leading healthcare provider with the needs of the end user in mind. We’re in the process of adding video chat functionality so patients can also have remote physiotherapy appointments,” says Dr Holmes.

Going forward, the business is now looking to see the role its technology can play in the care pathway, optimising it for therapists and patients alike.

“After a stroke, a person will have a wide range of medical appointments and therapies, but through our take on physiotherapy, you’re increasing
the dose of that in a way that is accessible and engaging to patients,” says Dr Holmes. 

“And the real beauty of it is that a physiotherapist doesn’t need to be present. Therapists can spend more of their time with people who really need the in-person support, and see more patients. 

“People who are suitable for remote physio can benefit from that, with the appropriate supervision. We imagine that once they are in hospital, patients will be introduced to ReNeuro, and then they can take it home to continue their rehabilitation. If it’s in a clinical setting, you can have a try and they can be trained in how to use it. It makes that transition between clinical and home so much easier.”

Now, eXRt is looking at potential adoption across the NHS and private healthcare, as well as into other conditions too.

“There is a lot of interest, and we are talking to the NHS and private healthcare about what we can do for stroke patients, our longer-term ambition is to alsolook at other health areas that we could support and benefit from ReNeuro,” says Dr Holmes. 

“We are looking at brain injury and other neurological disorders, such as Parkinson’s, where exercise can be beneficial, and physiotherapy is important.

“We are also doing a project at the moment on healthy ageing, to help older people have a more active life, so they’re less likely to have other health problems. The exciting part about eXRt is that is can be applied to a number of issues experienced by our ageing population, improving mobility and giving individuals improved quality of life.” 

“Our main goal is to initially supply the UK healthcare systems such as the NHS, but we do see ourselves ultimately being global. As we grow as a business we plan to target the US market in the hope that patients in the US can also benefit from ReNeuro. 

“We’re concentrating on the UK currently and are excited about the potential to make a difference in patients’ lives in our own country.”