Romanian startup makes rehabilitation fun with games

We catch up with Romanian startup MIRA that uses game-play to make physiotherapy fun for patients.

Getting patients to do physiotherapy can be quite challenging. The exercises are often seen as boring or repetitive and it is hard work keeping patients engaged and motivated to aid their recovery. MIRA, a Romanian startup, believes it has solved this problem by transforming physical exercises into video-games, making recovery easier and faster for patients. We catch up with Alina Calin, Chief Research Officer, to find out more.

What does MIRA do and how does the technology work?

MIRA is a software platform designed to make physiotherapy fun and convenient for patients recovering from surgery or injury. The system transforms existing physical therapy exercises into video-games, and uses [the Microsoft Kinect] sensor to track and assess patient compliance. While the patient plays, MIRA tracks and evaluates their experience, to provide the physiotherapist with persistent information regarding the patient’s recovery.

What inspired you to come up with MIRA?

The project was born as a response to the ImagineCup competition organised by Microsoft in 2011, in the software design category. We wanted to offer a positive experience to people undergoing rehabilitation, knowing that they have to go through many boring exercises and [we knew] the technology was available was able to provide something much more engaging and fun. We got into the six worldwide finalists teams, so we decided to move forward with the business, as the general feedback was very positive.

Who are your typical patients?

MIRA’s purpose is to aid the physiotherapist in treating their patients. The system is not designed as a replacement of the physiotherapist, but rather as a new tool for the specialist to use in addition to the traditional treatment, for the rehabilitation of upper limbs or lower limbs, from surgery or injury. Most of the patients that use MIRA at the moment have either specific neurological conditions (children and young adults with cerebral palsy, adults recovering from stroke) or orthopaedic conditions (adults with frozen shoulder, adults recovering from shoulder injury or surgery) or general mobility issues (such as elderly people with high risks of falling).

What are the benefits of using games as a form of rehabilitation exercise?

Providing patients with a gamified version of exercises for their rehabilitation increases their interest and engagement. They appreciate not only the fun factor they bring, but also the immediate feedback they receive while exercising by playing and being able to monitor their progress. It is a new approach towards healthcare and rehabilitation. Mira encourages patients to persevere and this is expected to generally improve patient adherence. For this purpose, we are planning a big clinical study with patients using Mira at home, in which we want to put this impact in numbers: How much faster do patients recover? How much does Mira improve adherence? It’s all about improving their quality of life and we’re about to be able to measure just how much.

Can you adjust the games for each user?
MIRA offers a suite of exercises and games [designed] for patients that physiotherapists and clinicians can easily customise as they see fit in terms of difficulty, level, movement, interaction type, and personalise a rehabilitation schedule of exergames according to the patient’s particular needs.

Can patients communicate with each other?

This is a feature that we [are planning] as multiplayer games are known to be more engaging, and many patients expressed their desire to play the MIRA exergames with other patients from the clinic, or even from their homes – like network games.

What are some of the challenges of keeping patients engaged in the video game exercises?

Depending on the target group of patients the challenges are very different. For example, we started building exergames for the coordination of the upper limb mainly for children, as we were working a lot with children with cerebral palsy. They loved the games, but after a few months they were asking for new game levels so we built some more.

Also, because the exergames are also exercises and sometimes require some amount of effort, it was a challenge to keep the difficulty at an engaging rate while also pushing the patient to keep going regardless of the physical impediments. When building games for older adults [such as] fall prevention, the expertise input from the clinical collaborators was very important, but we also needed feedback regarding gaming and interaction preferences for older people, as they differ from children and young adults. Using a natural interaction sensor (Microsoft Kinect), an intuitive interface, and by creating games with a simple interface we managed to easily overcome these challenges.

How do you measure patient’s progress?

The platform MIRA is designed as a clinical rehabilitation tool, not just a platform of clinical video games. It contains a patient management component, designed for doctors and physiotherapists, as well the possibility to store a patient file with all details, including statistical motion data obtained during a rehab session with MIRA (while patient is playing). This statistical data is of utmost importance, as it offers adherence statistics (number of exergames played, frequency and duration of playing) and progress statistics (number of points obtained, distance, average speed, average acceleration, activity level during the played games). These numbers help therapists and patients measure progress and improvement. We have some clinical studies already published or soon to be published that state that the measurements are valid and reliable for clinical use.

Can gaming be as effective for rehabilitation if used independently at home?

It is commonly known that many patients don’t do their rehab at all or very little when they are at home, for several reasons: they lose their exercise leaflet and forget what they should be doing, they don’t make time for it as it is not too fun to keep them persevering, plus there is no one there to check that they have done their exercises. With MIRA, all their activity at home is stored and available for the clinician as they have an interactive alternative that gives them immediate feedback and incentives for the exercises performed and they don’t have to worry about what to do as their schedule is stored in the application. They just play. For all these reasons, we expect that MIRA will be even more effective as a rehabilitation tool at home than the traditional way for many patients.

Are you working on any other projects?

We are currently building a Rehabilitation Centre for Children called “Smile with MIRA” in Romania, Cluj-Napoca that offers free rehabilitation services for those that cannot afford it. We want to make MIRA available to those who would not benefit from it otherwise. In the meantime we continue to extend the platform, develop new packages of exergames for cognitive rehab, autism, lower limbs together with our collaborators and partner institutions.


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