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Virtual Reality For Physical Therapy: Dartmouth-hitchcock

Tim Kanellitsas


October 19, 2022


  • Project Overview: KairosXR designed and developed an interactive 3D virtual reality application for lower limb physical therapy. This solution trained recovering Dartmouth patients how to perform proper technique, provided real-time feedback on technique and progress, entertained the patients with a physical therapy game, and tracked all behavior and performance (viewed through an in-VR analytics dashboard).
  • Training Content: The solution encompassed three core training exercises: Heel Slide, Leg Raise, and Squat. Each exercise had their own set of constraints and technique requirements, such as knee angle, foot angle, and knee flexion.
  • Instructional Design: The North Star was an increase in knee flexion throughout the training period. As such, any demonstrable improvement in knee flexion was celebrated as a milestone in the application. Additionally, both narrations and a large UI menu provided instruction for each exercise, with several meters providing technique feedback. Each training activity and game provided feedback on technique quality and correct number of repetitions.
  • Results: Users consistently reported high NPS scores and demonstrated higher retention rates. Pilot study is still in progress, and demonstrating clear signs of worker performance improvement.

Interested in bringing XR to your training? Email at


Using Virtual Reality as a tool for physical therapy is more than a theoretical use case or future concept. In collaboration with Dartmouth-Hitchcock, we developed a VR application to assist recovering patients in their rehabilitation process.

The application was a part of a 6-month pilot study, and evaluated the efficacy of using VR to increase patient accessibility to instruction, patient attrition, and exercise assessments / data collection. The development process took 5 months.

The application exercises target lower-extremity rehabilitation, for high-trauma, post-surgery recovery. More specifically, this application focuses on knee rehabilitation, trains the users on proper exercise technique, collects performance and behavioral data, and challenges patients to continue practicing their technique in a surreal game environment.

The pilot study generated very promising results around the efficacy of virtual reality as a physical therapy tool. In short, VR can be used to improve patient technique with customized instruction and behavioral analytics, increase instruction accessibility with remote use and training, and increase rehabilitation completion rates due to novelty and entertainment from VR and gamification strategies.

Who is Dartmouth-Hitchcock?

Dartmouth-Hitchcock is New Hampshire’s only academic health system and the state’s largest private employer, serving a population of 1.9 million across northern New England. D-H provides access to more than 1,800 providers in almost every area of medicine, delivering care at its flagship hospital, Dartmouth-Hitchcock Medical Center (DHMC). In 2019, D-H was named the #1 hospital in New Hampshire by U.S. News & World Report, and recognized for high performance in 13 clinical specialties and procedures.

D-H is a leader in medical research, and continues to explore emerging technology as tools to enhance the medical field.

What was the aim of the study? The hypothesis

The DH team believes VR could be a great tool to improve three problem areas in modern day physical therapy programs:

  1. Patient program attrition and completion.
  2. Program accessibility: financial and time intensity.
  3. Standardized instruction

Problem #1: Patient Attrition

  1. PT is really boring, and often times patients stop performing their prescribed exercises due to boredom.
  2. Incomplete programs can lead to life-long physical ailments due to poor recoveries.
  3. Low patient accountability. Tough to keep patients honest.
Hypothesis #1:

A VR physical therapy application using game mechanics is not only entertaining, it increases patient accountability as the therapist can monitor the patients’ actions and behaviors when using the application, including frequency and duration of use, quality of technique, and range of motion.

Problem #2: Program Accessibility
  1. Patient accessibility
  2. Challenges in commuting to the office.
  3. Time investment (both patient and therapist) make a rehab program very expensive.

Hypothesis #2:

VR equipment can be taken home, and the application provides technique instruction. This means patients no longer need to come into the clinic for every therapy session, reducing the cost and time investment inherent to travel. This also means the therapist can dedicate more time to other patients, increasing the scalability of their practice.

Problem #3: Instructional Inconsistently
  1. Standardized Instruction
  2. Different PT assistants deliver different instructions for same exercise
  3. Exercise Insights & Data
  4. Which exercises work the best for patient recovery?
  5. Which exercises are the patient performing with the best technique?
  6. Which exercises are the most physically and mentally strenuous?

Hypothesis #3:

And finally, with consistent information delivered in the application and behavioral analytics, the therapists know exactly how the instruction is explained to the patients. Additionally, data collection around patient performance and improvements reveal insights into the benefits of certain exercises over others. Therapists can see which exercises lead to the most improvement and best results, refining and enhancing theory around prescribed exercises.

Which hardware did we use?

  1. HTC Vive (headset, controllers, lighthouses)
  2. Computer (model needed)
  3. Three Vive Tracker Pucks
  4. Leg Straps

Looking forward. What comes next? Magic Leap and Hololens

We are currently in the process of pursuing a larger grant to continue building out the application further. We are looking into integrating the data output into patient management systems as well. A web and mobile interface to monitor patient progress is coming soon, and finally, we will explore the benefits of using Augmented Reality for physical therapy as well. The application’s next iteration will include compatibility with the Hololens and Magic Leap headsets.


The study was and continues to be a success, and we look forward to working further with the Dartmouth-Hitchcock team on future iterations of the application. If you are interested in learning more about the study findings, application features, project friction points and breakthroughs, and other information on the nuts and bolts of the process, please reach out. We are happy to discuss further, in an effort to advance the physical therapy space. And if you are interested in working with us, shoot us a note. We work on projects across AEC, automotive, immersive design tools / industrial design, training, and healthcare.